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Li H, Ma W, Li C, He Q, Zhou Y, Xie A. Combined diagnosis for Parkinson's disease via gait and eye movement disorders. Parkinsonism Relat Disord 2024; 123:106979. [PMID: 38669851 DOI: 10.1016/j.parkreldis.2024.106979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/14/2024] [Accepted: 04/21/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND AND OBJECTIVES With the discovery of the potential role of gait and eye movement disorders in Parkinson's disease (PD) recognition, we intend to investigate the combined diagnostic value of gait and eye movement disorders for PD. METHODS We enrolled some Chinese PD patients and healthy controls and separated them into the training and validation sets based on enrollment time. Performance in five oculomotor paradigms and in one gait paradigm was examined using an infrared eye tracking device and a wearable gait analysis device. We developed and validated a combined model for PD diagnosis via multivariate stepwise logistic regression analysis. Furthermore, subgroup comparisons and multi-model comparison were performed to assess its applicability and advantages. RESULTS A total of 145 PD patients and 80 healthy controls in China were recruited. The pro-saccade velocity, the trunk-sway max, and the turn mean angular velocity were finally screened out for the model development. Incorporating age factor, the ternary model demonstrated more satisfactory performance on ROC (AUC of 0.953 in the training set and AUC of 0.972 in the validation set), calibration curve, and decision curve. A nomogram was drawn to visualize the model. The combined model outperforms individual models with a broad application and the unique diagnostic value for early detection of PD patients, especially TD-PD patients. CONCLUSION We demonstrated the presence of gait and eye movement disorders, as well as the feasibility, applicability, and superiority of employing them together to diagnose PD.
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Affiliation(s)
- Han Li
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China.
| | - Wenqi Ma
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China.
| | - Chengqian Li
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China; Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Qiqing He
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China.
| | - Yuting Zhou
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China.
| | - Anmu Xie
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China; Institute of Cerebrovascular Diseases, The Affiliated Hospital of Qingdao University, Qingdao, China.
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Smith ES, Crawford TJ. The inhibitory effect of a recent distractor: singleton vs. multiple distractors. Exp Brain Res 2024:10.1007/s00221-024-06846-3. [PMID: 38819649 DOI: 10.1007/s00221-024-06846-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 05/03/2024] [Indexed: 06/01/2024]
Abstract
In the complex interplay between sensory and cognitive processes, the brain must sift through a flood of sensory data to pinpoint relevant signals. This selective mechanism is crucial for the effective control of behaviour, by allowing organisms to focus on important tasks and blocking out distractions. The Inhibition of a Recent Distractor (IRD) Task examines this selection process by exploring how inhibiting distractors influences subsequent eye movements towards an object in the visual environment. In a series of experiments, research by Crawford et al. (2005a) demonstrated a delayed response to a target appearing at the location that was previously occupied by a distractor, demonstrating a legacy inhibition exerted by the distractor on the spatial location of the upcoming target. This study aimed to replicate this effect and to investigate any potential constraints when multiple distractors are presented. Exploring whether the effect is observed in more ecologically relevant scenarios with multiple distractors is crucial for assessing the extent to which it can be applied to a broader range of environments. Experiment 1 successfully replicated the effect, showing a significant IRD effect only with a single distractor. Experiments 2-5 explored a number of possible explanations for this phenomenon.
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Affiliation(s)
- Eleanor S Smith
- Centre for Ageing Research, Department of Psychology, Lancaster University, Lancaster, LA1 4YF, England
| | - Trevor J Crawford
- Centre for Ageing Research, Department of Psychology, Lancaster University, Lancaster, LA1 4YF, England.
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3
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Gui M, Lv L, Qin L, Wang C. Vestibular dysfunction in Parkinson's disease: a neglected topic. Front Neurol 2024; 15:1398764. [PMID: 38846039 PMCID: PMC11153727 DOI: 10.3389/fneur.2024.1398764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/14/2024] [Indexed: 06/09/2024] Open
Abstract
Dizziness and postural instability are frequently observed symptoms in patient with Parkinson's disease (PD), potentially linked to vestibular dysfunction. Despite their significant impact on quality of life, these symptoms are often overlooked and undertreated in clinical practice. This review aims to summarize symptoms associated with vestibular dysfunction in patients with PD and discusses vestibular-targeted therapies for managing non-specific dizziness and related symptoms. We conducted searches in PubMed and Web of Science using keywords related to vestibular dysfunction, Parkinson's disease, dizziness, and postural instability, alongside the reference lists of relevant articles. The available evidence suggests the prevalence of vestibular dysfunction-related symptoms in patients with PD and supports the idea that vestibular-targeted therapies may be effective in improving PD symptoms.
