Electrophysiological evidence for visuocognitive dysfunction in younger non Caucasian patients with Parkinson's disease

A study of "primary" (VEPs) and "cognitive" (ERPs) visual evoked potentials was carried out in a group of non-demented Afro-American Parkinson's disease (PD) patients. Current studies suggest that differences exist in the clinical manifestations of PD in Caucasian and non-Caucasian populations. Two horizontal sinusoidal gratings differing in spatial frequency, i.e., 1 and 4 cycles per degree (cpd), were presented in an "odd-ball" paradigm to 17 patients with PD and 17 age-matched control subjects. While the 1 cpd stimulus, is not expected to reveal retinal dopaminergic deficency, but only visuocognitive deficits, the 4cpd may give direct information of both "retinal" and "cognitive" visual deficits. We measured the latencies and amplitudes of N70, P100 and P300 components, and derived the "normalized" measures of P300-N70 latency difference (Central Processing Time-CPT70), the P300-P100 latency difference (CPT100) and the P300 amplitude responses normalized to either N70 and P100 amplitude (Amplitude Ratios AR70 and AR100). Our results do show that cognitive electrophysiological deficits in younger PD patients exist in non-Caucasians, perhaps to an even greater degree than in Caucasians, and confirm that absolute and normalized ERP amplitude and latency abnormalities are a distinguishing feature of younger PD patients from controls. In particular P300 measures are abnormal for 1 cpd pattern. A negative correlation exists between P300 amplitude and the motor score. By comparing the results for 1 and 4cpd stimuli it can be concluded that "primary" and "cognitive" visual abnormalities are independently affected in PD, implying that visuo-cognitive abnormalities are not passively determined by retinal dopaminergic deficiency.

Hidden visual loss in optic neuropathy is revealed using Gabor patch contrast perimetry

Visual sensitivity was evaluated in the central 16 degrees of the visual field in normal subjects, in patients with glaucomatous optic neuropathy, in glaucoma suspects, and in eyes of patients with multiple sclerosis without evidence of active optic neuritis. A novel method was used to assess sensitivity called contrast perimetry (CP). CP essentially samples every point in the central 16 degrees field, and the normal and deviant responses are relatable to spatial summation of contrast signals. In each visual field quadrant 1 cycles/degree sinusoidal grating stimuli limited in area by a gaussian circular aperture (called a Gabor stimulus) were presented. Contrast sensitivity was measured as a function of stimulus size. The normal curve is nearly S-shaped: For small Gabors contrast sensitivity increases slowly, then accelerates and then flattens again. Patients' results fell into two broad categories: a loss more or only evident for small Gabors and another type of loss for both small and large Gabor size. Glaucoma suspect and most glaucoma eyes showed predominant losses to small Gabors. There were more eyes and more VF quadrants identified by contrast perimetry as abnormal compared to the diagnostic yield of the Humphrey 30-2 (central) visual field even though a Humphrey VF defect was defined liberally. Apparently, contrast perimetry may yield diagnostically useful information of paracentral visual sensitivity. Furthermore, the results suggest that selective losses in POAG and some glaucoma suspects occur to spatially broad-band retinal mechanisms, presumably ganglion cells.

Dopamine D2 receptor blockade alters the primary and cognitive components of visual evoked potentials in the monkey, Macaca fascicularis

The effects of sulpiride, a dopamine D2 receptor antagonist, were studied on visual event-related potentials in a monkey performing in a visual oddball task in order to investigate receptor specific mechanisms in visuo-cognitive processes. Following the injection of 0.35 mg/kg sulpiride i.m., the amplitude and latency of the primary (P100) and cognitive (P300) components did not change significantly. When 1.05 mg/kg sulpiride was administered, the latency of the primary and cognitive components increased. The amplitude of the P100 component decreased, while that of the P300 component increased. These data suggest that D2 receptors play an important role in visuo-cognitive processes in both physiological and pathological conditions such as Parkinson's disease and schizophrenia.

