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ŞtefŞnescu E, Strilciuc Ş, Chelaru VF, Chira D, Mureşanu D. Eye tracking assessment of Parkinson's disease: a clinical retrospective analysis. J Med Life 2024; 17:360-367. [PMID: 39044921 PMCID: PMC11262608 DOI: 10.25122/jml-2024-0270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 05/16/2024] [Indexed: 07/25/2024] Open
Abstract
Parkinson's disease (PD) presents a significant clinical challenge due to its profound motor and cognitive impacts. Early diagnosis is crucial for implementing effective, stage-based treatment strategies. Recently, eye-tracking technology has emerged as a promising tool for the non-invasive diagnosis and monitoring of various neurological disorders, including PD. This retrospective study analyzed eye-tracking parameters, specifically visually-guided saccades (VGS), in PD patients within a clinical setting. We reviewed eye-tracking data from 62 PD patients, focusing on eye movement performance in horizontal and vertical VGS tasks. Our findings revealed significant correlations between demographic profiles, Mini-Mental State Examination (MMSE) scores, pattern recognition, and spatial working memory tests with saccadic performance in PD patients. Despite the retrospective nature of the study, our results support the potential of eye-tracking technology as a valuable diagnostic tool in PD assessment and monitoring. Future research should prioritize longitudinal studies and more comprehensive assessments to further understand and enhance the clinical application of eye-tracking in PD.
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Affiliation(s)
- Emanuel ŞtefŞnescu
- Department of Neuroscience, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - ştefan Strilciuc
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
- Research Center for Functional Genomics, Biomedicine, and Translational Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Vlad-Florin Chelaru
- Department of Neuroscience, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Diana Chira
- Department of Neuroscience, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Dafin Mureşanu
- Department of Neuroscience, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
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Ratan Y, Rajput A, Pareek A, Pareek A, Jain V, Sonia S, Farooqui Z, Kaur R, Singh G. Advancements in Genetic and Biochemical Insights: Unraveling the Etiopathogenesis of Neurodegeneration in Parkinson's Disease. Biomolecules 2024; 14:73. [PMID: 38254673 PMCID: PMC10813470 DOI: 10.3390/biom14010073] [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: 11/21/2023] [Revised: 12/15/2023] [Accepted: 12/28/2023] [Indexed: 01/24/2024] Open
Abstract
Parkinson's disease (PD) is the second most prevalent neurodegenerative movement disorder worldwide, which is primarily characterized by motor impairments. Even though multiple hypotheses have been proposed over the decades that explain the pathogenesis of PD, presently, there are no cures or promising preventive therapies for PD. This could be attributed to the intricate pathophysiology of PD and the poorly understood molecular mechanism. To address these challenges comprehensively, a thorough disease model is imperative for a nuanced understanding of PD's underlying pathogenic mechanisms. This review offers a detailed analysis of the current state of knowledge regarding the molecular mechanisms underlying the pathogenesis of PD, with a particular emphasis on the roles played by gene-based factors in the disease's development and progression. This study includes an extensive discussion of the proteins and mutations of primary genes that are linked to PD, including α-synuclein, GBA1, LRRK2, VPS35, PINK1, DJ-1, and Parkin. Further, this review explores plausible mechanisms for DAergic neural loss, non-motor and non-dopaminergic pathologies, and the risk factors associated with PD. The present study will encourage the related research fields to understand better and analyze the current status of the biochemical mechanisms of PD, which might contribute to the design and development of efficacious and safe treatment strategies for PD in future endeavors.