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Affiliation(s)
- Meilin Gui
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Lingling Lv
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Lixia Qin
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
- China National Clinical Research Center on Mental Disorders, Changsha, China
| | - Chunyu Wang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
- Department of Medical Genetics, The Second Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China
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4
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Ekin M, Akdal G, Bora E. Antisaccade error rates in first-episode psychosis, ultra-high risk for psychosis and unaffected relatives of schizophrenia: A systematic review and meta-analysis. Schizophr Res 2024; 266:41-49. [PMID: 38367611 DOI: 10.1016/j.schres.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 05/05/2023] [Accepted: 02/13/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Antisaccade, which is described as looking at the opposite location of the target, is an eye movements paradigm used for assessing cognitive functions in schizophrenia. Initiation and sustainment of saccades in antisaccade are managed by frontal and parietal cortical areas. Antisaccade abnormalities are well-established findings in schizophrenia. However, studies in the early phases of psychotic disorders and clinical/familial risk for psychosis reported inconsistent findings. The current systematic review aimed to review the results of studies investigating antisaccade error rates in first-episode psychosis (FEP), individuals with ultra-high-risk for psychosis (UHRP), and familial-high-risk for psychosis (FHRP) compared to healthy controls. METHOD A meta-analysis of 17 studies was conducted to quantitatively review antisaccade errors in FEP, UHR-P and FHRP. The error rate (Hedges'g) was compared between the total of 860 FEP, UHRP, FHRP, and 817 healthy controls. Hedges' g for effect size, I2 for estimating the percentage of variability, and publication bias were evaluated through the R software. RESULTS The outcomes of this meta-analysis suggested that FEP is associated with a robust deficit in the antisaccade error rate (g = 1.16, CI = 0.95-1.38). Additionally, both the clinical and familial high-risk groups showed small but significant increases in AS errors (g = 0.26, CI = 0.02-0.52 and g = 0.34, CI = 0.13-0.55, respectively). CONCLUSION The large effect size estimated for FEP was compatible with previously reported results in chronic schizophrenia patients. Additionally, relatives had abnormalities with small to medium effect sizes and significant differences. The current findings suggest that antisaccade errors might be a potential endophenotype for psychotic disorders.
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Affiliation(s)
- Merve Ekin
- Department of Neurosciences, Institute of Health Sciences, Dokuz Eylül University, Izmir, Turkey; Institude of Psychology, SWPS University, Warsaw, Poland.
| | - Gülden Akdal
- Department of Neurosciences, Institute of Health Sciences, Dokuz Eylül University, Izmir, Turkey; Department of Neurology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey.
| | - Emre Bora
- Department of Neurosciences, Institute of Health Sciences, Dokuz Eylül University, Izmir, Turkey; Department of Psychiatry, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey; Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Victoria, Australia.
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5
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Lage C, Sánchez-Rodríguez A, Rivera-Sánchez M, Sierra M, González-Aramburu I, Madera J, Delgado-Alvarado M, López-García S, Martínez-Dubarbie F, Fernández-Matarrubia M, Martínez-Amador N, Martínez-Rodríguez I, Calvo-Córdoba A, Rodríguez-Rodríguez E, García-Cena C, Sánchez-Juan P, Infante J. Oculomotor Dysfunction in Idiopathic and LRRK2-Parkinson's Disease and At-Risk Individuals. JOURNAL OF PARKINSON'S DISEASE 2024; 14:797-808. [PMID: 38701160 DOI: 10.3233/jpd-230416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Background Video-oculography constitutes a highly-sensitive method of characterizing ocular movements, which could detect subtle premotor changes and contribute to the early diagnosis of Parkinson's disease (PD). Objective To investigate potential oculomotor differences between idiopathic PD (iPD) and PD associated with the G2019S variant of LRRK2 (L2PD), as well as to evaluate oculomotor function in asymptomatic carriers of the G2019S variant of LRRK2. Methods The study enrolled 129 subjects: 30 PD (16 iPD, 14 L2PD), 23 asymptomatic carriers, 13 non-carrier relatives of L2PD patients, and 63 unrelated HCs. The video-oculographic evaluation included fixation, prosaccade, antisaccade, and memory saccade tests. Results We did not find significant differences between iPD and L2PD. Compared to controls, PD patients displayed widespread oculomotor deficits including larger microsaccades, hypometric vertical prosaccades, increased latencies in all tests, and lower percentages of successful antisaccades and memory saccades. Non-carrier relatives showed oculomotor changes with parkinsonian features, such as fixation instability and hypometric vertical saccades. Asymptomatic carriers shared multiple similarities with PD, including signs of unstable fixation and hypometric vertical prosaccades; however, they were able to reach percentages of successful antisaccade and memory saccades similar to controls, although at the expense of longer latencies. Classification accuracy of significant oculomotor parameters to differentiate asymptomatic carriers from HCs ranged from 0.68 to 0.74, with BCEA, a marker of global fixation instability, being the parameter with the greatest classification accuracy. Conclusions iPD and LRRK2-G2019S PD patients do not seem to display a differential oculomotor profile. Several oculomotor changes in asymptomatic carriers of LRRK2 mutations could be considered premotor biomarkers.
