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Visual dysfunction in Parkinson disease without dementia

From the Departments of Neurology (Drs. Uc, Rizzo, Anderson, Rodnitzky, and Dawson, S. Qian), Mechanical and Industrial Engineering (Dr. Rizzo), and Biostatistics (Dr. Dawson, S. Qian), and Public Policy Center (Dr. Rizzo), University of Iowa, and Neurology Service (Dr. Uc), Veterans Affairs Medical Center, Iowa City.

Address correspondence and reprint requests to Dr Uc, Department of Neurology, University of Iowa, Carver College of Medicine, 200 Hawkins Dr., 2RCP, Iowa City, IA 52242; e-mail: ergun-uc{at}uiowa.edu

Objective: To determine the profiles of visual dysfunction and their relationship to motor and cognitive dysfunction and to disability in mild to moderate Parkinson disease (PD) without dementia.

Methods: Seventy-six independently living participants with mild to moderate PD and 161 neurologically normal older adults were studied using a comprehensive battery to assess visual acuity, contrast sensitivity (CS), visual speed of processing and attention, spatial and motion perception, visual and verbal memory, visuoconstructional abilities, executive functions, depression, and motor function.

Results: Participants with PD scored significantly worse on all tests of vision and cognition compared with normal elderly persons. Reduced CS contributed to deficits on tests of spatial and motion perception and attention in participants with PD. Impairments in visual attention and spatial perception predicted worse cognitive function. Worse performances on tests of visual speed of processing and attention, spatial and motion perception, visual construction, and executive functions correlated with measures of postural instability and gait difficulty (in the Motor section of the Unified Parkinson's Disease Rating Scale). Impairments in motor function, visual memory, mood, and executive functions predicted worse disability as measured by Schwab–England Activities of Daily Living Scale.

Conclusions: Patients with mild to moderate Parkinson disease showed impaired visual perception and cognition compared with elderly control subjects. Visual dysfunction contributes to parkinsonian disability through its influences on cognition and locomotion.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the December 27 issue to find the title link for this article.

This article was previously published in electronic format as an Expedited E-Pub on November 9, 2005, at www.neurology.org.

Supported by NINDS NS044930 (E.Y.U.), University of Iowa–Carver College of Medicine New Investigator Research Award (E.Y.U.), NIA AG 17717 (M.R.), and NIA AG 15071 (M.R.).

Disclosure: The authors report no conflicts of interest.

Received March 21, 2005. Accepted in final form July 8, 2005.

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