Smooth-pursuit eye movements: alterations in Alzheimer's disease

Zaccara, Gaetano; Gangemi, P.F.; Muscas, Giovanni; Paganini, Marco; Pallanti, Stefano; Parigi, A.; Messori, Andrea; Arnetoli, G.

doi:10.1016/0022-510x(92)90136-9

Cited by 46 publications

(24 citation statements)

References 23 publications

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“…This is consistent with previous studies of smooth pursuit in typical Alzheimer's disease (Fletcher and Sharpe, 1988;Zaccara et al, 1992;Garbutt et al, 2008). The trace showing impaired smooth pursuit in PCA in Fig.…”

Section: Pursuit Functionsupporting

confidence: 92%

Abnormalities of Fixation, Saccade and Pursuit in Posterior Cortical Atrophy

Shakespeare¹,

Kaski²,

Yong³

et al. 2015

J Neurol Neurosurg Psychiatry

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See Antoniades and Kennard (doi:10.1093/brain/awv124) for a scientific commentary on this article.The clinico-neuroradiological syndrome posterior cortical atrophy is the cardinal 'visual dementia' and most common atypical Alzheimer's disease phenotype, offering insights into mechanisms underlying clinical heterogeneity, pathological propagation and basic visual phenomena (e.g. visual crowding). Given the extensive attention paid to patients' (higher order) perceptual function, it is surprising that there have been no systematic analyses of basic oculomotor function in this population. Here 20 patients with posterior cortical atrophy, 17 patients with typical Alzheimer's disease and 22 healthy controls completed tests of fixation, saccade (including fixation/target gap and overlap conditions) and smooth pursuit eye movements using an infrared pupil-tracking system. Participants underwent detailed neuropsychological and neurological examinations, with a proportion also undertaking brain imaging and analysis of molecular pathology. In contrast to informal clinical evaluations of oculomotor dysfunction frequency (previous studies: 38%, current clinical examination: 33%), detailed eyetracking investigations revealed eye movement abnormalities in 80% of patients with posterior cortical atrophy (compared to 17% typical Alzheimer's disease, 5% controls). The greatest differences between posterior cortical atrophy and typical Alzheimer's disease were seen in saccadic performance. Patients with posterior cortical atrophy made significantly shorter saccades especially for distant targets. They also exhibited a significant exacerbation of the normal gap/overlap effect, consistent with 'sticky fixation'. Time to reach saccadic targets was significantly associated with parietal and occipital cortical thickness measures. On fixation stability tasks, patients with typical Alzheimer's disease showed more square wave jerks whose frequency was associated with lower cerebellar grey matter volume, while patients with posterior cortical atrophy showed large saccadic intrusions whose frequency correlated significantly with generalized reductions in cortical thickness. Patients with both posterior cortical atrophy and typical Alzheimer's disease showed lower gain in smooth pursuit compared to controls. The current study establishes that eye movement abnormalities are near-ubiquitous in posterior cortical atrophy, and highlights multiple aspects of saccadic performance which distinguish posterior cortical atrophy from typical Alzheimer's disease. We suggest the posterior cortical atrophy oculomotor profile (e.g. exacerbation of the saccadic gap/overlap effect, preserved saccadic velocity) reflects weak input from degraded occipito-parietal spatial representations of stimulus location into a superior collicular spatial map for eye movement regulation. This may indicate greater impairment of identification of oculomotor targets rather than generation of oculomotor movements. The results highlight the critical role of spatial attention an...

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Section: Pursuit Functionsupporting

confidence: 92%

Abnormalities of Fixation, Saccade and Pursuit in Posterior Cortical Atrophy

Shakespeare¹,

Kaski²,

Yong³

et al. 2015

J Neurol Neurosurg Psychiatry

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“…Also Zaccara et al [9] and Fletcher and Sharpe [10] have described Alzheimer patients to have a significantly lower peak velocity of smooth pursuit at different target velocities for several frequencies of sinusoidal as well as triangular target motions.…”

Section: Discussionmentioning

confidence: 99%

Eye Movement Dysfunction in Dementia of the Alzheimer Type

Möser

Kömpf

Olschinka³

1995

Dement Geriatr Cogn Disord

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Patients with dementia of the Alzheimer type (DAT) are described to have disturbances in basic visual, complex visual and oculomotor functions. In order to study and quantify dysfunction of eye movements under several paradigms, they were measured with infrared photoelectric techniques and analyzed by a digital Computer. The study included 12 normal subjects and 10 patients with mild to moderate DAT (DSM-III-R criteria). The authors'' results could demonstrate both an attentional deficit to externally triggered, unpredictable targets and an impaired systematic, voluntary, internally organized scanning of the environment due to motivational and perceptional deficits.

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“…Reductions in pupillary responses have been reported, but the effect is highly variable and it is difficult to distinguish between patients with AD and patients with Parkinsonism or vascular dementia. Ability to fixate, saccades and pursuit movements are affected in patients with AD (Sadun et al 1987;Fletcher & Sharpe 1988;Zaccara et al 1992). These when combined with a high degree of clinical suspicion and retinal findings could be very sensitive in the diagnosis of Alzheimer's disease.…”

Section: Combining Clinical and Retinal Imaging Biomarkersmentioning

confidence: 99%

Can the retina be used to diagnose and plot the progression of Alzheimer's disease?

Mahajan

Votruba

2017

Acta Ophthalmologica

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Alzheimer's disease (AD) is a neurodegenerative disease and the most common cause of senile dementia. It impairs the quality of life of a person and their family, posing a serious economic and social threat in developed countries. The fact that the diagnosis can only be definitively made post‐mortem, or when the disease is fairly advanced, presents a serious problem if novel therapeutic interventions are to be devised and used early in the course of the disease. There is therefore a pressing need for more sensitive and specific diagnostic tests with which we can detect AD in the preclinical stage. The tau proteins and beta‐amyloid proteins start to accumulate 20 years before the symptoms begin to manifest. Detecting them in the preclinical stage would be a potential breakthrough in the management of AD. A high degree of clinical suspicion is needed to correlate problems in cognition with the changes in the eye, particularly the retina, pupil and ocular movements, so that the disease can be detected early and managed in the prodromal phase. In this systematic review, we ask the question whether the retina can be used to make a specific and early diagnosis of AD.

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Smooth-pursuit eye movements: alterations in Alzheimer's disease

Cited by 46 publications

References 23 publications

Abnormalities of Fixation, Saccade and Pursuit in Posterior Cortical Atrophy

Abnormalities of Fixation, Saccade and Pursuit in Posterior Cortical Atrophy

Eye Movement Dysfunction in Dementia of the Alzheimer Type

Can the retina be used to diagnose and plot the progression of Alzheimer's disease?

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