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Affiliation(s)
- Yashumati Ratan
- Department of Pharmacy, Banasthali Vidyapith, Banasthali 304022, Rajasthan, India; (A.R.); (A.P.); (A.P.)
| | - Aishwarya Rajput
- Department of Pharmacy, Banasthali Vidyapith, Banasthali 304022, Rajasthan, India; (A.R.); (A.P.); (A.P.)
| | - Ashutosh Pareek
- Department of Pharmacy, Banasthali Vidyapith, Banasthali 304022, Rajasthan, India; (A.R.); (A.P.); (A.P.)
| | - Aaushi Pareek
- Department of Pharmacy, Banasthali Vidyapith, Banasthali 304022, Rajasthan, India; (A.R.); (A.P.); (A.P.)
| | - Vivek Jain
- Department of Pharmaceutical Sciences, Mohan Lal Sukhadia University, Udaipur 313001, Rajasthan, India;
| | - Sonia Sonia
- Department of Pharmaceutical Sciences, Guru Nanak Dev University, Amritsar 143005, Punjab, India;
| | - Zeba Farooqui
- Department of Biomedical Engineering, University of Illinois Chicago, Chicago, IL 60607, USA;
| | - Ranjeet Kaur
- Adesh Institute of Dental Sciences and Research, Bathinda 151101, Punjab, India;
| | - Gurjit Singh
- Department of Biomedical Engineering, University of Illinois Chicago, Chicago, IL 60607, USA;
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Shkury E, Danziger-Schragenheim S, Katzir Z, Ezra Y, Giladi N, Mirelman A, Maidan I. Differences in EEG Event-Related Potentials during Dual Task in Parkinson's Disease Carriers and Non-Carriers of the G2019S-LRRK2 Mutation. SENSORS (BASEL, SWITZERLAND) 2023; 23:8266. [PMID: 37837096 PMCID: PMC10575245 DOI: 10.3390/s23198266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/28/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND The G2019S-LRRK2 gene mutation is a common cause of hereditary Parkinson's disease (PD), associated with a higher frequency of the postural instability gait difficulty (PIGD) motor phenotype yet with preserved cognition. This study investigated neurophysiological changes during motor and cognitive tasks in PD patients with and without the G2019S-LRRK2 mutation. METHODS 33 iPD patients and 22 LRRK2-PD patients performed the visual Go/NoGo task (VGNG) during sitting (single-task) and walking (dual-task) while wearing a 64-channel EEG cap. Event-related potentials (ERP) from Fz and Pz, specifically N200 and P300, were extracted and analyzed to quantify brain activity patterns. RESULTS The LRRK2-PD group performed better in the VGNG than the iPD group (group*task; p = 0.05). During Go, the iPD group showed reduced N2 amplitude and prolonged N2 latency during walking, whereas the LRRK2-PD group showed only shorter latency (group*task p = 0.027). During NoGo, opposite patterns emerged; the iPD group showed reduced N2 and increased P3 amplitudes during walking while the LRRK2-PD group demonstrated increased N2 and reduced P3 (N2: group*task, p = 0.010, P3: group*task, p = 0.012). CONCLUSIONS The LRRK2-PD group showed efficient early cognitive processes, reflected by N2, resulting in greater neural synchronization and prominent ERPs. These processes are possibly the underlying mechanisms for the observed better cognitive performance as compared to the iPD group. As such, future applications of intelligent medical sensing should be capable of capturing these electrophysiological patterns in order to enhance motor-cognitive functions.
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Affiliation(s)
- Eden Shkury
- Laboratory of Early Markers of Neurodegeneration, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel; (E.S.); (S.D.-S.); (Z.K.); (Y.E.); (N.G.); (A.M.)
- School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Shani Danziger-Schragenheim
- Laboratory of Early Markers of Neurodegeneration, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel; (E.S.); (S.D.-S.); (Z.K.); (Y.E.); (N.G.); (A.M.)
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Zoya Katzir
- Laboratory of Early Markers of Neurodegeneration, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel; (E.S.); (S.D.-S.); (Z.K.); (Y.E.); (N.G.); (A.M.)
- School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Yael Ezra
- Laboratory of Early Markers of Neurodegeneration, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel; (E.S.); (S.D.-S.); (Z.K.); (Y.E.); (N.G.); (A.M.)
