Fixation Duration and Pupil Size as Diagnostic Tools in Parkinson’s Disease

Tsitsi, Panagiota; Benfatto, Mattias Nilsson; Seimyr, Gustaf Öqvist; Larsson, Olof; Svenningsson, Per; Markaki, Ioanna

doi:10.3233/jpd-202427

Cited by 26 publications

(15 citation statements)

References 24 publications

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“…Recently, pupillometry has been widely used to assess ANS activity, cognitive impairments, and psychological disorders, and it has been found to have high sensitivity and reproducibility. 13 – 16 It is known that a short light stimulus evokes a miotic response, which is predominantly mediated by parasympathetic nerves. The amplitude of the pupillary light reflex has been found to be reduced in patients with generalized anxiety disorder, 23 , 24 thus indicating inhibition of the PNS.…”

Section: Discussionmentioning

confidence: 99%

“…The pupillary response can therefore provide a sensitive, inexpensive, and noninvasive measure that reflects the ANS pathways. The response has been utilized to assess diseases, such as Parkinson's disease, 13 Alzheimer's disease, 14 schizophrenia 15 , and depression. 16 It has also been measured during various cognitive tasks, because the increase in pupil size represents a psychophysiological index that reflects autonomic activation, which is influenced by levels of motivation, cognitive demands, and task-related effort.…”

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confidence: 99%

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Pupillary Responses Reveal Autonomic Regulation Impairments in Patients With Central Serous Chorioretinopathy

Xiao-yin

Fukuyama

Okita

et al. 2022

Invest. Ophthalmol. Vis. Sci.

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Purpose This study assessed the autonomic nervous system in patients with central serous chorioretinopathy (CSC) by simultaneously measuring pupillary responses and heart rate variability (HRV). Methods We recruited 33 patients with CSC and 26 age- and sex-matched healthy controls. Using a pupillometry and acceleration plethysmography system, we measured the participants’ pupillary light reflex and HRV simultaneously, and compared the following parameters between the two groups: the pupil diameters, diameter changes, and time and frequency domain HRV indices (high frequency power: HF; low frequency power: LF; log LF/HF ratio). Additional data from the Profile of Mood States (POMS) and pupillary responses during mental tasks were also analyzed. Results The CSC group had a significantly lower constriction amplitude and a higher re-dilation ratio compared with the control group, indicating parasympathetic inhibition and sympathetic activation. For the HRV measures, the CSC group demonstrated significantly lower HF and higher LF and log LF/HF ratio, indicative of higher sympathetic activity. The CSC group also showed significantly larger pupil dilation during tasks of moderate difficulty, and higher negative/lower positive POMS mood scores. Further analyses also revealed that the baseline pupil diameter was significantly larger in patients with active as opposed to chronic CSC. Conclusions Pupillary responses and HRV measures both revealed sympathetic activation and parasympathetic attenuation in patients with CSC. Larger pupil dilation during mental tasks in CSC could be a potential marker of psychophysiological stress.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Pupillary Responses Reveal Autonomic Regulation Impairments in Patients With Central Serous Chorioretinopathy

Xiao-yin

Fukuyama

Okita

et al. 2022

Invest. Ophthalmol. Vis. Sci.

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“…Tsitsi et al [ 35 ] evaluated gaze constancy and pupil size in steady light surroundings, as well as eye movements (EMs) during constant fixation in a group of 50 Parkinson’s disease subjects (66% males) with unilateral to mild symptoms (Hoehn and Yahr 1–3; Schwab and England 70–90%) and 43 control subjects (37% males) with an eye tracker (1200 Hz) and logistic regression analysis. They examined the potency of the relationship of EM measures with the ROC curve results of 0.817, 95% CI: 0.732–0.901, and concluded that eye-tracking-established amounts of gaze fixation and pupil reaction might be valuable biomarkers of Parkinson’s disease indications.…”

Section: Eye Movements and Neurodegenerative Diseasesmentioning

confidence: 99%

Machine Learning and Eye Movements Give Insights into Neurodegenerative Disease Mechanisms

