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

A rat model of Parkinsonism shows depletion of dopamine in the retina

The retinal dopamine (DA) deficiency is an important feature of the pathogenesis in Parkinson's disease (PD) visual dysfunction. Systemic inhibition of complex I (rotenone) in rats has been proposed as a model of PD. In this study, we investigated whether systemic inhibition of complex I can induce impairment of DA-ergic cells in the retina, similar to the destruction of retinal cells found in PD patients. Rotenone (2.5mg/kg i.p., daily) was administered over 60 days. Neurochemically, rotenone treated rats showed a depletion of DA in the striatum and substantia nigra (SN). In addition, the number of retinal DA-ergic amacrine cells was significantly reduced in the rotenone treated animals. This study is the first one giving highlight towards a deeper understanding of systemic complex I inhibition (rotenone as an environmental toxin) and the connection between both, DA-ergic degeneration in the nigrostriatal pathway, and in the DA-ergic amacrine cells of the retina.

Chromatic pattern-reversal electroretinograms (ChPERGs) are spared in multiple system atrophy compared with Parkinson's disease

Idiopathic Parkinson's disease (IPD) patients have abnormal visual evoked potentials (VEPs) and pattern electroretinograms (PERGs), attributed to dopaminergic transmission deficiency in visual pathway, probably the retina. VEP abnormalities are not reported in multiple system atrophy (MSA). The aim of this study was to investigate and compare chromatic (Ch) red-green (R-G) and blue-yellow (B-Y), and luminance yellow-black (Y-Bk) PERGs in patients with MSA and IPD. We investigated 6 MSA patients (mean age: 62+/-7.4 years) not undergoing any pharmacological treatment, as well as 12 early IPD patients (mean age: 60.1+/-8.3 years) and 12 age-matched normal observers. ChPERGs were recorded monocularly in response to full-field equiluminant R-G, B-Y and Y-Bk horizontal gratings. In MSA only responses to R-G stimuli showed minimal insignificant changes (slight but not significant amplitude reduction without any significant latency delay); no significant abnormality was detected for B-Y and luminance Y-Bk stimuli. By contrast, in IPD all responses were reduced in amplitude and delayed in latency, above all for B-Y stimuli. Present data indicate that both chromatic and achromatic PERGs are virtually unaffected in MSA, whereas in early IPD they are clearly impaired, suggesting different pathogenic retinal mechanisms and a useful simple tool for distinguishing MSA from IPD.

Independent patterns of damage within magno-, parvo- and koniocellular pathways in Parkinson's disease

Sensory deficits have been documented in Parkinson's disease, in particular within the visual domain. However, ageing factors related to the brain and to neural and non-neural ocular structures could explain some of the previously reported results, in particular the claimed impairment within the koniocellular pathway. This study addressed visual impairment attributable to the magno- (luminance), parvo- (red-green) and koniocellular (blue-yellow) pathways in a population of Parkinson's disease patients. To avoid potentially confounding factors, all subjects underwent a full neurophthalmological assessment which led to exclusion of subjects with increased intraocular pressure, diabetes even in the absence of retinopathy, and ocular abnormalities (from a total of 72 patients' eyes, 12 were excluded). Both parvo- and koniocellular pathways were studied by means of contrast sensitivity (CS) measurements along protan, tritan and deutan axes and also by fitting chromatic discrimination ellipses using eight measured contrast axes. Magnocellular function was assessed, using stimuli that induce a frequency doubling illusion, in 17 locations in the fovea and periphery. Achromatic (luminance modulation) thresholds were significantly higher in Parkinson's disease both in foveal and peripheral locations. A significant impairment was observed along protan and deutan axes, but only marginally along the tritan axis. These results were corroborated by a significant elongation of chromatic discrimination ellipses in our Parkinson's disease group. Correlation analysis showed that achromatic and chromatic CS measures were independent, which implies that multiple visual pathways are affected independently in Parkinson's disease. Magnocellular impairment was significantly correlated with age and disease stage, in contrast to the measured chromatic deficits. We conclude that in Parkinson's disease, independent damage occurs in the early magno- and parvocellular pathways. Furthermore, traditional koniocellular probing strategies in Parkinson's disease may be confounded by ageing factors, which may reconcile the previously reported controversial findings concerning chromatic impairment in Parkinson's disease.

