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Mildner S, Hotz I, Kübler F, Rausch L, Stampfer-Kountchev M, Panzl J, Brenneis C, Seebacher B. Effects of activity-oriented physiotherapy with and without eye movement training on dynamic balance, functional mobility, and eye movements in patients with Parkinson's disease: An assessor-blinded randomised controlled pilot trial. PLoS One 2024; 19:e0304788. [PMID: 38875243 PMCID: PMC11178185 DOI: 10.1371/journal.pone.0304788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 05/16/2024] [Indexed: 06/16/2024] Open
Abstract
OBJECTIVES To describe changes in balance, walking speed, functional mobility, and eye movements following an activity-oriented physiotherapy (AOPT) or its combination with eye movement training (AOPT-E) in patients with Parkinson's disease (PD). To explore the feasibility of a full-scale randomised controlled trial (RCT). METHODS Using an assessor-blinded pilot RCT, 25 patients with PD were allocated to either AOPT or AOPT-E. Supervised interventions were performed 30 minutes, 4x/weekly, for 4 weeks, alongside inpatient rehabilitation. Outcomes were assessed at baseline and post-intervention, including dynamic balance, walking speed, functional and dual-task mobility, ability to safely balance, health-related quality of life (HRQoL), depression, and eye movements (number/duration of fixations) using a mobile eye tracker. Freezing of gait (FOG), and falls-related self-efficacy were assessed at baseline, post-intervention, and 4-week follow-up. Effect sizes of 0.10 were considered weak, 0.30 moderate, and ≥0.50 strong. Feasibility was assessed using predefined criteria: recruitment, retention and adherence rates, adverse events, falls, and post-intervention acceptability using qualitative interviews. RESULTS Improvements were observed in dynamic balance (effect size r = 0.216-0.427), walking speed (r = 0.165), functional and dual-task mobility (r = 0.306-0.413), ability to safely balance (r = 0.247), HRQoL (r = 0.024-0.650), and depression (r = 0.403). Falls-related self-efficacy (r = 0.621) and FOG (r = 0.248) showed varied improvements, partly sustained at follow-up. Eye movement improvements were observed after AOPT-E only. Feasibility analysis revealed that recruitment was below target, with less than two patients recruited per month due to COVID-19 restrictions. Feasibility targets were met, with a retention rate of 96% (95% confidence interval [CI]: 77.68-99.79) and a 98.18% (95% CI: 96.12-99.20) adherence rate, exceeding the targets of 80% and 75%, respectively. One adverse event unrelated to the study intervention confirmed intervention safety, and interview data indicated high intervention acceptability. CONCLUSIONS AOPT-E and AOPT appeared to be effective in patients with PD. Feasibility of a larger RCT was confirmed and is needed to validate results.
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Affiliation(s)
- Sarah Mildner
- Department of Rehabilitation Science, Clinic for Rehabilitation Münster, Münster, Austria
| | - Isabella Hotz
- Department of Rehabilitation Science, Clinic for Rehabilitation Münster, Münster, Austria
| | - Franziska Kübler
- Department of Rehabilitation Science, Clinic for Rehabilitation Münster, Münster, Austria
| | - Linda Rausch
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | | | - Johanna Panzl
- Department of Neurology, Clinic for Rehabilitation Münster, Münster, Austria
| | - Christian Brenneis
- Department of Neurology, Clinic for Rehabilitation Münster, Münster, Austria
- Karl Landsteiner Institute for Interdisciplinary Rehabilitation Research, Münster, Austria
| | - Barbara Seebacher
- Department of Rehabilitation Science, Clinic for Rehabilitation Münster, Münster, Austria
- Karl Landsteiner Institute for Interdisciplinary Rehabilitation Research, Münster, Austria
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Munoz MJ, Reilly JL, Pal GD, Verhagen Metman L, Sani SB, Rosenow JM, Rivera YM, Drane QH, Goelz LC, Corcos DM, David FJ. Benefits of subthalamic nucleus deep brain stimulation on visually-guided saccades depend on stimulation side and classic paradigm in Parkinson's disease. Clin Neurophysiol 2024; 162:41-52. [PMID: 38555666 PMCID: PMC11104565 DOI: 10.1016/j.clinph.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 01/16/2024] [Accepted: 03/12/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVE We aimed to gain further insight into previously reported beneficial effects of subthalamic nucleus deep brain stimulation (STN-DBS) on visually-guided saccades by examining the effects of unilateral compared to bilateral stimulation, paradigm, and target eccentricity on saccades in individuals with Parkinson's disease (PD). METHODS Eleven participants with PD and STN-DBS completed the visually-guided saccade paradigms with OFF, RIGHT, LEFT, and BOTH stimulation. Rightward saccade performance was evaluated for three paradigms and two target eccentricities. RESULTS First, we found that BOTH and LEFT increased gain, peak velocity, and duration compared to OFF stimulation. Second, we found that BOTH and LEFT stimulation decreased latency during the gap and step paradigms but had no effect on latency during the overlap paradigm. Third, we found that RIGHT was not different compared to OFF at benefiting rightward saccade performance. CONCLUSIONS Left unilateral and bilateral stimulation both improve the motor outcomes of rightward visually-guided saccades. Additionally, both improve latency, a cognitive-motor outcome, but only in paradigms when attention does not require disengagement from a present stimulus. SIGNIFICANCE STN-DBS primarily benefits motor and cognitive-motor aspects of visually-guided saccades related to reflexive attentional shifting, with the latter only evident when the fixation-related attentional system is not engaged.
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Affiliation(s)
- Miranda J Munoz
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA.
| | - James L Reilly
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Gian D Pal
- Department of Neurology, Rutgers - Robert Wood Johnson Medical School, New Brunswick, NJ, USA; Department of Neurological Sciences, Section of Parkinson Disease and Movement Disorders, Rush University Medical Center, Chicago, IL, USA
| | - Leo Verhagen Metman
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sepehr B Sani
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Joshua M Rosenow
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Yessenia M Rivera
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Quentin H Drane
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Lisa C Goelz
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
| | - Daniel M Corcos
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Fabian J David
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
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Li H, Zhang X, Yang Y, Xie A. Abnormal eye movements in Parkinson's disease: From experimental study to clinical application. Parkinsonism Relat Disord 2023; 115:105791. [PMID: 37537120 DOI: 10.1016/j.parkreldis.2023.105791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 07/24/2023] [Accepted: 07/28/2023] [Indexed: 08/05/2023]
Abstract
Parkinson's disease (PD) is a neurodegenerative disease that integrates a series of motor symptoms and non-motor symptoms, making early recognition challenging. The exploration of biomarkers is urgently required. Abnormal eye movements in PD have been reported to appear in a variety of ways since eye tracking technology was developed, such as decreased saccade amplitude, extended saccade latency, and unique saccade patterns. Non-invasive, objective and simple eye tracking has the potential to provide effective biomarkers for the PD diagnosis, progression and cognitive impairment, as well as ideas for research into the occurrence and treatment strategy of motor symptoms. In this review, we introduced the fundamental eye movement patterns and typical eye movement paradigms (such as fixation, pro-saccade, anti-saccade, smooth tracking, and visual search), summarized the symptoms of various ocular motor abnormalities in PD, and discussed the research implications of oculomotor investigation to the pathogenesis of PD and related motor symptoms, as well as the clinical implications as biomarkers and its inspiration on treatment.
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Affiliation(s)
- Han Li
- Department of Neurology, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China.
| | - Xue Zhang
- Department of Neurology, Affiliated Qingdao Central Hospital of Qingdao University, Qingdao Cancer Hospital, Qingdao, China
| | - Yong Yang
- Department of Neurology, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
| | - Anmu Xie
- Department of Neurology, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China; The Cerebral Vascular Disease Institute, Qingdao University, Qingdao, China.
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Inomata-Terada S, Fukuda H, Tokushige SI, Matsuda SI, Hamada M, Ugawa Y, Tsuji S, Terao Y. Abnormal saccade profiles in hereditary spinocerebellar degeneration reveal cerebellar contribution to visually guided saccades. Clin Neurophysiol 2023; 154:70-84. [PMID: 37572405 DOI: 10.1016/j.clinph.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/17/2023] [Accepted: 07/16/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVE To study how the pathophysiology underlying hereditary spinocerebellar degeneration (spinocerebellar ataxia; SCA) with pure cerebellar manifestation evolves with disease progression using saccade recordings. METHODS We recorded visually- (VGS) and memory-guided saccade (MGS) task performance in a homogeneous population of 20 genetically proven SCA patients (12 SCA6 and eight SCA31 patients) and 19 normal controls. RESULTS For VGS but not MGS, saccade latency and amplitude were increased and more variable than those in normal subjects, which correlated with cerebellar symptom severity assessed using the International Cooperative Ataxia Rating Scale (ICARS). Parameters with significant correlations with cerebellar symptoms showed an aggravation after disease stage progression (ICARS > 50). The saccade velocity profile exhibited shortened acceleration and prolonged deceleration, which also correlated with disease progression. The main sequence relationship between saccade amplitude and peak velocity as well as saccade inhibitory control were preserved. CONCLUSIONS The cerebellum may be involved in initiating VGS, which was aggravated acutely during disease stage progression. Dysfunction associated with disease progression occurs mainly in the cerebellum and brainstem interaction but may also eventually involve cortical saccade processing. SIGNIFICANCE Saccade recording can reveal cerebellar pathophysiology underlying SCA with disease progression.