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Affiliation(s)
- Carmen Lage
- Neurology Service, Marqués de Valdecilla University Hospital, Santander, Spain
- Institute for Research Marqués de Valdecilla (IDIVAL), Santander, Spain
- CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, National Institute of Health Carlos III (ISCIII), Madrid, Spain
- Atlantic Fellow for Equity in Brain Health, Global Brain Health Institute, University of California - San Francisco (UCSF), San Francisco, CA, USA
| | - Antonio Sánchez-Rodríguez
- Institute for Research Marqués de Valdecilla (IDIVAL), Santander, Spain
- Neurology Service, Hospital de Cabueñes, Gijón, Spain
| | - María Rivera-Sánchez
- Neurology Service, Marqués de Valdecilla University Hospital, Santander, Spain
- Institute for Research Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - María Sierra
- Neurology Service, Marqués de Valdecilla University Hospital, Santander, Spain
- Institute for Research Marqués de Valdecilla (IDIVAL), Santander, Spain
- CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, National Institute of Health Carlos III (ISCIII), Madrid, Spain
- University of Cantabria, Santander, Spain
| | - Isabel González-Aramburu
- Neurology Service, Marqués de Valdecilla University Hospital, Santander, Spain
- Institute for Research Marqués de Valdecilla (IDIVAL), Santander, Spain
- CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, National Institute of Health Carlos III (ISCIII), Madrid, Spain
- University of Cantabria, Santander, Spain
| | - Jorge Madera
- Neurology Service, Marqués de Valdecilla University Hospital, Santander, Spain
- Institute for Research Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Manuel Delgado-Alvarado
- Institute for Research Marqués de Valdecilla (IDIVAL), Santander, Spain
- CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, National Institute of Health Carlos III (ISCIII), Madrid, Spain
- University of Cantabria, Santander, Spain
- Neurology Service, Hospital de Sierrallana, Santander, Spain
| | - Sara López-García
- Neurology Service, Marqués de Valdecilla University Hospital, Santander, Spain
- Institute for Research Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Francisco Martínez-Dubarbie
- Neurology Service, Marqués de Valdecilla University Hospital, Santander, Spain
- Institute for Research Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Marta Fernández-Matarrubia
- Neurology Service, Marqués de Valdecilla University Hospital, Santander, Spain
- Institute for Research Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Néstor Martínez-Amador
- Institute for Research Marqués de Valdecilla (IDIVAL), Santander, Spain
- Nuclear Medicine Service, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Isabel Martínez-Rodríguez
- Institute for Research Marqués de Valdecilla (IDIVAL), Santander, Spain
- University of Cantabria, Santander, Spain
- Nuclear Medicine Service, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Alberto Calvo-Córdoba
- Centre for Automation and Robotics, Escuela Técnica de Ingenieros Industriales (ETSII), Universidad Politécnica de Madrid, Madrid, Spain
| | - Eloy Rodríguez-Rodríguez
- Neurology Service, Marqués de Valdecilla University Hospital, Santander, Spain
- Institute for Research Marqués de Valdecilla (IDIVAL), Santander, Spain
- CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, National Institute of Health Carlos III (ISCIII), Madrid, Spain
- University of Cantabria, Santander, Spain
| | - Cecilia García-Cena
- Centre for Automation and Robotics, UPM-CSIC, Escuela Técnica Superiorde Ingeniería y Diseño Industrial, Universidad Politécnica de Madrid, Madrid, Spain
| | - Pascual Sánchez-Juan
- Institute for Research Marqués de Valdecilla (IDIVAL), Santander, Spain
- CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, National Institute of Health Carlos III (ISCIII), Madrid, Spain
- CIEN Foundation/Queen Sofia Foundation Alzheimer Center, Madrid, Spain
| | - Jon Infante
- Neurology Service, Marqués de Valdecilla University Hospital, Santander, Spain
- Institute for Research Marqués de Valdecilla (IDIVAL), Santander, Spain
- CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, National Institute of Health Carlos III (ISCIII), Madrid, Spain
- University of Cantabria, Santander, Spain
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Antoniades CA, Spering M. Eye movements in Parkinson's disease: from neurophysiological mechanisms to diagnostic tools. Trends Neurosci 2024; 47:71-83. [PMID: 38042680 DOI: 10.1016/j.tins.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/13/2023] [Accepted: 11/01/2023] [Indexed: 12/04/2023]
Abstract
Movement disorders such as Parkinson's disease (PD) impact oculomotor function - the ability to move the eyes accurately and purposefully to serve a multitude of sensory, cognitive, and secondary motor tasks. Decades of neurophysiological research in monkeys and behavioral studies in humans have characterized the neural basis of healthy oculomotor control. This review links eye movement abnormalities in persons living with PD to the underlying neurophysiological mechanisms and pathways. Building on this foundation, we highlight recent progress in using eye movements to gauge symptom severity, assess treatment effects, and serve as potential precision biomarkers. We conclude that whereas eye movements provide insights into PD mechanisms, based on current evidence they appear to lack sufficient sensitivity and specificity to serve as a standalone diagnostic tool. Their full potential may be realized when combined with other disease indicators in big datasets.
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Affiliation(s)
- Chrystalina A Antoniades
- Nuffield Department of Clinical Neurosciences, Medical Sciences Division, University of Oxford, Oxford, UK.
| | - Miriam Spering
- Department of Ophthalmology & Visual Sciences and Djavad Mowafaghian Center for Brain Health, University of British Columbia, Vancouver, Canada.
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Li H, Zhang X, Yang Y, Xie A. Abnormal eye movements in Parkinson's disease: From experimental study to clinical application. Parkinsonism Relat Disord 2023; 115:105791. [PMID: 37537120 DOI: 10.1016/j.parkreldis.2023.105791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 07/24/2023] [Accepted: 07/28/2023] [Indexed: 08/05/2023]
Abstract
Parkinson's disease (PD) is a neurodegenerative disease that integrates a series of motor symptoms and non-motor symptoms, making early recognition challenging. The exploration of biomarkers is urgently required. Abnormal eye movements in PD have been reported to appear in a variety of ways since eye tracking technology was developed, such as decreased saccade amplitude, extended saccade latency, and unique saccade patterns. Non-invasive, objective and simple eye tracking has the potential to provide effective biomarkers for the PD diagnosis, progression and cognitive impairment, as well as ideas for research into the occurrence and treatment strategy of motor symptoms. In this review, we introduced the fundamental eye movement patterns and typical eye movement paradigms (such as fixation, pro-saccade, anti-saccade, smooth tracking, and visual search), summarized the symptoms of various ocular motor abnormalities in PD, and discussed the research implications of oculomotor investigation to the pathogenesis of PD and related motor symptoms, as well as the clinical implications as biomarkers and its inspiration on treatment.
