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Tan YY, Kang HG, Lee CJ, Kim SS, Park S, Thakur S, Da Soh Z, Cho Y, Peng Q, Tham YC, Rim TH, Cheng CY. Prognostic potentials of AI in ophthalmology: systemic disease forecasting via retinal imaging. EYE AND VISION (LONDON, ENGLAND) 2024; 11:17. [PMID: 38711111 PMCID: PMC11071258 DOI: 10.1186/s40662-024-00384-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 04/17/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Artificial intelligence (AI) that utilizes deep learning (DL) has potential for systemic disease prediction using retinal imaging. The retina's unique features enable non-invasive visualization of the central nervous system and microvascular circulation, aiding early detection and personalized treatment plans for personalized care. This review explores the value of retinal assessment, AI-based retinal biomarkers, and the importance of longitudinal prediction models in personalized care. MAIN TEXT This narrative review extensively surveys the literature for relevant studies in PubMed and Google Scholar, investigating the application of AI-based retina biomarkers in predicting systemic diseases using retinal fundus photography. The study settings, sample sizes, utilized AI models and corresponding results were extracted and analysed. This review highlights the substantial potential of AI-based retinal biomarkers in predicting neurodegenerative, cardiovascular, and chronic kidney diseases. Notably, DL algorithms have demonstrated effectiveness in identifying retinal image features associated with cognitive decline, dementia, Parkinson's disease, and cardiovascular risk factors. Furthermore, longitudinal prediction models leveraging retinal images have shown potential in continuous disease risk assessment and early detection. AI-based retinal biomarkers are non-invasive, accurate, and efficient for disease forecasting and personalized care. CONCLUSION AI-based retinal imaging hold promise in transforming primary care and systemic disease management. Together, the retina's unique features and the power of AI enable early detection, risk stratification, and help revolutionizing disease management plans. However, to fully realize the potential of AI in this domain, further research and validation in real-world settings are essential.
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Affiliation(s)
| | - Hyun Goo Kang
- Division of Retina, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Chan Joo Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Sung Soo Kim
- Division of Retina, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Sungha Park
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Sahil Thakur
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Zhi Da Soh
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yunnie Cho
- Mediwhale Inc, Seoul, Republic of Korea
- Department of Education and Human Resource Development, Seoul National University Hospital, Seoul, South Korea
| | - Qingsheng Peng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Yih-Chung Tham
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Mediwhale Inc, Seoul, Republic of Korea
| | - Tyler Hyungtaek Rim
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.
- Mediwhale Inc, Seoul, Republic of Korea.
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Centre for Innovation and Precision Eye Health and Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Polat OA, Gultekin M, Sener H, Ozer F, Arda H. Retinal dysfunction in Parkinson's disease-results of the extended protocol for photopic negative response (PHNR) full-field electroretinogram (ERG). Doc Ophthalmol 2023; 147:89-98. [PMID: 37515709 DOI: 10.1007/s10633-023-09945-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 07/06/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND We investigated whether the photopic negative response (PhNR) in the electroretinogram (ERG) was affected in Parkinson's disease (PD) patients and whether it was associated with retinal changes on optical coherence tomography (OCT). METHODS Thirty-two patients with PD and 31 age and sex-matched healthy controls from a single tertiary centre were included in the study. Hoehn and Yahr scale scores and the presence of REM sleep behaviour were recorded. PhNR, a-wave and b-wave responses in photopic ERG (red on blue background) and retinal layer thicknesses in OCT were obtained. RESULTS The mean age was 61 ± 10.4 in the PD group (female/male: 18/14) and 60.9 ± 7 in the control group (female/male: 18/13). The amplitudes of the PhNR, a- and b-waves in the ERG were significantly decreased in the PD group, but the implicit times were not significantly different. BCVA was significantly correlated with Hoehn and Yahr scores (p < 0.001, r = - 0.596). There was a significant correlation between BCVA and a-wave amplitude (p = 0.047, r = - 0.251). On OCT analysis, the thickness of the nasal INL was increased, and the temporal and inferior OPL and temporal peripapillary RNFL were decreased in the PD group compared to healthy controls (p = 0.032, p = 0.002, p = 0.016 and p = 0.012, respectively). CONCLUSION This study demonstrated reduced a-wave, b-wave and PhNR-wave amplitudes on ERG measurements in PD patients. These findings suggest that the whole ERG response, not just the PhNR, is attenuated in patient with PD, suggesting a possible involvement of the visual system in the disease.
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Affiliation(s)
- Osman Ahmet Polat
- Department of Ophthalmology, Erciyes University Medical Faculty, Kayseri, Turkey.
| | - Murat Gultekin
- Department of Neurology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Hidayet Sener
- Department of Ophthalmology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Furkan Ozer
- Department of Ophthalmology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Hatice Arda
- Department of Ophthalmology, Erciyes University Medical Faculty, Kayseri, Turkey
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Elanwar R, Al Masry H, Ibrahim A, Hussein M, Ibrahim S, Masoud MM. Retinal functional and structural changes in patients with Parkinson's disease. BMC Neurol 2023; 23:330. [PMID: 37723424 PMCID: PMC10506234 DOI: 10.1186/s12883-023-03373-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 09/07/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Visual dysfunction have been well reported as one of the non-motor symptoms in Parkinson's disease (PD). The aim of this study was to evaluate the functional and structural changes in the retina in patients with PD, and to correlate these changes with disease duration and motor dysfunction. METHODS For this case-control study, we recruited patients fulfilling the diagnostic criteria for idiopathic PD according to British Brain Bank criteria, aged between 50 and 80 years. Age- and sex-matched healthy controls aged between 50 and 80 years were also recruited. Motor function for PD patients was assessed using Modified Hoehn and Yahr staging scale (H & Y staging) and Unified Parkinson's Disease Rating Scale (UPDRS). Optical Coherence Tomography (OCT) and full field electroretinogram (ff-ERG) were done to all participants. RESULTS Data from 50 patients and 50 healthy controls were included in the analysis. Patients with idiopathic Parkinson's had significantly reduced peripapillary retinal nerve fiber layer (RNFL) thickness and macular ganglion cell complex (GCC) thickness compared to healthy controls (P-value < 0.05 in all parameters). They also had significantly delayed latency and reduced amplitude in both dark-adapted rods and the light-adapted cone for both a & b waves compared to healthy controls (P-value < 0.001 in all parameters). There were statistically significant negative correlations between disease duration, and left superior, right inferior and right & left average RNFL thickness [(r) coef. = -0.327, -0.301, -0.275, and -0.285 respectively]. UPDRS total score was negatively correlated with the amplitude of light-adapted of both RT and LT a & b wave and with dark-adapted RT b-wave latency [(r) coef. = -0.311, -0.395, -0.362, -0.419, and -0.342]. CONCLUSION The retinal structure and function were significantly affected in patients with PD in comparison to healthy controls. There was a significant impact of disease duration on retinal thickness, and there was a significant negative correlation between the degree of motor dysfunction in patients with PD and retinal function.
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Affiliation(s)
- Rehab Elanwar
- Neuro Diagnostic Research Center, Beni-Suef University, Beni-Suef, Egypt
| | - Hatem Al Masry
- Department of Neurology, Beni-Suef University, Salah Salem Street, Beni-Suef, Egypt
| | - Amna Ibrahim
- Department of Neurology, Beni-Suef University, Salah Salem Street, Beni-Suef, Egypt
| | - Mona Hussein
- Department of Neurology, Beni-Suef University, Salah Salem Street, Beni-Suef, Egypt.
| | - Sahar Ibrahim
- Department of Ophthalmology, Beni-Suef University, Beni-Suef, 62511, Egypt
| | - Mohammed M Masoud
- Department of Neurology, Beni-Suef University, Salah Salem Street, Beni-Suef, Egypt
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Zhang Y, Valsecchi M, Gegenfurtner KR, Chen J. Laplacian reference is optimal for steady-state visual-evoked potentials. J Neurophysiol 2023; 130:557-568. [PMID: 37492903 DOI: 10.1152/jn.00469.2022] [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: 11/10/2022] [Revised: 07/18/2023] [Accepted: 07/20/2023] [Indexed: 07/27/2023] Open
Abstract
Steady-state visual-evoked potentials (SSVEPs) are widely used in human neuroscience studies and applications such as brain-computer interfaces (BCIs). Surprisingly, no previous study has systematically evaluated different reference methods for SSVEP analysis, despite that signal reference is crucial for the proper assessment of neural activities. In the present study, using four datasets from our previous SSVEP studies (Chen J, Valsecchi M, Gegenfurtner KR. J Neurophysiol 118: 749-754, 2017; Chen J, Valsecchi M, Gegenfurtner KR. Neuropsychologia 102: 206-216, 2017; Chen J, McManus M, Valsecchi M, Harris LR, Gegenfurtner KR. J Vis 19: 8, 2019) and three public datasets from other studies (Baker DH, Vilidaite G, Wade AR. PLoS Comput Biol 17: e1009507, 2021; Lygo FA, Richard B, Wade AR, Morland AB, Baker DH. NeuroImage 230: 117780, 2021; Vilidaite G, Norcia AM, West RJH, Elliott CJH, Pei F, Wade AR, Baker DH. Proc R Soc B 285: 20182255, 2018), we compared four reference methods: monopolar reference, common average reference, averaged-mastoids reference, and Laplacian reference. The quality of the resulting SSVEP signals was compared in terms of both signal-to-noise ratios (SNRs) and reliability. The results showed that Laplacian reference, which uses signals at the maximally activated electrode after subtracting the average of the nearby electrodes to reduce common noise, gave rise to the highest SNRs. Furthermore, the Laplacian reference resulted in SSVEP signals that were highly reliable across recording sessions or trials. These results suggest that Laplacian reference is optimal for SSVEP studies and applications. Laplacian reference is especially advantageous for SSVEP experiments where short preparation time is preferred as it requires only data from the maximally activated electrode and a few surrounding electrodes.NEW & NOTEWORTHY The present study provides a comprehensive evaluation of the use of different reference methods for steady-state visual-evoked potentials (SSVEPs) and has found that Laplacian reference increases signal-to-noise ratios (SNRs) and enhances reliabilities of SSVEP signals. Thus, the results suggest that Laplacian reference is optimal for SSVEP analysis.