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Affiliation(s)
- Satomi Inomata-Terada
- Department of Medical Physiology, Faculty of Medicine, Kyorin University, Tokyo, Japan; Department of Neurology, Graduate School of Medicine, University of Tokyo, Japan
| | - Hideki Fukuda
- Segawa Memorial Neurological Clinic for Children, Tokyo, Japan
| | | | - Shun-Ichi Matsuda
- Department of Neurology, Graduate School of Medicine, University of Tokyo, Japan
| | - Masashi Hamada
- Department of Neurology, Graduate School of Medicine, University of Tokyo, Japan
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, Fukushima Medical University, Fukushima, Japan
| | - Shoji Tsuji
- Department of Neurology, Graduate School of Medicine, University of Tokyo, Japan
| | - Yasuo Terao
- Department of Medical Physiology, Faculty of Medicine, Kyorin University, Tokyo, Japan; Department of Neurology, Graduate School of Medicine, University of Tokyo, Japan.
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Ouerfelli-Ethier J, Fournet R, Khan AZ, Pisella L. Spatial bias in anti-saccade endpoints following bilateral dorsal posterior parietal lesions. Eur J Neurosci 2023; 58:3488-3502. [PMID: 37501610 DOI: 10.1111/ejn.16102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/21/2023] [Accepted: 07/07/2023] [Indexed: 07/29/2023]
Abstract
Anti-saccades are eye movements in which the saccade is executed in the opposite direction of a visual target and are often hypometric. Because the visual target and saccade goal are decoupled, it has been suggested that competition between the two locations occurs and needs to be resolved. It has been hypothesized that the hypometria of anti-saccades reflects this spatial competition by revealing a bias towards the visual target. To confirm that this hypometria is not simply due to reduced gain, we tested 10 healthy subjects on three different anti-saccade spatial configuration tasks: 90° away across hemifields, 90° away within the same hemifield and 180° away (classic, diagonally opposite). Specifically, we examined whether saccade endpoints showed evidence for the visual target location's interference with anti-saccade programming and execution processes. Among other neural substrates involved in anti-saccades production, the dorsal posterior parietal cortex (PPC) has been implicated in the spatial inhibition of contralateral visual target. To gain insight into the neural processes involved in spatial competition during anti-saccades, we also tested one patient with a bilateral dorsal PPC lesion. In all spatial configurations, we observed that anti-saccade endpoints demonstrated a spatial bias towards the visual target for all participants, likely due to an incomplete inhibition of the visual target location. This spatial bias was exacerbated in our patient, which suggests that the dorsal PPC contributes to the amalgamation of the two competing spatial representations.
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Affiliation(s)
- Julie Ouerfelli-Ethier
- Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL, Trajectoires, France
- School of Optometry, University of Montreal, Montreal, Quebec, Canada
| | - Romain Fournet
- School of Optometry, University of Montreal, Montreal, Quebec, Canada
| | - Aarlenne Z Khan
- School of Optometry, University of Montreal, Montreal, Quebec, Canada
| | - Laure Pisella
- Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL, Trajectoires, France
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Terao Y, Tokushige SI, Inomata-Terada S, Miyazaki T, Kotsuki N, Fisicaro F, Ugawa Y. How do patients with Parkinson's disease and cerebellar ataxia read aloud? -Eye-voice coordination in text reading. Front Neurosci 2023; 17:1202404. [PMID: 37638315 PMCID: PMC10452879 DOI: 10.3389/fnins.2023.1202404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 07/18/2023] [Indexed: 08/29/2023] Open
Abstract
Background The coordination between gaze and voice is closely linked when reading text aloud, with the gaze leading the reading position by a certain eye-voice lead (EVL). How this coordination is affected is unknown in patients with cerebellar ataxia and parkinsonism, who show oculomotor deficits possibly impacting coordination between different effectors. Objective To elucidate the role of the cerebellum and basal ganglia in eye-voice coordination during reading aloud, by studying patients with Parkinson's disease (PD) and spinocerebellar degeneration (SCD). Methods Participants were sixteen SCD patients, 18 PD patients, and 30 age-matched normal subjects, all native Japanese speakers without cognitive impairment. Subjects read aloud Japanese texts of varying readability displayed on a monitor in front of their eyes, consisting of Chinese characters and hiragana (Japanese phonograms). The gaze and voice reading the text was simultaneously recorded by video-oculography and a microphone. A custom program synchronized and aligned the gaze and audio data in time. Results Reading speed was significantly reduced in SCD patients (3.53 ± 1.81 letters/s), requiring frequent regressions to compensate for the slow reading speed. In contrast, PD patients read at a comparable speed to normal subjects (4.79 ± 3.13 letters/s vs. 4.71 ± 2.38 letters/s). The gaze scanning speed, excluding regressive saccades, was slower in PD patients (9.64 ± 4.26 letters/s) compared to both normal subjects (12.55 ± 5.42 letters/s) and SCD patients (10.81 ± 4.52 letters/s). PD patients' gaze could not far exceed that of the reading speed, with smaller allowance for the gaze to proceed ahead of the reading position. Spatial EVL was similar across the three groups for all texts (normal: 2.95 ± 1.17 letters/s, PD: 2.95 ± 1.51 letters/s, SCD: 3.21 ± 1.35 letters/s). The ratio of gaze duration to temporal EVL was lowest for SCD patients (normal: 0.73 ± 0.50, PD: 0.70 ± 0.37, SCD: 0.40 ± 0.15). Conclusion Although coordination between voice and eye movements and normal eye-voice span was observed in both PD and SCD, SCD patients made frequent regressions to manage the slowed vocal output, restricting the ability for advance processing of text ahead of the gaze. In contrast, PD patients experience restricted reading speed primarily due to slowed scanning, limiting their maximum reading speed but effectively utilizing advance processing of upcoming text.
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Affiliation(s)
- Yasuo Terao
- Department of Neurology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
- Department of Medical Physiology, Kyorin University, Mitaka, Japan
| | - Shin-ichi Tokushige
- Department of Neurology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
- Department of Neurology, Kyorin University, Mitaka, Japan
| | - Satomi Inomata-Terada
- Department of Neurology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
- Department of Medical Physiology, Kyorin University, Mitaka, Japan
| | - Tai Miyazaki
- Department of Neurology, Kyorin University, Mitaka, Japan
| | - Naoki Kotsuki
- Department of Neurology, Kyorin University, Mitaka, Japan
| | - Francesco Fisicaro
- Department of Human Neurophysiology, Fukushima Medical University, Fukushima, Japan
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, Fukushima Medical University, Fukushima, Japan
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Tokushige SI, Matsumoto H, Matsuda SI, Inomata-Terada S, Kotsuki N, Hamada M, Tsuji S, Ugawa Y, Terao Y. Early detection of cognitive decline in Alzheimer's disease using eye tracking. Front Aging Neurosci 2023; 15:1123456. [PMID: 37025964 PMCID: PMC10070704 DOI: 10.3389/fnagi.2023.1123456] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/06/2023] [Indexed: 04/08/2023] Open
Abstract
Background Patients with Alzheimer's disease (AD) are known to exhibit visuospatial processing impairment, as reflected in eye movements from the early stages of the disease. We investigated whether the pattern of gaze exploration during visual tasks could be useful for detecting cognitive decline at the earliest stage. Methods Sixteen AD patients (age: 79.1 ± 7.9 years, Mini Mental State Examination [MMSE] score: 17.7 ± 5.3, mean ± standard deviation) and 16 control subjects (age: 79.4 ± 4.6, MMSE score: 26.9 ± 2.4) participated. In the visual memory task, subjects memorized presented line drawings for later recall. In the visual search tasks, they searched for a target Landolt ring of specific orientation (serial search task) or color (pop-out task) embedded among arrays of distractors. Using video-oculography, saccade parameters, patterns of gaze exploration, and pupil size change during task performance were recorded and compared between AD and control subjects. Results In the visual memory task, the number of informative regions of interest (ROIs) fixated was significantly reduced in AD patients compared to control subjects. In the visual search task, AD patients took a significantly longer time and more saccades to detect the target in the serial but not in pop-out search. In both tasks, there was no significant difference in the saccade frequency and amplitude between groups. On-task pupil modulation during the serial search task was decreased in AD. The number of ROIs fixated in the visual memory task and search time and saccade numbers in the serial search task differentiated both groups of subjects with high sensitivity, whereas saccade parameters of pupil size modulation were effective in confirming normal cognition from cognitive decline with high specificity. Discussion Reduced fixation on informative ROIs reflected impaired attentional allocation. Increased search time and saccade numbers in the visual search task indicated inefficient visual processing. Decreased on-task pupil size during visual search suggested decreased pupil modulation with cognitive load in AD patients, reflecting impaired function of the locus coeruleus. When patients perform the combination of these tasks to visualize multiple aspects of visuospatial processing, cognitive decline can be detected at an early stage with high sensitivity and specificity and its progression be evaluated.
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Affiliation(s)
- Shin-ichi Tokushige
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Neurology, Kyorin University, Tokyo, Japan
| | | | | | | | - Naoki Kotsuki
- Department of Neurology, Kyorin University, Tokyo, Japan
| | - Masashi Hamada
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shoji Tsuji
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Institute of Medical Genomics, International University of Health and Welfare, Chiba, Japan
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, Fukushima Medical University, Fukushima, Japan
| | - Yasuo Terao
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Medical Physiology, Kyorin University, Tokyo, Japan
- *Correspondence: Yasuo Terao,
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Munoz MJ, Reilly JL, Pal GD, Verhagen Metman L, Rivera YM, Drane QH, Corcos DM, David FJ, Goelz LC. Medication adversely impacts visually-guided eye movements in Parkinson's disease. Clin Neurophysiol 2022; 143:145-153. [PMID: 35995722 DOI: 10.1016/j.clinph.2022.07.505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We examined whether previous inconsistent findings about the effect of anti-Parkinsonian medication on visually-guided saccades (VGS) were due to the use of different paradigms, which change the timing of fixation offset and target onset, or different target eccentricities. METHODS Thirty-three participants with Parkinson's disease (PD) completed the VGS tasks OFF and ON medication, along with 13 healthy controls. Performance on 3 paradigms (gap, step, and overlap) and 2 target eccentricities was recorded. We used mixed models to determine the effect of medication, paradigm, and target eccentricity on saccade latency, gain, and peak velocity. RESULTS First, we confirmed known paradigm effects on latency, and target eccentricity effects on gain and peak velocity in participants with PD. Second, latency was positively associated with OFF medication Movement Disorders Society - Unified Parkinson's Disease Rating Scale (MDS-UPDRS) motor score in PD. Third, medication prolonged latency for the larger target eccentricity across the 3 paradigms, while decreasing gain and peak velocity in the step paradigm across target eccentricities. CONCLUSIONS Medication adversely affected and was not therapeutically beneficial for VGS. Previous inconsistencies may have resulted from chosen target eccentricity. SIGNIFICANCE The negative medication effect on VGS may be clinically significant, as many activities in daily life require oculomotor control, inhibitory control, and visually-guided shifts of attention.
