Neuro-Ophthalmologic Abnormalities in Alzheimer Disease, Parkinson Disease, and Progressive Supranuclear Palsy

Abstract

Introduction and Purpose

The visual symptoms of neurodegenerative diseases, specifically Alzheimer disease, Parkinson disease, the two most common neurodegenerative diseases, and progressive supranuclear palsy, may be the initial manifestation of a progressive and emotionally and physically distressing course. Often the ophthalmologic examination is normal and the patient dismissed only to provoke further anxiety and frustration to the patient. But with careful attention given to the subtleties of eye movement abnormalities and visuospatial tasking, the patient's symptoms can be readily explained. It therefore behooves the ophthalmologist and orthoptist to identify these abnormalities, as their recognition can be diagnostic as well as therapeutic. Therefore, the purpose of this paper is to review the neuro-ophthalmologic abnormalities including the eye movements in these specific neurodegenerative diseases and offer some distinguishing characteristics.

Methods

A literature review was performed; sentinel articles and comprehensive as well as specific task-oriented manuscripts were selected. The salient features from these manuscripts and personal experiences were collated to provide meaningful and comprehensive information.

Results

The most common neuro-ophthalmologic features involving the afferent and efferent pathways of these neurodegenerative diseases are provided. There are manifestations common to all three diseases as well as distinguishing characteristics of each. The mechanisms of disease and explanations for the visual signs and symptoms are discussed. Furthermore, management typically within the realm of the ophthalmologist and orthoptist are offered.

Conclusions

Awareness of the expected neuro-ophthalmologic findings of Alzheimer disease, Parkinson disease, and progressive supranuclear palsy allows the ophthalmologist and orthoptist to be armed with knowledge to diagnose and treat the patient afflicted with these diseases. Patients and their families are comforted by acknowledgement of symptoms and signs; furthermore, appropriate and compensatory actions can be instituted to provide functional relief. Medications may be altered if the diagnosis is clarified by the eye examination.

• Alzheimer disease
• Parkinson disease
• progressive supranuclear palsy
• eye movements