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Affiliation(s)
- Yuan Zhang
- School of Psychology, Shanghai University of Sport, Shanghai, China
| | - Matteo Valsecchi
- Dipartimento di Psicologia, Universitá di Bologna, Bologna, Italy
| | - Karl R Gegenfurtner
- Abteilung Allgemeine Psychologie, Justus-Liebig-Universität Gießen, Gießen, Germany
| | - Jing Chen
- School of Psychology, Shanghai University of Sport, Shanghai, China
- Research Center for Exercise and Brain Science, Shanghai University of Sport, Shanghai, China
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Constable PA, Lim JKH, Thompson DA. Retinal electrophysiology in central nervous system disorders. A review of human and mouse studies. Front Neurosci 2023; 17:1215097. [PMID: 37600004 PMCID: PMC10433210 DOI: 10.3389/fnins.2023.1215097] [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: 05/01/2023] [Accepted: 07/17/2023] [Indexed: 08/22/2023] Open
Abstract
The retina and brain share similar neurochemistry and neurodevelopmental origins, with the retina, often viewed as a "window to the brain." With retinal measures of structure and function becoming easier to obtain in clinical populations there is a growing interest in using retinal findings as potential biomarkers for disorders affecting the central nervous system. Functional retinal biomarkers, such as the electroretinogram, show promise in neurological disorders, despite having limitations imposed by the existence of overlapping genetic markers, clinical traits or the effects of medications that may reduce their specificity in some conditions. This narrative review summarizes the principal functional retinal findings in central nervous system disorders and related mouse models and provides a background to the main excitatory and inhibitory retinal neurotransmitters that have been implicated to explain the visual electrophysiological findings. These changes in retinal neurochemistry may contribute to our understanding of these conditions based on the findings of retinal electrophysiological tests such as the flash, pattern, multifocal electroretinograms, and electro-oculogram. It is likely that future applications of signal analysis and machine learning algorithms will offer new insights into the pathophysiology, classification, and progression of these clinical disorders including autism, attention deficit/hyperactivity disorder, bipolar disorder, schizophrenia, depression, Parkinson's, and Alzheimer's disease. New clinical applications of visual electrophysiology to this field may lead to earlier, more accurate diagnoses and better targeted therapeutic interventions benefiting individual patients and clinicians managing these individuals and their families.
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Affiliation(s)
- Paul A. Constable
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Jeremiah K. H. Lim
- Discipline of Optometry, School of Allied Health, University of Western Australia, Perth, WA, Australia
| | - Dorothy A. Thompson
- The Tony Kriss Visual Electrophysiology Unit, Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
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Tran KKN, Wong VHY, Hoang A, Finkelstein DI, Bui BV, Nguyen CTO. Retinal alpha-synuclein accumulation correlates with retinal dysfunction and structural thinning in the A53T mouse model of Parkinson's disease. Front Neurosci 2023; 17:1146979. [PMID: 37214398 PMCID: PMC10196133 DOI: 10.3389/fnins.2023.1146979] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 04/17/2023] [Indexed: 05/24/2023] Open
Abstract
Abnormal alpha-synuclein (α-SYN) protein deposition has long been recognized as one of the pathological hallmarks of Parkinson's disease's (PD). This study considers the potential utility of PD retinal biomarkers by investigating retinal changes in a well characterized PD model of α-SYN overexpression and how these correspond to the presence of retinal α-SYN. Transgenic A53T homozygous (HOM) mice overexpressing human α-SYN and wildtype (WT) control littermates were assessed at 4, 6, and 14 months of age (male and female, n = 15-29 per group). In vivo retinal function (electroretinography, ERG) and structure (optical coherence tomography, OCT) were recorded, and retinal immunohistochemistry and western blot assays were performed to examine retinal α-SYN and tyrosine hydroxylase. Compared to WT controls, A53T mice exhibited reduced light-adapted (cone photoreceptor and bipolar cell amplitude, p < 0.0001) ERG responses and outer retinal thinning (outer plexiform layer, outer nuclear layer, p < 0.0001) which correlated with elevated levels of α-SYN. These retinal signatures provide a high throughput means to study α-SYN induced neurodegeneration and may be useful in vivo endpoints for PD drug discovery.
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Affiliation(s)
- Katie K. N. Tran
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Vickie H. Y. Wong
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Anh Hoang
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - David I. Finkelstein
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Bang V. Bui
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Christine T. O. Nguyen
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, VIC, Australia
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Sánchez-Sáez X, Ortuño-Lizarán I, Sánchez-Castillo C, Lax P, Cuenca N. Starburst amacrine cells, involved in visual motion perception, loose their synaptic input from dopaminergic amacrine cells and degenerate in Parkinson's disease patients. Transl Neurodegener 2023; 12:17. [PMID: 37013599 PMCID: PMC10071607 DOI: 10.1186/s40035-023-00348-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/10/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND The main clinical symptoms characteristic of Parkinson's disease (PD) are bradykinesia, tremor, and other motor deficits. However, non-motor symptoms, such as visual disturbances, can be identified at early stages of the disease. One of these symptoms is the impairment of visual motion perception. Hence, we sought to determine if the starburst amacrine cells, which are the main cellular type involved in motion direction selectivity, are degenerated in PD and if the dopaminergic system is related to this degeneration. METHODS Human eyes from control (n = 10) and PD (n = 9) donors were available for this study. Using immunohistochemistry and confocal microscopy, we quantified starburst amacrine cell density (choline acetyltransferase [ChAT]-positive cells) and the relationship between these cells and dopaminergic amacrine cells (tyrosine hydroxylase-positive cells and vesicular monoamine transporter-2-positive presynapses) in cross-sections and wholemount retinas. RESULTS First, we found two different ChAT amacrine populations in the human retina that presented different ChAT immunoreactivity intensity and different expression of calcium-binding proteins. Both populations are affected in PD and their density is reduced compared to controls. Also, we report, for the first time, synaptic contacts between dopaminergic amacrine cells and ChAT-positive cells in the human retina. We found that, in PD retinas, there is a reduction of the dopaminergic synaptic contacts into ChAT cells. CONCLUSIONS Taken together, this work indicates degeneration of starburst amacrine cells in PD related to dopaminergic degeneration and that dopaminergic amacrine cells could modulate the function of starburst amacrine cells. Since motion perception circuitries are affected in PD, their assessment using visual tests could provide new insights into the diagnosis of PD.
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Grants
- FEDER-PID 2019-106230RB-I00 Ministerio de Ciencia e Innovación
- FEDER-PID 2019-106230RB-I00 Ministerio de Ciencia e Innovación
- FPU16/04114 Ministerio de Universidades
- RETICS-FEDER RD16/0008/0016 Instituto de Salud Carlos III
- IDIFEDER/2017/064 Conselleria de Innovación, Universidades, Ciencia y Sociedad Digital, Generalitat Valenciana
- PROMETEO/2021/024 Conselleria de Innovación, Universidades, Ciencia y Sociedad Digital, Generalitat Valenciana
- PROMETEO/2021/024 Conselleria de Innovación, Universidades, Ciencia y Sociedad Digital, Generalitat Valenciana
- APOSTD/2020/245 Conselleria de Innovación, Universidades, Ciencia y Sociedad Digital, Generalitat Valenciana
- 2019/00286/001 Es Retina Asturias
- 2019/00286/001 Es Retina Asturias
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Affiliation(s)
- Xavier Sánchez-Sáez
- Department of Physiology, Genetics and Microbiology, University of Alicante, San Vicente del Raspeig, Spain
| | - Isabel Ortuño-Lizarán
- Department of Physiology, Genetics and Microbiology, University of Alicante, San Vicente del Raspeig, Spain
| | - Carla Sánchez-Castillo
- Department of Physiology, Genetics and Microbiology, University of Alicante, San Vicente del Raspeig, Spain
| | - Pedro Lax
- Department of Physiology, Genetics and Microbiology, University of Alicante, San Vicente del Raspeig, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Nicolás Cuenca
- Department of Physiology, Genetics and Microbiology, University of Alicante, San Vicente del Raspeig, Spain.
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain.
- Ramón Margalef Institute, University of Alicante, San Vicente del Raspeig, Spain.
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Alves JN, Westner BU, Højlund A, Weil RS, Dalal SS. Structural and functional changes in the retina in Parkinson's disease. J Neurol Neurosurg Psychiatry 2023; 94:448-456. [PMID: 36806480 PMCID: PMC7614544 DOI: 10.1136/jnnp-2022-329342] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 01/05/2023] [Indexed: 02/19/2023]
Abstract
Parkinson's disease is caused by degeneration of dopaminergic neurons, originating in the substantia nigra pars compacta and characterised by bradykinesia, rest tremor and rigidity. In addition, visual disorders and retinal abnormalities are often present and can be identified by decreased visual acuity, abnormal spatial contrast sensitivity or even difficulty in complex visual task completion. Because of their early onset in patients with de novo Parkinson's disease, the anatomical retinal changes and electrophysiological modification could be valuable markers even at early stages of the disease. However, due to the concomitant occurrence of normal ageing, the relevance and specificity of these predictive values can be difficult to interpret. This review examines retinal dysfunction arising in Parkinson's disease. We highlight the electrophysiological delays and decreased amplitude in the electroretinography recorded in patients and animal models. We relate this to coexisting anatomical changes such as retinal nerve fibre layer and macular thinning, measured using optical coherence tomography, and show that functional measures are more consistent overall than optical coherence-measured structural changes. We review the underlying chemical changes seen with loss of retinal dopaminergic neurons and the effect of levodopa treatment on the retina in Parkinson's disease. Finally, we consider whether retinal abnormalities in Parkinson's disease could have a role as potential markers of poorer outcomes and help stratify patients at early stages of the disease. We emphasise that retinal measures can be valuable, accessible and cost-effective methods in the early evaluation of Parkinson's disease pathogenesis with potential for patient stratification.