Homology of assessment of visual function in human and animal models

To connect animal models with human neurobehavioral evaluations, it is necessary to understand the level of homology present between tests administered across species. This paper identifies four different levels of homology of assessment based on identity of measurement, function, and underlying neural substrate. These are discussed using detailed examples from toxicology of the visual system, with additional examples from tests of motor and cognitive function. This should provide a framework for considering both animal to human extrapolation and human to animal extrapolation, that is, how to import human experimental epidemiology findings into the lab for further work investigating mechanisms of toxicity. Designing neurobehavioral or sensory evaluations that permit easier extrapolation between human and animal models is necessary if we are to develop testing strategies that take advantage of mechanistic information at whole animal, in vitro, proteonomic, or genomic levels.

Visual processing of rapidly presented stimuli is normalized in Parkinson’s disease when proximal stimulus strength is enhanced

Deficient perception and cognition in Parkinson's disease (PD) has been attributed to slow information processing, but an alternative explanation may be reduced signal strength. In 18 nondemented individuals with PD and 15 healthy adults, we enhanced the contrast level of rapidly flashed masked letters. The PD group required significantly higher contrast to reach criterion (80% accuracy). Normal motion detection in these participants indicated no gross, general dysfunction of the dorsal visual processing stream. These results suggest that putatively slowed processing in PD may be an artifact of reduced signal strength arising from depletion of dopamine in retina or cortical visual areas.

Changes in Pattern Electroretinograms to Equiluminant Red-Green and Blue-Yellow Gratings in Patients with Early Parkinson’s Disease

In Parkinson's disease (PD), the luminance pattern electroretinogram (PERG) is reported to be abnormal, indicating dysfunction of retinal ganglion cells (RGCs). To determine the vulnerability of different subpopulations of RGCs in PD patients, the authors recorded the PERG to stimuli of chromatic (red-green [R-G] and blue-yellow [B-Y]) and achromatic (yellow-black [Y-Bk]) contrast, known to emphasize the contribution of parvocellular, koniocellular, and magnocellular RGCs, respectively. Subjects were early PD patients (n = 12; mean age, 60.1 +/- 8.3 years; range, 46 to 74 years) not undergoing treatment with levodopa and age-sex-matched controls (n = 12). Pattern electroretinograms were recorded monocularly in response to equiluminant R-G, B-Y, and Y-Bk horizontal gratings of 0.3 c/deg and 90% contrast, reversed at 1Hz, and presented at a viewing distance of 24 cm (59.2 x 59 degree field). In PD patients, the PERG amplitude was significantly reduced (by 40 to 50% on average) for both chromatic and luminance stimuli. Pattern electroretinogram latency was significantly delayed (by about 15 ms) for B-Y stimuli only. Data indicate that, in addition to achromatic PERGs, chromatic PERGs are altered in PD before levodopa therapy. Overall, chromatic PERGs to B-Y equiluminant stimuli exhibited the largest changes. Data are consistent with previous findings in PD, showing that visual evoked potentials (VEP) to B-Y chromatic stimuli are more delayed than VEPs to R-G and achromatic stimuli. The results suggest that the koniocellular subpopulation of RGCs may be particularly vulnerable in early stages of Parkinson's disease.

Beyond visual acuity: new and complementary tests of visual function

Visual acuity is an essential component of the routine ophthalmic examination and the most common measure of visual function. There is increasing recognition, however, of the need to evaluate visual function beyond the limited extent afforded by visual acuity. The primary objective of this article is to introduce a variety of new and lesser-used techniques for measuring visual function that complement visual acuity assessment, each of which has been shown to detect visual dysfunction in patients with normal visual acuity.

Competition, inhibition, and semantic judgment errors in Parkinson's disease

Semantic processing errors are symptoms of an up-regulation (schizophrenia) or degradation (Parkinsonism) of dopaminergic pathways. A recent connectionist model attributed errors in the schizophrenic processing of context to increased gain in competitive neural processes. This study extends this "gain hypothesis" by comparing the sensitivity to reduced gain of a simulation of semantic route activation to characteristic semantic judgment errors made by Parkinson's patients in an open search task. Under normal gain conditions, the dominant sense of polysemous words "wins" through competition and lateral inhibition at the word sense level (beta(inh)). For words with very different sense frequencies, decreasing gain by increasing beta(inh) resulted in the dominant word sense winning; however, for words with similar sense frequencies, increasing beta(inh) resulted in the dominant word sense winning only for low to moderate values. At high levels, no clear winner emerged after 200 epochs, with the least dominant sense reaching the maximum activation value. These results are discussed in the context of the Yerkes-Dodson Law, which may provide a theoretical basis for understanding normal and impaired semantic performance in catecholaminergic disorders.

