Nieto-Escamez Francisco, Obrero-Gaitán Esteban, Cortés-Pérez Irene
Department of Psychology, University of Almeria, 04120 Almeria, Spain.
Center for Neuropsychological Assessment and Rehabilitation (CERNEP), 04120 Almeria, Spain.
Brain Sci. 2023 Aug 7;13(8):1173. doi: 10.3390/brainsci13081173.
Non-motor symptoms in Parkinson's disease (PD) include ocular, visuoperceptive, and visuospatial impairments, which can occur as a result of the underlying neurodegenerative process. Ocular impairments can affect various aspects of vision and eye movement. Thus, patients can show dry eyes, blepharospasm, reduced blink rate, saccadic eye movement abnormalities, smooth pursuit deficits, and impaired voluntary and reflexive eye movements. Furthermore, visuoperceptive impairments affect the ability to perceive and recognize visual stimuli accurately, including impaired contrast sensitivity and reduced visual acuity, color discrimination, and object recognition. Visuospatial impairments are also remarkable, including difficulties perceiving and interpreting spatial relationships between objects and difficulties judging distances or navigating through the environment. Moreover, PD patients can present visuospatial attention problems, with difficulties attending to visual stimuli in a spatially organized manner. Moreover, PD patients also show perceptual disturbances affecting their ability to interpret and determine meaning from visual stimuli. And, for instance, visual hallucinations are common in PD patients. Nevertheless, the neurobiological bases of visual-related disorders in PD are complex and not fully understood. This review intends to provide a comprehensive description of visual disturbances in PD, from sensory to perceptual alterations, addressing their neuroanatomical, functional, and neurochemical correlates. Structural changes, particularly in posterior cortical regions, are described, as well as functional alterations, both in cortical and subcortical regions, which are shown in relation to specific neuropsychological results. Similarly, although the involvement of different neurotransmitter systems is controversial, data about neurochemical alterations related to visual impairments are presented, especially dopaminergic, cholinergic, and serotoninergic systems.
帕金森病（PD）的非运动症状包括眼部、视觉感知和视觉空间障碍，这些症状可能是由潜在的神经退行性过程引起的。眼部障碍会影响视力和眼球运动的各个方面。因此，患者可能会出现干眼、眼睑痉挛、眨眼频率降低、眼球扫视运动异常、平稳跟踪缺陷以及自主和反射性眼球运动受损。此外，视觉感知障碍会影响准确感知和识别视觉刺激的能力，包括对比敏感度受损、视力下降、颜色辨别和物体识别能力降低。视觉空间障碍也很明显，包括难以感知和解释物体之间的空间关系，以及难以判断距离或在环境中导航。此外，帕金森病患者可能存在视觉空间注意力问题，难以以空间组织的方式关注视觉刺激。此外，帕金森病患者还表现出感知障碍，影响他们从视觉刺激中解释和确定意义的能力。例如，视觉幻觉在帕金森病患者中很常见。然而，帕金森病中与视觉相关障碍的神经生物学基础很复杂，尚未完全了解。本综述旨在全面描述帕金森病中的视觉障碍，从感觉改变到感知改变，探讨其神经解剖学、功能和神经化学相关性。描述了结构变化，特别是后皮质区域的变化，以及皮质和皮质下区域的功能改变，并将其与特定的神经心理学结果相关联。同样，尽管不同神经递质系统的参与存在争议，但本文介绍了与视觉障碍相关的神经化学改变的数据，特别是多巴胺能、胆碱能和5-羟色胺能系统。