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Affiliation(s)
- Jordan N Alves
- Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
| | - Britta U Westner
- Radboud University, Donders Institute for Brain, Cognition and Behaviours, Nijmegen, The Netherlands
| | - Andreas Højlund
- Department of Linguistics, Cognitive Science & Semiotics, Aarhus University, Aarhus, Denmark
| | - Rimona Sharon Weil
- Dementia Research Centre, University College London, London, UK.,Movement Disorders Consortium, University College London, London, UK.,Wellcome Centre for Human Neuroimaging, University College London, London, UK
| | - Sarang S Dalal
- Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
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Multimodal brain and retinal imaging of dopaminergic degeneration in Parkinson disease. Nat Rev Neurol 2022; 18:203-220. [PMID: 35177849 DOI: 10.1038/s41582-022-00618-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2022] [Indexed: 12/12/2022]
Abstract
Parkinson disease (PD) is a progressive disorder characterized by dopaminergic neurodegeneration in the brain. The development of parkinsonism is preceded by a long prodromal phase, and >50% of dopaminergic neurons can be lost from the substantia nigra by the time of the initial diagnosis. Therefore, validation of in vivo imaging biomarkers for early diagnosis and monitoring of disease progression is essential for future therapeutic developments. PET and single-photon emission CT targeting the presynaptic terminals of dopaminergic neurons can be used for early diagnosis by detecting axonal degeneration in the striatum. However, these techniques poorly differentiate atypical parkinsonian syndromes from PD, and their availability is limited in clinical settings. Advanced MRI in which pathological changes in the substantia nigra are visualized with diffusion, iron-sensitive susceptibility and neuromelanin-sensitive sequences potentially represents a more accessible imaging tool. Although these techniques can visualize the classic degenerative changes in PD, they might be insufficient for phenotyping or prognostication of heterogeneous aspects of PD resulting from extranigral pathologies. The retina is an emerging imaging target owing to its pathological involvement early in PD, which correlates with brain pathology. Retinal optical coherence tomography (OCT) is a non-invasive technique to visualize structural changes in the retina. Progressive parafoveal thinning and fovea avascular zone remodelling, as revealed by OCT, provide potential biomarkers for early diagnosis and prognostication in PD. As we discuss in this Review, multimodal imaging of the substantia nigra and retina is a promising tool to aid diagnosis and management of PD.
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Past, present and future role of retinal imaging in neurodegenerative disease. Prog Retin Eye Res 2021; 83:100938. [PMID: 33460813 PMCID: PMC8280255 DOI: 10.1016/j.preteyeres.2020.100938] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/11/2020] [Accepted: 12/17/2020] [Indexed: 02/08/2023]
Abstract
Retinal imaging technology is rapidly advancing and can provide ever-increasing amounts of information about the structure, function and molecular composition of retinal tissue in humans in vivo. Most importantly, this information can be obtained rapidly, non-invasively and in many cases using Food and Drug Administration-approved devices that are commercially available. Technologies such as optical coherence tomography have dramatically changed our understanding of retinal disease and in many cases have significantly improved their clinical management. Since the retina is an extension of the brain and shares a common embryological origin with the central nervous system, there has also been intense interest in leveraging the expanding armamentarium of retinal imaging technology to understand, diagnose and monitor neurological diseases. This is particularly appealing because of the high spatial resolution, relatively low-cost and wide availability of retinal imaging modalities such as fundus photography or OCT compared to brain imaging modalities such as magnetic resonance imaging or positron emission tomography. The purpose of this article is to review and synthesize current research about retinal imaging in neurodegenerative disease by providing examples from the literature and elaborating on limitations, challenges and future directions. We begin by providing a general background of the most relevant retinal imaging modalities to ensure that the reader has a foundation on which to understand the clinical studies that are subsequently discussed. We then review the application and results of retinal imaging methodologies to several prevalent neurodegenerative diseases where extensive work has been done including sporadic late onset Alzheimer's Disease, Parkinson's Disease and Huntington's Disease. We also discuss Autosomal Dominant Alzheimer's Disease and cerebrovascular small vessel disease, where the application of retinal imaging holds promise but data is currently scarce. Although cerebrovascular disease is not generally considered a neurodegenerative process, it is both a confounder and contributor to neurodegenerative disease processes that requires more attention. Finally, we discuss ongoing efforts to overcome the limitations in the field and unmet clinical and scientific needs.
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11
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Netser R, Demmin DL, Dobkin R, Goldstein A, Roché M, Netser Zernik A, Silverstein SM. Flash Electroretinography Parameters and Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2020; 11:251-259. [PMID: 33074189 DOI: 10.3233/jpd-191830] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Parkinson's disease (PD) is known to affect retinal structure and activity. As such, retinal evaluations may be used to develop objective and possibly early PD diagnostic tools. OBJECTIVE The aim of this study was to investigate the effects of Parkinson's disease (PD) manifestation and treatment on retinal activity. METHODS Data were collected on 21 participants diagnosed with PD, including the number of medications taken, clinical scales and flash electroretinography (fERG) measurements, under light-adapted and dark-adapted conditions. The fERG parameters measured included a-wave and b-wave amplitude and implicit time (i.e., latency). First, we investigated correlations between symptom measure scores and the fERG parameters. Next, we divided participants into two groups based on their antiparkinsonian medication load and analyzed differences between these groups' fERG parameters. RESULTS fERG parameters were strongly correlated with a number of clinical variables, including motor and non-motor symptoms and age at PD onset. Photoreceptor cell implicit time was longer among participants taking one or less antiparkinsonian medication as compared to those taking two or more. However, overall there was not strong evidence of a relationship between the number of antiparkinsonian medications taken and the fERG parameters. CONCLUSION Findings suggest that fERG may be a useful, non-intrusive measure of retinal, and, perhaps overall CNS function, in PD. However, additional studies in larger samples are needed to clarify this association.
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Affiliation(s)
- Roni Netser
- Shalvata Mental Health Center, Hod Hasharon, Israel
| | - Docia L Demmin
- Department of Psychology, Rutgers University, Piscataway, NJ, USA
| | - Roseanne Dobkin
- Department of Psychiatry, Rutgers - Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | - Ariel Goldstein
- Princeton Neuroscience Institute, Princeton University, Princeton, NJ, USA
| | - Matthew Roché
- Rutgers University - University Behavioral Health Care, Piscataway, NJ, USA
| | | | - Steven M Silverstein
- Department of Psychiatry, Rutgers - Robert Wood Johnson Medical School, Piscataway, NJ, USA.,Rutgers University - University Behavioral Health Care, Piscataway, NJ, USA.,Department of Ophthalmology, Rutgers - Robert Wood Johnson Medical School, Piscataway, NJ, USA.,Departments of Psychiatry, Neuroscience, and Ophthalmology, University of Rochester Medical Center, Rochester, NY, USA
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12
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Korshunov KS, Blakemore LJ, Trombley PQ. Illuminating and Sniffing Out the Neuromodulatory Roles of Dopamine in the Retina and Olfactory Bulb. Front Cell Neurosci 2020; 14:275. [PMID: 33110404 PMCID: PMC7488387 DOI: 10.3389/fncel.2020.00275] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/04/2020] [Indexed: 01/28/2023] Open
Abstract
In the central nervous system, dopamine is well-known as the neuromodulator that is involved with regulating reward, addiction, motivation, and fine motor control. Yet, decades of findings are revealing another crucial function of dopamine: modulating sensory systems. Dopamine is endogenous to subsets of neurons in the retina and olfactory bulb (OB), where it sharpens sensory processing of visual and olfactory information. For example, dopamine modulation allows the neural circuity in the retina to transition from processing dim light to daylight and the neural circuity in the OB to regulate odor discrimination and detection. Dopamine accomplishes these tasks through numerous, complex mechanisms in both neural structures. In this review, we provide an overview of the established and emerging research on these mechanisms and describe similarities and differences in dopamine expression and modulation of synaptic transmission in the retinas and OBs of various vertebrate organisms. This includes discussion of dopamine neurons’ morphologies, potential identities, and biophysical properties along with their contributions to circadian rhythms and stimulus-driven synthesis, activation, and release of dopamine. As dysregulation of some of these mechanisms may occur in patients with Parkinson’s disease, these symptoms are also discussed. The exploration and comparison of these two separate dopamine populations shows just how remarkably similar the retina and OB are, even though they are functionally distinct. It also shows that the modulatory properties of dopamine neurons are just as important to vision and olfaction as they are to motor coordination and neuropsychiatric/neurodegenerative conditions, thus, we hope this review encourages further research to elucidate these mechanisms.
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Affiliation(s)
- Kirill S Korshunov
- Department of Biological Science, Florida State University, Tallahassee, FL, United States.,Program in Neuroscience, Florida State University, Tallahassee, FL, United States
| | - Laura J Blakemore
- Department of Biological Science, Florida State University, Tallahassee, FL, United States.,Program in Neuroscience, Florida State University, Tallahassee, FL, United States
| | - Paul Q Trombley
- Department of Biological Science, Florida State University, Tallahassee, FL, United States.,Program in Neuroscience, Florida State University, Tallahassee, FL, United States
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13
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Pinkhardt EH, Ding Y, Slotnick S, Kassubek J, Ludolph AC, Glazman S, Selesnick I, Bodis-Wollner I. The intrinsically restructured fovea is correlated with contrast sensitivity loss in Parkinson's disease. J Neural Transm (Vienna) 2020; 127:1275-1283. [PMID: 32676747 DOI: 10.1007/s00702-020-02224-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/30/2020] [Indexed: 10/23/2022]
Abstract
Foveal structure that is specified by the thickness, depth and the overall shape of the fovea is a promising tool to qualify and quantify retinal pathology in Parkinson's disease. To determine the model variable that is best suited for discriminating Parkinson's disease eyes from those of healthy controls and to assess correlations between impaired contrast sensitivity and foveal shape we characterized the fovea in 48 Parkinson's disease patients and 45 control subjects by optical coherence tomography (OCT). The model quantifies structural changes in the fovea of Parkinson's disease patients that are correlated with a decline in contrast sensitivity. Retinal foveal remodeling may serve as a parameter for vision deficits in Parkinson's disease. Whether foveal remodeling reflects dopaminergic driven pathology or rather both dopaminergic and non-dopaminergic pathology has to be investigated in longitudinal studies.
