Article

Relation of Parkinson's Disease Subtypes to Visual Activities of Daily Living

Department of Psychology, Boston University, Boston, MA02215, USA.
Journal of the International Neuropsychological Society (Impact Factor: 2.96). 08/2011; 17(5):841-52. DOI: 10.1017/S1355617711000853
Source: PubMed

ABSTRACT

Visual perceptual problems are common in Parkinson's disease (PD) and often affect activities of daily living (ADLs). PD patients with non-tremor symptoms at disease onset (i.e., rigidity, bradykinesia, gait disturbance or postural instability) have more diffuse neurobiological abnormalities and report worse non-motor symptoms and functional changes than patients whose initial symptom is tremor, but the relation of motor symptom subtype to perceptual deficits remains unstudied. We assessed visual ADLs with the Visual Activities Questionnaire in 25 non-demented patients with PD, 13 with tremor as the initial symptom and 12 with an initial symptom other than tremor, as well as in 23 healthy control participants (NC). As expected, the non-tremor patients, but not the tremor patients, reported more impairment in visual ADLs than the NC group, including in light/dark adaptation, acuity/spatial vision, depth perception, peripheral vision and visual processing speed. Non-tremor patients were significantly worse than tremor patients overall and on light/dark adaptation and depth perception. Environmental enhancements especially targeted to patients with the non-tremor PD subtype may help to ameliorate their functional disability.

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    • "Additional PD subgroups are described by the initial motor symptom, referred to as tremor-dominant (TD) and nontremor-dominant (NTD: rigidity, akinesia, and disordered gait, posture, and balance). Relative to TD, NTD patients exhibit more pronounced visual difficulties, greater Lewy body pathology load, more extensive and rapid cognitive impairment, and heightened risk for dementia (Alves, Larsen, Emre, Wentzel-Larsen, & Aarsland, 2006;Lewis et al., 2005;Seichepine et al., 2011;Selikhova et al., 2009;Taylor et al., 2008). It is critical for researchers and clinicians to determine different neurocognitive profiles by subgroup as this would guide disease management and treatment more effectively than is possible at present. "
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    • "For example, Vakil and Herishanu- Naaman (1998) found that tremor-dominant patients are less impaired at procedural learning tasks than akinesia-dominant patients. Studies also showed that PD patients with tremor are less impaired than PD patients with other motor subtypes on perceptual tasks, including peripheral vision and visual processing speed (Seichepine et al., 2011). Interestingly, we also found that akinesia-dominant patients were more impaired than tremordominant patients at various working memory (Moustafa et al., 2013a) and learning (Moustafa et al., 2013b) measures. "
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    • "Larger samples would enable analysis by subgroups, which may be informative. For example, we recently reported that self-identified impairments in visual ADLs were more extensive in PD patients whose initial motor symptom was not tremor than in those whose initial symptom was tremor [33]. In particular, future work should focus on expanding the range of PD severity to include participants with milder and more severe motor impairment than were assessed here. "
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