Pupillary unrest correlates with arousal symptoms and motor signs in Parkinson disease

Authors

  • Samay Jain MD, MS,

    Corresponding author
    1. University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
    2. Pittsburgh Institute for Neurodegenerative Diseases, Pittsburgh, Pennsylvania, USA
    • Assistant Professor of Neurology, Clinical Director, Movement Disorders Division, Department of Neurology, University of Pittsburgh Medical Center, 3471 Fifth Ave., Suite 811, Kaufmann Medical Building, Pittsburgh, PA 15213-3232, USA

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  • Greg J. Siegle PhD,

    1. University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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  • Chen Gu MS,

    1. University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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  • Charity G. Moore PhD,

    1. University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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  • Larry S. Ivanco MSW,

    1. University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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  • Stephanie Studenski MD, MPH,

    1. University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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  • J. Timothy Greenamyre MD, PhD,

    1. University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
    2. Pittsburgh Institute for Neurodegenerative Diseases, Pittsburgh, Pennsylvania, USA
    3. VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
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  • Stuart R. Steinhauer PhD

    1. University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
    2. VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
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  • Funding agencies: This study was funded by NIH grants KL2 RR024154, KMH082998, MH55762, UL1 RR024153, and P30 AG-024827, the Department of Veterans Affairs, and the American Parkinson Disease Association Center for Advanced Research at the University of Pittsburgh. Relevant conflicts of interest/financial disclosures: Nothing to report.

    Full financial disclosures and author roles may be found in the online version of this article.

Abstract

Background:

Arousal symptoms (e.g., sleepiness) are common in Parkinson's disease, and pupillary unrest (spontaneous changes in pupil diameter) is positively associated with sleepiness. We explored pupillary unrest in Parkinson's disease.

Methods:

Arousal symptoms (Epworth sleepiness scale and sleep/fatigue domain of the nonmotor symptoms scale for Parkinson's disease) and pupillary unrest were assessed in 31 participants (14 patients with Parkinson's disease, 17 controls). Effect sizes and t tests compared patients with Parkinson's disease with control participants. Correlation coefficients were calculated among arousal symptoms, pupillary unrest, and Unified Parkinson Disease Rating Scale Part III. Linear regression was performed with arousal symptoms or pupillary unrest as outcome.

Results:

Participants with Parkinson's disease reported more arousal symptoms than controls. Pupillary unrest, arousal symptoms, and Unified Parkinson Disease Rating Scale Part III were positively correlated. The association between nonmotor symptoms scale–sleep score and pupillary unrest was higher in participants with Parkinson's disease than controls and higher in those with more Parkinsonian motor signs. Unified Parkinson Disease Rating Scale Part III was positively associated with pupillary unrest.

Conclusions:

Pupillary unrest correlates with motor and nonmotor features associated with Lewy-related pathology, suggesting it may be a nonmotor marker of progression in Parkinson's disease. © 2011 Movement Disorder Society

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