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Affiliation(s)
- Elmar H Pinkhardt
- Department of Neurology, Ulm University, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Yin Ding
- Department of Electrical and Computer Engineering, Polytechnic Institute of New York University, Brooklyn, NY, 11203, USA
| | | | - Jan Kassubek
- Department of Neurology, Ulm University, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Albert C Ludolph
- Department of Neurology, Ulm University, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Sofya Glazman
- Downstate Medical Center, State University of New York, Brooklyn, NY, USA
| | - Ivan Selesnick
- Department of Electrical and Computer Engineering, Polytechnic Institute of New York University, Brooklyn, NY, 11203, USA
| | - Ivan Bodis-Wollner
- Downstate Medical Center, State University of New York, Brooklyn, NY, USA. .,SUNY Eye Institute, State University of New York, New York, NY, USA.
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14
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Silverstein SM, Demmin DL, Schallek JB, Fradkin SI. Measures of Retinal Structure and Function as Biomarkers in Neurology and Psychiatry. Biomark Neuropsychiatry 2020. [DOI: 10.1016/j.bionps.2020.100018] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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15
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Feitosa-Santana C, Fernandes Costa M, Ballalai Ferraz H, Andrade LAF, Moura AL, Amaro E, Hamer RD, Fix Ventura D. Visual losses in early-onset and late-onset Parkinson's disease. JOURNAL OF THE OPTICAL SOCIETY OF AMERICA. A, OPTICS, IMAGE SCIENCE, AND VISION 2020; 37:A285-A293. [PMID: 32400706 DOI: 10.1364/josaa.382042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 03/14/2020] [Indexed: 06/11/2023]
Abstract
Patients with Parkinson's disease (PD) manifest visual losses. However, it is not known whether these losses are equivalent in both early-onset (EOPD) and late-onset (LOPD) patients. We evaluated contrast sensitivity and color vision in EOPD and LOPD patients and in age-matched controls. Losses occurred in both patient groups but were more pronounced in EOPD, consistent with the notion that non-motor symptoms are affected by age of symptom onset. More studies of visual function in EOPD and LOPD patients are needed to understand how aging is related to the pathophysiology of non-motor PD symptomatology. This would permit earlier diagnosis and, perhaps, better management of the disease.
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16
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Optical coherence tomography and cognitive dysfunction in Parkinson disease. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2019. [DOI: 10.1186/s41983-019-0097-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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17
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Altered dynamics of visual contextual interactions in Parkinson's disease. NPJ PARKINSONS DISEASE 2019; 5:13. [PMID: 31286057 PMCID: PMC6609710 DOI: 10.1038/s41531-019-0085-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 05/29/2019] [Indexed: 01/09/2023]
Abstract
Over the last decades, psychophysical and electrophysiological studies in patients and animal models of Parkinson's disease (PD), have consistently revealed a number of visual abnormalities. In particular, specific alterations of contrast sensitivity curves, electroretinogram (ERG), and visual-evoked potentials (VEP), have been attributed to dopaminergic retinal depletion. However, fundamental mechanisms of cortical visual processing, such as normalization or "gain control" computations, have not yet been examined in PD patients. Here, we measured electrophysiological indices of gain control in both space (surround suppression) and time (sensory adaptation) in PD patients based on steady-state VEP (ssVEP). Compared with controls, patients exhibited a significantly higher initial ssVEP amplitude that quickly decayed over time, and greater relative suppression of ssVEP amplitude as a function of surrounding stimulus contrast. Meanwhile, EEG frequency spectra were broadly elevated in patients relative to controls. Thus, contrary to what might be expected given the reduced contrast sensitivity often reported in PD, visual neural responses are not weaker; rather, they are initially larger but undergo an exaggerated degree of spatial and temporal gain control and are embedded within a greater background noise level. These differences may reflect cortical mechanisms that compensate for dysfunctional center-surround interactions at the retinal level.
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18
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Roy S, Field GD. Dopaminergic modulation of retinal processing from starlight to sunlight. J Pharmacol Sci 2019; 140:86-93. [PMID: 31109761 DOI: 10.1016/j.jphs.2019.03.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/13/2019] [Accepted: 03/29/2019] [Indexed: 12/17/2022] Open
Abstract
Neuromodulators such as dopamine, enable context-dependent plasticity of neural circuit function throughout the central nervous system. For example, in the retina, dopamine tunes visual processing for daylight and nightlight conditions. Specifically, high levels of dopamine release in the retina tune vision for daylight (photopic) conditions, while low levels tune it for nightlight (scotopic) conditions. This review covers the cellular and circuit-level mechanisms within the retina that are altered by dopamine. These mechanisms include changes in gap junction coupling and ionic conductances, both of which are altered by the activation of diverse types of dopamine receptors across diverse types of retinal neurons. We contextualize the modulatory actions of dopamine in terms of alterations and optimizations to visual processing under photopic and scotopic conditions, with particular attention to how they differentially impact distinct cell types. Finally, we discuss how transgenic mice and disease models have shaped our understanding of dopaminergic signaling and its role in visual processing. Cumulatively, this review illustrates some of the diverse and potent mechanisms through which neuromodulation can shape brain function.
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Affiliation(s)
- Suva Roy
- Department of Neurobiology, Duke University School of Medicine, Durham, NC, USA
| | - Greg D Field
- Department of Neurobiology, Duke University School of Medicine, Durham, NC, USA.
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19
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Guo L, Normando EM, Shah PA, De Groef L, Cordeiro MF. Oculo-visual abnormalities in Parkinson's disease: Possible value as biomarkers. Mov Disord 2018; 33:1390-1406. [DOI: 10.1002/mds.27454] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 05/16/2018] [Accepted: 05/18/2018] [Indexed: 12/16/2022] Open
Affiliation(s)
- Li Guo
- Glaucoma and Retinal Degenerative Disease Research Group, Institute of Ophthalmology; University College London; London UK
| | - Eduardo M. Normando
- Glaucoma and Retinal Degenerative Disease Research Group, Institute of Ophthalmology; University College London; London UK
- Western Eye Hospital, Imperial College Healthcare National Health Service Trust; London UK
- Imperial College Ophthalmology Research Group, Department of Surgery and Cancer, Imperial College London; London UK
| | - Parth Arvind Shah
- Glaucoma and Retinal Degenerative Disease Research Group, Institute of Ophthalmology; University College London; London UK
| | - Lies De Groef
- Glaucoma and Retinal Degenerative Disease Research Group, Institute of Ophthalmology; University College London; London UK
- Neural Circuit Development and Regeneration Research Group, Department of Biology; University of Leuven; Leuven Belgium
| | - M. Francesca Cordeiro
- Glaucoma and Retinal Degenerative Disease Research Group, Institute of Ophthalmology; University College London; London UK
- Western Eye Hospital, Imperial College Healthcare National Health Service Trust; London UK
- Imperial College Ophthalmology Research Group, Department of Surgery and Cancer, Imperial College London; London UK
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20
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Bandini F. On the role of visual electrophysiology in Parkinson’s disease. Parkinsonism Relat Disord 2017; 45:97. [DOI: 10.1016/j.parkreldis.2017.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 09/03/2017] [Indexed: 10/18/2022]
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21
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Mora-Cortes A, Ridderinkhof KR, Cohen MX. Evaluating the feasibility of the steady-state visual evoked potential (SSVEP) to study temporal attention. Psychophysiology 2017; 55:e13029. [DOI: 10.1111/psyp.13029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 10/03/2017] [Accepted: 10/12/2017] [Indexed: 01/23/2023]
Affiliation(s)
- Anderson Mora-Cortes
- Department of Psychology; University of Amsterdam; Amsterdam The Netherlands
- Amsterdam Brain & Cognition (ABC); University of Amsterdam; Amsterdam The Netherlands
- Laboratory for Neuro- and Psychophysiology, Department of Neuroscience; KU Leuven; Leuven Belgium
| | - K. Richard Ridderinkhof
- Department of Psychology; University of Amsterdam; Amsterdam The Netherlands
- Amsterdam Brain & Cognition (ABC); University of Amsterdam; Amsterdam The Netherlands
| | - Michael X Cohen
- Donders Center for Neuroscience, Radboud University Nijmegen Medical Centre, Radboud University; Nijmegen The Netherlands
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22
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Emek-Savaş DD, Özmüş G, Güntekin B, Dönmez Çolakoğlu B, Çakmur R, Başar E, Yener GG. Decrease of Delta Oscillatory Responses in Cognitively Normal Parkinson's Disease. Clin EEG Neurosci 2017; 48:355-364. [PMID: 27582502 DOI: 10.1177/1550059416666718] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Parkinson's disease (PD) is a common progressive neurodegenerative disorder. This study aims to compare sensory-evoked oscillations (SEOs) and event-related oscillations (EROs) of visual modality in cognitively normal PD patients and healthy controls. Sixteen PD and 16 age-, gender-, and education-matched healthy controls participated in the study. A simple flashlight was used for SEO and a classical visual oddball paradigm was used for target ERO. Oscillatory responses in the delta frequency range (0.5-3.5 Hz) were examined. Significantly lower delta ERO and SEO responses were found in PD patients than healthy controls. Delta ERO responses were decreased at all frontal, central and parietal locations, whereas delta SEO responses were decreased over mid and right central locations in PD. According to the notion that SEO reflects the activity of sensory networks and ERO reflects cognitive networks, these findings indicate that PD patients have impairments in both cognitive and sensory networks of visual modality. Decreased delta ERO responses indicate that the subliminal cognitive changes in PD can be detected by electrophysiological methods. These results demonstrate that brain oscillatory responses have the potential to be studied as a biomarker for visual cognitive and sensory networks in PD.
