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

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Weil, Rimona S. and Schwarzkopf, Dietrich S. and Bahrami, Bahador and Fleming, Stephen M. and Jackson, Ben M. and Goch, Tristam J. C. and Saygin, Ayse P. and Miller, Luke E. and Pappa, Katerina and Pavisic, Ivanna and Schade, Rachel N. and Noyce, Alastair J. and Crutch, Sebastian J. and O'Keeffe, Aidan G. and Schrag, Anette E. and Morris, Huw R. (2018) Assessing cognitive dysfunction in Parkinson's disease : an online tool to detect visuo-perceptual deficits. Movement Disorders, 33 (4). pp. 544-553. ISSN 0885-3185 (https://doi.org/10.1002/mds.27311)

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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.

ORCID iDs

Weil, Rimona S., Schwarzkopf, Dietrich S., Bahrami, Bahador, Fleming, Stephen M., Jackson, Ben M., Goch, Tristam J. C., Saygin, Ayse P., Miller, Luke E., Pappa, Katerina ORCID logoORCID: https://orcid.org/0000-0003-3322-496X, Pavisic, Ivanna, Schade, Rachel N., Noyce, Alastair J., Crutch, Sebastian J., O'Keeffe, Aidan G., Schrag, Anette E. and Morris, Huw R.;
CORE (COnnecting REpositories)