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Nir Giladi
- Laboratory of Early Markers of Neurodegeneration, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel; (E.S.); (S.D.-S.); (Z.K.); (Y.E.); (N.G.); (A.M.)
- School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Anat Mirelman
- Laboratory of Early Markers of Neurodegeneration, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel; (E.S.); (S.D.-S.); (Z.K.); (Y.E.); (N.G.); (A.M.)
- School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Inbal Maidan
- Laboratory of Early Markers of Neurodegeneration, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel; (E.S.); (S.D.-S.); (Z.K.); (Y.E.); (N.G.); (A.M.)
- School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
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Li H, Zhang X, Yang Y, Xie A. Abnormal eye movements in Parkinson's disease: From experimental study to clinical application. Parkinsonism Relat Disord 2023; 115:105791. [PMID: 37537120 DOI: 10.1016/j.parkreldis.2023.105791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 07/24/2023] [Accepted: 07/28/2023] [Indexed: 08/05/2023]
Abstract
Parkinson's disease (PD) is a neurodegenerative disease that integrates a series of motor symptoms and non-motor symptoms, making early recognition challenging. The exploration of biomarkers is urgently required. Abnormal eye movements in PD have been reported to appear in a variety of ways since eye tracking technology was developed, such as decreased saccade amplitude, extended saccade latency, and unique saccade patterns. Non-invasive, objective and simple eye tracking has the potential to provide effective biomarkers for the PD diagnosis, progression and cognitive impairment, as well as ideas for research into the occurrence and treatment strategy of motor symptoms. In this review, we introduced the fundamental eye movement patterns and typical eye movement paradigms (such as fixation, pro-saccade, anti-saccade, smooth tracking, and visual search), summarized the symptoms of various ocular motor abnormalities in PD, and discussed the research implications of oculomotor investigation to the pathogenesis of PD and related motor symptoms, as well as the clinical implications as biomarkers and its inspiration on treatment.
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Affiliation(s)
- Han Li
- Department of Neurology, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China.
| | - Xue Zhang
- Department of Neurology, Affiliated Qingdao Central Hospital of Qingdao University, Qingdao Cancer Hospital, Qingdao, China
| | - Yong Yang
- Department of Neurology, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
| | - Anmu Xie
- Department of Neurology, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China; The Cerebral Vascular Disease Institute, Qingdao University, Qingdao, China.
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Nieto-Escamez F, Obrero-Gaitán E, Cortés-Pérez I. Visual Dysfunction in Parkinson's Disease. Brain Sci 2023; 13:1173. [PMID: 37626529 PMCID: PMC10452537 DOI: 10.3390/brainsci13081173] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/11/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023] Open
Abstract
Non-motor symptoms in Parkinson's disease (PD) include ocular, visuoperceptive, and visuospatial impairments, which can occur as a result of the underlying neurodegenerative process. Ocular impairments can affect various aspects of vision and eye movement. Thus, patients can show dry eyes, blepharospasm, reduced blink rate, saccadic eye movement abnormalities, smooth pursuit deficits, and impaired voluntary and reflexive eye movements. Furthermore, visuoperceptive impairments affect the ability to perceive and recognize visual stimuli accurately, including impaired contrast sensitivity and reduced visual acuity, color discrimination, and object recognition. Visuospatial impairments are also remarkable, including difficulties perceiving and interpreting spatial relationships between objects and difficulties judging distances or navigating through the environment. Moreover, PD patients can present visuospatial attention problems, with difficulties attending to visual stimuli in a spatially organized manner. Moreover, PD patients also show perceptual disturbances affecting their ability to interpret and determine meaning from visual stimuli. And, for instance, visual hallucinations are common in PD patients. Nevertheless, the neurobiological bases of visual-related disorders in PD are complex and not fully understood. This review intends to provide a comprehensive description of visual disturbances in PD, from sensory to perceptual alterations, addressing their neuroanatomical, functional, and neurochemical correlates. Structural changes, particularly in posterior cortical regions, are described, as well as functional alterations, both in cortical and subcortical regions, which are shown in relation to specific neuropsychological results. Similarly, although the involvement of different neurotransmitter systems is controversial, data about neurochemical alterations related to visual impairments are presented, especially dopaminergic, cholinergic, and serotoninergic systems.