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Affiliation(s)
- Miranda J Munoz
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA.
| | - James L Reilly
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Gian D Pal
- Department of Neurology, Rutgers University, New Brunswick, NJ, USA; Department of Neurological Sciences, Section of Parkinson Disease and Movement Disorders, Rush University Medical Center, Chicago, IL, USA
| | - Leo Verhagen Metman
- Department of Neurological Sciences, Section of Parkinson Disease and Movement Disorders, Rush University Medical Center, Chicago, IL, USA
| | - Yessenia M Rivera
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Quentin H Drane
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Daniel M Corcos
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Fabian J David
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Lisa C Goelz
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA; Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
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Eye movements in Parkinson's disease during visual search. J Neurol Sci 2022; 440:120299. [DOI: 10.1016/j.jns.2022.120299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 04/30/2022] [Accepted: 05/23/2022] [Indexed: 10/18/2022]
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10
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Kassavetis P, Kaski D, Anderson T, Hallett M. Eye Movement Disorders in Movement Disorders. Mov Disord Clin Pract 2022; 9:284-295. [PMID: 35402641 PMCID: PMC8974874 DOI: 10.1002/mdc3.13413] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/24/2021] [Accepted: 12/03/2021] [Indexed: 11/05/2022] Open
Abstract
Oculomotor assessment is an essential element of the neurological clinical examination and is particularly important when evaluating patients with movements disorders. Most of the brain is involved in oculomotor control, and thus many neurological conditions present with oculomotor abnormalities. Each of the different classes of eye movements and their features can provide important information that can facilitate differential diagnosis. This educational review presents a clinical approach to eye movement abnormalities that are commonly seen in parkinsonism, ataxia, dystonia, myoclonus, tremor, and chorea. In parkinsonism, subtle signs such as prominent square wave jerks, impaired vertical optokinetic nystagmus, and/or the "round the houses" sign suggest early progressive supranuclear gaze palsy before vertical gaze is restricted. In ataxia, nystagmus is common, but other findings such as oculomotor apraxia, supranuclear gaze palsy, impaired fixation, or saccadic pursuit can contribute to diagnoses such as ataxia with oculomotor apraxia, Niemann-Pick type C, or ataxia telangiectasia. Opsoclonus myoclonus and oculopalatal myoclonus present with characteristic phenomenology and are usually easy to identify. The oculomotor exam is usually unremarkable in isolated dystonia, but oculogyric crisis is a medical emergency and should be recognized and treated in a timely manner. Gaze impersistence in a patient with chorea suggests Huntington's disease, but in a patient with dystonia or tremor, Wilson's disease is more likely. Finally, functional eye movements can reinforce the clinical impression of a functional movement disorder.
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Affiliation(s)
- Panagiotis Kassavetis
- National Institute of Neurological Disorders and Stroke, National Institutes of HealthBethesdaMarylandUSA,Department of NeurologyUniversity of UtahSalt Lake CityUtahUSA
| | - Diego Kaski
- Centre for Vestibular and Behavioural Neurosciences, Department of Clinical and Movement NeurosciencesUniversity College London, Institute of NeurologyLondonUK
| | - Tim Anderson
- New Zealand Brain Research InstituteChristchurchNew Zealand,Department of MedicineUniversity of OtagoChristchurchNew Zealand
| | - Mark Hallett
- National Institute of Neurological Disorders and Stroke, National Institutes of HealthBethesdaMarylandUSA
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Cucca A, Di Rocco A, Acosta I, Beheshti M, Berberian M, Bertisch HC, Droby A, Ettinger T, Hudson TE, Inglese M, Jung YJ, Mania DF, Quartarone A, Rizzo JR, Sharma K, Feigin A, Biagioni MC, Ghilardi MF. Art therapy for Parkinson's disease. Parkinsonism Relat Disord 2021; 84:148-154. [PMID: 33526323 DOI: 10.1016/j.parkreldis.2021.01.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 12/01/2020] [Accepted: 01/14/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To explore the potential rehabilitative effect of art therapy and its underlying mechanisms in Parkinson's disease (PD). METHODS Observational study of eighteen patients with PD, followed in a prospective, open-label, exploratory trial. Before and after twenty sessions of art therapy, PD patients were assessed with the UPDRS, Pegboard Test, Timed Up and Go Test (TUG), Beck Depression Inventory (BDI), Modified Fatigue Impact Scale and PROMIS-Self-Efficacy, Montreal Cognitive Assessment, Rey-Osterrieth Complex Figure Test (RCFT), Benton Visual Recognition Test (BVRT), Navon Test, Visual Search, and Stop Signal Task. Eye movements were recorded during the BVRT. Resting-state functional MRI (rs-fMRI) was also performed to assess functional connectivity (FC) changes within the dorsal attention (DAN), executive control (ECN), fronto-occipital (FOC), salience (SAL), primary and secondary visual (V1, V2) brain networks. We also tested fourteen age-matched healthy controls at baseline. RESULTS At baseline, PD patients showed abnormal visual-cognitive functions and eye movements. Analyses of rs-fMRI showed increased functional connectivity within DAN and ECN in patients compared to controls. Following art therapy, performance improved on Navon test, eye tracking, and UPDRS scores. Rs-fMRI analysis revealed significantly increased FC levels in brain regions within V1 and V2 networks. INTERPRETATION Art therapy improves overall visual-cognitive skills and visual exploration strategies as well as general motor function in patients with PD. The changes in brain connectivity highlight a functional reorganization of visual networks.
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Affiliation(s)
- Alberto Cucca
- The Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, Department of Neurology, NYU School of Medicine, New York, NY, USA; Department of Life Sciences, University of Trieste, Trieste, Italy; Department of Physical Medicine and Rehabilitation, Villa Margherita Fresco Parkinson Center, Vicenza, Italy.
| | - Alessandro Di Rocco
- Department of Neurology, Zucker School of Medicine, Hofstra/Northwell Health, New York, NY, USA
| | - Ikuko Acosta
- Department of Art and Art Professions, NYU Steinhardt, New York, NY, USA
| | - Mahya Beheshti
- Department of Rehabilitation Medicine, NYU School of Medicine, New York, NY, USA
| | | | - Hilary C Bertisch
- Department of Rehabilitation Medicine, NYU School of Medicine, New York, NY, USA
| | - Amgad Droby
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tom Ettinger
- Department of Art and Art Professions, NYU Steinhardt, New York, NY, USA
| | - Todd E Hudson
- Department of Rehabilitation Medicine, NYU School of Medicine, New York, NY, USA
| | - Matilde Inglese
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy
| | - Yoon J Jung
- Department of Physiology and Pharmacology, City University of New York Medical School, New York, NY, USA
| | - Daniella F Mania
- The Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, Department of Neurology, NYU School of Medicine, New York, NY, USA
| | - Angelo Quartarone
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - John-Ross Rizzo
- Department of Rehabilitation Medicine, NYU School of Medicine, New York, NY, USA; Department of Neurology, NYU School of Medicine, New York, NY, USA; Biomedical Engineering, Mechanical & Aerospace Engineering, Tandon School of Engineering, Brooklyn, NY, USA
| | - Kush Sharma
- The Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, Department of Neurology, NYU School of Medicine, New York, NY, USA
| | - Andrew Feigin
- The Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, Department of Neurology, NYU School of Medicine, New York, NY, USA
| | - Milton C Biagioni
- The Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, Department of Neurology, NYU School of Medicine, New York, NY, USA
| | - M Felice Ghilardi
- Department of Physiology and Pharmacology, City University of New York Medical School, New York, NY, USA
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12
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Social Cognition in Patients with Early-Onset Parkinson's Disease. PARKINSONS DISEASE 2021; 2021:8852087. [PMID: 33505651 PMCID: PMC7810525 DOI: 10.1155/2021/8852087] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 11/23/2020] [Accepted: 12/30/2020] [Indexed: 12/24/2022]
Abstract
Social cognition (SC) deficits have been linked to Parkinson's disease (PD) but have been less well researched than general cognitive processes, especially in early-onset PD (EOPD), despite this population often having greater social and family demands. Most studies focus on recognition of facial emotion, theory of mind (ToM), and decision-making domains, with limited research reporting on social reasoning. The main objective of this work was to compare SC ability across four domains: emotional processing, social reasoning, ToM, and decision-making between patients with EOPD and healthy controls. Twenty-five nondemented patients with EOPD and 25 controls matched for sex, age, and educational level were enrolled. A battery that included six SC tests was administered to all study participants; a decision-making scale was completed by participants' partners. Statistically significant differences were found between patients with EOPD and controls in all subtests across the four SC domains studied. The EOPD group demonstrated worse performance on all tasks, with large effect sizes. Differences remained significant after adjusting for Montreal Cognitive Assessment (MoCA) test scores for all SC subtests except the decision-making scale and the Iowa gambling task. No significant correlations between SC and other clinical PD variables were found. Our study shows that patients with EOPD perform significantly below controls in multiple SC domains affecting recognition of facial emotion, social reasoning, ToM, and decision-making. Only decision-making seems to be mediated by overall cognitive ability. The confounding or contributing effect of other clinical PD variables should be studied further.
