Bargagli Alessia, Fontanelli Enrica, Zanca Dario, Castelli Ilaria, Rosini Francesca, Maddii Silvia, Di Donato Ilaria, Carluccio Alessandra, Battisti Carla, Tosi Gian M, Dotti Maria T, Rufa Alessandra
Neurosense-EVAlab DSMCN Università di Siena, Siena, Italy.
UOC Oculistica Università di Siena, Siena, Italy.
Front Neurol. 2020 Nov 3;11:577362. doi: 10.3389/fneur.2020.577362. eCollection 2020.
Patients with Alzheimer's disease (AD) and Parkinson's disease (PD) develop a progressive decline of visual function. This condition aggravates overall cognitive and motor abilities, is a risk factor for developing hallucinations, and can have a significant influence on general quality of life. Visual problems are common complaints of patients with PD and AD in the early stages of the disease, but they also occur during normal aging, making it difficult to differentiate between normal and pathological conditions. In this respect, their real incidence has remained largely underestimated, and no rehabilitative approaches have been standardized. With the aim to increase awareness for ocular and visual disorders, we collected the main neurophthalmologic and orthoptic parameters, including optical coherence tomography (OCT), in six patients with a diagnosis of PD, six patients with a diagnosis of early AD, and eight control subjects in an easily assessable outpatient setting. We also evaluated the patient's ability to recognize changes in facial expression. Our study demonstrates that visual problems, including blurred vision, diplopia, reading discomfort, photophobia, and glare, are commonly reported in patients with PD and AD. Moreover, abnormal eye alignment and vergence insufficiency were documented in all patients during examination. Despite the small size of the sample, we demonstrated greater ganglion cell and retinal nerve fibers layer (RNFL) damage and a defect of facial emotion recognition in AD/PD patients with respect to a comparable group of normal elderly persons, with peculiarities depending upon the disease. Ocular defects or visual discomfort could be correctly evaluated in these patients and possibly corrected by means of lens, orthoptic exercises, and visual rehabilitation. Such a practical approach may help to ameliorate motor autonomy, reading ability, and may also reduce the risk of falls, with a positive impact in daily living activities.
阿尔茨海默病（AD）和帕金森病（PD）患者会出现视觉功能的进行性衰退。这种情况会加重整体认知和运动能力，是引发幻觉的一个风险因素，并且会对总体生活质量产生重大影响。视觉问题是PD和AD患者在疾病早期常见的主诉，但在正常衰老过程中也会出现，这使得区分正常情况和病理状况变得困难。在这方面，它们的实际发病率在很大程度上一直被低估，并且尚未有标准化的康复方法。为了提高对眼部和视觉障碍的认识，我们在一个易于评估的门诊环境中，收集了6名诊断为PD的患者、6名诊断为早期AD的患者以及8名对照受试者的主要神经眼科和视光学参数，包括光学相干断层扫描（OCT）。我们还评估了患者识别面部表情变化的能力。我们的研究表明，视觉问题，包括视力模糊、复视、阅读不适、畏光和眩光，在PD和AD患者中普遍存在。此外，在检查过程中所有患者均记录到眼位异常和聚散功能不全。尽管样本量较小，但我们证明，与一组年龄相仿的正常老年人相比，AD/PD患者存在更严重的神经节细胞和视网膜神经纤维层（RNFL）损伤以及面部情绪识别缺陷，且这些情况因疾病而异。这些患者的眼部缺陷或视觉不适能够得到正确评估，并且可能通过佩戴眼镜、视光学训练和视觉康复来纠正。这种实用的方法可能有助于改善运动自主性、阅读能力，还可能降低跌倒风险，对日常生活活动产生积极影响。
