Progress of visual dysfunction in Parkinson's disease

Dopamine, Alpha-Synuclein, and Mitochondrial Dysfunctions in Parkinsonian Eyes

Parkinson’s disease (PD) is characterized by motor dysfunctions including bradykinesia, tremor at rest and motor instability. These symptoms are associated with the progressive degeneration of dopaminergic neurons originating in the substantia nigra pars compacta and projecting to the corpus striatum, and by accumulation of cytoplasmic inclusions mainly consisting of aggregated alpha-synuclein, called Lewy bodies. PD is a complex, multifactorial disorder and its pathogenesis involves multiple pathways and mechanisms such as α-synuclein proteostasis, mitochondrial function, oxidative stress, calcium homeostasis, axonal transport, and neuroinflammation. Motor symptoms manifest when there is already an extensive dopamine denervation. There is therefore an urgent need for early biomarkers to apply disease-modifying therapeutic strategies. Visual defects and retinal abnormalities, including decreased visual acuity, abnormal spatial contrast sensitivity, color vision defects, or deficits in more complex visual tasks are present in the majority of PD patients. They are being considered for early diagnosis together with retinal imaging techniques are being considered as non-invasive biomarkers for PD. Dopaminergic cells can be found in the retina in a subpopulation of amacrine cells; however, the molecular mechanisms leading to visual deficits observed in PD patients are still largely unknown. This review provides a comprehensive analysis of the retinal abnormalities observed in PD patients and animal models and of the molecular mechanisms underlying neurodegeneration in parkinsonian eyes. We will review the role of α-synuclein aggregates in the retina pathology and/or in the onset of visual symptoms in PD suggesting that α-synuclein aggregates are harmful for the retina as well as for the brain. Moreover, we will summarize experimental evidence suggesting that the optic nerve pathology observed in PD resembles that seen in mitochondrial optic neuropathies highlighting the possible involvement of mitochondrial abnormalities in the development of PD visual defects. We finally propose that the eye may be considered as a complementary experimental model to identify possible novel disease’ pathways or to test novel therapeutic approaches for PD.

Visual losses in early-onset and late-onset Parkinson's disease

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.

Seeing ophthalmologic problems in Parkinson disease: Results of a visual impairment questionnaire

Objective

To determine the prevalence and clinical effect of ophthalmologic symptoms in patients with Parkinson disease (PD), compared with controls, using a standardized questionnaire.

Methods

In this observational, cross-sectional, multicenter study, 848 patients with PD and 250 healthy controls completed the Visual Impairment in Parkinson's Disease Questionnaire (VIPD-Q). The VIPD-Q addressed 4 domains according to structures: (1) ocular surface; (2) intraocular; (3) oculomotor; and (4) optic nerve. The questionnaire also assessed the effect of ophthalmologic symptoms on daily activities.

Results

One or more ophthalmologic symptoms were reported by 82% (95% confidence interval [CI], 80–85) of patients, compared with 48% (95% CI, 42–54) of controls (p < 0.001). Patients with PD experienced more ophthalmologic symptoms across all domains than controls (p < 0.001), as reflected by a higher VIPD-Q total score among patients (median 10 [interquartile range (IQR) 13]) than controls (median 2 [IQR 5]; p < 0.001). Ophthalmologic symptoms interfered with daily activities in 68% (95% CI, 65–71) of patients, compared with 35% (95% CI, 29–41) of controls (p < 0.001).

Conclusion

Patients with PD have a higher prevalence of ophthalmologic symptoms than controls. Moreover, these frequently interfere with daily activities. A screening questionnaire such as the VIPD-Q may help with identifying ophthalmologic symptoms in PD, thereby enabling more timely treatment.