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Affiliation(s)
- Francisco Nieto-Escamez
- Department of Psychology, University of Almeria, 04120 Almeria, Spain
- Center for Neuropsychological Assessment and Rehabilitation (CERNEP), 04120 Almeria, Spain
| | - Esteban Obrero-Gaitán
- Department of Health Sciences, University of Jaen, Paraje Las Lagunillas s/n, 23071 Jaen, Spain;
| | - Irene Cortés-Pérez
- Department of Health Sciences, University of Jaen, Paraje Las Lagunillas s/n, 23071 Jaen, Spain;
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6
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Narrative Review Concerning the Clinical Spectrum of Ophthalmological Impairments in Parkinson's Disease. Neurol Int 2023; 15:140-161. [PMID: 36810467 PMCID: PMC9944508 DOI: 10.3390/neurolint15010012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 01/30/2023] Open
Abstract
Ophthalmic non-motor impairments are common in Parkinson's disease patients, from the onset of the neurodegenerative disease and even prior to the development of motor symptoms. This is a very crucial component of the potential for early detection of this disease, even in its earliest stages. Since the ophthalmological disease is extensive and impacts all extraocular and intraocular components of the optical analyzer, a competent assessment of it would be beneficial for the patients. Because the retina is an extension of the nervous system and has the same embryonic genesis as the central nervous system, it is helpful to investigate the retinal changes in Parkinson's disease in order to hypothesize insights that may also be applicable to the brain. As a consequence, the detection of these symptoms and signs may improve the medical evaluation of PD and predict the illness' prognosis. Another valuable aspect of this pathology is the fact that the ophthalmological damage contributes significantly to the decrease in the quality of life of patients with Parkinson's disease. We provide an overview of the most significant ophthalmologic impairments associated with Parkinson's disease. These results certainly constitute a large number of the prevalent visual impairments experienced by PD patients.
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7
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Sosnik R, Danziger-Schragenheim S, Possti D, Fahoum F, Giladi N, Hausdorff JM, Mirelman A, Maidan I. Impaired Inhibitory Control During Walking in Parkinson's Disease Patients: An EEG Study. JOURNAL OF PARKINSONS DISEASE 2021; 12:243-256. [PMID: 34569972 DOI: 10.3233/jpd-212776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The performance on a visual Go/NoGo (VGNG) task during walking has been used to evaluate the effect of gait on response inhibition in young and older adults; however, no work has yet included Parkinson's disease (PD) patients for whom such changes may be even more enhanced. OBJECTIVE In this study, we aimed to explore the effect of gait on automatic and cognitive inhibitory control phases in PD patients and the associated changes in neural activity and compared them with young and older adults. METHODS 30 PD patients, 30 older adults, and 11 young adults performed a visual Go/NoGo task in a sitting position and during walking on a treadmill while their EEG activity and gait were recorded. Brain electrical activity was evaluated by the amplitude, latency, and scalp distribution of N2 and P300 event related potentials. Mix model analysis was used to examine group and condition effects on task performance and brain activity. RESULTS The VGNG accuracy rates in PD patients during walking were lower than in young and older adults (F = 5.619, p = 0.006). For all groups, N2 latency during walking was significantly longer than during sitting (p = 0.013). In addition, P300 latency was significantly longer in PD patients (p < 0.001) and older adults (p = 0.032) during walking compared to sitting and during 'NoGo' trials compared with 'Go' trials. Moreover, the young adults showed the smallest number of electrodes for which a significant differential activation between sit to walk was observed, while PD patients showed the largest with N2 being more strongly manifested in bilateral parietal electrodes during walking and in frontocentral electrodes while seated. CONCLUSION The results show that response inhibition during walking is impaired in older subjects and PD patients and that increased cognitive load during dual-task walking relates to significant change in scalp electrical activity, mainly in parietal and frontocentral channels.