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Affiliation(s)
- Derya Durusu Emek-Savaş
- 1 Department of Psychology, Dokuz Eylül University, Izmir, Turkey.,2 Department of Neurosciences, Dokuz Eylül University, Izmir, Turkey
| | - Gülin Özmüş
- 2 Department of Neurosciences, Dokuz Eylül University, Izmir, Turkey
| | - Bahar Güntekin
- 3 Department of Biophysics, Istanbul Medipol University, Istanbul, Turkey
| | | | - Raif Çakmur
- 4 Department of Neurology, Dokuz Eylül University Medical School, Izmir, Turkey.,5 Brain Dynamics Multidisciplinary Research Center, Dokuz Eylül University, Izmir, Turkey
| | - Erol Başar
- 6 Brain Dynamics, Cognition and Complex Systems Research Center, Istanbul Kultur University, Istanbul, Turkey
| | - Görsev G Yener
- 2 Department of Neurosciences, Dokuz Eylül University, Izmir, Turkey.,4 Department of Neurology, Dokuz Eylül University Medical School, Izmir, Turkey.,5 Brain Dynamics Multidisciplinary Research Center, Dokuz Eylül University, Izmir, Turkey.,6 Brain Dynamics, Cognition and Complex Systems Research Center, Istanbul Kultur University, Istanbul, Turkey.,7 Izmir International Biomedicine and Genome Institute, Dokuz Eylül University Health Campus, Izmir, Turkey
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23
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Giovanni A, Capone F, di Biase L, Ferreri F, Florio L, Guerra A, Marano M, Paolucci M, Ranieri F, Salomone G, Tombini M, Thut G, Di Lazzaro V. Oscillatory Activities in Neurological Disorders of Elderly: Biomarkers to Target for Neuromodulation. Front Aging Neurosci 2017; 9:189. [PMID: 28659788 PMCID: PMC5468377 DOI: 10.3389/fnagi.2017.00189] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 05/26/2017] [Indexed: 12/13/2022] Open
Abstract
Non-invasive brain stimulation (NIBS) has been under investigation as adjunct treatment of various neurological disorders with variable success. One challenge is the limited knowledge on what would be effective neuronal targets for an intervention, combined with limited knowledge on the neuronal mechanisms of NIBS. Motivated on the one hand by recent evidence that oscillatory activities in neural systems play a role in orchestrating brain functions and dysfunctions, in particular those of neurological disorders specific of elderly patients, and on the other hand that NIBS techniques may be used to interact with these brain oscillations in a controlled way, we here explore the potential of modulating brain oscillations as an effective strategy for clinical NIBS interventions. We first review the evidence for abnormal oscillatory profiles to be associated with a range of neurological disorders of elderly (e.g., Parkinson's disease (PD), Alzheimer's disease (AD), stroke, epilepsy), and for these signals of abnormal network activity to normalize with treatment, and/or to be predictive of disease progression or recovery. We then ask the question to what extent existing NIBS protocols have been tailored to interact with these oscillations and possibly associated dysfunctions. Our review shows that, despite evidence for both reliable neurophysiological markers of specific oscillatory dis-functionalities in neurological disorders and NIBS protocols potentially able to interact with them, there are few applications of NIBS aiming to explore clinical outcomes of this interaction. Our review article aims to point out oscillatory markers of neurological, which are also suitable targets for modification by NIBS, in order to facilitate in future studies the matching of technical application to clinical targets.
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Affiliation(s)
- Assenza Giovanni
- Clinical Neurology, Campus Biomedico University of RomeRome, Italy
| | | | - Lazzaro di Biase
- Clinical Neurology, Campus Biomedico University of RomeRome, Italy
- Nuffield Department of Clinical Neurosciences, University of OxfordOxford, United Kingdom
| | - Florinda Ferreri
- Clinical Neurology, Campus Biomedico University of RomeRome, Italy
- Department of Clinical Neurophysiology, Kuopio University Hospital, University of Eastern FinlandKuopio, Finland
| | - Lucia Florio
- Clinical Neurology, Campus Biomedico University of RomeRome, Italy
| | - Andrea Guerra
- Clinical Neurology, Campus Biomedico University of RomeRome, Italy
- Nuffield Department of Clinical Neurosciences, University of OxfordOxford, United Kingdom
| | - Massimo Marano
- Clinical Neurology, Campus Biomedico University of RomeRome, Italy
| | - Matteo Paolucci
- Clinical Neurology, Campus Biomedico University of RomeRome, Italy
| | - Federico Ranieri
- Clinical Neurology, Campus Biomedico University of RomeRome, Italy
| | - Gaetano Salomone
- Clinical Neurology, Campus Biomedico University of RomeRome, Italy
| | - Mario Tombini
- Clinical Neurology, Campus Biomedico University of RomeRome, Italy
| | - Gregor Thut
- Centre for Cognitive Neuroimaging (CCNi), Institute of Neuroscience and Psychology, University of GlasgowGlasgow, United Kingdom
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24
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Abstract
This chapter describes the visual problems likely to be encountered in Parkinson's disease (PD) and whether such signs are useful in differentiating the parkinsonian syndromes. Visual dysfunction in PD may involve visual acuity, contrast sensitivity, color discrimination, pupil reactivity, saccadic and pursuit eye movements, motion perception, visual fields, and visual processing speeds. In addition, disturbance of visuospatial orientation, facial recognition problems, rapid eye movement (REM) sleep behavior disorder, and chronic visual hallucinations may be present. Problems affecting pupil reactivity, stereopsis, pursuit eye movement, and visuomotor adaptation, when accompanied by REM sleep behavior disorder, could be early features of PD. Dementia associated with PD is associated with enhanced eye movement problems, visuospatial deficits, and visual hallucinations. Visual dysfunction may be a useful diagnostic feature in differentiating PD from other parkinsonian symptoms, visual hallucinations, visuospatial dysfunction, and variation in saccadic eye movement problems being particularly useful discriminating features.
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25
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The role of the retina in visual hallucinations: A review of the literature and implications for psychosis. Neuropsychologia 2017; 99:128-138. [DOI: 10.1016/j.neuropsychologia.2017.03.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 02/09/2017] [Accepted: 03/01/2017] [Indexed: 12/14/2022]
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26
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Sharon O, Nir Y. Attenuated Fast Steady-State Visual Evoked Potentials During Human Sleep. Cereb Cortex 2017; 28:1297-1311. [DOI: 10.1093/cercor/bhx043] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Indexed: 12/30/2022] Open
Affiliation(s)
- Omer Sharon
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Department of Physiology and Pharmacology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yuval Nir
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Department of Physiology and Pharmacology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Functional Neurophysiology and Sleep Research Lab, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
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27
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Irving EL, Chriqui E, Law C, Kergoat MJ, Leclerc BS, Panisset M, Postuma R, Kergoat H. Prevalence of Convergence Insufficiency in Parkinson's Disease. Mov Disord Clin Pract 2016; 4:424-429. [PMID: 30363406 DOI: 10.1002/mdc3.12453] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 09/22/2016] [Accepted: 09/24/2016] [Indexed: 11/10/2022] Open
Abstract
Background We recently reported that convergence insufficiency (CI)-type visual symptomatology was more prevalent in participants with Parkinson's disease (PD), compared to controls. The objective of this work was to determine the prevalence of a confirmed clinical diagnosis of CI in PD, compared to controls. Methods Participants with (n = 80) and without (n = 80) PD were recruited and received an eye exam. Published criteria were used to arrive at a clinical diagnosis of CI. The Convergence Insufficiency Symptom Survey (CISS-15) questionnaire was administered to each participant, with a score of ≥21 being considered positive for CI symptomatology. Student t test, chi-square, or nonparametric tests at the 0.05 level were used for statistical significance. Results A total of 43.8% of participants with versus 16.3% without PD had a clinical diagnosis of CI (P ≤ 0.001). A total of 53.8% of participants with versus 18.8% without PD had scores on the CISS-15 of ≥21 (P ≤ 0.001). Conclusions These results indicate that individuals with PD have a higher prevalence of CI and CI symptomatology than controls. These data provide evidence supporting the notion that treatment for symptomatic CI should be investigated in individuals with PD.
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Affiliation(s)
- Elizabeth L Irving
- School of Optometry and Vision Science University of Waterloo Waterloo ON Canada
| | - Estefania Chriqui
- School of Optometry University of Montréal Montréal QC Canada.,Research Center Montréal University Institute of Geriatrics Montréal QC Canada
| | - Caroline Law
- School of Optometry University of Montréal Montréal QC Canada.,Research Center Montréal University Institute of Geriatrics Montréal QC Canada
| | - Marie-Jeanne Kergoat
- Research Center Montréal University Institute of Geriatrics Montréal QC Canada.,Faculty of Medicine University of Montréal Montréal QC Canada
| | - Bernard-Simon Leclerc
- Research Center Montréal University Institute of Geriatrics Montréal QC Canada.,Department of Social and Preventive Medicine School of Public Health University of Montréal Montréal QC Canada.,"InterActions" Research Center Integrated University Health and Social Services Center North of the Island of Montréal Montréal QC Canada
| | - Michel Panisset
- Department of Neurology Research Center - CHUM Montréal QC Canada
| | - Ronald Postuma
- Department of Neurology Montréal General Hospital (MGH) McGill University
| | - Hélène Kergoat
- School of Optometry University of Montréal Montréal QC Canada.,Research Center Montréal University Institute of Geriatrics Montréal QC Canada
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28
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Weil RS, Schrag AE, Warren JD, Crutch SJ, Lees AJ, Morris HR. Visual dysfunction in Parkinson's disease. Brain 2016; 139:2827-2843. [PMID: 27412389 PMCID: PMC5091042 DOI: 10.1093/brain/aww175] [Citation(s) in RCA: 240] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 05/23/2016] [Accepted: 06/05/2016] [Indexed: 01/09/2023] Open
Abstract
Patients with Parkinson's disease have a number of specific visual disturbances. These include changes in colour vision and contrast sensitivity and difficulties with complex visual tasks such as mental rotation and emotion recognition. We review changes in visual function at each stage of visual processing from retinal deficits, including contrast sensitivity and colour vision deficits to higher cortical processing impairments such as object and motion processing and neglect. We consider changes in visual function in patients with common Parkinson's disease-associated genetic mutations including GBA and LRRK2 . We discuss the association between visual deficits and clinical features of Parkinson's disease such as rapid eye movement sleep behavioural disorder and the postural instability and gait disorder phenotype. We review the link between abnormal visual function and visual hallucinations, considering current models for mechanisms of visual hallucinations. Finally, we discuss the role of visuo-perceptual testing as a biomarker of disease and predictor of dementia in Parkinson's disease.
