Chromatic Pupillometry in Isolated Rapid Eye Movement Sleep Behavior Disorder

Morgia, Chiara La; Romagnoli, Martina; Pizza, Fabio; Biscarini, Francesco; Filardi, Marco; Donadio, Vincenzo; Carbonelli, Michele; Amore, Giulia; Park, Jason C; Tinazzi, Michèle; Carelli, Valério; Liguori, Rocco; Plazzi, Giuseppe; Antelmi, Elena

doi:10.1002/mds.28809

Cited by 10 publications

(12 citation statements)

References 19 publications

(49 reference statements)

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“…Our findings are consistent with a recent study by Perkins et al [9] that demonstrated that pupil constriction and dilatation in iRBD patients were significantly decreased compared to controls, but were not different from those in PD patients. A decrease in pupillary constriction amplitude in patients with iRBD was also found in a chromatic pupillometry study [10]. Notably, only iRBD patients with positive skin biopsy for α-synuclein deposits showed significant PLR abnormalities compared to controls, supporting that parasympathetic pathways are affected by the underlying α-synucleinopathy in iRBD.…”

Section: Discussionsupporting

confidence: 54%

“…Of the 7 pupillometric parameters in this study, the only difference was the larger pupil diameter before and after light stimulation (PDmax and PDmin) in the PD patients, than that in the RBD patients. Larger baseline pupil diameters in patients with iRBD and PD compared to controls were reported in a few studies [10,21]. Along with the reduced constriction amplitude and delayed latency, they are considered to reflect parasympathetic dysfunction.…”

Section: Discussionmentioning

confidence: 98%

“…However, there are still few studies on the abnormality of PLR in patients with iRBD. Only two recent studies have reported altered pupil responses in iRBD [9,10]. Therefore, we herein quantitatively analyzed the PLR of iRBD patients using an automated pupillometer, and compared the measurements with those of PD patients.…”

Section: Introductionmentioning

confidence: 99%

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Comparative Analysis of Pupillometry in Idiopathic Rapid Eye Movement Sleep Behavior Disorder and Parkinson’s Disease

2022

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Background and Objective Pupillary light reflex (PLR) abnormalities have been reported in patients with Parkinson’s disease (PD). However, few studies have been conducted on the abnormality of PLR in patients with idiopathic rapid eye movement sleep behavior disorder (iRBD), which is a prodromal stage of α-synucleinopathy. We herein quantitatively analyzed the PLR of iRBD using an automated pupillometer, and compared the results with those of PD.Methods In this cross-sectional study, we prospectively enrolled 27 patients with polysomnography-confirmed iRBD, and 23 patients with PD. Pupillometry was performed three times in each eye, alternating left and right. We compared seven pupillometric parameters between the iRBD and PD patients.Results Maximum and minimum pupil diameters were significantly larger in PD patients than in iRBD patients. However, the other pupillometric parameters, such as mean constriction velocity, maximum constriction velocity, reflex amplitude, latency, and mean dilation velocity, did not differ between the two groups. Among iRBD patients, the pupillometric parameters were not correlated with any clinical characteristics related to autonomic dysfunction or neurodegeneration.Conclusions We found that the pupillary constriction and dilation in response to light of iRBD were not different from those of PD. These findings suggest that autonomic pupillary dysfunction already existed in the prodromal stage of α-synucleinopathy to a degree comparable to that in PD. Larger pupil diameters in PD than in iRBD may reflect the pharmacological effect of dopaminergic medications. Future studies are needed to elucidate the association between the PLR abnormalities and the risk of phenoconversion in iRBD.

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Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 98%

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Comparative Analysis of Pupillometry in Idiopathic Rapid Eye Movement Sleep Behavior Disorder and Parkinson’s Disease

2022

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“…Immunohistochemical analysis of nerve fibers using primary antibodies that simultaneously allow both to unmask the deposits of phosphorylated α-synuclein and to highlight the presence of specific markers of nerve fibers such as the antibody for the pan-neuronal marker. The superposition of both these markers will allow to establish the intraneuronal deposition of phosphorylated α-synuclein deposits; (ii) salivary alpha-synuclein ELISA analysis; (iii) pupillometry obtained through the use of a pupillometer that evaluates the activity of retinal ganglion cells, evaluating the changes in pupil diameter in relation to light stimuli of different intensity, according to the methods previously described [ 20 – 22 ]; optical coherence tomography (OCT), obtained using an instrument (Heidelberg Spectralis) which allows, using reflected light, to reconstruct a three-dimensional image of the thickness of the optic nerve; and (iv) genetic investigation from DNA with a screening panel in which all known gene associated with PD and other synucleinopathies are tested, sampled following a specific protocol.…”

Section: Methodsmentioning

confidence: 99%

Predictive risk factors of phenoconversion in idiopathic REM sleep behavior disorder: the Italian study “FARPRESTO”

