Impaired oculomotor function in a community-based patient population with newly diagnosed idiopathic parkinsonism

Abstract

The differential diagnosis of idiopathic parkinsonism can be very challenging, especially early in the course of the disease. Oculomotor function has been reported to differ between the diseases constituting idiopathic parkinsonism. A detailed examination of the oculomotor functions could thus possibly be useful in the early differential diagnostic procedure. Oculomotor function could also differ between subgroups of patients with Parkinson's disease (PD). We examined the oculomotor function in a population-based incidence cohort with newly diagnosed idiopathic parkinsonism and 38 controls. We examined 135 patients with parkinsonism 105 PD, 11 progressive supranuclear palsy (PSP), and 19 multiple system atrophy with predominant parkinsonism (MSA-P)] within 3 months of their first visit to our clinic and before initiation of dopaminergic medication. The oculomotor measurements were repeated after 12 months. The clinical diagnosis was that of the latest clinical follow-up (median follow-up was 3 years). All patients were examined with (123)I-N-(omega)-fluoropropyl-2-β-carbomethoxy-3-β-(4-iodophenyl) nortropane single-photon emission computed tomography (FP-CIT SPECT), and only patients with pathological uptake of the ligand were included. Pathological changes in the oculomotor function were found in all patient groups compared to controls at the baseline examination. In PD, there were correlations between total axial motor scores and vertical saccade velocity and precision, horizontal saccade velocity and precision, and smooth pursuit gain at 20 and 30°/s. Oculomotor test results could not separate the different forms of idiopathic parkinsonism in the early phase from each other. Few changes in the oculomotor functions were observed between the baseline and the 12-month follow-up examinations. No correlations were found between the oculomotor measurements and disease severity or duration.

Different decision deficits impair response inhibition in progressive supranuclear palsy and Parkinson’s disease

“…In patients with Parkinson’s disease, pro-saccades may have longer latency to controls ( Michell et al , 2006 ) or normal ( Chan et al , 2005 ; van Koningsbruggen et al , 2009), and reflective saccades may be faster ( Briand et al , 2001 ). Horizontal saccadic latency in PSP has been reported to be either slower than controls ( Linder et al , 2012 ; Ghosh et al , 2013 ) or normal, at least at the group level ( Pierrot-Deseilligny et al , 1989 ; Vidailhet et al , 1994 ). By using the full distribution of response latencies and accuracy, the model-based approach instead provides clear evidence of abnormality in both PSP and Parkinson’s disease.…”

Metabolite and Peptide Levels in Plasma and CSF Differentiating Healthy Controls from Patients with Newly Diagnosed Parkinson’s Disease

“…The NYPUM (New Parkinsonism in Umeå) project was initiated at the University Hospital of Northern Sweden in Umeå, Sweden to examine fluid biomarkers in conjunction with detailed clinical characterization and neuroimaging [11]. The collection includes CSF and plasma taken at multiple time-points during the course of disease using strictly standardized procedures to minimize the risk of pre-analytical variation influencing the data.…”

Eye Movement Abnormalities in Neurodegenerative Diseases

“…Oculomotor findings of patients suffering from other parkinsonian disorders are varied and usually distinctive to the PD. In cases with multisystem atrophy with predominant Parkinsonism (MSA-P), the clinical assessments of oculomotor function usually reveal increased square wave jerks, saccade hypometria, as well as abnormal smooth pursuit and vestibulo-ocular reflex [29,30]. Less common oculomotor features in MSA-P include downbeat nystagmus, head-shaking nystagmus, and mild vertical supranuclear gaze palsy [29,31].…”