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Affiliation(s)
- Rimona S. Weil
- 1 Institute of Neurology, University College London, London, UK
- 2 National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- 3 Department of Clinical Neurosciences, Royal Free Hospital NHS Trust, London, UK
| | - Anette E. Schrag
- 1 Institute of Neurology, University College London, London, UK
- 2 National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Jason D. Warren
- 2 National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- 4 Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Sebastian J. Crutch
- 4 Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Andrew J. Lees
- 1 Institute of Neurology, University College London, London, UK
- 2 National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Huw R. Morris
- 1 Institute of Neurology, University College London, London, UK
- 2 National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- 3 Department of Clinical Neurosciences, Royal Free Hospital NHS Trust, London, UK
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29
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West RJH, Elliott CJH, Wade AR. Classification of Parkinson's Disease Genotypes in Drosophila Using Spatiotemporal Profiling of Vision. Sci Rep 2015; 5:16933. [PMID: 26597171 PMCID: PMC4657034 DOI: 10.1038/srep16933] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 10/19/2015] [Indexed: 12/13/2022] Open
Abstract
Electrophysiological studies indicate altered contrast processing in some Parkinson's Disease (PD) patients. We recently demonstrated that vision is altered in Drosophila PD models and hypothesised that different types of genetic and idiopathic PD may affect dopaminergic visual signalling pathways differently. Here we asked whether visual responses in Drosophila could be used to identify PD mutations. To mimic a clinical setting a range of flies was used. Young flies from four control lines were compared to three early-onset PD mutations (PINK1, DJ-1α and DJ-1β), and to two other neurodegenerative mutations, one in the fly LRRK2 orthologue (dLRRK) the other in eggroll, a model of general neurodegeneration in Drosophila. Stimuli were contrast reversing gratings spanning 64 spatiotemporal frequency combinations. We recorded the steady-state visually-evoked response amplitude across all combinations. We found that the pattern of neuronal responses differed between genotypes. Wild-type and early-onset PD flies formed separate clusters; the late-onset mutation is an outlier. Neuronal responses in early-onset PD flies were stronger than in wild-types. Multivariate pattern analysis grouped flies by PD/non-PD genotype with an accuracy >85%. We propose that machine learning algorithms may be useful in increasing the diagnostic specificity of human electrophysiological measurements in both animal models and PD patients.
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Affiliation(s)
- Ryan J H West
- Department of Biology, The University of York, York.,Department of Psychology, The University of York, York
| | | | - Alex R Wade
- Department of Psychology, The University of York, York
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Miri S, Glazman S, Mylin L, Bodis-Wollner I. A combination of retinal morphology and visual electrophysiology testing increases diagnostic yield in Parkinson's disease. Parkinsonism Relat Disord 2015; 22 Suppl 1:S134-7. [PMID: 26414119 DOI: 10.1016/j.parkreldis.2015.09.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 09/02/2015] [Accepted: 09/03/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Impaired vision and remodeled foveal pit have been demonstrated in Parkinson's disease (PD) patients using different techniques. METHODS Ten PD (20 eyes) and eight healthy controls (HC) subjects (16 eyes) were enrolled. Subjects were evaluated for N70 and P100 latencies using two-channel VEP with pattern reversal and on/off pattern; Contrast sensitivity (CS) using Pelli-Robson chart; macular thickness measured using Zeiss-HD optical coherence tomography (OCT). RESULTS PD patients had a significantly delayed N70 (reversal pattern) and P100 (on/off pattern), lower CS score, and decreased retinal thickness at temporal 1.5-2.5 mm from the foveola. N70 latency was negatively correlated with CS (R = -0.419, P = 0.01) and average GCL-IPL thickness (R = -0.529, P = 0.001). CS was positively correlated with parafoveal thickness (R = 0.490, P = 0.002). A combination of parafoveal thickness and CS score yielded an AUC of 0.784 for PD discrimination which increased to 0.844 when combined with N70 and P100 measures. CONCLUSION A combination of pattern reversal VEP latency, CS score, and inner retinal foveal thickness measures has a high diagnostic yield for PD.
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Affiliation(s)
- Shahnaz Miri
- Department of Neurology, SUNY Downstate Medical Center, 450 Clarkson Ave, MSC 1213, Brooklyn, NY 11203, USA
| | - Sofya Glazman
- Department of Neurology, SUNY Downstate Medical Center, 450 Clarkson Ave, MSC 1213, Brooklyn, NY 11203, USA
| | - Leland Mylin
- Department of Neurology, SUNY Downstate Medical Center, 450 Clarkson Ave, MSC 1213, Brooklyn, NY 11203, USA
| | - Ivan Bodis-Wollner
- Department of Neurology, SUNY Downstate Medical Center, 450 Clarkson Ave, MSC 1213, Brooklyn, NY 11203, USA; Department of Ophthalmology, SUNY Downstate Medical Center, 450 Clarkson Ave, MSC 1213, Brooklyn, NY 11203, USA.
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Hashimoto T, Katai S, Goto T. Discharge responses of the optic tract to flash stimuli in Parkinson's disease. Ann Clin Transl Neurol 2015; 1:298-301. [PMID: 25590042 PMCID: PMC4292747 DOI: 10.1002/acn3.50] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 02/03/2014] [Accepted: 02/12/2014] [Indexed: 11/06/2022] Open
Abstract
Dopamine has a significant role in retinal processing, and it has been demonstrated that retinal dopamine content is decreased in parkinsonian patients. We measured the latency of the evoked discharges in the optic tract (OT) to flash stimuli during stereotactic pallidal neurosurgery in 25 patients with Parkinson's disease (PD) (13 women and 12 men, age 38-78 years, unified Parkinson's disease rating scale (UPDRS) Motor Score in the Off state 11-54, Hoehn and Yahr stage in the Off state 1.5-5) and investigated the effects of age at surgery, disease duration, levodopa dose, and severity of parkinsonian symptoms on the latency. OT discharges were evoked by monocular flash stimuli delivered from a flashlight with a krypton bulb with a tungsten filament. The luminance at the eye measured ∼4 × 10(4) cd/m(2). The light wavelength of the stimulus was composed of a wide spectrum with its peak at around 800 nm or longer. The latency of OT discharges ranged 49-79 msec, and there was a significant positive correlation between the latencies of evoked activities in the OT to a flashlight and age (r = 0.59, P < 0.001, by Pearson correlation), but no correlation between the latency and the severity of parkinsonian symptoms and between the latency and duration of illness. These results indicate that the delay in visual processing and conduction at the level of the retina and the OT are substantially derived from age-related degenerative changes in the retina and visual pathway which are apparently unrelated to the striatal dopamine deficiency in PD.
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Affiliation(s)
- Takao Hashimoto
- Center for Neurological Diseases, Aizawa Hospital Matsumoto, Japan
| | - Satoshi Katai
- Department of Neurology, Kakeyu Hospital Ueda, Japan
| | - Tetsuya Goto
- Department of Neurosurgery, Shinshu University School of Medicine Matsumoto, Japan
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Abstract
This review describes the oculo-visual problems likely to be encountered in Parkinson's disease (PD) with special reference to three questions: (1) are there visual symptoms characteristic of the prodromal phase of PD, (2) is PD dementia associated with specific visual changes, and (3) can visual symptoms help in the differential diagnosis of the parkinsonian syndromes, viz. PD, progressive supranuclear palsy (PSP), dementia with Lewy bodies (DLB), multiple system atrophy (MSA), and corticobasal degeneration (CBD)? Oculo-visual dysfunction in PD can involve visual acuity, dynamic contrast sensitivity, colour discrimination, pupil reactivity, eye movement, motion perception, and visual processing speeds. In addition, disturbance of visuo-spatial orientation, facial recognition problems, and chronic visual hallucinations may be present. Prodromal features of PD may include autonomic system dysfunction potentially affecting pupil reactivity, abnormal colour vision, abnormal stereopsis associated with postural instability, defects in smooth pursuit eye movements, and deficits in visuo-motor adaptation, especially when accompanied by idiopathic rapid eye movement (REM) sleep behaviour disorder. PD dementia is associated with the exacerbation of many oculo-visual problems but those involving eye movements, visuo-spatial function, and visual hallucinations are most characteristic. Useful diagnostic features in differentiating the parkinsonian symptoms are the presence of visual hallucinations, visuo-spatial problems, and variation in saccadic eye movement dysfunction.
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Schneider JS, Ault ME, Anderson DW. Retinal pathology detected by optical coherence tomography in an animal model of Parkinson's disease. Mov Disord 2014; 29:1547-51. [PMID: 25070726 DOI: 10.1002/mds.25974] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 06/24/2014] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Optical coherence tomography (OCT) is a noninvasive procedure for analysis of retinal morphology. Significant changes in the thickness of the peripapillary retinal nerve fiber layer (RNFL) in Parkinson's disease (PD) have been reported, and the current study was performed to examine whether such changes can also be detected in an animal model of PD. METHODS Optical coherence tomography measurements of peripapillary RNFL thickness, macula volume, and foveal thickness were obtained from 10 normal and five 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-treated cynomolgus monkeys with stable Parkinsonian signs. RESULTS Average RNFL thickness was significantly decreased in Parkinsonian monkeys compared with controls, with statistically significant RNFL thinning found in nasal and inferior quadrants. Macula volume and foveal thickness were also significantly reduced in Parkinsonian animals compared with controls. CONCLUSIONS As described in PD, RNFL thinning, reduced macula volume, and reduced foveal thickness also occurs in monkeys with MPTP-induced Parkinsonism. These findings pave the way for additional studies in which OCT may be used to track changes in the retina that might be present very early in the PD pathological process, perhaps preceding the onset of motor signs.
