Lee Jungyeun, Kang Sung Hoon, Koh Seong-Beom
Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
PLoS One. 2025 Jan 23;20(1):e0317935. doi: 10.1371/journal.pone.0317935. eCollection 2025.
Visual dysfunction, including abnormal stereopsis, is a significant non-motor symptom in Parkinson's disease (PD) that can reduce quality of life and appears early in the disease. Abnormal stereopsis is associated with worsening of bradykinesia and freezing of gait, though the exact pathways linking stereopsis to motor symptoms remain unclear. Furthermore, in PD patients, the pedunculopontine nucleus and laterodorsal tegmental complex play an active role in sensorimotor control, and these areas provide cholinergic projections. Cholinergic degeneration may be associated with symptoms such as abnormal stereopsis, postural instability, gait disturbances and cognitive impairment. Therefore, in this study, we hypothesized that a high postural instability and gait disturbance score would increase the risk of abnormal stereopsis in PD.
We designed a cross-sectional study and included 240 early PD patients without ophthalmologic problems other than abnormal stereopsis. To evaluate stereopsis, we used Titmus stereo test plates. Stereopsis testing was performed only once at the time of the patient's initial PD diagnosis. We collected data from medical history taking, scales, cognitive function tests, gait analysis, and tilt table tests. To analyze the potential risk factors for abnormal stereopsis in PD, we conducted a binary logistic stepwise selection analysis.
Among the total of 240 PD patients, 185 were in the normal stereopsis group and 55 were in the abnormal stereopsis group. In the analysis for risk factors related to abnormal stereopsis, the postural instability and gait difficulties (PIGD) subtype score was significantly associated with abnormal stereopsis. (95% confidence interval: 1.37-5.15).
In PD, particularly in PIGD subtype patients, abnormal stereopsis can lead to a decrease in the quality of sensory information, potentially interfering with feedback and adaptation processes. This, in turn, can negatively affect posture and gait, creating a vicious cycle.
视觉功能障碍，包括异常立体视觉，是帕金森病（PD）中一种重要的非运动症状，可降低生活质量且在疾病早期出现。异常立体视觉与运动迟缓及步态冻结的加重相关，尽管将立体视觉与运动症状联系起来的确切途径仍不清楚。此外，在PD患者中，脚桥核和脑桥背外侧被盖复合体在感觉运动控制中起积极作用，且这些区域提供胆碱能投射。胆碱能变性可能与诸如异常立体视觉、姿势不稳、步态障碍和认知障碍等症状相关。因此，在本研究中，我们假设姿势不稳和步态障碍评分高会增加PD患者出现异常立体视觉的风险。
我们设计了一项横断面研究，纳入240例除异常立体视觉外无眼科问题的早期PD患者。为评估立体视觉，我们使用了Titmus立体视测试图板。立体视觉测试仅在患者首次PD诊断时进行一次。我们从病史采集、量表、认知功能测试、步态分析和倾斜台测试中收集数据。为分析PD患者异常立体视觉的潜在危险因素，我们进行了二元逻辑逐步选择分析。
在总共240例PD患者中，185例属于正常立体视觉组，55例属于异常立体视觉组。在与异常立体视觉相关的危险因素分析中，姿势不稳和步态困难（PIGD）亚型评分与异常立体视觉显著相关。（95%置信区间：1.37 - 5.15）。
在PD中，尤其是在PIGD亚型患者中，异常立体视觉可导致感觉信息质量下降，可能干扰反馈和适应过程。这反过来又会对姿势和步态产生负面影响，形成恶性循环。