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Affiliation(s)
- Ronen Sosnik
- Faculty of Electrical Engineering, Holon Institute of Technology (H.I.T.), Holon, Israel
| | - Shani Danziger-Schragenheim
- Laboratory of Early Markers of Neurodegeneration (LEMON), Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Possti
- Laboratory of Early Markers of Neurodegeneration (LEMON), Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Israel
| | - Firas Fahoum
- Epilepsy and EEG Unit, Neurological Institute, Tel Aviv Sourasky Medical Center, Israel.,Department of Neurology, Sackler School of Medicine, Tel Aviv University, Israel
| | - Nir Giladi
- Laboratory of Early Markers of Neurodegeneration (LEMON), Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.,Epilepsy and EEG Unit, Neurological Institute, Tel Aviv Sourasky Medical Center, Israel.,Department of Neurology, Sackler School of Medicine, Tel Aviv University, Israel
| | - Jeffrey M Hausdorff
- Laboratory of Early Markers of Neurodegeneration (LEMON), Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Israel.,Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Israel.,Alzheimer's Disease Center and Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Anat Mirelman
- Laboratory of Early Markers of Neurodegeneration (LEMON), Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.,Department of Neurology, Sackler School of Medicine, Tel Aviv University, Israel
| | - Inbal Maidan
- Laboratory of Early Markers of Neurodegeneration (LEMON), Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.,Department of Neurology, Sackler School of Medicine, Tel Aviv University, Israel
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Zangemeister WH, Heesen C, Röhr D, Gold SM. Oculomotor Fatigue and Neuropsychological Assessments mirror Multiple Sclerosis Fatigue. J Eye Mov Res 2020; 13:10.16910/jemr.13.4.6. [PMID: 33828807 PMCID: PMC8006090 DOI: 10.16910/jemr.13.4.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Fatigue is a major complaint in MS. Up to now no objective assessment tools have been established which hampers any treatment approach. Previous work has indicated an association of fatigue with cognitive measures of attention. Oculomotor tests have been established in healthy individuals as a read-out of fatigue, and to some extent in MS patients. Based on these observations we compared two groups of MS patients, one with fatigue (n=28) and one without fatigue (n=21) and a group of healthy subjects (n=15) with a standardised computerised measure of alertness and an oculomotor stress test. Patients with fatigue showed highly significant changes of their saccade dynamics as defined by the Main Sequence and Phase Plane plots: They showed slowing of saccades, the characteristical fatigue double peak, and an asymmetrical phase plane. Oculomotor tests differentiated significantly between fatigue and fatigabiliy in our MS patients. They also showed significantly worse performance in the alertness test as well as in the oculomotor task. Significantly slower reaction times were observed for tonic alertness in 2 series without a cue (p=.025 and p=.037) but not in phasic alertness with a cue (p=.24 and p=.34). Performance was influenced by disability as well as by affective state. We conclude, when controlling for disability and depression, saccadic stress tests and alertness tests could be used as an objective read-out for fatigability and fatigue in MS patients.