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Affiliation(s)
- Jay S Schneider
- Department of Pathology, Anatomy and Cell Biology, Thomas Jefferson University, Philadelphia, PA, USA
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Müller AK, Blasberg C, Südmeyer M, Aktas O, Albrecht P. Photoreceptor layer thinning in parkinsonian syndromes. Mov Disord 2014; 29:1222-3. [PMID: 24925731 DOI: 10.1002/mds.25939] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 02/10/2014] [Accepted: 05/07/2014] [Indexed: 11/06/2022] Open
Affiliation(s)
- Ann-Kristin Müller
- Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Germany
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Roth NM, Saidha S, Zimmermann H, Brandt AU, Isensee J, Benkhellouf-Rutkowska A, Dornauer M, Kühn AA, Müller T, Calabresi PA, Paul F. Photoreceptor layer thinning in idiopathic Parkinson's disease. Mov Disord 2014; 29:1163-70. [DOI: 10.1002/mds.25896] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 02/20/2014] [Accepted: 03/03/2014] [Indexed: 11/09/2022] Open
Affiliation(s)
- Nicolas M. Roth
- NeuroCure Clinical Research Center; Charité-Universitätsmedizin Berlin; Germany
| | - Shiv Saidha
- Department of Neurology; Beaumont University Hospital; Republic of Ireland
- Department of Neurology; John Hopkins School of Medicine; Baltimore Maryland USA
| | - Hanna Zimmermann
- NeuroCure Clinical Research Center; Charité-Universitätsmedizin Berlin; Germany
| | - Alexander U. Brandt
- NeuroCure Clinical Research Center; Charité-Universitätsmedizin Berlin; Germany
| | - Justine Isensee
- NeuroCure Clinical Research Center; Charité-Universitätsmedizin Berlin; Germany
| | | | - Matthias Dornauer
- NeuroCure Clinical Research Center; Charité-Universitätsmedizin Berlin; Germany
| | - Andrea A. Kühn
- NeuroCure Clinical Research Center; Charité-Universitätsmedizin Berlin; Germany
- Department of Neurology; Charité-Universitätsmedizin Berlin; Germany
| | - Thomas Müller
- Department of Neurology; St. Joseph Hospital; Berlin Germany
| | - Peter A. Calabresi
- Department of Neurology; John Hopkins School of Medicine; Baltimore Maryland USA
| | - Friedemann Paul
- NeuroCure Clinical Research Center; Charité-Universitätsmedizin Berlin; Germany
- Department of Neurology; Charité-Universitätsmedizin Berlin; Germany
- Experimental and Clinical Research Center; Charité-Universitätsmedizin Berlin and Max-Delbrück-Center for Molecular Medicine; Berlin Germany
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Bayhan HA, Aslan Bayhan S, Tanık N, Gürdal C. The association of spectral-domain optical coherence tomography determined ganglion cell complex parameters and disease severity in Parkinson's disease. Curr Eye Res 2014; 39:1117-22. [PMID: 24655112 DOI: 10.3109/02713683.2014.894080] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate the association between the retinal structural changes provided by spectral domain optical coherence tomography (SD-OCT) and disease severity in Parkinson's disease (PD). MATERIALS AND METHODS Thirty-eight eyes of 20 patients with PD and 30 eyes of 30 healthy subjects were enrolled in this prospective study. The eyes ipsilateral (20 eyes) and contralateral (18 eyes) to the most affected body side in patients with PD were evaluated separately. SD-OCT (RTVue-100) was used to measure the macular ganglion cell complex thickness (mGCC), outer retinal thickness, and peripapillary retinal nerve fiber layer (RNFL) thickness. Disease severity was assessed using Unified Parkinson's Disease Rating Scale (UPDRS). RESULTS The differences in the nasal RNFL (p = 0.004), average mGCC (p = 0.014), superior mGCC (p = 0.007), inferior mGCC (p = 0.03) were significant between the ipsilateral eye group and controls. The differences in the nasal RNFL (p = 0.002), and superior mGCC (p = 0.038) were statisticallly significant between the contralateral eye group and controls. Inferior and average mGCC thicknesses of ipsilateral eyes were inversely correlated with UPDRS score (p = 0.001, r = -0.678 and p = 0.009, r = -0.568, respectively). Significant inverse correlation was demonstrated between UPDRS score and inferior RNFL of both eyes ipsilateral and contralateral to the most affected body side. CONCLUSIONS There is significant thinning in mGCC parameters of the retina in PD. The SD-OCT derived mGCC parameters may improve the detection of PD progression.
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Correlation of inner retinal thickness evaluated by spectral-domain optical coherence tomography and contrast sensitivity in Parkinson disease. J Neuroophthalmol 2014; 33:137-42. [PMID: 23612240 DOI: 10.1097/wno.0b013e31828c4e1a] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND To compare inner retinal layer (IRL) thickness measured by spectral-domain optical coherence tomography (SD-OCT) and contrast sensitivity (CS) in patients with Parkinson disease (PD) and in healthy control (HC) subjects. METHODS Consecutive patients with and without PD were prospectively analyzed using SD-OCT and Pelli-Robson CS testing. SD-OCT IRL (ganglion-cell complex) thickness, consisting of the nerve fiber layer, ganglion cell layer, and inner plexiform layer, was segmented using an RTVue Model-RT100 with an EMM5 scan parameter covering a 5.0 × 5.0 mm cube centered on the fovea. Thickness voxel measurements at 0.25-mm intervals at sequential radial distances from the foveola were acquired horizontally and vertically. SD-OCT thickness raw data files were imported and analyzed within MATLAB (version 7.10.0). A database of CS scores and IRL thickness values by foveal location was constructed and statistically evaluated using JMP 10 (SAS Institute, Inc, Cary, NC). RESULTS The results were compared between 28 eyes of 14 patients with PD and 28 eyes of 14 HC subjects. Controlling for age, mean CS scores of monocular right and randomized eyes were statistically lower in PD eyes (P < 0.05). IRL was significantly thinner in PD eyes than in HC eyes at several distances from the foveola (P < 0.05). The most numerous and significant thickness differences by diagnosis were located in the superior quadrant at a distance of 1.00-1.75 mm from the foveal center (17 μm; P < 0.01, maximum significant thickness difference and P value). Correlation was demonstrated between monocular CS and IRL thickness by diagnosis at multiple foveal locations for HC eyes as follows: nasal quadrant, 0.75-1.00 mm (P < 0.02); temporal quadrant, 0.50-1.00 mm (P < 0.05); superior quadrant, 1.00 mm (P < 0.05); and inferior quadrant, 1.00 mm (P < 0.03). No significant correlation was found between monocular CS and IRL thickness within PD subjects (P > 0.05 for each foveal location measured). CONCLUSION CS and foveal IRL thickness are decreased in patients with PD. CS and IRL thickness correlated in HC subjects; however, no such correlation was demonstrated in PD. The functional deficit of dopaminergic interneurons, including amacrine cells, may outstrip the anatomic structural changes in the inner retina of PD patients. Inner retinal atrophic changes may underlie the pathogenesis of CS deficit and IRL thinning in PD.
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Jiménez B, Ascaso FJ, Cristóbal JA, López del Val J. Development of a prediction formula of Parkinson disease severity by optical coherence tomography. Mov Disord 2013; 29:68-74. [PMID: 24458320 DOI: 10.1002/mds.25747] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 09/30/2013] [Accepted: 10/18/2013] [Indexed: 12/24/2022] Open
Abstract
The aims of this study were to assess the peripapillary retinal nerve fiber layer (RNFL) thickness in patients with Parkinson's disease (PD), to determine its correlation with disease severity, and to define a simple biomarker for predicting clinical severity. One hundred two eyes from 52 patients affected by PD were compared with 97 eyes from 50 age-comparable controls. In all patients, peripapillary RNFL thickness was measured by optical coherence tomography (OCT). We used the Unified Parkinson's Disease Rating Scale (UPDRS) total score and measured responses in the on medication state. Eyes from patients with PD had a statistically significant decrease in average peripapillary RNFL thickness compared with control eyes (P < 0.001). This reduction was observed in every quadrant (inferior, superior, nasal [P < 0.001], and temporal [P = 0.017]) in patients with PD. Furthermore, a strong inverse correlation was found between the PD severity measured according to the UPDRS score and the average peripapillary RNFL thickness (r = -0.615; P < 0.001) and PD duration (r = -0.303; P = 0.002). From these results, we defined a regression equation that predicts the UPDRS score from the above-mentioned variables: UPDRS = 81.6 + 29.6 * log PD duration (years) - 0.6 * RFNL thickness (μm). We observed that, as the evolution and severity of PD progress, the peripapillary RNFL layer thickness, as evaluated by OCT, gradually diminishes. These results suggest that the average peripapillary RNFL thickness measured by OCT might be useful as a biomarker to detect the early onset and progression of PD.
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Affiliation(s)
- Beatriz Jiménez
- Department of Ophthalmology, "Lozano Blesa" University Clinic Hospital, Zaragoza, Spain
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Foveal vision is impaired in Parkinson's disease. Parkinsonism Relat Disord 2013; 19:1-14. [DOI: 10.1016/j.parkreldis.2012.07.012] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 07/16/2012] [Accepted: 07/21/2012] [Indexed: 11/23/2022]
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Remodeling of the fovea in Parkinson disease. J Neural Transm (Vienna) 2012; 120:745-53. [DOI: 10.1007/s00702-012-0909-5] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 10/19/2012] [Indexed: 01/24/2023]
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Interocular asymmetry of foveal thickness in Parkinson disease. J Ophthalmol 2012; 2012:728457. [PMID: 22900149 PMCID: PMC3415246 DOI: 10.1155/2012/728457] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Revised: 06/03/2012] [Accepted: 06/03/2012] [Indexed: 01/19/2023] Open
Abstract
Purpose. To quantify interocular asymmetry (IA) of foveal thickness in Parkinson disease (PD) versus that of controls. Design. Prospective case-control series. Methods. In vivo assessment of foveal thickness of 46 eyes of 23 PD patients and 36 eyes of 18 control subjects was studied using spectral domain optical coherence tomography (SD-OCT). Inner versus outer layer retinal segmentation and macular volumes were quantified using the manufacturer's software, while foveal thickness was measured using the raw data from each eye in a grid covering a 6 by 6 mm area centered on the foveola in 0.25 mm steps. Thickness data were entered into MATLAB software. Results. Macular volumes differed significantly at the largest (Zone 3) diameter centered on the foveola (ETDRS protocol). By segmenting inner from outer layers, we found that the IA in PD is mostly due to changes on the slope of the foveal pit at the radial distances of 0.5 and 0.75 mm (1.5 mm and 1 mm diameter). Conclusions. About half of the PD patients had IA of the slope of the foveal pit. IA is a potentially useful marker of PD and is expected to be comparable across different SD-OCT equipment. Data of larger groups may be developed in future multicenter studies.