Przybyszewski

Śledzianowski

Chudzik

et al. 2023

Sensors

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Humans are a vision-dominated species; what we perceive depends on where we look. Therefore, eye movements (EMs) are essential to our interactions with the environment, and experimental findings show EMs are affected in neurodegenerative disorders (ND). This could be a reason for some cognitive and movement disorders in ND. Therefore, we aim to establish whether changes in EM-evoked responses can tell us about the progression of ND, such as Alzheimer’s (AD) and Parkinson’s diseases (PD), in different stages. In the present review, we have analyzed the results of psychological, neurological, and EM (saccades, antisaccades, pursuit) tests to predict disease progression with machine learning (ML) methods. Thanks to ML algorithms, from the high-dimensional parameter space, we were able to find significant EM changes related to ND symptoms that gave us insights into ND mechanisms. The predictive algorithms described use various approaches, including granular computing, Naive Bayes, Decision Trees/Tables, logistic regression, C-/Linear SVC, KNC, and Random Forest. We demonstrated that EM is a robust biomarker for assessing symptom progression in PD and AD. There are navigation problems in 3D space in both diseases. Consequently, we investigated EM experiments in the virtual space and how they may help find neurodegeneration-related brain changes, e.g., related to place or/and orientation problems. In conclusion, EM parameters with clinical symptoms are powerful precision instruments that, in addition to their potential for predictions of ND progression with the help of ML, could be used to indicate the different preclinical stages of both diseases.

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“…The recorded data were filtered through the Tobii I-VT algorithm available in the analysis software Tobii Pro Lab (Tobii Technology K.K., Tokyo, Japan) (Tobii, 2022), with reference to a previous study (Tsitsi et al, 2021). The I-VT filter calculates whether a sequence of gaze sample belongs to the same fixation or is part of a saccade, using a velocity criterion.…”

Section: Eye Tracking and Visual Stimuli Presentationmentioning

confidence: 99%

Gaze instability after exposure to moving visual stimuli in patients with persistent postural-perceptual dizziness

Yagi

Morita²,

Yamagishi³

et al. 2022

Front. Hum. Neurosci.

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IntroductionPersistent postural-perceptual dizziness (PPPD) is a chronic vestibular syndrome lasting more than 3 months. The core vestibular symptoms are dizziness, unsteadiness, and non-spinning vertigo, which are exacerbated by upright posture or walking, active or passive motion, and exposure to moving or complex visual stimuli. Among these, visual exacerbation is a key feature of PPPD for which the neural mechanisms are unknown. We hypothesized that vestibular symptoms may be exacerbated by visual stimuli through gaze behavioral change after exposure to moving or complex visual stimuli. The study aimed to examine gaze stability after exposure to moving visual stimuli in patients with PPPD.MethodsFourteen healthy controls (HCs), 27 patients with PPPD, and 12 patients with unilateral vestibular hypofunction (UVH), showing chronic vestibular symptoms for >3 months, were enrolled in the study. The participants were instructed to fixate on the gazing point at the center of a screen for 30 s before and after 90 s of exposure to moving visual stimuli. Gaze stability, best represented by the bivariate contour ellipse area (BCEA), was compared among three groups, both before and after exposure to the moving visual stimuli. Comparisons between pre- and post-moving visual stimuli in BCEA were also conducted. Correlation between the post/pre ratio of BCEA and vestibular tests, several clinical symptom scales including the Dizziness Handicap Inventory, Niigata PPPD Questionnaire, and Hospital Anxiety and Depression Scale, and the exacerbation of dizziness by exposure to moving visual stimuli was examined in the PPPD group.ResultsBCEA, both before and after exposure to moving visual stimuli in the PPPD group, was not different from that in HC and UVH groups. In the PPPD group, BCEA increased significantly after exposure to moving visual stimuli. The post/pre ratio of BCEA correlated with the occurrence of exacerbation of the dizziness sensation by exposure to moving visual stimuli; however, it did not correlate with vestibular tests or clinical symptom scales.ConclusionPatients with PPPD were more likely to exhibit gaze instability after exposure to moving visual stimuli, which potentially exacerbated vestibular symptoms. This phenomenon may help elucidate the neural mechanisms of visual exacerbation in patients with PPPD.

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Fixation Duration and Pupil Size as Diagnostic Tools in Parkinson’s Disease

Cited by 26 publications

References 24 publications

Pupillary Responses Reveal Autonomic Regulation Impairments in Patients With Central Serous Chorioretinopathy

Pupillary Responses Reveal Autonomic Regulation Impairments in Patients With Central Serous Chorioretinopathy

Machine Learning and Eye Movements Give Insights into Neurodegenerative Disease Mechanisms

Gaze instability after exposure to moving visual stimuli in patients with persistent postural-perceptual dizziness

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