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Affiliation(s)
| | | | - Dorit Röhr
- University Medical Center Hamburg-Eppendorf, Germany
| | - Stefan M Gold
- University Medical Center Hamburg-Eppendorf, Germany
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9
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Borm CDJM, Smilowska K, de Vries NM, Bloem BR, Theelen T. How I do it: The Neuro-Ophthalmological Assessment in Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2020; 9:427-435. [PMID: 30958314 PMCID: PMC6597980 DOI: 10.3233/jpd-181523] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Visual disorders like double vision, dry eyes, and visual field deficits are common but frequently missed in Parkinson’s disease. Here, we aim to increase awareness for these visual disorders in Parkinson patients by discussing several common problems that can be easily diagnosed using comprehensive history taking and a basic neuro-ophthalmological examination. We offer practical guidance for the patient interview and physical exam that can facilitate a timelier recognition of visual disorders. Such recognition has immediate therapeutic relevance, because Parkinson patients are strongly dependent on an adequate vision, for example to optimally benefit from visual cueing strategies.
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Affiliation(s)
- Carlijn D J M Borm
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Parkinson Center Nijmegen (ParC) Nijmegen, The Netherlands
| | - Katarzyna Smilowska
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Parkinson Center Nijmegen (ParC) Nijmegen, The Netherlands
| | - Nienke M de Vries
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Parkinson Center Nijmegen (ParC) Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Parkinson Center Nijmegen (ParC) Nijmegen, The Netherlands
| | - Thomas Theelen
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Department of Ophthalmology, Nijmegen, The Netherlands
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10
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Zhang Y, Yan A, Liu B, Wan Y, Zhao Y, Liu Y, Tan J, Song L, Gu Y, Liu Z. Oculomotor Performances Are Associated With Motor and Non-motor Symptoms in Parkinson's Disease. Front Neurol 2018; 9:960. [PMID: 30546341 PMCID: PMC6280559 DOI: 10.3389/fneur.2018.00960] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 10/25/2018] [Indexed: 12/22/2022] Open
Abstract
Background: Parkinson's disease (PD) patients exhibit deficits in oculomotor behavior, yet the results are inconsistent across studies. In addition, how these results are associated with clinical symptoms is unclear, especially in China. Methods: We designed a case-control study in China including 37 PD patients and 39 controls. Clinical manifestations in PD patients were recorded. Oculomotor performance was measured by a video-based eye tracker system. Results: We found that six oculomotor parameters, including fixation stability, saccadic latency, smooth pursuit gain, saccade frequency, viewing range, and saccade frequency during free-viewing context, were significantly different in PD patients and control group. Combining application of these six parameters could improve diagnostic accuracy to over 90%. Moreover, pursuit gain was significantly associated with PD duration, UPDRS III, in PD patients. Saccade latency was significantly associated with PD duration, Berg balance score, RBD score, and Total LEDD in PD patients. Conclusions: PD patients commonly exhibit oculomotor deficits in multiple behavioral contexts, which are associated with both motor and non-motor symptoms. Oculomotor test may provide a valuable tool for the clinical assessment of PD.
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Affiliation(s)
- Yu Zhang
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Aijuan Yan
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bingyu Liu
- Key Laboratory of Primate Neurobiology, CAS Center for Excellence in Brain Science and Intelligence Technology, Institute of Neuroscience, Chinese Academy of Sciences, Shanghai, China
| | - Ying Wan
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuchen Zhao
- Key Laboratory of Primate Neurobiology, CAS Center for Excellence in Brain Science and Intelligence Technology, Institute of Neuroscience, Chinese Academy of Sciences, Shanghai, China
| | - Ying Liu
- Key Laboratory of Primate Neurobiology, CAS Center for Excellence in Brain Science and Intelligence Technology, Institute of Neuroscience, Chinese Academy of Sciences, Shanghai, China
| | - Jiangxiu Tan
- Key Laboratory of Primate Neurobiology, CAS Center for Excellence in Brain Science and Intelligence Technology, Institute of Neuroscience, Chinese Academy of Sciences, Shanghai, China
| | - Lu Song
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yong Gu
