Reading Difficulties in Parkinson’s Disease: A Stepped Care Model for Neurovisual Rehabilitation

Abstract

Background: People with Parkinson’s disease (PD) frequently experience reading difficulties. Little is known about what functional impairments distinguish people with PD with and without reading difficulties and how these should guide rehabilitation. Objective: To provide concrete advice for an efficient stepped care model for reading difficulties in PD, based on extensive functional assessments. Methods: This study included 74 people with PD in a neurovisual rehabilitation setting who underwent assessment of visual, visuoperceptual, and cognitive functions. Outcomes were compared between those with frequent (RD+; N = 55) and infrequent reading difficulties (RD–; N = 19). Aids and advice provided during rehabilitation were registered. Results: Only a few functions appeared to distinguish RD+ and RD–. Visual functions (i.e., contrast sensitivity, g = 0.76; reading acuity, g = 0.66; visual acuity, g = 0.54) and visuoperceptual functions (i.e., visual attention, g = 0.58, visual motor speed, g = 0.56) showed significant worse scores in RD+ compared to RD–. Aids and advice applied consisted mainly of optimizing refraction, improving lighting, and optimizing text size and spacing. Conclusion: The test battery showed significant differences between RD+ and RD–on only a few tests on visual and visuoperceptual functions. The applied aids and advice matched well with these impairments. Therefore, we recommend a stepped care model, starting with a short test battery on these functions. If this battery indicates functional impairments, this can be followed by standard aids and advice to improve reading. Only in case of insufficient effect additional testing should take place.