Functional MRI mapping of occipital and frontal cortical activity during voluntary and imagined saccades

We investigated the activation of frontal and occipital cortical areas in 14 normal volunteers during voluntary saccades in light or dark and during imagined saccades using functional magnetic resonance imaging (FMRI) with electro-oculogram monitoring. Voluntary saccades in light or dark and imagined saccades led to a significant activation (p < 0.005) of the precentral and posterior medial frontal gyrus (frontal eye field). The medial part of the superior frontal gyrus (supplementary eye field) also showed significant activity during voluntary saccades in all subjects, but only in four subjects during imagined saccades. In addition to frontal activity we found an activated primary visual cortex during voluntary saccades, both in light and in dark. In contrast to executed saccades, imagined eye movements revealed to occipital response under either condition. Our FMRI study supports the concept of frontal eye fields during voluntary saccades and demonstrates that occipital areas are associated with the generation of voluntary eye movements. However, the primary visual cortex is not active when eye movement is only imagined.

Visual electrophysiology in Parkinson's disease: PERG, VEP and visual P300

A retinal dopaminergic deficiency underlies some visual changes in Parkinson's disease (PD), in particular those elicited by stimuli near the peak of the human and monkey spatial contrast sensitivity. The correspondence of retinal changes and VEP alterations is not perfect: they do not seem to rely on identical mechanisms. It seems that additional pathology beyond the retina affects visual responses, including VEPs. The relevance of "distal" primary VEP changes to higher cognitive visual abnormalities in PD is not established at present.

Longitudinal study of a heteroplasmic 3460 Leber hereditary optic neuropathy family by multiplexed primer-extension analysis and nucleotide sequencing

Nucleotide-sequencing and multiplexed primer-extension assays have been used to quantitate the mutant-allele frequency in 14 maternal relatives, spanning three generations, from a family that is heteroplasmic for the primary Leber hereditary optic neuropathy (LHON) mutation at nucleotide 3460 of the mitochondrial genome. There was excellent agreement between the values that were obtained with the two different methods. The longitudinal study shows that the mutant-allele frequency was constant within individual family members over a sampling period of 3.5 years. Second, although there was an overall increase in the mutant-allele frequency in successive generations, segregation in the direction of the mutant allele was not invariant, and there was one instance in which there was a significant decrease in the frequency from parent to offspring. From these two sets of results, and from previous studies of heteroplasmic LHON families, we conclude that there is no evidence for a marked selective pressure that determines the replication, segregation, or transmission of primary LHON mutations to white blood cells and platelets. Instead, the mtDNA molecules are most likely to replicate and segregate under conditions of random drift at the cellular level. Finally, the pattern of transmission in this maternal lineage is compatible with a developmental bottleneck model in which the number of mitochondrial units of segregation in the female germ line is relatively small in relation to the number of mtDNA molecules within a cell. However, this is not an invariant pattern for humans, and simple models of mitochondrial gene transmission are inappropriate at the present time.

Simultaneously evoked primary and cognitive visual evoked potentials distinguish younger and older patients with Parkinson's disease

While it is known that both primary visual processes and visuocognitive responses are affected in Parkinson's Disease (PD), their relationship is not known. It is known that both of these measures can be affected by age per se. Our aims were to determine if in non-demented PD patients visual cognitive event-related potential (ERP) changes simply reflect abnormal primary visual processing and to determine the effects of age and disease on their relationship. In order to do so, we introduce a new normalizing procedure for visual ERPs. In addition to the latencies and amplitudes of P100, N140, P200, N200 and P300 components, the P300-P100 latency difference (termed "central processing time"-CPT) were measured. In order to avoid confounding factors of absolute amplitude differences due to say, generally low voltage recordings or poor primary visual responses, P300 responses normalized to P100 responses were also evaluated (P300/P100 amplitude ratio). Visual ERPs were obtained in an "oddball" paradigm in 20 nondemented patients with PD and 20 normal age-matched subjects. The stimuli were horizontal sinusoidal gratings differing only in spatial frequency (0.5 and 1 cycle/degree). While simple ERP latency criteria did not distinguish non-demented PD patients as a group from controls, when younger PD patients were compared to older PD patients and controls CPT acceleratedly increased in younger PD patients. The amplitudes of both N200 and P300 provided significant distinction between patient and control groups. The surprising result emerging from this study is that an individually normalized P300 amplitude provides significant distinction of younger PD patients from age matched normals.