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Affiliation(s)
- Han Li
- Department of Neurology, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China.
| | - Xue Zhang
- Department of Neurology, Affiliated Qingdao Central Hospital of Qingdao University, Qingdao Cancer Hospital, Qingdao, China
| | - Yong Yang
- Department of Neurology, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
| | - Anmu Xie
- Department of Neurology, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China; The Cerebral Vascular Disease Institute, Qingdao University, Qingdao, China.
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Reiner J, Franken L, Raveh E, Rosset I, Kreitman R, Ben-Ami E, Djaldetti R. Oculometric measures as a tool for assessment of clinical symptoms and severity of Parkinson's disease. J Neural Transm (Vienna) 2023; 130:1241-1248. [PMID: 37553460 PMCID: PMC10480268 DOI: 10.1007/s00702-023-02681-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 08/02/2023] [Indexed: 08/10/2023]
Abstract
Abnormalities of oculometric measures (OM) are widely described in people with Parkinson's disease (PD). However, knowledge of correlations between abnormal OM, disease severity and clinical assessment in PD patients is still lacking. To evaluate these correlations, PD patients (215 patients, mean age 69 ± 9.1 years, 79 females) with severe (H&Y > 3) and mild to moderate (H&Y ≤ 2) disease, and 215 age-matched healthy subjects were enrolled. All patients were evaluated using MDS-UPDRS and an oculometric test using computer vision and deep learning algorithms. Comparisons of OM between groups and correlations between OM and MDS-UPDRS scores were calculated. Saccadic latency (ms) was prolonged in patients with severe compared with mild to moderate disease (pro-saccades: 267 ± 69 vs. 238 ± 53, p = 0.0011; anti-saccades: 386 ± 119 vs. 352 ± 106, p = 0.0393) and in patients with mild to moderate disease versus healthy subjects (pro-saccades: 238 ± 53 vs. 220 ± 45, p = 0.0003; anti-saccades: 352 ± 106 vs. 289 ± 71, p < 0.0001). Error rate (%) was higher among patients with severe (64.06 ± 23.08) versus mild to moderate disease (49.84 ± 24.81, p = 0.0001), and versus healthy subjects (49.84 ± 24.81 vs. 28.31 ± 21.72, p = 0.00001). Response accuracy (%) was lower for patients with severe (75.66 ± 13.11) versus mild to moderate disease (79.66 ± 13.56, p = 0.0462), and versus healthy subjects (79.66 ± 13.56 vs. 90.27 ± 8.79, p < 0.0001). Pro- and anti-saccadic latency, error rate and accuracy were correlated with MDS-UPDRS scores (r = 0.32, 0.28, 0.36 and -0.30, respectively, p < 0.0001) and similar correlations were found with its axial subscore (R = 0.38, 0.29, 0.44, and -0.30, respectively, p < 0.0001). Several OM were different in patients under levodopa treatment. OM worsened as PD severity increases, and were correlated with MDS-UPDRS scores. Using OM can be implemented for PD patients' assessment as a tool to follow disease progression.
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Affiliation(s)
- Johnathan Reiner
- Department of Neurology, Rabin Medical Center, Movement Disorders Clinic, Beilinson Hospital, 4941492, Petach Tikva, Israel
- Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liron Franken
- Department of Neurology, Rabin Medical Center, Movement Disorders Clinic, Beilinson Hospital, 4941492, Petach Tikva, Israel
- Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | | | | | - Ruth Djaldetti
- Department of Neurology, Rabin Medical Center, Movement Disorders Clinic, Beilinson Hospital, 4941492, Petach Tikva, Israel
- Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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de Villers-Sidani É, Voss P, Guitton D, Cisneros-Franco JM, Koch NA, Ducharme S. A novel tablet-based software for the acquisition and analysis of gaze and eye movement parameters: a preliminary validation study in Parkinson's disease. Front Neurol 2023; 14:1204733. [PMID: 37396780 PMCID: PMC10310943 DOI: 10.3389/fneur.2023.1204733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/25/2023] [Indexed: 07/04/2023] Open
Abstract
The idea that eye movements can reflect certain aspects of brain function and inform on the presence of neurodegeneration is not a new one. Indeed, a growing body of research has shown that several neurodegenerative disorders, such as Alzheimer's and Parkinson's Disease, present characteristic eye movement anomalies and that specific gaze and eye movement parameters correlate with disease severity. The use of detailed eye movement recordings in research and clinical settings, however, has been limited due to the expensive nature and limited scalability of the required equipment. Here we test a novel technology that can track and measure eye movement parameters using the embedded camera of a mobile tablet. We show that using this technology can replicate several well-known findings regarding oculomotor anomalies in Parkinson's disease (PD), and furthermore show that several parameters significantly correlate with disease severity as assessed with the MDS-UPDRS motor subscale. A logistic regression classifier was able to accurately distinguish PD patients from healthy controls on the basis of six eye movement parameters with a sensitivity of 0.93 and specificity of 0.86. This tablet-based tool has the potential to accelerate eye movement research via affordable and scalable eye-tracking and aid with the identification of disease status and monitoring of disease progression in clinical settings.