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Abstract
Background/Objective Parkinson's disease (PD) and the atypical parkinsonian syndromes multiple system atrophy (MSA), progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS) are movement disorders associated with degeneration of the central nervous system. Degeneration of the retina has not been systematically compared in these diseases. Methods This cross-sectional study used spectral-domain optical coherence tomography with manual segmentation to measure the peripapillar nerve fiber layer, the macular thickness, and the thickness of all retinal layers in foveal scans of 40 patients with PD, 19 with MSA, 10 with CBS, 15 with PSP, and 35 age- and sex-matched controls. Results The mean paramacular thickness and volume were reduced in PSP while the mean RNFL did not differ significantly between groups. In PSP patients, the complex of retinal ganglion cell- and inner plexiform layer and the outer nuclear layer was reduced. In PD, the inner nuclear layer was thicker than in controls, MSA and PSP. Using the ratio between the outer nuclear layer and the outer plexiform layer with a cut-off at 3.1 and the additional constraint that the inner nuclear layer be under 46 µm, we were able to differentiate PSP from PD in our patient sample with a sensitivity of 96% and a specificity of 70%. Conclusion Different parkinsonian syndromes are associated with distinct changes in retinal morphology. These findings may serve to facilitate the differential diagnosis of parkinsonian syndromes and give insight into the degenerative processes of patients with atypical parkinsonian syndromes.
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Tian T, Zhu XH, Liu YH. Potential role of retina as a biomarker for progression of Parkinson's disease. Int J Ophthalmol 2011; 4:433-8. [PMID: 22553695 DOI: 10.3980/j.issn.2222-3959.2011.04.21] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 06/28/2011] [Indexed: 01/14/2023] Open
Abstract
Optical coherence tomography (OCT) noninvasively quantifies the thickness of the retinal nerve fiber layer (RNFL). OCT has been studied in several neuro-ophthalmic conditions, including Parkinson's disease (PD). Recent studies suggest that the quantitative analysis of RNFL can be precisely and noninvasively done by OCT scans and the results suggest that the thickness of RNFL is significantly decreased in patients with PD compared with age-matched controls and the foveal retinal thickness correlates with disease severity in PD. In this article, the application of OCT imaging of the retina in PD was reviewed. Literature survey of PubMed was carried out using the search terms of "Optical Coherence Tomography" combined with "Parkinson's Disease" and "retinal nerve fiber layer" (without restriction to the year of publication). Some related articles were also included. The search was completed in Jul. 2011 and revised and updated as necessary. The aim of this article is to review the current literatures on the use of optical coherence tomography in patients affected by PD and to enhance its use in clinical practice in neuro-ophthalmology.
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Affiliation(s)
- Tian Tian
- Department of Neurology, Xiangya Hospital, Central-South University, 87 Xiangya Road, Changsha 410008, Hunan Province, China
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Armstrong RA. Visual symptoms in Parkinson's disease. PARKINSON'S DISEASE 2011; 2011:908306. [PMID: 21687773 PMCID: PMC3109513 DOI: 10.4061/2011/908306] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 02/21/2011] [Accepted: 03/24/2011] [Indexed: 11/20/2022]
Abstract
Parkinson's disease (PD) is a common disorder of middle-aged and elderly people in which degeneration of the extrapyramidal motor system causes significant movement problems. In some patients, however, there are additional disturbances in sensory systems including loss of the sense of smell and auditory and/or visual problems. This paper is a general overview of the visual problems likely to be encountered in PD. Changes in vision in PD may result from alterations in visual acuity, contrast sensitivity, colour discrimination, pupil reactivity, eye movements, motion perception, visual field sensitivity, and visual processing speeds. Slower visual processing speeds can also lead to a decline in visual perception especially for rapidly changing visual stimuli. In addition, there may be disturbances of visuospatial orientation, facial recognition problems, and chronic visual hallucinations. Some of the treatments used in PD may also have adverse ocular reactions. The pattern electroretinogram (PERG) is useful in evaluating retinal dopamine mechanisms and in monitoring dopamine therapies in PD. If visual problems are present, they can have an important effect on the quality of life of the patient, which can be improved by accurate diagnosis and where possible, correction of such defects.
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Affiliation(s)
- R. A. Armstrong
- Department of Vision Sciences, Aston University, Birmingham B4 7ET, UK
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Retinal thickness in Parkinson's disease. Parkinsonism Relat Disord 2011; 17:431-6. [PMID: 21454118 DOI: 10.1016/j.parkreldis.2011.03.004] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Revised: 03/07/2011] [Accepted: 03/08/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND Visual symptoms are common in Parkinson's disease with studies consistently demonstrating reductions in visual acuity, contrast sensitivity, colour and motion perception as well as alterations in electroretinogram latencies and amplitudes. Optical coherence tomography can examine retinal structure non-invasively and retinal thinning has been suggested as a potential biomarker for neurodegeneration in Parkinson's disease. Our aim was to examine the retinal thickness of a cohort of Parkinson's disease subjects (and age-matched controls) to establish the practical utility of optical coherence tomography in a representative older Parkinson's disease group. METHODS Fifty-one established Parkinson's disease subjects and 25 healthy controls were subjected to ophthalmological assessment and optical coherence tomography (Zeiss Stratus 3000™) of macular thickness and volume and retinal nerve fibre thickness around the optic nerve head. Twenty four percent of control and 20% of Parkinson's disease subjects were excluded from final analysis due to co-morbid ocular pathology. Further data was excluded either due to poor tolerability of optical coherence tomography or poor quality scans. RESULTS Despite a reduction in both visual acuity and contrast sensitivity in the residual evaluable Parkinson's disease cohort, we did not detect any differences between the two study groups for any measures of retinal thickness, in contrast to previously published work. CONCLUSIONS In addition to technical problems inherent in the evaluation, the lack of difference between Parkinson's disease and healthy control subjects suggests longitudinal studies, employing newer techniques, will be required to define the role of optical coherence tomography as a potential diagnostic biomarker.
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Cardoso EF, Fregni F, Maia FM, Melo LM, Sato JR, Cruz AC, Bianchi ET, Fernandes DB, Monteiro MLR, Barbosa ER, Amaro E. Abnormal visual activation in Parkinson's disease patients. Mov Disord 2010; 25:1590-6. [DOI: 10.1002/mds.23101] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Vialatte FB, Maurice M, Dauwels J, Cichocki A. Steady-state visually evoked potentials: focus on essential paradigms and future perspectives. Prog Neurobiol 2009; 90:418-38. [PMID: 19963032 DOI: 10.1016/j.pneurobio.2009.11.005] [Citation(s) in RCA: 541] [Impact Index Per Article: 36.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Revised: 11/26/2009] [Accepted: 11/30/2009] [Indexed: 11/26/2022]
Abstract
After 40 years of investigation, steady-state visually evoked potentials (SSVEPs) have been shown to be useful for many paradigms in cognitive (visual attention, binocular rivalry, working memory, and brain rhythms) and clinical neuroscience (aging, neurodegenerative disorders, schizophrenia, ophthalmic pathologies, migraine, autism, depression, anxiety, stress, and epilepsy). Recently, in engineering, SSVEPs found a novel application for SSVEP-driven brain-computer interface (BCI) systems. Although some SSVEP properties are well documented, many questions are still hotly debated. We provide an overview of recent SSVEP studies in neuroscience (using implanted and scalp EEG, fMRI, or PET), with the perspective of modern theories about the visual pathway. We investigate the steady-state evoked activity, its properties, and the mechanisms behind SSVEP generation. Next, we describe the SSVEP-BCI paradigm and review recently developed SSVEP-based BCI systems. Lastly, we outline future research directions related to basic and applied aspects of SSVEPs.
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Affiliation(s)
- François-Benoît Vialatte
- Riken BSI, Laboratory for Advanced Brain Signal Processing, 2-1 Hirosawa, Wako-Shi, Saitama-Ken 351-0128, Japan.
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Subtype specification of GABAergic amacrine cells by the orphan nuclear receptor Nr4a2/Nurr1. J Neurosci 2009; 29:10449-59. [PMID: 19692620 DOI: 10.1523/jneurosci.3048-09.2009] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
In the mammalian retina, amacrine cells (ACs) contain numerous subtypes with extremely diverse morphologies and physiological functions. To date, how these subtypes arise during retinogenesis remains largely unknown at the molecular level. The orphan nuclear receptor Nr4a2 plays an essential role in specifying ventral midbrain dopaminergic neurons, and its mutations are associated with familial Parkinson's disease. Here we show that Nr4a2 is also critically involved in the specification of AC subtype identity. During mouse retinogenesis, Nr4a2 is expressed in a subset of postmitotic GABAergic ACs and their precursors. Its targeted inactivation results in the loss of a subpopulation of GABAergic ACs that include all dopaminergic and p57Kip2(+) neurons as well as a simultaneous increase of calbindin(+) ACs. Misexpressed Nr4a2 can promote GABAergic AC differentiation and repress calbindin(+) ACs, whereas its dominant-negative form has the ability to suppress the GABAergic AC fate. Moreover, the expression of Nr4a2 is positively regulated by Foxn4 and negatively controlled by Brn3b, two retinogenic factors previously shown to promote and suppress GABAergic ACs, respectively. These data suggest that Nr4a2 is both necessary and sufficient to confer AC precursors with the identity of a GABAergic AC phenotype, and that it may network with multiple other retinogenic factors to ensure proper specification and differentiation of AC neurotransmitter subtypes.
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Retinopathy in Parkinson disease. J Neural Transm (Vienna) 2009; 116:1493-501. [DOI: 10.1007/s00702-009-0292-z] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2009] [Accepted: 08/02/2009] [Indexed: 10/20/2022]
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Abstract
As a more complete picture of the clinical phenotype of Parkinson's disease emerges, non-motor symptoms have become increasingly studied. Prominent among these non-motor phenomena are mood disturbance, cognitive decline and dementia, sleep disorders, hyposmia and autonomic failure. In addition, visual symptoms are common, ranging from complaints of dry eyes and reading difficulties, through to perceptual disturbances (feelings of presence and passage) and complex visual hallucinations. Such visual symptoms are a considerable cause of morbidity in Parkinson's disease and, with respect to visual hallucinations, are an important predictor of cognitive decline as well as institutional care and mortality. Evidence exists of visual dysfunction at several levels of the visual pathway in Parkinson's disease. This includes psychophysical, electrophysiological and morphological evidence of disruption of retinal structure and function, in addition to disorders of 'higher' (cortical) visual processing. In this review, we will draw together work from animal and human studies in an attempt to provide an insight into how Parkinson's disease affects the retina and how these changes might contribute to the visual symptoms experienced by patients.
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Affiliation(s)
- Neil K Archibald
- Clinical Research Fellow, Clinical Ageing Research Unit, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.
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