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13
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Spatial attention and spatial short term memory in PSP and Parkinson's disease. Cortex 2021; 137:49-60. [PMID: 33588132 DOI: 10.1016/j.cortex.2020.12.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/27/2020] [Accepted: 12/03/2020] [Indexed: 11/20/2022]
Abstract
Progressive Supranuclear Palsy (PSP) is a neurodegenerative disorder characterised by deterioration in motor, oculomotor and cognitive function. A key clinical feature of PSP is the progressive paralysis of eye movements, most notably for vertical saccades. These oculomotor signs can be subtle, however, and PSP is often misdiagnosed as Parkinson's disease (PD), in its early stages. Although some of the clinical features of PD and PSP overlap, they are distinct disorders with differing underlying pathological processes, responses to treatment and prognoses. One key difference lies in the effects the diseases have on cognition. The oculomotor system is tightly linked to cognitive processes such as spatial attention and spatial short-term memory (sSTM), and previous studies have suggested that PSP and PD experience different deficits in these domains. We therefore hypothesised that people with PSP (N = 15) would experience problems with attention (assessed with feature and conjunction visual search tasks) and sSTM (assessed with the Corsi blocks task) compared to people with PD (N = 16) and Age Matched Controls (N = 15). As predicted, feature and conjunction search were sgnificantly slower in the PSP group compared to the other groups, and this deficit was significantly worse for feature compared to conjunction search. The PD group did not differ from AMC on feature search but were significantly impaired on the conjunction search. The PSP group also had a pronounced vertical sSTM impairment that was not present in PD or AMC groups. It is argued that PSP is associated with specific impairment of visuospatial cognition which is caused by degeneration of the oculomotor structures that support exogenous spatial attention, consistent with oculomotor theories of spatial attention and memory.
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14
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Revankar GS, Hattori N, Kajiyama Y, Nakano T, Mihara M, Mori E, Mochizuki H. Ocular fixations and presaccadic potentials to explain pareidolias in Parkinson's disease. Brain Commun 2020; 2:fcaa073. [PMID: 32954309 PMCID: PMC7425388 DOI: 10.1093/braincomms/fcaa073] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 03/27/2020] [Accepted: 05/04/2020] [Indexed: 01/05/2023] Open
Abstract
In Parkinson's disease, a precursor phenomenon to visual hallucinations presents as 'pareidolias' which make ambiguous forms appear meaningful. To evoke and detect pareidolias in patients, a noise pareidolia test was recently developed, although its task-dependent mechanisms are yet to be revealed. When subjected to this test, we hypothesized that patients exhibiting pareidolias would show altered top-down influence of visual processing allowing us to demonstrate the influence of pareidolic illusionary behaviour in Parkinson's disease patients. To that end, we evaluated eye-movement strategies and fixation-related presaccadic activity on scalp EEG when participants performed the test. Twelve healthy controls and 21 Parkinson's disease patients, evaluated for cognitive, visuo-spatial and executive functions, took a modified computer-based version of the noise pareidolia test in a free-viewing EEG eye-tracking experiment. Eye-tracking metrics (fixation-related durations and counts) documented the eye movement behaviour employed in correct responses (face/noise) and misperceptions (pareidolia/missed) during early and late visual search conditions. Simultaneously, EEG recorded the presaccadic activity in frontal and parietal areas of the brain. Based on the noise pareidolia test scores, we found certain Parkinson's disease patients exhibited pareidolias whereas others did not. ANOVA on eye-tracking data showed that patients dwelled significantly longer to detect faces and pareidolias which affected both global and local search dynamics depending on their visuo-perceptual status. Presaccadic activity in parietal electrodes for the groups was positive for faces and pareidolias, and negative for noise, though these results depended mainly on saccade size. However, patients sensitive to pareidolias showed a significantly higher presaccadic potential on frontal electrodes independent of saccade sizes, suggesting a stronger frontal activation for pareidolic stimuli. We concluded with the following interpretations (i) the noise pareidolia test specifically characterizes visuo-perceptual inadequacies in patients despite their wide range of cognitive scores, (ii) Parkinson's disease patients dwell longer to converge attention to pareidolic stimuli due to abnormal saccade generation proportional to their visuo-perceptual deficit during early search, and during late search, due to time-independent alteration of visual attentional network and (iii) patients with pareidolias show increased frontal activation reflecting the allocation of attention to irrelevant targets that express the pareidolic phenomenon. While the disease per se alters the visuo-perceptual and oculomotor dynamics, pareidolias occur in Parkinson's disease due to an abnormal top-down modulation of visual processing that affects visual attention and guidance to ambiguous stimuli.
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Affiliation(s)
- Gajanan S Revankar
- Department of Neurology, Graduate School of Medicine, Osaka University, Osaka 5650871, Japan
| | - Noriaki Hattori
- Department of Neurology, Graduate School of Medicine, Osaka University, Osaka 5650871, Japan.,Endowed Research Department of Clinical Neuroengineering, Global Center for Medical Engineering and Informatics, Osaka University, Osaka 5650871, Japan
| | - Yuta Kajiyama
- Department of Neurology, Graduate School of Medicine, Osaka University, Osaka 5650871, Japan
| | - Tomohito Nakano
- Department of Neurology, Graduate School of Medicine, Osaka University, Osaka 5650871, Japan
| | - Masahito Mihara
- Department of Neurology, Graduate School of Medicine, Osaka University, Osaka 5650871, Japan
| | - Etsuro Mori
- Department of Behavioral Neurology and Neuropsychiatry, Osaka University, Osaka 5650871, Japan
| | - Hideki Mochizuki
- Department of Neurology, Graduate School of Medicine, Osaka University, Osaka 5650871, Japan
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15
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Waldthaler J, Krüger-Zechlin C, Stock L, Deeb Z, Timmermann L. New insights into facial emotion recognition in Parkinson's disease with and without mild cognitive impairment from visual scanning patterns. Clin Park Relat Disord 2019; 1:102-108. [PMID: 34316611 PMCID: PMC8288515 DOI: 10.1016/j.prdoa.2019.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/27/2019] [Accepted: 11/16/2019] [Indexed: 11/28/2022] Open
Abstract
Background Recognizing emotional facial expressions is crucial for social interactions. Cognitive impairment and oculomotor abnormalities are common features of Parkinson's disease (PD) which may contribute to the performance in facial emotion recognition (FER) in PD. Objective The aim of this study was to analyze eye movement behavior during a facial emotion recognition (FER) task with respect to cognitive state in PD patients and healthy controls. Methods Eye movements of 24 non-demented, non-depressed PD patients (12 with intact cognitive functions and 12 with Mild Cognitive Impairment (MCI) according to MDS task force criteria level 2), and 12 age-, sex and education-matched healthy controls were recorded during visual exploration of 28 emotional (happiness, surprise, disgust, anger, fear and sadness) and neutral faces. Participants were asked to identify the displayed emotion out of a sevenfold multiple choice question. Results PD-MCI patients showed reduced FER with specific impairment of anger recognition. Although the scanned area of PD patients with intact cognition was significantly restricted, they did not differ in FER from healthy subjects. While healthy subjects and cognitively intact PD patients scanned faces with preference for mouth and eyes, patients with PD-MCI tended to look at the center of the face and spent significantly less time fixating the mouth. Conclusions Ineffective visual exploration may contribute to impaired emotion recognition in PD. Visual scanning of emotional faces is altered in PD even in the absence of cognitive impairment. The progression to PD-MCI may result in further deterioration of scanning behavior and FER impairment.
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Affiliation(s)
- Josefine Waldthaler
- Department of Neurology, University Hospital Marburg, Germany.,Center for Mind, Brain and Behavior - CMBB, Universities Marburg and Gießen, Germany
| | | | - Lena Stock
- Department of Neurology, University Hospital Marburg, Germany
| | - Zain Deeb
- Department of Neurology, University Hospital Marburg, Germany
| | - Lars Timmermann
- Department of Neurology, University Hospital Marburg, Germany.,Center for Mind, Brain and Behavior - CMBB, Universities Marburg and Gießen, Germany
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16
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Nagai K, Kaneko Y, Suzuki M, Teramoto H, Morita A, Kamei S, Watanabe Y, Okada M, Uchiyama M. Multimodal visual exploration disturbances in Parkinson's disease detected with an infrared eye-movement assessment system. Neurosci Res 2019; 160:50-56. [PMID: 31715198 DOI: 10.1016/j.neures.2019.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/03/2019] [Accepted: 11/07/2019] [Indexed: 12/25/2022]
Abstract
Parkinson's disease (PD) reportedly show disturbed visual exploration. However, whether this disturbance is due to dysfunctional visual information processing remains unclear. To clarify the effects of PD on visual information processing when exploring for targets and to compare disease effects with aging effects, we used an infrared eye-movement assessment system. Cognitively normal PD patients (n = 13), healthy age-matched (n = 17) and young controls (n = 36) participated in this study, and were evaluated using two figure-matching tasks representing visual information processing (clock-matching and inverted clock-matching tasks) and saccade tasks representing oculomotor function. With figure-matching tasks, PD patients showed significantly larger numbers of images watched in a single trial compared to healthy age-matched controls on the inverted clock-matching task. No aging effects was found in these variables. In contrast, no disease effect was apparent for reaction time, which was significantly longer in healthy age-matched controls than in healthy young controls. For saccade tasks, PD patients showed significantly smaller saccade size than healthy age-matched controls on the antisaccade task, but no aging effects were evident. Our approaches highlighted that visual exploration disturbance in PD may be due to dysfunctional visual information processing in addition to dysfunctional oculomotor processing. These disease effects may differ from aging effects.