- Key Laboratory of Primate Neurobiology, CAS Center for Excellence in Brain Science and Intelligence Technology, Institute of Neuroscience, Chinese Academy of Sciences, Shanghai, China
| | - Zhenguo Liu
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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11
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Effect of subthalamic nucleus deep brain stimulation on visual scanning. Clin Neurophysiol 2018; 129:2421-2432. [DOI: 10.1016/j.clinph.2018.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 07/12/2018] [Accepted: 08/22/2018] [Indexed: 11/19/2022]
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12
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Stuart S, Lord S, Galna B, Rochester L. Saccade frequency response to visual cues during gait in Parkinson's disease: the selective role of attention. Eur J Neurosci 2018; 47:769-778. [PMID: 29431890 DOI: 10.1111/ejn.13864] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 02/05/2018] [Accepted: 02/06/2018] [Indexed: 12/01/2022]
Abstract
Gait impairment is a core feature of Parkinson's disease (PD) with implications for falls risk. Visual cues improve gait in PD, but the underlying mechanisms are unclear. Evidence suggests that attention and vision play an important role; however, the relative contribution from each is unclear. Measurement of visual exploration (specifically saccade frequency) during gait allows for real-time measurement of attention and vision. Understanding how visual cues influence visual exploration may allow inferences of the underlying mechanisms to response which could help to develop effective therapeutics. This study aimed to examine saccade frequency during gait in response to a visual cue in PD and older adults and investigate the roles of attention and vision in visual cue response in PD. A mobile eye-tracker measured saccade frequency during gait in 55 people with PD and 32 age-matched controls. Participants walked in a straight line with and without a visual cue (50 cm transverse lines) presented under single task and dual-task (concurrent digit span recall). Saccade frequency was reduced when walking in PD compared to controls; however, visual cues ameliorated saccadic deficit. Visual cues significantly increased saccade frequency in both PD and controls under both single task and dual-task. Attention rather than visual function was central to saccade frequency and gait response to visual cues in PD. In conclusion, this study highlights the impact of visual cues on visual exploration when walking and the important role of attention in PD. Understanding these complex features will help inform intervention development.
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Affiliation(s)
- Samuel Stuart
- Institute of Neuroscience/Newcastle University Institute of Ageing, Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK.,Department of Neurology, Oregon Health and Science University, Portland, OR, USA
| | - Sue Lord
- Institute of Neuroscience/Newcastle University Institute of Ageing, Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK.,School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Brook Galna
- Institute of Neuroscience/Newcastle University Institute of Ageing, Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK.,School of Biomedical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Lynn Rochester
- Institute of Neuroscience/Newcastle University Institute of Ageing, Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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13
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Forsayeth J, Hadaczek P. Ganglioside Metabolism and Parkinson's Disease. Front Neurosci 2018; 12:45. [PMID: 29459819 PMCID: PMC5807391 DOI: 10.3389/fnins.2018.00045] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 01/18/2018] [Indexed: 12/21/2022] Open
Abstract
Here we advance the hypothesis that Parkinson's disease (PD) is fundamentally a failure of trophic support for specific classes of neurons, primarily catecholaminergic. Evidence from our laboratory provides a framework into which a broad array of findings from many quarters can be integrated into a general theory that offers testable hypotheses to new and established investigators. Mice deficient in the ability to synthesize series-a gangliosides, specifically GM1 ganglioside, develop parkinsonism. We found that this seems to be due to a failure in signaling efficiency by the important catecholaminergic growth factor, GDNF. Interestingly, these mice accumulate alpha-synuclein in nigral neurons. Striatal over-expression of GDNF eliminates these aggregates and also restores normal motor function. These findings bring into question common beliefs about alpha-synuclein pathology and may help us to reinterpret other experimental findings in a new light. The purpose of this article is to provoke new thinking about PD and hopefully encourage younger scientists to explore some of the ideas presented below.