New players in basal ganglia dysfunction in Parkinson's disease

The classical model of the basal ganglia (BG) circuit has been recently revised with the identification of other structures that play an increasing relevant role especially in the pathophysiology of Parkinson's disease (PD). Numerous studies have supported the spreading of the alpha-synuclein pathology to several areas beyond the BG and likely even before their involvement. With the aim of better understanding PD pathophysiology and finding new targets for treatment, the spinal cord, the pedunculopontine nucleus, the substantia nigra pars reticulata, the retina, the superior colliculus, the cerebellum, the nucleus parabrachialis and the Meynert's nucleus have been investigated both in animal and human studies. In this chapter, we describe the main anatomical and functional connections between the above structures and the BG, the relationship between their pathology and PD features, and the rational of applying neuromodulation treatment to improve motor and non-motor symptoms in PD. Some of these new players in the BG circuits might also have a potential intriguing role as early biomarkers of PD.

Parkinson's disease and changes in the appreciation of art: A comparison of aesthetic and formal evaluations of paintings between PD patients and healthy controls

Parkinson's disease (PD) is a progressing neurodegenerative disease predominantly involving the loss of dopamine producing neurons with hallmark symptoms of motor disorders and cognitive, motivational, emotional, and perceptual impairments. Intriguingly, PD can also be connected-often anecdotally-with a sudden burst of artistic creativity, motivation, or changed quality/style of produced art. This has led to growing empirical interest, promising a window into brain function and the unique neurological signature of artists. This topic also fits a growing interest from researchers in other areas, including Alzheimer's or other dementia, which have suggested that specific changes in art production/appraisal may provide a unique basis for therapy, diagnosis, or understanding of these diseases. However, whether PD also shows similar impacts on how we perceive and evaluate art has never been systematically addressed. We compared a cohort of PD patients against age-matched healthy controls, asking participants to rate paintings using scales of liking and beauty and terms pertaining to artworks' formal and conceptual qualities previously designed to provide a rubric for symptom identification. We found no evidence for PD-related differences in liking or beauty. However, PD patients showed higher ratings on assessed "emotionality," potentially relating to the tie between PD, dopamine pathways, and emotion/reward.

Towards seeing the visual impairments in Parkinson's disease: protocol for a multicentre observational, cross-sectional study

Background

Visual disorders are common in Parkinson’s disease (PD) but their exact frequency and severity are unknown. Good visual functioning is crucial for patients with PD, because of their need to compensate for loss of automated motor control and their postural instability, forcing patients to guide their movements visually. Here, we describe the study design of a cross-sectional, multi-centre study aiming to: (1) validate the Visual Impairment screening questionnaire (VIPD-Q, which aims to identify PD patients who should be referred to an ophthalmologist for further assessment); (2) study the prevalence of visual disorders in PD; (3) study the severity and clinical impact of different types of visual disorders in PD; and (4) explore treatment options for ophthalmologic disorders in PD, as a basis for future guideline development.

Methods

This study consists of two phases. In phase one, 750 PD patients and 250 healthy controls will be recruited to complete the VIPD-Q. In phase two, a subgroup of responders (n = 100) (with the highest and lowest scores on the VIPD-Q) will be invited for an extensive neurological and ophthalmological assessment. The in-depth ophthalmologic examination will serve as the “gold standard” for validating the VIPD-Q. Moreover, these assessments will be used to study associations between visual disorders and clinical presentation, in order to gain more insight in their clinical impact.

Discussion

Our study will heighten the awareness of visual problems in PD and offers a robust starting point to systematically approach this subject. In current daily practice, the association between visual problems and PD is far from obvious to both patients and clinicians. Consequently, patients may not adequately report visual problems themselves, while clinicians miss potentially treatable visual disorders. Routinely asking patients to complete a simple screening questionnaire could be an easy solution leading to timely identification of visual problems, tailored treatment, restored mobility, greater independence and improved quality of life.

Trial registration

Dutch Trial Registration, NL7421, Registered on 4 December 2018 – Retrospectively registered.

Electronic supplementary material

The online version of this article (10.1186/s12883-019-1365-8) contains supplementary material, which is available to authorized users.