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Affiliation(s)
- Kou Nagai
- Department of Psychiatry, Nihon University School of Medicine, 30-1 Oyaguchi-kamicho, Itabashi-ku, Tokyo, Japan
| | - Yoshiyuki Kaneko
- Department of Psychiatry, Nihon University School of Medicine, 30-1 Oyaguchi-kamicho, Itabashi-ku, Tokyo, Japan
| | - Masahiro Suzuki
- Department of Psychiatry, Nihon University School of Medicine, 30-1 Oyaguchi-kamicho, Itabashi-ku, Tokyo, Japan.
| | - Hiroko Teramoto
- Department of Neurology, Nihon University School of Medicine, 30-1 Oyaguchi-kamicho, Itabashi-ku, Tokyo, Japan
| | - Akihiko Morita
- Department of Neurology, Nihon University School of Medicine, 30-1 Oyaguchi-kamicho, Itabashi-ku, Tokyo, Japan
| | - Satoshi Kamei
- Department of Neurology, Nihon University School of Medicine, 30-1 Oyaguchi-kamicho, Itabashi-ku, Tokyo, Japan
| | - Yusuke Watanabe
- Department of Radiology, Showa General Hospital, 2-450 Tenjincho, Kodaira-shi, Tokyo, Japan
| | - Masahiro Okada
- Department of Radiology, Nihon University School of Medicine, 30-1 Oyaguchi-kamicho, Itabashi-ku, Tokyo, Japan
| | - Makoto Uchiyama
- Department of Psychiatry, Nihon University School of Medicine, 30-1 Oyaguchi-kamicho, Itabashi-ku, Tokyo, Japan
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17
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Pretegiani E, Vanegas-Arroyave N, FitzGibbon EJ, Hallett M, Optican LM. Evidence From Parkinson's Disease That the Superior Colliculus Couples Action and Perception. Mov Disord 2019; 34:1680-1689. [PMID: 31633242 DOI: 10.1002/mds.27861] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/12/2019] [Accepted: 08/12/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Action and perception should be coordinated for good visual-motor performance. The mechanism coupling action and perception may be a prominence map in the intermediate layer of the superior colliculus that modulates motor and attentional/perceptual processes. This coordination comes with a cost: the misperception that briefly overlapping stimuli are separated in time. Our model predicts that abnormal intermediate layer of the superior colliculus inhibition, such as that arising from increased basal ganglia output, would affect the action and perception coupling, and it would worsen the misperception. OBJECTIVE To test the prominence map model by measuring reaction times and perceptions in human intermediate layer of the superior colliculus dysfunction. METHODS We measured the saccadic and perceptual reaction time changes and the percept for different temporal asynchronies between fixation point offset and peripheral target onset in Parkinson's disease (PD). RESULTS We found that increased basal ganglia inhibitory output to the intermediate layer of the superior colliculus prominence map disrupted the normal coupling of action and perception. With increasing temporal asynchronies, the PD perceptual reaction times increased approximately 3 times more than the increase of the saccadic reaction times. Also, PD subjects misperceive small overlaps as gaps for temporal asynchronies up to 3 times longer than controls. The results can be reproduced by an intermediate layer of the superior colliculus rostral-caudal gradient of inhibition. CONCLUSION These findings support the hypothesis that a prominence map in the intermediate layer of the superior colliculus couples action and perception through modulation of attention. A dysfunction of this network quantifies abnormal basal ganglia output and could underlie visual deficits, including common, yet poorly understood, misperceptions and visual-motor deficits of PD. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Elena Pretegiani
- Laboratory of Sensorimotor Research, National Eye Institute, NIH, Bethesda, Maryland, USA
| | - Nora Vanegas-Arroyave
- Department of Neurology, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Edmond J FitzGibbon
- Laboratory of Sensorimotor Research, National Eye Institute, NIH, Bethesda, Maryland, USA
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Maryland, USA
| | - Lance M Optican
- Laboratory of Sensorimotor Research, National Eye Institute, NIH, Bethesda, Maryland, USA
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18
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Barbosa P, Kaski D, Castro P, Lees AJ, Warner TT, Djamshidian A. Saccadic Direction Errors are Associated with Impulsive Compulsive Behaviours in Parkinson’s Disease Patients. JOURNAL OF PARKINSONS DISEASE 2019; 9:625-630. [DOI: 10.3233/jpd-181460] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Pedro Barbosa
- Reta Lila Weston Institute of Neurological Studies, UCL Queen Square Institute of Neurology, University College London, London, UK
- The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Diego Kaski
- Department of Clinical and Movement Neurosciences, University College London, London, UK
- Department of Neuro-Otology, Charing Cross Hospital, Imperial College London, London, UK
| | - Patricia Castro
- Escuela de Fonoaudiologia, Facultad de Medicina, Clinica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Andrew J. Lees
- Reta Lila Weston Institute of Neurological Studies, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Thomas T. Warner
- Reta Lila Weston Institute of Neurological Studies, UCL Queen Square Institute of Neurology, University College London, London, UK
- The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Atbin Djamshidian
- Reta Lila Weston Institute of Neurological Studies, UCL Queen Square Institute of Neurology, University College London, London, UK
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
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19
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Shishido E, Ogawa S, Miyata S, Yamamoto M, Inada T, Ozaki N. Application of eye trackers for understanding mental disorders: Cases for schizophrenia and autism spectrum disorder. Neuropsychopharmacol Rep 2019; 39:72-77. [PMID: 30712295 PMCID: PMC7292297 DOI: 10.1002/npr2.12046] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 12/10/2018] [Accepted: 12/12/2018] [Indexed: 12/31/2022] Open
Abstract
Studies of eye movement have become an essential tool of basic neuroscience research. Measures of eye movement have been applied to higher brain functions such as cognition, social behavior, and higher‐level decision‐making. With the development of eye trackers, a growing body of research has described eye movements in relation to mental disorders, reporting that the basic oculomotor properties of patients with mental disorders differ from those of healthy controls. Using discrimination analysis, several independent research groups have used eye movements to differentiate patients with schizophrenia from a mixed population of patients and controls. Recently, in addition to traditional oculomotor measures, several new techniques have been applied to measure and analyze eye movement data. One research group investigated eye movements in relation to the risk of autism spectrum disorder several years prior to the emergence of verbal‐behavioral abnormalities. Research on eye movement in humans in social communication is therefore considered important, but has not been well explored. Since eye movement patterns vary between patients with mental disorders and healthy controls, it is necessary to collect a large amount of eye movement data from various populations and age groups. The application of eye trackers in the clinical setting could contribute to the early treatment of mental disorders. Studies of eye movement have become an essential tool of basic neuroscience research. With the development of eye trackers, a growing body of research has described eye movements in relation to mental disorders.![]()
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Affiliation(s)
- Emiko Shishido
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan.,National Institute for Physiological Sciences, Okazaki, Japan
| | - Shiori Ogawa
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Seiko Miyata
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Maeri Yamamoto
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toshiya Inada
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Norio Ozaki
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
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20
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Bhidayasiri R, Rattanachaisit W, Phokaewvarangkul O, Lim TT, Fernandez HH. Exploring bedside clinical features of parkinsonism: A focus on differential diagnosis. Parkinsonism Relat Disord 2018; 59:74-81. [PMID: 30502095 DOI: 10.1016/j.parkreldis.2018.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/29/2018] [Accepted: 11/04/2018] [Indexed: 12/12/2022]
Abstract
The proper diagnosis of parkinsonian disorders usually involves three steps: identifying core features of parkinsonism; excluding other causes; and collating supportive evidence based on clinical signs or investigations. While the recognition of cardinal parkinsonian features is usually straightforward, the appreciation of clinical features suggestive of specific parkinsonian disorders can be challenging, and often requires greater experience and skills. In this review, we outline the clinical features that are relevant to the differential diagnosis of common neurodegenerative parkinsonian disorders, including Parkinson's disease, multiple system atrophy, progressive supranuclear palsy, and corticobasal degeneration. We aim to make this process relatable to clinicians-in-practice, therefore, have categorised the list of clinical features into groups according to the typical sequence on how clinicians would elicit them during the examination, starting with observation of facial expression and clinical signs of the face, spotting eye movement abnormalities, examination of tremors and jerky limb movements, and finally, examination of posture and gait dysfunction. This review is not intended to be comprehensive. Rather, we have focused on the most common clinical signs that are potentially key to making the correct diagnosis and those that do not require special skills or training for interpretation. Evidence is also provided, where available, such as diagnostic criteria, consensus statements, clinicopathological studies or large multi-centre registries. Pitfalls are also discussed when relevant to the diagnosis. While no clinical signs are pathognomonic for certain parkinsonian disorders, certain clinical clues may assist in narrowing a differential diagnosis and tailoring focused investigations for the individual patient.