Puligheddu

Figorilli²,

Antelmi³

et al. 2022

Neurol Sci

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Most patients with idiopathic REM sleep behavior disorder (iRBD) will develop an overt α-synucleinopathy over time, with a rate of phenoconversion of 73.5% after 12 years from diagnosis. Several markers of phenoconversion were identified; however, most studies investigated biomarkers separately, with retrospective study designs, in small cohorts or without standardized data collection methods. The risk FActoRs PREdictive of phenoconversion in idiopathic REM sleep behavior disorder: the Italian STudy (FARPRESTO) is a multicentric longitudinal retrospective and prospective study with a cohort of incident (prospective recruitment) and prevalent (retrospective recruitment) iRBD patients, whose primary aim is to stratify the risk of phenoconversion, through the systematic collection by means of electronic case report forms of different biomarkers. Secondary aims are to (1) describe the sociodemographic and clinical characteristics of patients with iRBD; (2) collect longitudinal data about the development of α-synucleinopathies; (3) monitor the impact of iRBD on quality of life and sleep quality; (4) assess the correlation between phenoconversion, cognitive performance, and loss of normal muscle atony during REM sleep; (5) identify RBD phenotypes through evaluating clinical, biological, neurophysiological, neuropsychological, and imaging biomarkers; and (6) validate vPSG criteria for RBD diagnosis. The FARPRESTO study will collect a large and harmonized dataset, assessing the role of different biomarkers providing a unique opportunity for a holistic, multidimensional, and personalized approach to iRBD, with several possible application and impact at different levels, from basic to clinical research, and from prevention to management. The FARPRESTO has been registered at clinicaltrials.gov (NCT05262543).

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“…Also, in this study, we used a higher luminance to obtain a cone-driven response than in some previous works (2.4 log cd.m –2 vs. 1 log cd.m –2 ) ( Park et al, 2017 ; Joyce et al, 2018 ; La Morgia et al, 2022 ). However, this luminance is still slightly lower than followed in a protocol previously established by Park et al (2011) , who used 2.6 log cd.m –2 .…”

Section: Discussionmentioning

confidence: 99%

Alterations of color vision and pupillary light responses in age-related macular degeneration

Decleva

Vidal

Kreuz

et al. 2023

Front. Aging Neurosci.

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IntroductionAge-related macular degeneration (AMD) is the leading cause of irreversible central vision loss in developed countries and one of the leading causes of blindness. In this work, we evaluated color vision and the pupil light reflex (PLR) to assess visual function in patients with early and neovascular AMD (NVAMD) compared with the control group.MethodsWe recruited 34 early patients with dry AMD and classified them into two groups following AREDS: 13 patients with NVAMD and 24 healthy controls. Controls and patients with early dry AMD had visual acuity (VA) best or equal to 20/25 (0.098 logMAR). Color vision was assessed in controls and patients with early dry AMD using the Cambridge Color Test (CCT) 2.0 through the Trivector protocol. The PLR was evaluated using a Ganzfeld, controlled by the RETI–port system. The stimuli consisted of 1s blue (470 nm) and red (631 nm) light flashes presented alternately at 2-min intervals. To assess the cone contribution, we used a red flash at 2.4 log cd.m–2, with a blue background at 0.78 log cd.m–2. For rods, we used 470-nm flashes at –3 log cd.m–2, and for the melanopsin function of ipRGCs, we used 470 nm at 2.4 log cd.m–2.ResultsPatients with early dry AMD had reduced color discrimination in all three axes: protan (p = 0.0087), deutan (p = 0.0180), and tritan (p = 0.0095) when compared with the control group. The PLR has also been affected in patients with early dry AMD and patients with NVAMD. The amplitude for the melanopsin-driven response was smaller in patients with early dry AMD (p = 0.0485) and NVAMD (p = 0.0035) than in the control group. The melanopsin function was lower in patients with NVAMD (p = 0.0290) than the control group. For the rod-driven response, the latency was lower in the NVAMD group (p = 0.0041) than in the control group. No changes were found in cone-driven responses between the control and AMD groups.ConclusionPatients with early dry AMD present diffusely acquired color vision alteration detected by CCT. Rods and melanopsin contributions for PLR are affected in NVAMD. The CCT and the PLR may be considered sensitive tests to evaluate and monitor functional changes in patients with AMD.

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Chromatic Pupillometry in Isolated Rapid Eye Movement Sleep Behavior Disorder

Cited by 10 publications

References 19 publications

Comparative Analysis of Pupillometry in Idiopathic Rapid Eye Movement Sleep Behavior Disorder and Parkinson’s Disease

Comparative Analysis of Pupillometry in Idiopathic Rapid Eye Movement Sleep Behavior Disorder and Parkinson’s Disease

Predictive risk factors of phenoconversion in idiopathic REM sleep behavior disorder: the Italian study “FARPRESTO”

Alterations of color vision and pupillary light responses in age-related macular degeneration

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