Why would Parkinson's disease lead to sudden changes in creativity, motivation, or style with visual art?: A review of case evidence and new neurobiological, contextual, and genetic hypotheses

Parkinson's disease (PD) is a devastating diagnosis with, however, potential for an extremely intriguing aesthetic component. Despite motor and cognitive deficits, an emerging collection of studies report a burst of visual artistic output and alterations in produced art in a subgroup of patients. This provides a unique window into the neurophysiological bases for why and how we might create and enjoy visual art, as well as into general brain function and the nature of PD or other neurodegenerative diseases. However, there has not been a comprehensive organization of literature on this topic. Nor has there been an attempt to connect case evidence and knowledge on PD with present understanding of visual art making in psychology and neuroaesthetics in order to propose hypotheses for documented artistic changes. Here, we collect the current research on this topic, tie this to PD symptoms and neurobiology, and provide new theories focusing on dopaminergic neuron damage, over-stimulation from dopamine agonist therapy, and context or genetic factors revealing the neurobiological basis of the visual artistic brain.

Use of a Modified STROOP Test to Assess Color Discrimination Deficit in Parkinson's Disease

Objective: To objectively measure color vision dysfunction in idiopathic Parkinson's disease (iPD) using an easily administered, essentially free, modified Stroop test. Methods: Sixty-one iPD patients and 26 age-matched controls (HC) were enrolled after IRB approval and performed congruent (CST) and incongruent (IST) modified Stroop tests consisting of 40 words in 10 colors arranged in a 5 x 8 grid. The scorer was blinded to participant diagnosis. Errors on IST were defined as type 1 (written word reported rather than color) or type 2 (color reported different from the written word or its color). Results: The iPD group and the control group completed testing with similar CST performance. On the IST, 75.4% of iPD patients had type 2 errors (p = 0.001, OR 4.907, 95%CI 1.838-13.097) compared to 38.5% HC, with a positive predictive value of 82%. The mean number of type 2 errors was also higher in the iPD group, even with MoCA scores as a covariate in the analysis. Type 1 errors were not significantly different between the groups. A univariate logistic regression model with age, gender, MoCA, normalized IST completion time and the presence/absence of type 2 errors also resulted in type 2 errors as the only significant factor in the equation (p = 0.026). Conclusions: The modified Stroop test incorporated into the clinical evaluation of a patient may provide a quick and inexpensive objective measure of a non-motor feature of iPD, which could help in the clinical diagnosis of iPD in conjunction with the motor assessments currently used by neurologists.

Postural sway in patients with early Parkinson's disease performing cognitive tasks while standing

OBJECTIVES

We investigated postural sway in patients with early Parkinson's disease (PD) to test the hypothesis that the postural control system was affected already at an early stage of PD. Moreover, we identified cases of dysfunction of stereopsis in PD patients.

METHODS

We examined 23 patients with early PD and 23 healthy, sex- and age-matched control subjects. Postural sway was measured with an accelerometer at the center of mass at the lower spine. Subjects were asked to stand quietly for 30 s under two usual conditions (eyes open and eyes closed) and two dual tasks conditions (eyes open with dual task, eyes closed with dual task). Stereopsis was assessed using the Titmus fly test.

RESULTS

In the usual conditions, no differences were found between the control group and PD group. With increasing task difficulty, PD patients showed an increase of RMS values of sway acceleration, compared to control subjects. These differences reached significance during cognitive task performance. PD patients showed larger JERK values with increasing difficulty of the sway task which also reached significance during cognitive task performance. Relative to controls, PD patients showed decreased stereopsis function. But, there were no statistically significant correlations between log seconds of arc of the Titmus test and JERK, even during cognitive task performance.

CONCLUSION

Our results indicate that patients with early PD have subtle signs of postural instability when their attention is diverted or reduced. In addition, deficits of stereopsis may be common in early PD patients. St Abbreviations: ACC: Accelerometers; ANOVA: Analysis of variance; AP: Antero-posterior; COP: Center of pressure; EC: Eyes closed; ECDT: eyes closed with dual task; EO: Eyes open; EODT: Eyes open with dual task; GDS: Geriatric depression scale; JERK: Jerkiness of sway; ML: Medio-lateral; MMSE: Mini mental state examination; MoCA: Montreal cognitive assessment; PD: Parkinson's disease; PDAbS: PD Patients with abnormal stereopsis; PDNrS: PD Patients with normal stereopsis; PIGD: Postural instability and gait disorder; RMS: Root mean square; UPDRS: Unified Parkinson's disease rating scale.

