Clinical Significance and Pathogenesis of Visual Impairment in Parkinson’s Disease

Abstract

Among non-motor symptoms in patients with Parkinson's disease (PD) have a number of specific visual disturbances. This review describes the main visual problems associated with PD, referring to their basic anatomical aspects and pathophysiological mechanisms. A wide range of visual disorders includes changes in color vision and contrast sensitivity, change in the electrophysiological properties of the retina due to the insufficiency of the retinal dopaminergic system, features of visual field defects, visuospatial and visuoperceptual impairments. The use of modern electrophysiological, neurophysiological, psychophysiological and other research methods makes it possible to comprehensively assess the state of all parts of the visual analyzer from the retina to the higher cortical centers in patients with PD. The article discusses controversial questions about the relationship between changes in color vision, a decrease in the level of contrast sensitivity and severity of motor disorders in Parkinson's disease. Finally, we discuss the advantages of using threshold and blue-yellow perimetry as more sensitive methods in detecting visual field defects in patients with PD. Keywords:

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

“…Perception of color also showed an interesting trend. As noted above, PD is associated to modulated color discrimination (Alenicova, et al, 2017;Birch, Kolle, Kunkel, Paulus, & Upadhyay, 1998;Müller et al, 2002;Oh et al, 2011), and in case studies of art production there is some evidence for increased color emphasis (Kulisevsky et al, 2009;Pinker, 2002), and especially use of 'coolers' blues and greens (Lauring et al, 2019). Interestingly, although we again do not find a general (across all PD patients) change, the ad hoc assessment of art ratings taking into account the HY scoring did suggest a similar potential progressive change toward viewing art as having cooler colors.…”

“…Sensory symptoms include impaired olfaction and vision (Bayulkemand & Lopez, 2011;Chaudhuri, et al, 2006;Sveinbjornsdottir, 2016). Notably, among the latter, researchers suggest blurred or double vision, reduced contrast sensitivity, color discrimination (Alenicova, Likhachev, & Davidova, 2017;Müller, Woitalla, Peters, Kohla, & Przuntek, 2002;Oh et al, 2011), motion detection and perception of space (Davidsdottir, Cronin-Golomb, & Lee, 2005), and selective attention or visual recognition (Bodis-Wollner 2009). These are most often connected to electrophysiological and morphological evidence of disruption of retinal structure and function (e.g., Bodis-Wollner et al, 2014), but may also tie to damaged visual cortices or ventral and dorsal pathways or visual association-related areas in the brain (Archibald, Hutton, Clarke, Mosimann, & Burn, 2009;Bodis-Wollner, 2009;Diederich et al, 2014).…”

“…This could also explain the change to more impressionistic or abstract styles, and increased complexity, which again may not relate to changed taste in art itself. Similarly, changed blue-yellow color discrimination is noted as a common issue with PD (Alenicova, et al, 2017;Birch, Kolle, Kunkel, Paulus, & Upadhyay, 1998;Müller et al, 2002;Oh et al, 2011), perhaps causing artists to ignore certain colors or to overuse them, explaining the more saturated or vibrant use of color, as could reduced contrast sensitivity. On the other hand, the above factors could also tie to more complex changes in other brain regions and altered cognitive and perceptual processes, which might impact viewing.…”

“…Especially blue is often difficult for PD patients to perceive (Alenicova et al, 2017). However, it is rather counterintuitive that individuals with difficulty perceiving blue might not only over-use this color in art making, but perceive others' artworks as overall more blue as well.…”

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

“…Sensory symptoms include deficits in the sense of smell, often very early in the disease, and, later, vision (Bayulkemand and Lopez, 2011;Chaudhuri et al, 2006;Sveinbjornsdottir, 2016), including reduced contrast sensitivity, color discrimination (both red-green and yellow-blue varieties: Alenicova et al, 2017;Oh et al, 2011), motion detection, and difficulties related to perception of space (Davidsdottir et al, 2005), visual recognition (Bodis-Wollner, 2009), and illusions (Diederich et al, 2014). Psychiatric disorders include depression, anxiety, dementia (Bayulkemand, and Lopez, 2011;Connolly and Lang, 2014;Grover et al, 2015), hallucinations (Connolly and Lang, 2014), and impulse control disorders.…”