Grünberger Josef, Prause Wolfgang, Frottier Patrick, Stöhr Hans, Saletu Bernd, Haushofer Manfred, Rainer Michael
Abteilung für klinische Psychodiagnostik, Universitätsklinik für Psychiatrie und Psychotherapie, Medizinische Universität Wien.
Neuropsychiatr. 2009;23(1):52-7.
Pupillometry is a non-invasive measurement technique based on the pupillary response to specific sensoric, mental and emotional variables. After topical application of a cholinergic antagonist (tropicamide) an increased pupillary dilatation response in Alzheimers s disease patients was described ("receptor test"). The aim of the present study was to evaluate the usefulness of the 0.01% tropicamide receptor test in differentiating types of dementia.
425 patients (159 men, 266 women, mean age 75 years) of the Memory Clinic of the SMZ Ost Vienna, Austria were included in the study. 195 patients suffered from a dementia in Alzheimer's disease with late onset (ICD-10: F00.1), 42 from dementia in Alzheimer's disease with early onset (F00.0), 71 from vascular dementia (F01), 34 from Lewy-Body dementia (F03) and 83 from mixed dementia (F00.2). All patients were investigated by means of a computer-assisted pupillometer. The pupillary diameter of the left eye was measured 4 times (baseline=0 minutes, after 20, 40 and 60 minutes). 4 minutes after baseline one drop of 0.01% tropicamide solution was installed onto the left eye of the patients.
At baseline the pupillary diameter was largest in Lewy-Body dementia, smallest in vascular dementia. Significant differences were observed between vascular dementia and early-onset dementia in Alzheimer's disease as well as between Lewy-Body dementia and all other dementia syndromes (except dementia in Alzheimer's disease with early onset). The 0.01% tropicamide receptor test made it possible to differentiate early-onset dementia in Alzheimer's disease from vascular and mixed dementia.
Utilizing pupillometry in combination with the 0.01% tropicamide receptor test allows to discriminate between different dementia types of, as demonstrated in our study.
瞳孔测量法是一种基于瞳孔对特定感官、心理和情绪变量反应的非侵入性测量技术。在局部应用胆碱能拮抗剂（托吡卡胺）后，有研究描述了阿尔茨海默病患者瞳孔扩张反应增强（“受体测试”）。本研究的目的是评估0.01%托吡卡胺受体测试在区分痴呆类型方面的实用性。
纳入了奥地利维也纳东部SMZ记忆诊所的425名患者（159名男性，266名女性，平均年龄75岁）。195名患者患有晚发性阿尔茨海默病痴呆（国际疾病分类第10版：F00.1），42名患有早发性阿尔茨海默病痴呆（F00.0），71名患有血管性痴呆（F01），34名患有路易体痴呆（F03），83名患有混合性痴呆（F00.2）。所有患者均通过计算机辅助瞳孔计进行检查。测量左眼瞳孔直径4次（基线=0分钟，20、40和60分钟后）。在基线后4分钟，将一滴0.01%托吡卡胺溶液滴入患者左眼。
在基线时，路易体痴呆患者的瞳孔直径最大，血管性痴呆患者的最小。在血管性痴呆与早发性阿尔茨海默病痴呆之间以及路易体痴呆与所有其他痴呆综合征（早发性阿尔茨海默病痴呆除外）之间观察到显著差异。0.01%托吡卡胺受体测试能够区分早发性阿尔茨海默病痴呆与血管性和混合性痴呆。
正如我们的研究所表明的，利用瞳孔测量法结合0.01%托吡卡胺受体测试可以区分不同类型的痴呆。