Ocular and visual disorders in Parkinson's disease: Common but frequently overlooked

Patients with Parkinson's disease (PD) often compensate for their motor deficits by guiding their movements visually. A wide range of ocular and visual disorders threatens the patients' ability to benefit optimally from visual feedback. These disorders are common in patients with PD, yet they have received little attention in both research and clinical practice, leading to unnecessary - but possibly treatable - disability. Based on a literature search covering 50 years, we review the range of ocular and visual disorders in patients with PD, and classify these according to anatomical structures of the visual pathway. We discuss six common disorders in more detail: dry eyes; diplopia; glaucoma and glaucoma-like visual problems; impaired contrast and colour vision; visuospatial and visuoperceptual impairments; and visual hallucinations. In addition, we review the effects of PD-related pharmacological and surgical treatments on visual function, and we offer practical recommendations for clinical management. Greater awareness and early recognition of ocular and visual problems in PD might enable timely instalment of tailored treatments, leading to improved patient safety, greater independence, and better quality of life.

Visual dysfunction in Parkinson's disease

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.

Category-Specific Visual Recognition and Aging from the PACE Theory Perspective: Evidence for a Presemantic Deficit in Aging Object Recognition

Background/Study Context: The objective of this study was to investigate the object recognition deficit in aging. Age-related declines were examined from the presemantic account of category effects (PACE) theory perspective (Gerlach, 2009, Cognition, 111, 281-301). This view assumes that the structural similarity/dissimilarity inherent in living and nonliving objects, respectively, can account for a wide range of category-specific effects.

METHODS

In two experiments on object recognition, young (36 participants, 18-27 years) and older (36 participants, 53-69 years) adult participants' performances were compared.

RESULTS

The young adults' results corroborate the PACE theory expectations. The results of the older adults showed an impairment in recognition of structurally similar objects irrespective of semantic category.

CONCLUSION

The two sets of results suggest that a deficit in the selection stage of the PACE theory (visual long-term memory matching) could be responsible for these impairments. Indeed, the older group showed a deficit when this stage was most relevant. This article emphasize on the critical need for taking into account structural component of the stimuli and type of tasks in further studies.

Reliability in perimetric multichannel contrast sensitivity measurements

BACKGROUND

In this study, the reliability of perimetric contrast sensitivity measurements favouring the achromatic, the red-green and the blue-yellow post-receptorial mechanisms was analysed.

METHODS

A new technique, multichannel ATD perimetry, provides spatial and temporal stimuli favouring the detection by an achromatic mechanism (A), from a magno or parvocellular origin or by a red-green (RG) chromatic mechanism, with a parvocellular origin or a blue-yellow (BY) mechanism, with a koniocellular origin. The repeatability and reproducibility of contrast sensitivity measurements with these stimuli were studied in a group of 40 healthy subjects. The analysis was carried out on 21 testing points within a 60° by 40° fovea-centred region of the visual field.

RESULTS

The within-observer repeatability for the four mechanisms studied is either good or excellent when the intra-class correlation coefficient (ICC) can be calculated. For the remaining points, the Friedman's test finds that the measurements are repeatable. The between-observer reproducibility was either excellent or good in cases where the ICC was applied and according to the Friedman's test all results were reproducible.

CONCLUSIONS

The results obtained showed good repeatability and reproducibility with A, RG and BY stimuli, although with BY stimuli repeatability is slightly worse. Future studies on the diagnostic validity of this device are based on the fact that changes of sensitivity can be compared by means of a visual single task, contrast sensitivity measurement and using a common metric.