Visual evoked potentials in Parkinson's disease-correlation with clinical involvement

A total of 18 patients with Parkinson's disease were evaluated clinically and by transient checker-board VEP study. There were significant differences between bradykinesia (P<0.01), rigidity (P<0.02), and tremor (P<0.05) subscores of the more and less severely affected sides. There were no asymmetry of VEP latency or amplitude between the more and less severely affected sides by stimulation of the corresponding eye. There were no significant correlations between the VEP latency or amplitude and any of the clinical features except the bradykinesia scores. The bradykinesia scores on the more severely involved side (r: 0.57; P=0.014) and less severely involved side (r: 0.82; P=0.00003) showed medium to high degree positive correlations with VEP amplitudes by stimulation of the corresponding eye. By studying monocular fullfield responses our data can only suggest that there is no prechiasmal asymmetry. The positive correlation between the VEP amplitude and bradykinesia score might indicate that D2 receptors dominate in the retina.

Parkinson's disease changes the balance of onset and offset visual responses: an evoked potential study

OBJECTIVES

We investigated whether the transient pattern onset and offset visual evoked potential (VEP) can distinguish between patients with Parkinson's disease (PD) and normal subjects.

METHODS

Two horizontal sinusoidal gratings differing in spatial frequency, i.e. 1 and 4 cycles per degree, were presented to 17 patients with PD and 16 age-matched control subjects. We analyzed the responses in the time-domain and measured the latencies and amplitudes of N1 and P1 to the onset and the offset of the stimulus; we also derived the measures of offset N1 and P1 amplitude responses 'normalized' to onset N1 and P1 amplitude values, respectively (amplitude ratios).

RESULTS

Absolute and normalized offset P1 amplitude is a distinguishing feature of PD patients from controls. Offset P1 amplitude was significantly larger in PD patients than in controls, particularly to the lower spatial frequency stimulus (P<0.01 for absolute and P<0.001 for normalized values, respectively).

CONCLUSIONS

We conclude that the pattern onset/offset VEP amplitude provides a simple measure to evaluate visual processing deficits in PD and could contribute to an understanding of the pathophysiology of these changes.

Age-related changes of evoked potentials

The aim of this review is to analyse the current state of our knowledge on evoked potentials (EPs) in ageing and to report some conclusions on the relation between EPs and elder age. Evoked potentials provide a measure of the function of sensory systems that change during the different stages of life. Each sensory system has its own time of maturation. The individuation of the exact period of life when brain ageing starts is difficult to define. Normally, the amplitude of EPs decreases, and their latency increases from adult to elder life. Many authors speculate that these modifications might depend on neuronal loss, changes in cell membrane, composition or senile plaques present in older patients, but there is no evidence that these changes might modify the cerebral function in healthy aged individuals. This review emphasises some incongruities present in different studies confirmed by daily neurophysiologic practice. Different techniques as event-related desynchronization (ERD), contingent negative variation (CNV) and Bereitschaftspotential, are available to study central neuronal changes in normal and pathologic ageing.

Visual contrast response functions in Parkinson's disease: evidence from electroretinograms, visually evoked potentials and psychophysics

OBJECTIVES

Visual contrast detection thresholds and suprathreshold contrast discrimination thresholds were compared to luminance and flash/pattern electroretinograms (ERG) and visually evoked potentials (VEP) in patients with Parkinson's disease (n = 31), patients with multiple system atrophy (n = 6), patients with progressive supranuclear palsy (n = 6) and control patients without central nervous disease (n = 33).

METHODS

The stimuli were luminance modulated full-field (flash) or horizontally oriented sinewave gratings (pattern), the latter having either a low (0.5 cycles/deg) or medium (4.0 cycles/deg) spatial frequency. Stimulus contrast ranged from 10 to 80% so that contrast response functions could be derived.

RESULTS

Contrast thresholds were higher in the patients with Parkinson's disease than in the control patients. Contrast discrimination thresholds were also somewhat elevated in patients with Parkinson's disease. Pattern ERG amplitudes were significantly reduced in patients with Parkinson's disease for the medium spatial frequency stimulus, but less for the low spatial frequency and flash stimuli.

CONCLUSIONS

Our results suggest that Parkinson's disease impairs contrast processing in the retina. VEP amplitudes did not significantly differ between the groups for the conditions tested. Patients with progressive supranuclear palsy also showed impaired contrast perception and reduced ERG amplitudes, whereas patients with multiple system atrophy were less impaired.

