Pupillary response test as a potential early diagnosis biomarker of Alzheimer's disease.

Q3 Medicine

Dementia e Neuropsychologia Pub Date : 2025-05-26 eCollection Date: 2025-01-01 DOI:10.1590/1980-5764-DN-2024-0153

Robert Shen, Yuda Turana, Yvonne Suzy Handajani, Lukas, Nelly Tina Widjaja, Nova Eka Budiyanta, Reiner Adi Putra Sumarta, Celine Gabriella Wahyudi, Hans Timothy Wijaya, Jimmy Fransisco Abadinta Barus, Linda Suryakusuma, Poppy Kristina Sasmita, Tara Puspitarini Sani

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引用次数: 0

Abstract

Psychometric tests as the gold-standard for diagnosing Alzheimer's disease (AD) tend to be inefficient, nonreproducible, and are affected by many factors. Research on pupillary response in AD is not novel; however, there has not been a single study providing the diagnostic value of pupillary response parameters as a recommendation for their potential use for early AD diagnosis.

Objective: To investigate pupillary response parameters as clinical biomarkers of AD that are dynamic, affordable, efficient, and objective (non-operator dependent).

Methods: A cross-sectional study on pupillary response parameters was conducted, with comparative and correlation-analytical tests between pupillary response and the Mini-Mental State Examination cognitive score. The diagnostic value of pupillary response parameters was obtained by determining the cutoff point of each parameter by calculating the sensitivity, specificity, Youden's maximum index, Area Under the Curve (AUC) value from the Receiver Operating Characteristic (ROC) curve, positive predictive value, and negative predictive value. Pupillary response parameters were classified into four types: size, response time, velocity, and acceleration.

Results: There were 128 respondents in total, consisting of cognitively-unimpaired young adults, cognitively-unimpaired older adults, and cognitively-impaired older adults. The pupillary response values without involving acceleration parameters were reliable. The diagnostic value of change in pupil size, the maximum and the average constriction velocity parameters have normal cognitive cutoff scores of 1.77 mm (sensitivity: 61.3%; specificity: 80%; positive predictive value [PPV]: 47.76%; negative predictive value [NPV]: 86.88%), ≥4.43 mm/s (sensitivity: 70.4%; specificity: 58.5%; PPV: 46.93%; NPV: 78.48%), and 3.12 mm/s (sensitivity: 70.4%; specificity: 55.0%; PPV: 45.83%; NPV: 77.5%), respectively.

Conclusions: Pupillary response, in particular changes in constriction and velocity, can be potentially used as an early diagnostic biomarker for AD.

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瞳孔反应试验作为阿尔茨海默病潜在的早期诊断生物标志物。

心理测试作为诊断阿尔茨海默病（AD）的金标准，往往效率低下，不可重复，并且受许多因素的影响。对AD患者瞳孔反应的研究并不新鲜；然而，目前还没有一项研究提供瞳孔反应参数的诊断价值，并推荐它们在早期AD诊断中的潜在应用。目的：探讨瞳孔反应参数作为AD临床生物标志物的动态、可负担、有效和客观（不依赖于操作者）。方法：对瞳孔反应参数进行横断面研究，并对瞳孔反应与简易精神状态检查认知评分进行对比分析和相关分析。通过计算敏感度、特异度、约登最大指数、受试者工作特征（ROC）曲线下面积（AUC）值、阳性预测值、阴性预测值，确定各参数的截止点，得出瞳孔反应参数的诊断价值。瞳孔响应参数分为大小、响应时间、速度和加速度四种类型。结果：共有128名受访者，包括认知功能健全的年轻人、认知功能健全的老年人和认知功能健全的老年人。不涉及加速度参数的瞳孔响应值是可靠的。瞳孔大小变化、最大收缩速度和平均收缩速度参数的诊断价值为1.77 mm(敏感性：61.3%；特异性:80%;阳性预测值[PPV]: 47.76%；阴性预测值[NPV]: 86.88%),≥4.43 mm/s(敏感性：70.4%；特异性:58.5%;PPV: 46.93%;NPV: 78.48%)、3.12 mm/s(灵敏度：70.4%；特异性:55.0%;PPV: 45.83%;净现值：77.5%)。结论：瞳孔反应，特别是收缩和速度的变化，可以作为AD的早期诊断生物标志物。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Dementia e Neuropsychologia Medicine-Geriatrics and Gerontology

CiteScore

2.20

自引率

0.00%

发文量

审稿时长

8 weeks

期刊介绍： Dementia top Neuropsychologia the official scientific journal of the Cognitive Neurology and Ageing Department of the Brazilian Academy of Neurology and of the Brazilian Association of Geriatric Neuropsychiatry, is published by the "Associação Neurologia Cognitiva e do Comportamento", a nonprofit Brazilian association. Regularly published on March, June, September, and December since 2007.