Assessing cognitive dysfunction in Parkinson's disease: an online tool to detect visuo-perceptual deficits

Weil, R. S. et al. (2018) Assessing cognitive dysfunction in Parkinson's disease: an online tool to detect visuo-perceptual deficits. Movement Disorders, 33(4), pp. 544-553. (doi: 10.1002/mds.27311) (PMID:29473691) (PMCID:PMC5901022)

Abstract

Background: People with Parkinson's disease (PD) who develop visuo‐perceptual deficits are at higher risk of dementia, but we lack tests that detect subtle visuo‐perceptual deficits and can be performed by untrained personnel. Hallucinations are associated with cognitive impairment and typically involve perception of complex objects. Changes in object perception may therefore be a sensitive marker of visuo‐perceptual deficits in PD. Objective: We developed an online platform to test visuo‐perceptual function. We hypothesised that (1) visuo‐perceptual deficits in PD could be detected using online tests, (2) object perception would be preferentially affected, and (3) these deficits would be caused by changes in perception rather than response bias. Methods: We assessed 91 people with PD and 275 controls. Performance was compared using classical frequentist statistics. We then fitted a hierarchical Bayesian signal detection theory model to a subset of tasks. Results: People with PD were worse than controls at object recognition, showing no deficits in other visuo‐perceptual tests. Specifically, they were worse at identifying skewed images (P  < .0001); at detecting hidden objects (P  = .0039); at identifying objects in peripheral vision (P  < .0001); and at detecting biological motion (P  = .0065). In contrast, people with PD were not worse at mental rotation or subjective size perception. Using signal detection modelling, we found this effect was driven by change in perceptual sensitivity rather than response bias. Conclusions: Online tests can detect visuo‐perceptual deficits in people with PD, with object recognition particularly affected. Ultimately, visuo‐perceptual tests may be developed to identify at‐risk patients for clinical trials to slow PD dementia. © 2018 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.

• Item Type: Articles
• Additional Information: Funding agencies: University College London (UCL) Excellence Fellowship, Academy of Medical Science (AMS‐SGCL13‐Weil), University College London Hospital (UCLH) Biomedical Research Centre Grant (BRC302/NS/RW/101410), European Research Council (ERC) starting grant NEUROCODEC (309865); European Research Council (ERC) starting grant WMOSPOTWU (310829); Economic and Social Research Council/National Institute for Health Research (ESRC/NIHR) (ES/L001810/1), Engineering and Physical Sciences Research Council (EPSRC) (EP/M006093/1), Alzheimer's Research UK Senior Research Fellowship (ARUK‐SRF2013‐8); Wellcome Trust (106882/Z/15/Z; 106882/Z/15/Z; 203147/Z/16/Z); Medical Research Council UK, Parkinson's UK (G‐1606; K‐1213; 8047; J‐0804), Ipsen Fund, Motor Neurone Disease Association, Welsh Assembly Government, Progressive Supranuclear Palsy (PSP) Association, CBD Solutions and Drake Foundation, Economic and Social Research Council, GE Healthcare, and the Movement Disorder's Society.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Pappa, Mrs Aikaterini
• Authors: Weil, R. S., Schwarzkopf, D. S., Bahrami, B., Fleming, S. M., Jackson, B. M., Goch, T. J.C., Saygin, A. P., Miller, L. E., Pappa, K., Pavisic, I., Schade, R. N., Noyce, A. J., Crutch, S. J., O'Keefe, A. G., Schrag, A. E., and Morris, H. R.
• College/School: College of Medical Veterinary and Life Sciences
• Journal Name: Movement Disorders
• Publisher: Wiley
• ISSN: 0885-3185
• ISSN (Online): 1531-8257
• Published Online: 23 February 2018
• Copyright Holders: Copyright © 2018 The Authors
• First Published: First published in Movement Disorders 33(4): 544-553
• Publisher Policy: Reproduced under a Creative Commons License