Premotor symptoms and early diagnosis of Parkinson's disease

Parkinson's disease is a disorder characterized by the motor findings of bradykinesia, rest tremor, cogwheel rigidity, and postural instability. As the disease progresses, most patients develop numerous nonmotor signs and symptoms, many of which play a major role in reducing quality of life. What is becoming increasingly clear is that nonmotor findings, including hyposmia, sleep disorders, autonomic abnormalities, cognitive changes, and neurobehavioral changes, often precede the motor findings.

Stereopsis in drug naïve Parkinson's disease patients

BACKGROUND

Motor deficits associated with Parkinson's disease (PD) have been well described, yet little attention has been paid to non-motor symptoms, especially cortical visual dysfunction. We investigated stereopsis, as well as the relationship between stereopsis and other cognitive function, in a sample of PD patients.

METHODS

We used Titmus stereotest plates for assessing stereopsis. Fifty-nine subjects (29 PD patients and 30 normal controls) were included in this study. The included patients underwent a neurological examination, clinical rating scale and neuropsychological tests.

RESULTS

Drug naïve PD patients showed decreased stereopsis on the Titmus fly stereopsis test (Pearson χ2=23.80, p<0.001) compared to PD patients with normal stereopsis. The Hoehn-Yahr stages and Unified Parkinson's Disease Rating Scale motor scores were significantly higher in patients with PD with abnormal stereopsis than in patients with PD with normal stereopsis (p=0.026; p=0.046). The frequency of abnormal visual perception/constructive function was greater in patients with PD with abnormal stereopsis compared to patients with PD with normal stereopsis (Pearson χ2=5.11, p=0.024).

CONCLUSION

These findings suggest that stereopsis deficits and visual perception/constructive dysfunction are common in de novo PD patients.

Progression of Parkinson's disease in the clinical phase: potential markers

Neuromodulatory or even neuroprotective therapy could soon be available for Parkinson's disease (PD), raising the question of how we should define and measure disease progression. Reported evidence suggests that several symptoms worsen with disease duration. Bradykinesia, rigidity, and activities of daily living deteriorate faster at the beginning of the disease, and this deterioration is paralleled by a decline in functional presynaptic dopaminergic activity, as shown by imaging techniques. Cognitive, speech, sleep, and gait difficulties might progress linearly in proportion to disease duration. Reduced variability in heart rate, orthostatic dysfunction, and visual hallucinations start to develop at mid-stage disease and are more common in late stages than earlier stages. In this Review, we summarise our current understanding of the progression of PD-associated symptoms and markers and conclude that an effective measurement of progression of PD must adapt to the different stages of the disease. In addition to routine clinical rating scales, new quantitative assessments of motor and non-motor symptoms, which should be more broadly available, reasonably priced, and easy-to-use, are needed.

A timeline for Parkinson's disease

It is reasonably well established that prior to the motor phase of classical Parkinson's disease (PD) there is a prodromal period of several years duration. Once typical motor features appear, the disease continues up to 20 years depending on multiple variables. The clinical features of the prodromal and motor phases may be correlated with pathological changes in the central and autonomic nervous systems to allow a sequential plan of disease progression. We present a 'best guess' for a typical individual presenting with PD in their sixties and speculate that the disease will last approximately 40 years from the earliest non-motor features to death. Appreciation of this concept may allow better strategies for slowing or halting disease progression.

Influence of Dopamine Deficiency in Early Parkinson’s Disease on the Slow Stimulation Multifocal-ERG

PURPOSE

In animal studies intravitreal injection of tetrodotoxin (TTX) results in mfERG waveform changes similar to those observed in glaucoma. As TTX blocks amacrine as well as ganglion cells, there is still a question regarding the underlying cell population responsible for these changes in waveform. In an attempt to assess the contribution of the amacrine cells to these changes, a mfERG was obtained from patients with Parkinson's disease as some amacrine cells are mediated by dopamine, a substance lacking in Parkinson's.