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Affiliation(s)
- Étienne de Villers-Sidani
- Innodem Neurosciences, Montreal, QC, Canada
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Patrice Voss
- Innodem Neurosciences, Montreal, QC, Canada
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Daniel Guitton
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - J. Miguel Cisneros-Franco
- Innodem Neurosciences, Montreal, QC, Canada
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Nils A. Koch
- Innodem Neurosciences, Montreal, QC, Canada
- Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada
| | - Simon Ducharme
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
- Douglas Mental Health University Institute, Montreal, QC, Canada
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Przybyszewski AW, Śledzianowski A, Chudzik A, Szlufik S, Koziorowski D. Machine Learning and Eye Movements Give Insights into Neurodegenerative Disease Mechanisms. SENSORS (BASEL, SWITZERLAND) 2023; 23:2145. [PMID: 36850743 PMCID: PMC9968124 DOI: 10.3390/s23042145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/07/2023] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
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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Affiliation(s)
- Andrzej W. Przybyszewski
- Polish-Japanese Academy of Information Technology, The Faculty of Information Technology, 86 Koszykowa Street, 02-008 Warsaw, Poland
- Department of Neurology, University of Massachusetts Medical School, 65 Lake Avenue, Worcester, MA 01655, USA
| | - Albert Śledzianowski
- Polish-Japanese Academy of Information Technology, The Faculty of Information Technology, 86 Koszykowa Street, 02-008 Warsaw, Poland
| | - Artur Chudzik
- Polish-Japanese Academy of Information Technology, The Faculty of Information Technology, 86 Koszykowa Street, 02-008 Warsaw, Poland
| | - Stanisław Szlufik
- Department of Neurology, Faculty of Health Science, Medical University of Warsaw, 8 Kondratowicza Street, 03-242 Warsaw, Poland
| | - Dariusz Koziorowski
- Department of Neurology, Faculty of Health Science, Medical University of Warsaw, 8 Kondratowicza Street, 03-242 Warsaw, Poland
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11
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Brien DC, Riek HC, Yep R, Huang J, Coe B, Areshenkoff C, Grimes D, Jog M, Lang A, Marras C, Masellis M, McLaughlin P, Peltsch A, Roberts A, Tan B, Beaton D, Lou W, Swartz R, Munoz DP. Classification and staging of Parkinson's disease using video-based eye tracking. Parkinsonism Relat Disord 2023; 110:105316. [PMID: 36822878 DOI: 10.1016/j.parkreldis.2023.105316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 01/11/2023] [Accepted: 02/04/2023] [Indexed: 02/10/2023]
Abstract
INTRODUCTION 83% of those diagnosed with Parkinson's Disease (PD) eventually progress to PD with mild cognitive impairment (PD-MCI) followed by dementia (PDD) - suggesting a complex spectrum of pathology concomitant with aging. Biomarkers sensitive and specific to this spectrum are required if useful diagnostics are to be developed that may supplement current clinical testing procedures. We used video-based eye tracking and machine learning to develop a simple, non-invasive test sensitive to PD and the stages of cognitive dysfunction. METHODS From 121 PD (45 Cognitively Normal/45 MCI/20 Dementia/11 Other) and 106 healthy controls, we collected video-based eye tracking data on an interleaved pro/anti-saccade task. Features of saccade, pupil, and blink behavior were used to train a classifier to predict confidence scores for PD/PD-MCI/PDD diagnosis. RESULTS The Receiver Operator Characteristic Area Under the Curve (ROC-AUC) of the classifier was 0.88, with the cognitive-dysfunction subgroups showing progressively increased AUC, and the AUC of PDD being 0.95. The classifier reached a sensitivity of 83% and a specificity of 78%. The confidence scores predicted PD motor and cognitive performance scores. CONCLUSION Biomarkers of saccade, pupil, and blink were extracted from video-based eye tracking to create a classifier with high sensitivity to the landscape of PD cognitive and motor dysfunction. A complex landscape of PD is revealed through a quick, non-invasive eye tracking task and our model provides a framework for such a task to be used as a supplementary screening tool in the clinic.
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Affiliation(s)
- Donald C Brien
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.
| | - Heidi C Riek
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.
| | - Rachel Yep
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.
| | - Jeff Huang
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.
| | - Brian Coe
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.
| | - Corson Areshenkoff
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.
| | - David Grimes
- Ottawa Hospital, uOttawa Brain and Mind Research Institute, Ottawa, ON, Canada.
| | - Mandar Jog
- PF Centre of Excellence, London Movement Disorders Centre, Lawson Health Research Institute, London, ON, Canada.
| | - Anthony Lang
- Edmond J. Safra Program in Parkinson's Disease, University Health Network and the Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada.
| | - Connie Marras
- Toronto Western Hospital Movement Disorders Centre and the Edmond J Safra Program in Parkinson's Disease, University of Toronto, Toronto, ON, Canada.
| | - Mario Masellis
- Sunnybrook Health Sciences Centre, Medicine (Neurology), Toronto, ON, Canada.
| | - Paula McLaughlin
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada; Nova Scotia Health, Halifax, NS, Canada; Department of Psychology and Neuroscience, Department of Medicine (Geriatrics), Dalhousie University, Halifax, NS, Canada.
| | - Alicia Peltsch
- Faculty of Engineering and Applied Science, Queen's University, Kingston, ON, Canada.
| | - Angela Roberts
- School of Communication Sciences and Disorders, Department of Computer Science, University of Western Ontario, London, ON, Canada.
| | - Brian Tan
- Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada.
| | - Derek Beaton
- Data Science & Advanced Analytics (DSAA), St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
| | - Wendy Lou
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Richard Swartz
- Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre; Faculty of Medicine, Department of Medicine (Neurology), University of Toronto, Toronto, ON, Canada.
| | | | - Douglas P Munoz
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada; Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada.