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Affiliation(s)
- Roongroj Bhidayasiri
- Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand; Department of Neurology, Juntendo University, Tokyo, Japan.
| | - Watchara Rattanachaisit
- Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand
| | - Onanong Phokaewvarangkul
- Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand
| | | | - Hubert H Fernandez
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA
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21
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Effect of subthalamic nucleus deep brain stimulation on visual scanning. Clin Neurophysiol 2018; 129:2421-2432. [DOI: 10.1016/j.clinph.2018.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 07/12/2018] [Accepted: 08/22/2018] [Indexed: 11/19/2022]
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22
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Visuospatial exploration and art therapy intervention in patients with Parkinson's disease: an exploratory therapeutic protocol. Complement Ther Med 2018; 40:70-76. [PMID: 30219472 DOI: 10.1016/j.ctim.2018.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/17/2018] [Accepted: 07/23/2018] [Indexed: 11/21/2022] Open
Abstract
Though abnormalities of visuospatial function occur in Parkinson's disease, the impact of such deficits on functional independence and psychological wellbeing has been historically under- recognized, and effective treatments for this impairment are unknown. These symptoms can be encountered at any stage of the disease, affecting many activities of daily living, and negatively influencing mood, self-efficacy, independence, and overall quality of life. Furthermore, visuospatial dysfunction has been recently linked to gait impairment and falls, symptoms that are known to be poor prognostic factors. Here, we aim to present an original modality of neurorehabilitation designed to address visuospatial dysfunction and related symptoms in Parkinson's disease, known as "Art Therapy". Art creation relies on sophisticated neurologic mechanisms including shape recognition, motion perception, sensory-motor integration, abstraction, and eye-hand coordination. Furthermore, art therapy may enable subjects with disability to understand their emotions and express them through artistic creation and creative thinking, thus promoting self-awareness, relaxation, confidence and self-efficacy. The potential impact of this intervention on visuospatial dysfunction will be assessed by means of combined clinical, behavioral, gait kinematic, neuroimaging and eye tracking analyses. Potential favorable outcomes may drive further trials validating this novel paradigm of neurorehabilitation.
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Abstract
Idiopathic Parkinson's Disease (PD) is characterized by degeneration of dopaminergic and other neurons, leading to motor and non-motor deficits. Abnormal eye movements in PD, including fixations, saccades, and convergence, are well described. However, saccadic reading, which requires serial and alternating saccades and fixations, is not well studied, despite its obvious impact on the quality of life. In this study, we assessed saccadic reading using variations of the King-Devick (KD) test, a rapid single digit number naming test, as a way to assess the ability to make serial left-to-right ocular motor movements necessary for reading. We recruited 42 treated PD patients and 80 age-matched controls and compared their reading times with a variety of measures, including age, duration of disease, Unified Parkinson's Disease Rating Scale (UPDRS), the National Eye Institute 25-Item Visual Functioning Questionnaire 25 (VFQ-25), and Montreal Cognitive assessment (MoCA) test. The subjects performed 4 trials of reading 120 single digit numbers aloud as fast as possible without making errors. In each trial, they read 3 pages (KD1, KD2, and KD3), and each page contained 40 numbers per page in 8 lines with 5 numbers/line. We found that PD patients read about 20% slower than controls on all tests (KD1, 2, and 3 tests) (p < 0.02), and both groups read irregularly spaced numbers slower than regularly spaced numbers. Having lines between numbers to guide reading (KD1 tests) did not impact reading time in both PD and controls, but increased visual crowding as a result of decreased spacing between numbers (KD3 tests) was associated with significantly slower reading times in both PD and control groups. Our study revealed that saccadic reading is slower in PD, but controls and PD patients are both impacted by visuospatial planning challenges posed by increased visual crowding and irregularity of number spacing. Reading time did not correlate with UPDRS or MoCA scores in PD patients but significantly correlated with age, duration of disease, and VFQ-25 scores. The presence of convergence insufficiency did not significantly correlate with reading time in PD patients, although on average there was slower reading time in those with convergence insufficiency by 8 s (p = 0.2613). We propose that a simple reading task using 120 single-digit numbers can be used as a screening tool in the clinical setting to assess functional ocular motor difficulties in Parkinson's disease that can have a profound impact on quality of life.
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Pretegiani E, Optican LM. Eye Movements in Parkinson's Disease and Inherited Parkinsonian Syndromes. Front Neurol 2017; 8:592. [PMID: 29170650 PMCID: PMC5684125 DOI: 10.3389/fneur.2017.00592] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 10/23/2017] [Indexed: 12/02/2022] Open
Abstract
Despite extensive research, the functions of the basal ganglia (BG) in movement control have not been fully understood. Eye movements, particularly saccades, are convenient indicators of BG function. Here, we review the main oculomotor findings reported in Parkinson’s disease (PD) and genetic parkinsonian syndromes. PD is a progressive, neurodegenerative disorder caused by dopaminergic cell loss within the substantia nigra pars compacta, resulting in depletion of striatal dopamine and subsequent increased inhibitory BG output from the internal globus pallidus and the substantia nigra pars reticulata. Eye movement abnormalities are common in PD: anomalies are more evident in voluntary than reflexive saccades in the initial stages, but visually guided saccades may also be involved at later stages. Saccadic hypometria (including abnormally fragmented saccades), reduced accuracy, and increased latency are among the most prominent deficits. PD patients show also unusually frequent and large square wave jerks and impaired inhibition of reflexive saccades when voluntary mirror saccades are required. Poor convergence ability and altered pursuit are common. Inherited parkinsonisms are a heterogeneous group of rare syndromes due to gene mutations causing symptoms resembling those of PD. Eye movement characteristics of some parkinsonisms have been studied. While sharing some PD features, each syndrome has a distinctive profile that could contribute to better define the clinical phenotype of parkinsonian disorders. Moreover, because the pathogenesis and the underlying neural circuit failure of inherited parkinsonisms are often well defined, they might offer a better prospect than idiopathic PD to understand the BG function.
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Affiliation(s)
- Elena Pretegiani
- Laboratory of Sensorimotor Research, National Eye Institute, NIH, Bethesda, MD, United States
| | - Lance M Optican
- Laboratory of Sensorimotor Research, National Eye Institute, NIH, Bethesda, MD, United States
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TERAO Y, FUKUDA H, HIKOSAKA O. What do eye movements tell us about patients with neurological disorders? - An introduction to saccade recording in the clinical setting. PROCEEDINGS OF THE JAPAN ACADEMY. SERIES B, PHYSICAL AND BIOLOGICAL SCIENCES 2017; 93:772-801. [PMID: 29225306 PMCID: PMC5790757 DOI: 10.2183/pjab.93.049] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 08/17/2017] [Indexed: 06/01/2023]
Abstract
Non-invasive and readily implemented in the clinical setting, eye movement studies have been conducted extensively not only in healthy human subjects but also in patients with neurological disorders. The purpose of saccade studies is to "read out" the pathophysiology underlying neurological disorders from the saccade records, referring to known primate physiology. In the current review, we provide an overview of studies in which we attempted to elucidate the patterns of saccade abnormalities in over 250 patients with neurological disorders, including cerebellar ataxia and brainstem pathology due to neurodegenerative disorders, and what they tell about the pathophysiology of patients with neurological disorders. We also discuss how interventions, such as deep brain stimulation, affect saccade performance and provide further insights into the workings of the oculomotor system in humans. Finally, we argue that it is important to understand the functional significance and behavioral correlate of saccade abnormalities in daily life, which could require eye tracking methodologies to be performed in settings similar to daily life.
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Affiliation(s)
- Yasuo TERAO
- Department of Cell Physiology, Kyorin University, Tokyo, Japan
| | | | - Okihide HIKOSAKA
- Section of Neuronal Networks, Laboratory of Sensorimotor Research, National Eye Institute, U.S.A.
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Abstract
PURPOSE OF REVIEW Abnormalities of oculomotor control accompany the pathological changes underlying many neurodegenerative diseases. Clinical examination of eye movements can contribute to differential diagnosis, whereas quantitative laboratory measures can provide detailed insight into the disease process. In this review of eye movements in neurodegenerative disease, we summarise recent empirical findings and conceptual advances. RECENT FINDINGS Oculomotor researchers continue to be particularly prolific in studying Parkinson's disease but there is also substantial activity in Alzheimer's disease and spinocerebellar ataxia. Interesting findings have been reported in Huntington's, motor neuron disease, and glaucoma. Most studies report laboratory-based investigations but useful progress in clinical description continues to be made. SUMMARY Eye movements remain an active field of investigation across a variety of neurodegenerative conditions. Progress continues to be made at the clinical level as well by using laboratory techniques.
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Affiliation(s)
- Michael R MacAskill
- aNew Zealand Brain Research Institute bDepartment of Medicine, University of Otago cDepartment of Neurology, Christchurch Hospital, Christchurch, New Zealand
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Fischer P, Ossandón JP, Keyser J, Gulberti A, Wilming N, Hamel W, Köppen J, Buhmann C, Westphal M, Gerloff C, Moll CKE, Engel AK, König P. STN-DBS Reduces Saccadic Hypometria but Not Visuospatial Bias in Parkinson's Disease Patients. Front Behav Neurosci 2016; 10:85. [PMID: 27199693 PMCID: PMC4853960 DOI: 10.3389/fnbeh.2016.00085] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 04/15/2016] [Indexed: 12/25/2022] Open
Abstract
In contrast to its well-established role in alleviating skeleto-motor symptoms in Parkinson's disease, little is known about the impact of deep brain stimulation (DBS) of the subthalamic nucleus (STN) on oculomotor control and attention. Eye-tracking data of 17 patients with left-hemibody symptom onset was compared with 17 age-matched control subjects. Free-viewing of natural images was assessed without stimulation as baseline and during bilateral DBS. To examine the involvement of ventral STN territories in oculomotion and spatial attention, we employed unilateral stimulation via the left and right ventralmost contacts respectively. When DBS was off, patients showed shorter saccades and a rightward viewing bias compared with controls. Bilateral stimulation in therapeutic settings improved saccadic hypometria but not the visuospatial bias. At a group level, unilateral ventral stimulation yielded no consistent effects. However, the evaluation of electrode position within normalized MNI coordinate space revealed that the extent of early exploration bias correlated with the precise stimulation site within the left subthalamic area. These results suggest that oculomotor impairments "but not higher-level exploration patterns" are effectively ameliorable by DBS in therapeutic settings. Our findings highlight the relevance of the STN topography in selecting contacts for chronic stimulation especially upon appearance of visuospatial attention deficits.