The pattern electroretinogram in Parkinson's disease reveals lack of retinal spatial tuning

Spatio-temporal visual abnormalities, involving processing of medium coarse stimuli, are known to occur in Parkinson's disease (PD). While these deficits have been related to retinal dopaminergic deficiency, previous ERG studies in PD patients have provided conflicting results, probably due to differences in stimulus conditions. The influence of pattern element size (spatial frequency, SF) on the pattern electroretinogram (PERG) in PD has not been systematically studied. We recorded steady-state PERG to sinusoidal gratings of 50% contrast, counterphase modulated at 7.5 Hz with a series of SFs ranging from 0.5 to 6.9 c/deg in 20 PD patients and 20 healthy volunteers, subdivided in 10 "young" and 10 "age-matched" (AM) subjects. The PERG was analyzed by means of Fast Fourier Transform and the amplitude and the phase of the second harmonic response (15 Hz) were taken into account. We evaluated the medium-to-low SF amplitude ratio and termed it "PERG tuning ratio" (TR). The results indicate that aging affects all the studied SF, but the pattern of age-related loss differs from that observed in PD. Compared to AM subjects, PD patients show a specific deficit at medium SF, with a distorted PERG SF response function. Consequently, all PD patients show an attenuated PERG TR and 17 of them (85%) have an inverted TR. A significant TR decrease is correlated with the clinical stage of PD. There is a marked TR difference between patients receiving and not receiving L-DOPA. We conclude that stimulus SF is a crucial variable of the PERG in PD. PERG measurements and the derived PERG TR may provide a simple tool to evaluate retinal dopaminergic mechanisms and could contribute to the clinical assessment and monitoring of dopaminergic therapy in PD.

Modality dependent changes in event-related potentials correlate with specific cognitive functions in nondemented patients with Parkinson's disease

The relationship between event-related potentials (ERPs) and cognitive functioning was studied in patients with Parkinson's Disease (PD) but without dementia. Auditory and visual stimuli were used; 30 subjects participated in the auditory study and 20 in the visual study. Patient groups did not differ with respect to gender, age, education, illness duration, and level of cognitive functioning. Visual stimuli were 2.3 cpd sinusoidal grating patterns randomly presented in an oddball paradigm (oblique vs. vertical spatial orientation). Auditory stimuli were tones presented at 70 dB SPL at a rate of 1.1/second, also using the oddball paradigm (1.5K vs. 1K tones). All patients were given neuropsychological tests to measure verbal fluency, memory, visual spatial perception, and abstract reasoning. P300 and N200 abnormalities correlated with a number of these measures, such that longer ERP latencies were related to lower scores on tests of cognitive functioning. Patterns of results suggest that auditory and visual ERPs correlate with different subsets of neuropsychological functions in nondemented PD patients and that N200 may provide a new metric for clinical use.

Spatial frequency tuning of the monkey pattern ERG depends on D2 receptor-linked action of dopamine

The pattern electroretinogram (PERG) has been previously shown to be sensitive to dopaminergic manipulations in the monkey's retina. In order to study the role of retinal D2 receptors were recorded the PERG before and during the acute administration of l-sulpiride, a selective D2 blocker, in three monkeys. The stimuli were sinusoidal vertical gratings, with a contrast of 70% counterphase modulated at 7.5 Hz. The response to four different spatial frequencies (0.5, 1.1, 2.3 and 4.6 c/deg) was explored. PERGs were recorded before and after 20 min of i.m. administration of l-sulpiride. Two different doses (0.07 and 0.35 mg/kg) were administered in different sessions for each spatial frequency (SF). Baseline (before sulpiride) responses showed high intersession reproducibility, with a clear SF tuning. Both doses of the drug affected the PERG to the peak SF of the stimulus, but the higher one was more consistently effective in all of the three monkeys. Our results confirm previous studies which suggested that DA is involved in retinal processing in the primate and reveal the new information that D2 receptors are necessary for spatio-temporal tuning of pattern vision.

Visual discrimination and P300 are affected in parallel by cholinergic agents in the behaving monkey

We studied the acute effect of cholinergic agents, scopolamine alone and scopolamine pretreatment and acetyl-L-carnitine (ALC) on visual event-related potentials (ERPs) in a monkey performing in a go/no-go visual oddball discrimination task. The same monkey was studied repeatedly for a period extending over 1.5 years. Scopolamine is known to cause cognitive impairment in primates. In the concentrations used, primary evoked potentials did not change significantly whereas P300 latency increased maximally 20-40 min following scopolamine administration. Acetyl-L-carnitine on its own increased P300 amplitude and decreased its latency. When ALC administration was preceded by scopolamine, both P300 latency and amplitude maximally increased in 25-45 min. Apparently ALC's effect on the latency and amplitude of visual P300 of the monkey is largely via muscarinic mechanisms. Our results suggest that scopolamine may provide a valuable tool to separate cognitive from primary visual processes.