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12
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Waldthaler J, Sperlich A, Stüssel C, Steidel K, Timmermann L, Pedrosa DJ. Stimulation of non-motor subthalamic nucleus impairs selective response inhibition via prefrontal connectivity. Brain Commun 2023; 5:fcad121. [PMID: 37113315 PMCID: PMC10128876 DOI: 10.1093/braincomms/fcad121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/03/2023] [Indexed: 04/29/2023] Open
Abstract
Given the inconsistent results in the past, there is an ongoing debate whether and how deep brain stimulation in the subthalamic nucleus modifies cognitive control processes like response inhibition in persons with Parkinson's disease. In this study, we examined how the location of the stimulation volume within the subthalamic nucleus affects the performance in an antisaccade task but also how its structural connectivity is related to response inhibition. Antisaccade error rates and latencies were collected in 14 participants on and off deep brain stimulation in a randomized order. Stimulation volumes were computed based on patient-specific lead localizations using preoperative MRI and postoperative CT scans. Structural connectivity of the stimulation volumes with pre-defined cortical oculomotor control regions as well as whole-brain connectivity was estimated using a normative connectome. We showed that the detrimental effect of deep brain stimulation on response inhibition, measured as antisaccade error rate, depended upon the magnitude of the intersection of volumes of activated tissue with the non-motor subregion of the subthalamic nucleus and on its structural connectivity with regions of the prefrontal oculomotor network including bilateral frontal eye fields and right anterior cingulate cortex. Our results corroborate previous recommendations for avoidance of stimulation in the ventromedial non-motor subregion of the subthalamic nucleus which connects to the prefrontal cortex to prevent stimulation-induced impulsivity. Furthermore, antisaccades were initiated faster with deep brain stimulation when the stimulation volume was connected to fibres passing the subthalamic nucleus laterally and projecting onto the prefrontal cortex, indicating that improvement of voluntary saccade generation with deep brain stimulation may be an off-target effect driven by stimulation of corticotectal fibres directly projecting from the frontal and supplementary eye fields onto brainstem gaze control areas. Taken together, these findings could help implement individualized circuit-based deep brain stimulation strategies that avoid impulsive side effects while improving voluntary oculomotor control.
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Affiliation(s)
- Josefine Waldthaler
- Correspondence to: Josefine Waldthaler, Department of Neurology, University Hospitals Gießen and Marburg, Baldingerstraße, 35033 Marburg, Hesse, Germany E-mail:
| | - Alexander Sperlich
- Department of Neurology, University Hospital Gießen and Marburg, 35033 Marburg, Germany
| | - Charlotte Stüssel
- Department of Neurology, University Hospital Gießen and Marburg, 35033 Marburg, Germany
| | - Kenan Steidel
- Department of Neurology, University Hospital Gießen and Marburg, 35033 Marburg, Germany
| | - Lars Timmermann
- Department of Neurology, University Hospital Gießen and Marburg, 35033 Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), Philipps-University Marburg and Justus-Liebig-University Giessen, 35033 Marburg, Germany
| | - David J Pedrosa
- Department of Neurology, University Hospital Gießen and Marburg, 35033 Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), Philipps-University Marburg and Justus-Liebig-University Giessen, 35033 Marburg, Germany
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13
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Waldthaler J, Sperlich A, König A, Stüssel C, Bremmer F, Timmermann L, Pedrosa D. High (130 Hz)- and mid (60 Hz)-frequency deep brain stimulation in the subthalamic nucleus differentially modulate response inhibition: A preliminary combined EEG and eye tracking study. Neuroimage Clin 2023; 37:103314. [PMID: 36630863 PMCID: PMC9841351 DOI: 10.1016/j.nicl.2023.103314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/23/2022] [Accepted: 01/02/2023] [Indexed: 01/06/2023]
Abstract
While deep brain stimulation (DBS) in the subthalamic nucleus (STN) improves motor functions in Parkinson's disease (PD), it may also increase impulsivity by interfering with the inhibition of reflexive responses. The aim of this study was to investigate if varying the pulse frequency of STN-DBS has a modulating effect on response inhibition and its neural correlates. For this purpose, 14 persons with PD repeated an antisaccade task in three stimulation settings (DBS off, high-frequency DBS (130 Hz), mid-frequency DBS (60 Hz)) in a randomized order, while eye movements and brain activity via high-density EEG were recorded. On a behavioral level, 130 Hz DBS stimulation had no effect on response inhibition measured as antisaccade error rate, while 60 Hz DBS induced a slight but significant reduction of directional errors compared with the DBS-off state and 130 Hz DBS. Further, stimulation with both frequencies decreased the onset latency of correct antisaccades, while increasing the latency of directional errors. Time-frequency domain analysis of the EEG data revealed that 60 Hz DBS was associated with an increase in preparatory theta power over a midfrontal region of interest compared with the off-DBS state which is generally regarded as a marker of increased cognitive control. While no significant differences in brain activity over mid- and lateral prefrontal regions of interest emerged between the 60 Hz and 130 Hz conditions, both stimulation frequencies were associated with a stronger midfrontal beta desynchronization during the mental preparation for correct antisaccades compared with DBS off-state which is discussed in the context of potentially enhanced proactive recruitment of the oculomotor network. Our preliminary findings suggest that mid-frequency STN-DBS may provide beneficial effects on response inhibition, while both 130 Hz- and 60 Hz STN-DBS may promote voluntary actions at the expense of slower reflexive responses.