METHODS

Eight patients with early Parkinson's disease underwent ophthalmologic examination, testing of contrast sensitivity and electrophysiological examination according to ISCEV standard at least 12 h following their last medication with Dopamine. A slow stimulation mfERG was obtained with a stimulus base interval of 53.3 ms and with a stimulus base interval of 106.6 ms. During MF-ERG recordings 103 hexagons stimulated the central 50 deg of the retina simultaneously and independently (m-sequence 2(13), L(max): 200 cd/m(2), approximately 100% contrast).

RESULTS

Contrast sensitivity and ISCEV standard electrophysiological testing was unremarkable. When the mfERG was analyzed, only four patients had an adequate signal-to-noise ratio to allow further data analysis - one of whom was diagnosed with a multi system atrophy in retrospect. The first order response component was analyzed at a filter setting of 10-300 Hz and at 100-300 Hz (OPs) and compared to mfERGs of a control group. On average, in patients, the amplitude of N1P1 was slightly lower in the central and nasal response averages. When the three OPs at a latency of 72-89 ms were analyzed in the 53.3 ms base interval recording, the most marked difference in amplitude was observed in the superior nasal response average of the first OP. Here a mean amplitude of 1.3 nV/deg(2) in patients compared to a mean amplitude of 1.9 nV/deg(2) in the control group (P: 0.08).

DISCUSSION

In contrast to our previous findings in NTG, there was a consistent presence of three OPs. Under the stimulus conditions applied, we did not find an influence of dopaminergic amacrine cells on the mfERG in our patients with moderate stages of Parkinsion's. The difficulties in obtaining an adequate signal-to noise ratio due to e.g. muscle artifacts even in Parkinson patients of moderate disease stages render a success of mfERG recording in patients with more advanced stages unlikely. The question of the influence of dopaminergic amacrine cells on the mfERG could possibly be addressed using MPDT in animal research.

Depth perception in cerebellar and basal ganglia disease

There is increasing evidence that the cerebellum and the basal ganglia serve not only a role in motor control but also in visual perception. Patients with Parkinson's disease (PD) as well as patients with cerebellar lesions exhibit impairments of vision that are not fully explained by ocular motor deficits. It is less clear to which extent these visual deficits contribute to an impaired control of visually guided movements. This study examined whether a dysfunction of the cerebellum or the basal ganglia induces impairments in depth perception, which affect action. We employed an illusionary display, the Ames trapezoidal window, to determine the ability of PD patients (n=10) and patients with spinocerebellar ataxia (SCA) (n=6) to process depth cues when estimating object slant. Participants either pointed to the edges of the window (motor judgement) or verbally indicated the perceived orientation of the display (verbal judgement). To control for ocular and limb motor deficits, participants judged the slant of a non-illusionary display in a second task. Slant estimation of the non-illusionary window was not impaired in either patient group when compared to control subjects (all P>0.2). In contrast, SCA as well as PD patients exhibited significantly greater slant estimation errors than controls when pointing to the illusionary window (P=0.005). In addition, both patient groups made larger errors than controls in their verbal judgements during binocular viewing of the illusion (P=0.005), but not during monocular viewing (P>0.2). In sum, the present findings point towards a role for both the basal ganglia and cerebellum for the processing of visual information about depth. Since the deficits were seen both in the context of action and perception and were only partially reconciled by the availability of binocular depth cues, we conclude that basal ganglia as well as cerebellar disease may affect the visual perception of depth.

Inhibitory interaction of cannabinoid CB1 receptor and dopamine D2 receptor agonists on voltage-gated currents of goldfish cones