The spatial tuning of steady state pattern electroretinogram in multiple sclerosis

In normal subjects, the steady-state electroretinogram in response to contrast reversing gratings (PERG), is spatially band-pass tuned in amplitude, with a maximum at intermediate spatial frequencies and an attenuation at lower and higher ones. The amplitude attenuation at low spatial frequencies is believed to reflect centre-surround antagonistic interactions in the receptive fields of inner retinal neurons. The aim of this study was to evaluate the PERG spatial tuning in multiple sclerosis (MS) patients without a previous optic neuritis history. Steady- state PERGs in response to counterphase-modulated (8 Hz) sinusoidal gratings of variable spatial frequency (0.6, 1.0, 1.4, 2.2 and 4.8 c/deg), were recorded from 18 patients with definite or probable MS and no history of optic neuritis (ON-). Nine of them had no signs of subclinical optic nerve demyelination (asymptomatic) in either eye, while nine had symptoms or signs of optic pathways involvement (symptomatic) in one or both eyes. Results were compared with those obtained from 10 MS patients with a previous history of optic neuritis (ON+) in one or both eyes, as well as from 21 age-matched controls. The amplitudes and phases of the responses' 2nd harmonics were measured. Compared with the controls, asymptomatic ON- patients showed selective losses in mean PERG amplitudes at medium and high (1.0-4.8 c/deg) spatial frequencies. Symptomatic ON- patients and ON+ patients had reductions in mean PERG amplitudes, with respect to controls, involving the whole spatial frequency range, but with greater losses at medium-high (1.0-4.8 c/deg) than at lower spatial frequencies. In all patients' groups, the average PERG spatial tuning function differed significantly from that of the controls, assuming a low-pass instead of the normal band-pass shape. The PERG phase was delayed in ON+ but not in ON- patients, as compared to controls. However, the phase delay was independent of spatial frequency. In both ON- and ON+ patients, losses in PERG amplitude and spatial tuning tended to be associated with corresponding abnormalities in perimetric sensitivity, visual acuity, colour vision and transient visual evoked potential (VEP) latency. The results indicate that abnormalities of the spatial tuning of steady-state PERG can be found in MS patients without either optic neuritis or signs of subclinical optic nerve demyelination. These changes may reflect a retinal dysfunction, developing early in the course of MS, due to a loss of specific subpopulations of inner neurons, changes in lateral interactions of their receptive fields, or both.

A mixed D1 and D2 antagonist does not replay pattern electroretinogram alterations observed with a selective D2 antagonist in normal humans: relationship with Parkinson's disease pattern electroretinogram alterations

The human retina produces a tuned response to stimuli of increasing spatial frequency reversed at a steady state. The peak amplitude response, at medium spatial frequencies, is decreased in Parkinson's disease and in normal subjects (n = 18) treated with a D2 dopaminergic antagonist (l-sulpiride). Here, we report that a mixed D1-D2 receptor antagonist (haloperidol) in normal subjects (n = 18) does not produce an amplitude decrease of medium spatial frequencies (SFs) responses but it decreases low-frequency response. It could argued that the increased dopamine release produced by the presynaptic D2 antagonistic action of haloperidol is subsequently counteracted at postsynaptic level by its D1 antagonistic effect, producing a net counterbalance at medium SFs. These data suggest that the two dopamine receptors may play different roles in the retinal function and in the origin of visual alterations in Parkinson's disease.

The push-pull action of dopamine on spatial tuning of the monkey retina: the effects of dopaminergic deficiency and selective D1 and D2 receptor ligands on the pattern electroretinogram

Retinal dopamine depletion in monkeys using either systemic MPTP or 6-OHDA results in attenuated electroretinographic (ERG) responses to peak spatial frequency stimuli. Diverse dopamine receptors have been identified in the primate retina. ERG studies performed using Haloperidol (a mixed antagonist), L-Sulpiride (D2 antagonist) and CY 208-243 (a D1 agonist) cause spatial frequency dependent diverse effects. 'Tuning' of the normal spatial contrast response PERG, was quantified by dividing the amplitude of the response at the peak spatial frequency with the amplitude to the low spatial frequency response yielding a number greater than one. Tuning for the pharmacological experiments was defined by dividing the actual amplitude obtained at the normal peak response with the actual amplitude at the low spatial frequency response. The PERG spatial contrast response function is discussed as the envelope output of retinal ganglion cells or the average or 'equivalent' retinal ganglion cell. However, we postulate the existence of two dopamine sensitive pathways with different weights for two classes of ganglion cells. It is inferred that D1 receptors are primarily affecting the 'surround' organization of ganglion cells with large centers, while D2 post-synaptic receptors contribute to 'center' response amplification of ganglion cells with smaller centers. These inferences are consistent with some lower vertebrate data. It is also inferred that low affinity D2 autoreceptors may be involved in the D1 'surround' pathway. An understanding of the logic performed by retinal D1 and D2 receptors may be useful to discern the functional role of diverse dopamine receptors in DA circuits elsewhere in the CNS.