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Affiliation(s)
- Josefine Waldthaler
- Department of Neurology, University Hospital Giessen and Marburg, Marburg, Germany; Department of Neurology, Philipps-University Marburg, Marburg, Germany; Center for Mind, Brain, and Behavior (CMBB), Philipps-University Marburg and Justus-Liebig-University, Giessen, Germany.
| | - Alexander Sperlich
- Department of Neurology, University Hospital Giessen and Marburg, Marburg, Germany; Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Aylin König
- Department of Neurophysics, Philipps-University Marburg, Marburg, Germany
| | - Charlotte Stüssel
- Department of Neurology, University Hospital Giessen and Marburg, Marburg, Germany; Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Frank Bremmer
- Center for Mind, Brain, and Behavior (CMBB), Philipps-University Marburg and Justus-Liebig-University, Giessen, Germany; Department of Neurophysics, Philipps-University Marburg, Marburg, Germany
| | - Lars Timmermann
- Department of Neurology, University Hospital Giessen and Marburg, Marburg, Germany; Department of Neurology, Philipps-University Marburg, Marburg, Germany; Center for Mind, Brain, and Behavior (CMBB), Philipps-University Marburg and Justus-Liebig-University, Giessen, Germany
| | - David Pedrosa
- Department of Neurology, University Hospital Giessen and Marburg, Marburg, Germany; Department of Neurology, Philipps-University Marburg, Marburg, Germany; Center for Mind, Brain, and Behavior (CMBB), Philipps-University Marburg and Justus-Liebig-University, Giessen, Germany
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14
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Yu Y, Yan W, Xu X, Zhang K, Si L, Liu X, Wang J, Song J, Sun H, Li X. Response times for reflexive saccades correlate with cognition in parkinson's disease, not disease severity or duration. Front Neurol 2022; 13:945201. [PMID: 36090872 PMCID: PMC9459151 DOI: 10.3389/fneur.2022.945201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/03/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveDementia is a common and serious non-motor symptom in Parkinson's disease (PD). We aimed to investigate the reflexive saccade in PD patients and explore its potential role as a biomarker for cognitive decline.MethodsUsing an infrared video-based eye tracker, we investigated reflexive saccades in 94 PD patients and 115 healthy controls (HCs). Saccadic parameters were compared between PD patients and HCs, and also among PD subgroups. The correlation of saccadic performance with disease duration, severity and cognition were further investigated.ResultsCompared with healthy controls, PD patients had prolonged and hypometric reflexive saccades even in early disease stage. Univariate and multivariate analysis showed that there was significant inverse relation between prolonged latency and MMSE in PD patients (P < 0.05); tremor dominant PD patients were more likely to have decreased velocity than non-tremor-dominant PD patients (P < 0.05); saccadic accuracy was found to have no significant relation with disease duration, H&Y staging or MMSE.ConclusionReflexive saccadic performance was abnormal in PD and worsened with cognitive decline. The negative correlation between prolonged latency and MMSE scores may make the reflexive saccade a potential predictor for cognitive decline in Parkinson's disease.
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Affiliation(s)
- Yaqin Yu
- Department of Neurology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weihong Yan
- Department of Neurology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xin Xu
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Kaili Zhang
- Department of Neurology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lihong Si
- Department of Neurology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaolei Liu
- Department of Neurology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinyu Wang
- Department of Neurology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Junling Song
- Department of Neurology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huanxin Sun
- Department of Neurology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xinyi Li
- Department of Neurology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Xinyi Li
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15
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Bredemeyer O, Patel S, FitzGerald JJ, Antoniades CA. Oculomotor deficits in Parkinson's disease: Increasing sensitivity using multivariate approaches. Front Digit Health 2022; 4:939677. [PMID: 35990016 PMCID: PMC9387998 DOI: 10.3389/fdgth.2022.939677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/27/2022] [Indexed: 11/17/2022] Open
Abstract
Parkinson's disease (PD) affects several domains of neurological function, from lower-level motor programs to higher cognitive processing. As certain types of eye movements (saccades) are fast, non-fatiguing, and can be measured objectively and non-invasively, they are a promising candidate for quantifying motor and cognitive dysfunction in PD, as well as other movement disorders. In this pilot study, we evaluate the latency (reaction time), damping (resistance to oscillation), and amplitude of saccadic movements in two tasks performed by 25 PD patients with mild to moderate disease and 26 age-matched healthy controls. As well as general increases in reaction time caused by PD, the damping of saccadic eye movements was found to be task-dependent and affected by disease. Finally, we introduce a proof-of-concept multivariate model to demonstrate how information from saccadometry can be combined to infer disease status.