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Affiliation(s)
- John Forsayeth
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Piotr Hadaczek
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
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14
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Stuart S, Galna B, Delicato LS, Lord S, Rochester L. Direct and indirect effects of attention and visual function on gait impairment in Parkinson's disease: influence of task and turning. Eur J Neurosci 2017; 46:1703-1716. [PMID: 28444834 DOI: 10.1111/ejn.13589] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 04/11/2017] [Accepted: 04/12/2017] [Indexed: 12/26/2022]
Abstract
Gait impairment is a core feature of Parkinson's disease (PD) which has been linked to cognitive and visual deficits, but interactions between these features are poorly understood. Monitoring saccades allows investigation of real-time cognitive and visual processes and their impact on gait when walking. This study explored: (i) saccade frequency when walking under different attentional manipulations of turning and dual-task; and (ii) direct and indirect relationships between saccades, gait impairment, vision and attention. Saccade frequency (number of fast eye movements per-second) was measured during gait in 60 PD and 40 age-matched control participants using a mobile eye-tracker. Saccade frequency was significantly reduced in PD compared to controls during all conditions. However, saccade frequency increased with a turn and decreased under dual-task for both groups. Poorer attention directly related to saccade frequency, visual function and gait impairment in PD, but not controls. Saccade frequency did not directly relate to gait in PD, but did in controls. Instead, saccade frequency and visual function deficit indirectly impacted gait impairment in PD, which was underpinned by their relationship with attention. In conclusion, our results suggest a vital role for attention with direct and indirect influences on gait impairment in PD. Attention directly impacted saccade frequency, visual function and gait impairment in PD, with connotations for falls. It also underpinned indirect impact of visual and saccadic impairment on gait. Attention therefore represents a key therapeutic target that should be considered in future research.
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Affiliation(s)
- Samuel Stuart
- Clinical Ageing Research Unit, Institute of Neuroscience, Newcastle University Institute of Ageing, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.,Newcastle upon Tyne Hospitals NHS foundation trust, Newcastle upon Tyne, UK
| | - Brook Galna
- Clinical Ageing Research Unit, Institute of Neuroscience, Newcastle University Institute of Ageing, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Louise S Delicato
- Clinical Ageing Research Unit, Institute of Neuroscience, Newcastle University Institute of Ageing, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.,School of Psychology, University of Sunderland, Sunderland, UK
| | - Sue Lord
- Clinical Ageing Research Unit, Institute of Neuroscience, Newcastle University Institute of Ageing, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Lynn Rochester
- Clinical Ageing Research Unit, Institute of Neuroscience, Newcastle University Institute of Ageing, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.,Newcastle upon Tyne Hospitals NHS foundation trust, Newcastle upon Tyne, UK
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15
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Stuart S, Lord S, Hill E, Rochester L. Gait in Parkinson's disease: A visuo-cognitive challenge. Neurosci Biobehav Rev 2016; 62:76-88. [PMID: 26773722 DOI: 10.1016/j.neubiorev.2016.01.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 12/15/2015] [Accepted: 01/05/2016] [Indexed: 12/18/2022]
Abstract
Vision and cognition have both been related to gait impairment in Parkinson's disease (PD) through separate strands of research. The cumulative and interactive effect of both (which we term visuo-cognition) has not been previously investigated and little is known about the influence of cognition on vision with respect to gait. Understanding the role of vision, cognition and visuo-cognition in gait in PD is critical for data interpretation and to infer and test underlying mechanisms. The purpose of this comprehensive narrative review was to examine the interdependent and interactive role of cognition and vision in gait in PD and older adults. Evidence from a broad range of research disciplines was reviewed and summarised. A key finding was that attention appears to play a pivotal role in mediating gait, cognition and vision, and should be considered emphatically in future research in this field.
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Affiliation(s)
- Samuel Stuart
- Institute of Neuroscience/Newcastle University Institute of Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Sue Lord
- Institute of Neuroscience/Newcastle University Institute of Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Elizabeth Hill
- Institute of Neuroscience/Newcastle University Institute of Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Lynn Rochester
- Institute of Neuroscience/Newcastle University Institute of Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality Newcastle University, Newcastle upon Tyne, United Kingdom.
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