Dopamine is a light-adaptive signal that desensitizes the retina, while cannabinoids reportedly increase photosensitivity. The presynaptic membrane of goldfish retinal cones has dopamine D2 receptors and cannabinoid CB1 receptors. This work focused on whether dopamine D2 receptor agonist quinpirole and cannabinoid CB1 receptor agonist WIN 55212-2 (WIN) interacted to modulate voltage-dependent membrane currents of cones. A conventional patch-clamp method was used to record depolarization evoked whole-cell outward currents (Iout) and an inward calcium current (ICa) from the inner segment of cones in goldfish retinal slices. WIN had biphasic actions: low concentrations (<1 μM) increased the currentsviaGs, while higher concentrations (>1 μM) decreased the currentsviaGi/Go. Neither dopamine nor the D2 agonist quinpirole (1–20 μM) had a significant effect on eitherIoutorICa. Quinpirole at 50 μM had a mild suppressive (∼20%) effect onIout. However, quinpirole (<10 μM) completely blocked the enhancement of both currents seen with 0.7 μM WIN. The effect of quinpirole was blocked by sulpiride and by pertussis toxin, indicating that quinpirole was actingviaa D2 receptor-Gi/o coupled mechanism. The suppressive action of 50 μM quinpirole (∼20%) was not additive with the suppressive effect of 3 μM WIN (∼40%). D2 agonistsviaGi/o oppose the action of low concentrations of CB1 agonists actingviaGs to modulate cone membrane currents, suggesting a role in shaping the cone light response and/or sensitivity to changes in ambient light conditions. The nonadditive effect of high concentrations of WIN and quinpirole suggests that both decrease membrane currentsviathe same transduction pathway, Gi/Go protein kinase A (PKA).

Dysfunction of the basal ganglia, but not the cerebellum, impairs kinaesthesia

Precise knowledge about limb position and orientation is essential for the ability of the nervous system to plan and control voluntary movement. While it is well established that proprioceptive signals from peripheral receptors are necessary for sensing limb position and motion, it is less clear which supraspinal structures mediate the signals that ultimately lead to the conscious awareness of limb position (kinaesthesia). Recent functional imaging studies have revealed that the cerebellum, but not the basal ganglia, are involved in sensory processing of proprioceptive information induced by passive and active movements. Yet psychophysical studies have suggested a prominent role of the basal ganglia in kinaesthesia. This study addresses this apparent dichotomy by investigating the contributions of the cerebellum and the basal ganglia to the perception of limb position. Using a passive movement task, we examined the elbow position sense in patients with a dysfunction of the basal ganglia (Parkinson's disease, n = 9), patients with cerebellar degeneration [spinocerebellar ataxia (SCA) types 6 and 8, n = 6] and age-matched healthy control subjects (n = 11). In comparison with healthy control subjects, Parkinson's disease patients, but not SCA patients, were significantly impaired in the ability to detect displacements correctly. A 1 degrees forearm displacement was correctly recognized in >75% of trials by control subjects and SCA patients, but only in 55% of Parkinson's disease patients. Only at 6 degrees displacement did Parkinson's disease patients exhibit a response rate similar to those of the two other groups. Thresholds for 75% correct responses were 1.03 degrees for controls, 1.15 degrees for cerebellar patients and 2.10 degrees for Parkinson's disease patients. This kinaesthetic impairment significantly correlated with the severity of disease in Parkinson's disease patients, as determined by the Unified Parkinson's Disease Rating Scale (r = -0.7, P = 0.03) and duration of disease (r = -0.7, P = 0.05). In contrast, there was no significant correlation between performance and the daily levodopa equivalent dose. These results imply that an intact cerebro-basal ganglia loop is essential for awareness of limb position and suggest a selective role of the basal ganglia but not the cerebellum in kinaesthesia.

Coenzyme Q10 supplementation provides mild symptomatic benefit in patients with Parkinson's disease

Features of Parkinson's disease (PD) include oxidative stress, nigral mitochondrial complex I deficiency and visual dysfunction, all of which are also associated with coenzyme Q(10) (CoQ(10)) deficiency. The objective of this monocenter, parallel group, placebo controlled, double-blind trial was to determine the symptomatic response of daily oral application of 360 mg CoQ(10) lasting 4 weeks on scored PD symptoms and visual function, measured with the Farnsworth-Munsell 100 Hue test (FMT), in 28 treated and stable PD patients. CoQ(10) supplementation provided a significant (P=0.01) mild symptomatic benefit on PD symptoms and a significantly (F((1,24))=8.48, P=0.008) better improvement of FMT performance compared with placebo. Our results indicate a moderate beneficial effect of oral CoQ(10) supplementation in PD patients.