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Affiliation(s)
- Oliver Bredemeyer
- NeuroMetrology Group, Nuffield Department of Clinical Neurosciences, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Salil Patel
- NeuroMetrology Group, Nuffield Department of Clinical Neurosciences, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - James J FitzGerald
- NeuroMetrology Group, Nuffield Department of Clinical Neurosciences, Medical Sciences Division, University of Oxford, Oxford, United Kingdom.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom.,Oxford Functional Neurosurgery, John Radcliffe Hospital, Oxford, United Kingdom
| | - Chrystalina A Antoniades
- NeuroMetrology Group, Nuffield Department of Clinical Neurosciences, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
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16
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Abstract
For over 100 years, eye movements have been studied and used as indicators of human sensory and cognitive functions. This review evaluates how eye movements contribute to our understanding of the processes that underlie decision-making. Eye movement metrics signify the visual and task contexts in which information is accumulated and weighed. They indicate the efficiency with which we evaluate the instructions for decision tasks, the timing and duration of decision formation, the expected reward associated with a decision, the accuracy of the decision outcome, and our ability to predict and feel confident about a decision. Because of their continuous nature, eye movements provide an exciting opportunity to probe decision processes noninvasively in real time. Expected final online publication date for the Annual Review of Vision Science, Volume 8 is September 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Miriam Spering
- Department of Ophthalmology & Visual Sciences and the Djavad Mowafaghian Center for Brain Health, University of British Columbia, Vancouver, Canada;
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17
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Reverse Visually Guided Reaching in Patients with Parkinson’s Disease. PARKINSON'S DISEASE 2022; 2022:8132923. [PMID: 35386952 PMCID: PMC8979744 DOI: 10.1155/2022/8132923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 01/11/2022] [Accepted: 02/22/2022] [Indexed: 11/18/2022]
Abstract
In addition to motor symptoms such as difficulty in movement initiation and bradykinesia, patients with Parkinson’s disease (PD) display nonmotor executive cognitive dysfunction with deficits in inhibitory control. Preoperative psychological assessments are used to screen for impulsivity that may be worsened by deep brain stimulation (DBS) of the subthalamic nucleus (STN). However, it is unclear whether anti-Parkinson’s therapy, such as dopamine replacement therapy (DRT) or DBS, which has beneficial effects on motor function, adversely affects inhibitory control or its domains. The detrimental effects of STN-DBS are more apparent when tasks test the inhibition of habitual prepotent responses or involve complex cognitive loads. Our goal was to use a reverse visually guided reaching (RVGR) task, a hand-based version of the antisaccade task, to simultaneously measure motor performance and response inhibition in subjects with PD. We recruited 55 healthy control subjects, 26 PD subjects receiving treatment with DRTs, and 7 PD subjects receiving treatment with STN-DBS and DRTs. In the RVGR task, a cursor moved opposite to the subject’s hand movement. This was compared to visually guided reaching (VGR) where the cursor moved in the same direction as the subject’s hand movement. Reaction time, mean speed, and direction errors (in RVGR) were assessed. Reaction times were longer, and mean speeds were slower during RVGR compared to VGR in all three groups but worse in untreated subjects with PD. Treatment with DRTs, DBS, or DBS + DRT improved the reaction time and speed on the RVGR task to a greater extent than VGR. Additionally, DBS or DBS + DRT demonstrated an increase in direction errors, which was correlated with decreased reaction time. These results show that the RVGR task quantifies the benefit of STN-DBS on bradykinesia and the concomitant reduction of proactive inhibitory control. The RVGR task has the potential to be used to rapidly screen for preoperative deficits in inhibitory control and to titrate STN-DBS, to maximize the therapeutic benefits on movement, and minimize impaired inhibitory control.
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18
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Waldthaler J, Vinding MC, Eriksson A, Svenningsson P, Lundqvist D. Neural correlates of impaired response inhibition in the antisaccade task in Parkinson’s disease. Behav Brain Res 2022; 422:113763. [DOI: 10.1016/j.bbr.2022.113763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/12/2022] [Accepted: 01/15/2022] [Indexed: 11/02/2022]
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19
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Waldthaler J, Stock L, Krüger-Zechlin C, Timmermann L. Age at Parkinson's disease onset modulates the effect of levodopa on response inhibition: Support for the dopamine overdose hypothesis from the antisaccade task. Neuropsychologia 2021; 163:108082. [PMID: 34728241 DOI: 10.1016/j.neuropsychologia.2021.108082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/07/2021] [Accepted: 10/29/2021] [Indexed: 11/15/2022]
Abstract
The antisaccade task is an established eye-tracking paradigm to explore response inhibition. While many studies showed that antisaccade performance is impaired in Parkinson's disease (PD), the effect of dopaminergic medication is still an area of debate. According to the dopamine overdose hypothesis, intrinsic basal dopamine levels in ventral parts of the striatum determine whether levodopa intake has beneficial or detrimental effects on dopamine-dependent cognitive tasks. The objective of this study was therefore to explore the effect of several disease-related factors on changes in antisaccade performance after levodopa intake in PD. Thirty-five individuals with PD (and 30 healthy controls) performed antisaccades in OFF and ON medication state. Multiple linear regressions were calculated to predict the change in antisaccade latency, directive errors and express saccade rate based on age at PD onset, disease duration, levodopa-equivalent daily dose, motor symptom severity and executive functions. Levodopa intake did not alter antisaccade performance on a group level. However, the effect of levodopa was differentially modulated by age at PD onset and motor symptom severity. Earlier disease onset and milder motor symptoms in OFF medication state were associated with reduced response inhibition capacity after levodopa intake measured as increased express saccade and error rates. Our results indicate that levodopa may have opposing effects on oculomotor response inhibition dependent on the age at PD onset and motor disease severity. Assuming less dopaminergic loss in ventral parts of the striatum in early compared to late onset PD, these findings support the dopamine overdose hypothesis.
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Affiliation(s)
- Josefine Waldthaler
- Department of Neurology, Philipps-University Marburg, Marburg, Germany; CMBB - Center for Mind, Brain, and Behavior, Universities of Marburg and Gießen, Marburg, Germany; Department of Neurology, University Hospital Giessen and Marburg, Campus Marburg, Marburg, Germany.
| | - Lena Stock
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | | | - Lars Timmermann
- Department of Neurology, Philipps-University Marburg, Marburg, Germany; CMBB - Center for Mind, Brain, and Behavior, Universities of Marburg and Gießen, Marburg, Germany; Department of Neurology, University Hospital Giessen and Marburg, Campus Marburg, Marburg, Germany
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