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Affiliation(s)
- Petra Fischer
- Institute of Cognitive Science, University of OsnabrückOsnabrück, Germany; Medical Research Council Brain Network Dynamics Unit, University of OxfordOxford, UK; Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of OxfordOxford, UK
| | - José P Ossandón
- Institute of Cognitive Science, University of Osnabrück Osnabrück, Germany
| | - Johannes Keyser
- Institute of Cognitive Science, University of Osnabrück Osnabrück, Germany
| | - Alessandro Gulberti
- Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf Hamburg, Germany
| | - Niklas Wilming
- Institute of Cognitive Science, University of OsnabrückOsnabrück, Germany; Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-EppendorfHamburg, Germany
| | - Wolfgang Hamel
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf Hamburg, Germany
| | - Johannes Köppen
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf Hamburg, Germany
| | - Carsten Buhmann
- Department of Neurology, University Medical Center Hamburg-Eppendorf Hamburg, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf Hamburg, Germany
| | - Christian K E Moll
- Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf Hamburg, Germany
| | - Andreas K Engel
- Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf Hamburg, Germany
| | - Peter König
- Institute of Cognitive Science, University of OsnabrückOsnabrück, Germany; Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-EppendorfHamburg, Germany
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Pieruccini-Faria F, Jones J, Almeida Q. Insight into dopamine-dependent planning deficits in Parkinson’s disease: A sharing of cognitive & sensory resources. Neuroscience 2016; 318:219-29. [DOI: 10.1016/j.neuroscience.2016.01.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 12/16/2015] [Accepted: 01/08/2016] [Indexed: 11/15/2022]
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Matsumoto H. A neurophysiological examination of basal ganglia and cerebellum. Clin Neurophysiol 2016; 127:1007-1008. [DOI: 10.1016/j.clinph.2015.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 08/05/2015] [Accepted: 08/11/2015] [Indexed: 10/23/2022]
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The Cognition of Maximal Reach Distance in Parkinson’s Disease. PARKINSON'S DISEASE 2016; 2016:6827085. [PMID: 27597927 PMCID: PMC5002485 DOI: 10.1155/2016/6827085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 07/10/2016] [Accepted: 07/20/2016] [Indexed: 11/23/2022]
Abstract
This study aimed to investigate whether the cognition of spatial distance in reaching movements was decreased in patients with Parkinson's disease (PD) and whether this cognition was associated with various symptoms of PD. Estimated and actual maximal reaching distances were measured in three directions in PD patients and healthy elderly volunteers. Differences between estimated and actual measurements were compared within each group. In the PD patients, the associations between “error in cognition” of reaching distance and “clinical findings” were also examined. The results showed that no differences were observed in any values regardless of dominance of hand and severity of symptoms. The differences between the estimated and actual measurements were negatively deviated in the PD patients, indicating that they tended to underestimate reaching distance. “Error in cognition” of reaching distance correlated with the items of posture in the motor section of the Unified Parkinson's Disease Rating Scale. This suggests that, in PD patients, postural deviation and postural instability might affect the cognition of the distance from a target object.
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Kim HF, Hikosaka O. Parallel basal ganglia circuits for voluntary and automatic behaviour to reach rewards. Brain 2015; 138:1776-800. [PMID: 25981958 DOI: 10.1093/brain/awv134] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 04/14/2015] [Indexed: 11/13/2022] Open
Abstract
The basal ganglia control body movements, value processing and decision-making. Many studies have shown that the inputs and outputs of each basal ganglia structure are topographically organized, which suggests that the basal ganglia consist of separate circuits that serve distinct functions. A notable example is the circuits that originate from the rostral (head) and caudal (tail) regions of the caudate nucleus, both of which target the superior colliculus. These two caudate regions encode the reward values of visual objects differently: flexible (short-term) values by the caudate head and stable (long-term) values by the caudate tail. These value signals in the caudate guide the orienting of gaze differently: voluntary saccades by the caudate head circuit and automatic saccades by the caudate tail circuit. Moreover, separate groups of dopamine neurons innervate the caudate head and tail and may selectively guide the flexible and stable learning/memory in the caudate regions. Studies focusing on manual handling of objects also suggest that rostrocaudally separated circuits in the basal ganglia control the action differently. These results suggest that the basal ganglia contain parallel circuits for two steps of goal-directed behaviour: finding valuable objects and manipulating the valuable objects. These parallel circuits may underlie voluntary behaviour and automatic skills, enabling animals (including humans) to adapt to both volatile and stable environments. This understanding of the functions and mechanisms of the basal ganglia parallel circuits may inform the differential diagnosis and treatment of basal ganglia disorders.
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Affiliation(s)
- Hyoung F Kim
- Laboratory of Sensorimotor Research, National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Okihide Hikosaka
- Laboratory of Sensorimotor Research, National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
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Matsuda S, Matsumoto H, Furubayashi T, Fukuda H, Emoto M, Hanajima R, Tsuji S, Ugawa Y, Terao Y. Top-down but not bottom-up visual scanning is affected in hereditary pure cerebellar ataxia. PLoS One 2014; 9:e116181. [PMID: 25545148 PMCID: PMC4278854 DOI: 10.1371/journal.pone.0116181] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 12/04/2014] [Indexed: 11/18/2022] Open
Abstract
The aim of this study was to clarify the nature of visual processing deficits caused by cerebellar disorders. We studied the performance of two types of visual search (top-down visual scanning and bottom-up visual scanning) in 18 patients with pure cerebellar types of spinocerebellar degeneration (SCA6: 11; SCA31: 7). The gaze fixation position was recorded with an eye-tracking device while the subjects performed two visual search tasks in which they looked for a target Landolt figure among distractors. In the serial search task, the target was similar to the distractors and the subject had to search for the target by processing each item with top-down visual scanning. In the pop-out search task, the target and distractor were clearly discernible and the visual salience of the target allowed the subjects to detect it by bottom-up visual scanning. The saliency maps clearly showed that the serial search task required top-down visual attention and the pop-out search task required bottom-up visual attention. In the serial search task, the search time to detect the target was significantly longer in SCA patients than in normal subjects, whereas the search time in the pop-out search task was comparable between the two groups. These findings suggested that SCA patients cannot efficiently scan a target using a top-down attentional process, whereas scanning with a bottom-up attentional process is not affected. In the serial search task, the amplitude of saccades was significantly smaller in SCA patients than in normal subjects. The variability of saccade amplitude (saccadic dysmetria), number of re-fixations, and unstable fixation (nystagmus) were larger in SCA patients than in normal subjects, accounting for a substantial proportion of scattered fixations around the items. Saccadic dysmetria, re-fixation, and nystagmus may play important roles in the impaired top-down visual scanning in SCA, hampering precise visual processing of individual items.
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Affiliation(s)
| | | | - Toshiaki Furubayashi
- Department of Neurology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Hideki Fukuda
- Segawa Neurological Clinic for Children, Tokyo, Japan
| | - Masaki Emoto
- Interfaculty Initiative in Information Studies, The University of Tokyo, Tokyo, Japan
| | | | - Shoji Tsuji
- Department of Neurology, The University of Tokyo, Tokyo, Japan
| | - Yoshikazu Ugawa
- Department of Neurology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yasuo Terao
- Department of Neurology, The University of Tokyo, Tokyo, Japan
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Matsuda S, Matsumoto H, Furubayashi T, Fukuda H, Hanajima R, Tsuji S, Ugawa Y, Terao Y. Visual Scanning Area is Abnormally Enlarged in Hereditary Pure Cerebellar Ataxia. THE CEREBELLUM 2014; 14:63-71. [PMID: 25231433 DOI: 10.1007/s12311-014-0600-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Leong DF, Master CL, Messner LV, Pang Y, Smith C, Starling AJ. The effect of saccadic training on early reading fluency. Clin Pediatr (Phila) 2014; 53:858-64. [PMID: 24790022 DOI: 10.1177/0009922814532520] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Eye movements are necessary for the physical act of reading and have been shown to relate to underlying cognitive and visuoattentional processes during reading. The purpose of this study was to determine the effect of saccadic training using the King-Devick remediation software on reading fluency. METHODS In this prospective, single-blinded, randomized, crossover trial, a cohort of elementary students received standardized reading fluency testing pre- and posttreatment. Treatment consisted of in-school training 20 minutes per day, 3 days per week for 6 weeks. RESULTS The treatment group had significantly higher reading fluency scores after treatment (P < .001), and posttreatment scores were significantly higher than the control group (P < .005). CONCLUSION Saccadic training can significantly improve reading fluency. We hypothesize that this improvement in reading fluency is a result of rigorous practice of eye movements and shifting visuospatial attention, which are vital to the act of reading.