Do visual-evoked potentials and spatiotemporal contrast sensitivity help to distinguish idiopathic Parkinson's disease and multiple system atrophy?

A large number of patients with Parkinson's disease were reported to have abnormal visual-evoked potentials (VEPs) and spatiotemporal contrast sensitivity (STCS) suggesting dopaminergic deficiency in the visual pathway, probably the retina. Until now, VEPs and STCS have not been studied in multiple system atrophy (MSA). We investigated 12 patients with idiopathic Parkinson's disease (IPD) and 12 patients with MSA. The age medians were 64.5 years for IPD and 63.5 years for MSA. None of the patients showed any ocular disease that could interfere with the results. Checkboard VEPs and STCS measurements to horizontal sinusoidal gratings were evaluated. Statistical analysis was performed, including Student's t test and two- or three-way analysis of variance. A significant interocular difference in spatial contrast sensitivity was observed in IPD, which was not present in MSA. VEPs were not delayed in MSA, whereas latency of the major component and the second negative deflection were increased in IPD. VEPs and STCS measurements might provide useful help for distinguishing IPD from MSA.

Does pattern electroretinogram spatial tuning alteration in Parkinson's disease depend on motor disturbances or retinal dopaminergic loss?

Systemic decrease of dopaminergic cells, such as in Parkinson's disease may produce visual alterations in humans. In order to show possible pattern electroretinogram (PERG) spatial tuning function (STF) alterations due to impaired dopaminergic transmission in humans, we studied a group of Parkinson's disease patients before and during treatment with the dopamine precursor, levodopa, and compared their performances with those of an age-matched control group. Moreover, in order to exclude the possible involvement of motor disabilities to produce PERG alterations, we also investigated PERG responses in post-traumatic parkinsonian patients who exhibited motor abnormalities as a consequence of focal lesions of basal ganglia, in the absence of systemic dopaminergic degeneration. Our results showed a clear decrease of PERG responses in Parkinson's disease patients particularly at medium spatial frequency range (2.7-4.0 cycles/degree) with a substantial preservation of responses at low frequencies. Levodopa therapy reversed these alterations in Parkinson's disease patients, resulting in the recovery of a normal tuning function shape. In contrast to Parkinson's disease, the tuning function appeared to be preserved in post-traumatic parkinsonian patients. Our results clearly establish a relationship between retinal alteration in PD patients and dopaminergic retinal function.

D1 agonist CY208-243 attenuates the pattern electroretinogram to low spatial frequency stimuli in the monkey

We investigated whether or not the D1 agonist, CY 208-243, affects the spatial tuning function of pattern electroretinogram (PERG). Two lightly anaesthetised monkeys were studied before and after CY 208-243 or placebo administration. The results show that the PERG response to 0.5 cycles/degree (c/d; coarse), but not to 2.3 c/d (medium) spatial frequency stimuli disappears following systemic administration of this drug. Since previous results show that D2 blockers attenuate the PERG only above 2.3 c/d, foremost the peak of the normal spatial frequency response function, the current results suggest that dopamine itself, via D1 receptors, may be responsible for the low spatial frequency decline of normal spatial PERG tuning function. We infer that the synergistic activation of D1 and D2 receptors is needed to shape the spatially tuned primate ERG.

Neurobiology of retinal dopamine in relation to degenerative states of the tissue

Neurobiology of retinal dopamine is reviewed and discussed in relation to degenerative states of the tissue. The Introduction deals with the basic physiological actions of dopamine on the different neurons in vertebrate retinae with an emphasis upon mammals. The intimate relationship between the dopamine and melatonin systems is also covered. Recent advances in the molecular biology of dopamine receptors is reviewed in some detail. As degenerative states of the retina, three examples are highlighted: Parkinson's disease; ageing; and retinal dystrophy (retinitis pigmentosa). As visual functions controlled, at least in part, by dopamine, absolute sensitivity, spatial contrast sensitivity, temporal (including flicker) sensitivity and colour vision are reviewed. Possible cellular and synaptic bases of the visual dysfunctions observed during retinal degenerations are discussed in relation to dopaminergic control. It is concluded that impairment of the dopamine system during retinal degenerations could give rise to many of the visual abnormalities observed. In particular, the involvement of dopamine in controlling the coupling of horizontal and amacrine cell lateral systems appears to be central to the visual defects seen.

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.

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.