Holden Samantha K, Van Dok Erin, Pelak Victoria S
Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States.
Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, United States.
Front Neurol. 2019 Aug 9;10:864. doi: 10.3389/fneur.2019.00864. eCollection 2019.
Convergence insufficiency (CI) in parkinsonian conditions causes disabling visual symptoms during near tasks and usually manifests as double vision. Since double vision is more common in patients who report cognitive symptoms, we sought to determine if symptomatic CI, as opposed to asymptomatic CI, could serve as a marker of cognitive impairment in parkinsonian disorders. Twenty-four participants with parkinsonian disorders (18 Parkinson's disease, 5 progressive supranuclear palsy, 1 multiple system atrophy) and objective findings of convergence insufficiency on neuro-ophthalmologic examination were included. Subjective visual symptoms and cognitive complaints were recorded, and the Self-Administered Gerocognitive Examination was used as a global cognitive screening measure. 54.1% of parkinsonian participants had cognitive impairment, but there were no significant differences in the degree of convergence insufficiency, measured by near point of convergence (NPC), or cognitive outcomes between those with symptomatic CI, and asymptomatic CI. However, NPC was greater for those with cognitive impairment ( = 18.4 cm), compared to those who were cognitively intact ( = 12.5 cm, = 0.003). Cognitive impairment commonly co-occurs in parkinsonian disorders with convergence insufficiency and is associated with significantly greater NPC distances. Clinicians should have a high index of suspicion for cognitive impairment in patients with objective findings of convergence insufficiency, whether symptomatic or not. Further investigation of convergence insufficiency in relationship to cognitive impairment in parkinsonian disorders is warranted, as there may be a shared mechanism of dysfunction.
帕金森病相关病症中的集合不足（CI）在近距任务期间会引发致残性视觉症状，通常表现为复视。由于复视在报告有认知症状的患者中更为常见，我们试图确定有症状的CI与无症状的CI相比，是否可作为帕金森病相关病症中认知障碍的一个标志物。纳入了24名患有帕金森病相关病症的参与者（18例帕金森病、5例进行性核上性麻痹、1例多系统萎缩），他们在神经眼科检查中存在集合不足的客观表现。记录主观视觉症状和认知主诉，并使用自我管理老年认知检查作为整体认知筛查手段。54.1%的帕金森病参与者存在认知障碍，但在有症状的CI患者和无症状的CI患者之间，通过集合近点（NPC）测量的集合不足程度或认知结果并无显著差异。然而，与认知功能正常者（NPC = 12.5 cm，P = 0.003）相比，认知障碍者的NPC更大（NPC = 18.4 cm）。认知障碍在伴有集合不足的帕金森病相关病症中通常同时出现，且与显著更大的NPC距离相关。对于有集合不足客观表现的患者，无论有无症状，临床医生都应高度怀疑其存在认知障碍。鉴于可能存在共同的功能障碍机制，有必要进一步研究帕金森病相关病症中集合不足与认知障碍之间的关系。