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Affiliation(s)
| | - Christina L Master
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Leonard V Messner
- Illinois Eye Institute, Illinois College of Optometry, Chicago, IL, USA
| | - Yi Pang
- Illinois Eye Institute, Illinois College of Optometry, Chicago, IL, USA
| | - Craig Smith
- Aegis Creative, Lakewood, CO, USA Bill and Melinda Gates Foundation, Seattle, WA, USA
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Stuart S, Alcock L, Galna B, Lord S, Rochester L. The measurement of visual sampling during real-world activity in Parkinson's disease and healthy controls: a structured literature review. J Neurosci Methods 2013; 222:175-88. [PMID: 24291711 DOI: 10.1016/j.jneumeth.2013.11.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 11/18/2013] [Accepted: 11/19/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Visual sampling techniques are used to investigate the complex role of vision during real-world activities in Parkinson's disease. Earlier research is limited to static simple tasks or measurement of eye movements alone, but more recent investigations involve more real-world activities. The approach to the objective measurement of eye movements varies with respect to instrumentation, testing protocols, and mediating factors that may influence visual sampling. OBJECTIVES The aim of this review was to examine previous work measuring visual sampling during real-world activities in Parkinson's disease to inform the development of robust protocols. Within this review a real-world activity was considered to be a goal-orientated motor task involving more than one body segment such as reaching or walking. METHODS Medline, Embase, PsychInfo, Scopus, Web of Knowledge, PubMed and the Cochrane library databases were searched. Two independent reviewers and an adjudicator screened articles that described quantitative visual sampling in people with Parkinson's disease and healthy controls. RESULTS Twenty full-text articles were screened and 15 met inclusion/exclusion criteria. A wide range of instruments and outcome measures were reported which were generally used in a task-dependent manner. Instrument reliability and validity was insufficiently reported in all studies. Few studies considered mediators of visual sampling such as visual or cognitive deficits. CONCLUSIONS Future research is required to accurately characterise visual impairments in Parkinson's disease and during real-world activities. Composite use of instruments may be required to achieve reliability and validity of visual sampling outcomes which need to be standardised. Recommendations also include assessment of cognition and basic visual function.
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Affiliation(s)
- Samuel Stuart
- Institute for Ageing and Health, Clinical Ageing Research Unit, Newcastle University, United Kingdom
| | - Lisa Alcock
- Institute for Ageing and Health, Clinical Ageing Research Unit, Newcastle University, United Kingdom
| | - Brook Galna
- Institute for Ageing and Health, Clinical Ageing Research Unit, Newcastle University, United Kingdom
| | - Sue Lord
- Institute for Ageing and Health, Clinical Ageing Research Unit, Newcastle University, United Kingdom
| | - Lynn Rochester
- Institute for Ageing and Health, Clinical Ageing Research Unit, Newcastle University, United Kingdom.
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Lin TP, Adler CH, Hentz JG, Balcer LJ, Galetta SL, Devick S. Slowing of number naming speed by King-Devick test in Parkinson's disease. Parkinsonism Relat Disord 2013; 20:226-9. [PMID: 24269283 DOI: 10.1016/j.parkreldis.2013.10.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 09/27/2013] [Accepted: 10/10/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The King-Devick (KD) test measures the speed of rapid number naming, and is postulated to require fast eye movements, attention, language, and possibly other aspects of cognitive functions. While used in multiple sports concussion studies, it has not been applied to the field of movement disorders. METHODS Forty-five Parkinson's disease (PD), 23 essential tremor (ET), and 65 control subjects were studied. Subjects performed two trials of reading out loud single-digit numbers separated by varying spacing on three test cards that were of different formats. The sum time of the faster trial was designated the KD score and compared across the three groups. RESULTS PD patients had higher (worse) KD scores, with longer reading times compared to ET and control subjects (66 s vs. 49 s vs. 52 s, p < 0.001, adjusting for age and gender). No significant difference was found between ET and control (Δ = -3 s, 95% CI: -10 to 4). CONCLUSIONS This is the first study of the King-Devick Test in Parkinson's disease. PD patients were found to have a slower rapid number naming speed compared to controls. This test may be a simple and rapid bedside tool for quantifying correlates of visual and cognitive function in Parkinson's disease.
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Affiliation(s)
- Tanya P Lin
- Department of Neurology, Mayo Clinic College of Medicine, Scottsdale, AZ, USA
| | - Charles H Adler
- Department of Neurology, Mayo Clinic College of Medicine, Scottsdale, AZ, USA.
| | - Joseph G Hentz
- Department of Biostatistics, Mayo Clinic College of Medicine, Scottsdale, AZ, USA
| | - Laura J Balcer
- Department of Neurology, NYU School of Medicine, New York, NY, USA
| | - Steven L Galetta
- Department of Neurology, NYU School of Medicine, New York, NY, USA
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Terao Y, Fukuda H, Ugawa Y, Hikosaka O. New perspectives on the pathophysiology of Parkinson’s disease as assessed by saccade performance: A clinical review. Clin Neurophysiol 2013; 124:1491-506. [DOI: 10.1016/j.clinph.2013.01.021] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Revised: 01/01/2013] [Accepted: 01/15/2013] [Indexed: 10/27/2022]
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Matsumoto H, Terao Y, Ugawa Y. Ocular paradoxical movement and severity of Parkinson’s disease. Brain 2013; 136:e250. [DOI: 10.1093/brain/awt124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Archibald NK, Hutton SB, Clarke MP, Mosimann UP, Burn DJ. Visual exploration in Parkinson's disease and Parkinson's disease dementia. Brain 2013; 136:739-50. [PMID: 23436502 DOI: 10.1093/brain/awt005] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Parkinson's disease, typically thought of as a movement disorder, is increasingly recognized as causing cognitive impairment and dementia. Eye movement abnormalities are also described, including impairment of rapid eye movements (saccades) and the fixations interspersed between them. Such movements are under the influence of cortical and subcortical networks commonly targeted by the neurodegeneration seen in Parkinson's disease and, as such, may provide a marker for cognitive decline. This study examined the error rates and visual exploration strategies of subjects with Parkinson's disease, with and without cognitive impairment, whilst performing a battery of visuo-cognitive tasks. Error rates were significantly higher in those Parkinson's disease groups with either mild cognitive impairment (P = 0.001) or dementia (P < 0.001), than in cognitively normal subjects with Parkinson's disease. When compared with cognitively normal subjects with Parkinson's disease, exploration strategy, as measured by a number of eye tracking variables, was least efficient in the dementia group but was also affected in those subjects with Parkinson's disease with mild cognitive impairment. When compared with control subjects and cognitively normal subjects with Parkinson's disease, saccade amplitudes were significantly reduced in the groups with mild cognitive impairment or dementia. Fixation duration was longer in all Parkinson's disease groups compared with healthy control subjects but was longest for cognitively impaired Parkinson's disease groups. The strongest predictor of average fixation duration was disease severity. Analysing only data from the most complex task, with the highest error rates, both cognitive impairment and disease severity contributed to a predictive model for fixation duration [F(2,76) = 12.52, P ≤ 0.001], but medication dose did not (r = 0.18, n = 78, P = 0.098, not significant). This study highlights the potential use of exploration strategy measures as a marker of cognitive decline in Parkinson's disease and reveals the efficiency by which fixations and saccades are deployed in the build-up to a cognitive response, rather than merely focusing on the outcome itself. The prolongation of fixation duration, present to a small but significant degree even in cognitively normal subjects with Parkinson's disease, suggests a disease-specific impact on the networks directing visual exploration, although the study also highlights the multi-factorial nature of changes in exploration and the significant impact of cognitive decline on efficiency of visual search.
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Affiliation(s)
- Neil K Archibald
- Consultant Neurologist, The James Cook University Hospital, Middlesbrough, TS4 3BW, UK.
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Anderson TJ, MacAskill MR. Eye movements in patients with neurodegenerative disorders. Nat Rev Neurol 2013; 9:74-85. [DOI: 10.1038/nrneurol.2012.273] [Citation(s) in RCA: 185] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Gaymard B. Cortical and sub-cortical control of saccades and clinical application. Rev Neurol (Paris) 2012; 168:734-40. [DOI: 10.1016/j.neurol.2012.07.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 07/26/2012] [Accepted: 07/27/2012] [Indexed: 10/27/2022]
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Matsumoto H, Terao Y, Furubayashi T, Yugeta A, Fukuda H, Emoto M, Hanajima R, Ugawa Y. Basal ganglia dysfunction reduces saccade amplitude during visual scanning in Parkinson’s disease. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.baga.2012.01.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Matsumoto H, Terao Y, Yugeta A, Fukuda H, Emoto M, Furubayashi T, Okano T, Hanajima R, Ugawa Y. Where do neurologists look when viewing brain CT images? An eye-tracking study involving stroke cases. PLoS One 2011; 6:e28928. [PMID: 22174928 PMCID: PMC3236228 DOI: 10.1371/journal.pone.0028928] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Accepted: 11/17/2011] [Indexed: 11/19/2022] Open
Abstract
The aim of this study was to investigate where neurologists look when they view brain computed tomography (CT) images and to evaluate how they deploy their visual attention by comparing their gaze distribution with saliency maps. Brain CT images showing cerebrovascular accidents were presented to 12 neurologists and 12 control subjects. The subjects' ocular fixation positions were recorded using an eye-tracking device (Eyelink 1000). Heat maps were created based on the eye-fixation patterns of each group and compared between the two groups. The heat maps revealed that the areas on which control subjects frequently fixated often coincided with areas identified as outstanding in saliency maps, while the areas on which neurologists frequently fixated often did not. Dwell time in regions of interest (ROI) was likewise compared between the two groups, revealing that, although dwell time on large lesions was not different between the two groups, dwell time in clinically important areas with low salience was longer in neurologists than in controls. Therefore it appears that neurologists intentionally scan clinically important areas when reading brain CT images showing cerebrovascular accidents. Both neurologists and control subjects used the "bottom-up salience" form of visual attention, although the neurologists more effectively used the "top-down instruction" form.
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Narme P, Bonnet AM, Dubois B, Chaby L. Understanding facial emotion perception in Parkinson's disease: The role of configural processing. Neuropsychologia 2011; 49:3295-302. [DOI: 10.1016/j.neuropsychologia.2011.08.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Revised: 06/28/2011] [Accepted: 08/04/2011] [Indexed: 10/17/2022]
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Hallett M. Bradykinesia: why do Parkinson's patients have it and what trouble does it cause? Mov Disord 2011; 26:1579-81. [PMID: 21547949 DOI: 10.1002/mds.23730] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2011] [Accepted: 03/07/2011] [Indexed: 11/10/2022] Open
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