Visual and visual perceptual disorders in neurodegenerative diseases

Optic neuropathy is reported to occur in 10-30% of patients, while retinopathy is characteristic of type III OPCA. The use of visual and visual electrophysiological tests in early diagnosis and classification is promising. The relationship between visual impairment and other manifestations of these diseases has not been explored.

Retinal periphlebitis in multiple sclerosis

BACKGROUND

The ocular and visual manifestations of multiple sclerosis are varied. The most uncommon is sheathing of the veins, periphlebitis.

METHODS

A 39-year-old white female presented with primary visual complaints of contrast problems on a computer terminal. The patient was lost to follow up for 4 years, however, upon return a clinical diagnosis of multiple sclerosis was confirmed. Six years after the initial presentation, ophthalmoscopic exam of both eyes revealed marked focal sheathing of the retinal veins in the periphery, and associated hemorrhages in the right eye.

RESULTS

During follow-up, the left eye became further involved developing hemorrhages and a retinal hole, which was treated. The visual consequence of the multiple sclerosis as a result of further exacerbations were bilateral centrocecal scotomas and midly reduced visual acuity.

CONCLUSIONS

Multiple sclerosis should be considered in the differential diagnosis of patients with retinal periphlebitis.

The effect of levo-acetyl-carnitine on visual cognitive evoked potentials in the behaving monkey

We studied acute and chronic effects of levo-acetyl-carnitine (LAC) on event-related potentials (ERPs) in 3 monkeys trained in a "go"/"no-go" visual "oddball" discrimination task. The stimuli were 2.5 cpd sinusoidal gratings differing in their respective orientation only (0 degrees or 45 degrees). Each monkey was trained to release a lever during a prespecified time window. Target stimulus presentation probabilities were between 0.25 and 0.5. ERPs had comparable mean latencies and amplitudes in all monkeys. Primary evoked potentials recorded to either the target or non-target stimulus did not change significantly as a result of LAC treatment. On the other hand, P300 latency decreased following LAC administration, with a maximum occurring in 15-20 min. The major effects of LAC were consistent within each animal and for all three of them.

Sensory evoked potentials: PERG, VEP, and SEP

The review summarizes current developments in pattern electroretinography practice and theory: generator sources and clinical applications. This is particularly relevant to neuronal disease of the central nervous system (CNS). Visual evoked potentials (VEPs) are discussed in reference to the evolution and follow up of multiple sclerosis (MS) and in conjunction with magnetic resonance imaging (MRI) demonstrated abnormalities. These reveal that the techniques are complementary. Sensory evoked potentials (SEPs) in conjunction with MRI studies are highlighted as quantitatively comparable in spinal cord disorders.

A short latency cortical component of the foveal VEP is revealed by hemifield stimulation

Transient evoked potentials were recorded simultaneously over 5 electrodes placed in a horizontal row across the occiput. A range of spatial frequencies were presented as either full-field or hemifield stimuli. Subjects were 11 normal observers and 5 patients with lesions causing a homonymous hemianopic field defect. The shortest latency peak response was at approximately 70 msec, a negative potential (N70). For all spatial frequencies, full-field stimuli evoked a lower amplitude N70 at the midline than the sum of N70 amplitudes to two hemifield stimuli, suggesting partial cancellation. The latency and amplitude of N70 increased as spatial frequency increased. N70 and P100 differed in respect to their response to spatial frequency and field size, further suggesting that they may not be subsets of a unitary response. For hemifield stimulation, N70 had an ipsilateral maximum and attenuated or completely reversed in polarity across the midline. Consistent with the data of normals using hemifield stimuli, in 5 patients a full-field stimulus elicited an N70 lateralized contralaterally to the homonymous hemianopia, i.e., the ipsilateral N70 was absent. The absolute amplitude difference between the left and right electrodes was significant for hemifield stimulation in normals and full-field stimulation in the patients, but not for full-field stimulation in normals. Our results imply that the evaluation of N70 hemispheric distribution is useful for the evaluation of paramacular visual field defects.