Clinical and Imaging Characteristics Associated with Color Vision Impairment in Lewy Body Disease

Article type: Research Article

Authors: Unger, Robert H.^{a; b} | Flanigan, Patrick M.^c | Khosravi, Mitra^d | Leverenz, James B.^b | Tousi, Babak^{b; *}

Affiliations: [a] Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA | [b] Lou Ruvo Center for Brain Health, Cleveland Clinic, Cleveland, OH, USA | [c] Department of Neurosurgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA | [d] Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA

Correspondence: [*] Correspondence to: Babak Tousi, MD, FACP, Lou Ruvo Center for Brain Health, U-10, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA. Tel.: +1 216 219 5007; E-mail: batous@ccf.org.

Abstract: Background:Color vision impairment (CVI) has been reported in dementia with Lewy bodies (DLB) and prodromal Lewy body disease (pro-LBD). Objective:In order to better characterize the diagnostic value of CVI testing, we compared the prevalence of CVI in patients with with Lewy body disease compared to Alzheimer’s disease (AD), and we examined clinical and imaging characteristics associated with CVI in patients with DLB and suspected pro-LBD. Methods:We retrospectively reviewed medical records, dopamine transporter (DaT-SPECT) imaging, and volumetric MRI from patients with AD, DLB, and suspected pro-LBD who underwent an online Farnsworth D-15 color vision test. Results:111 patients (62 DLB, 25 pro-LBD, and 24 AD) were included with a median age of 75 years. Newly diagnosed CVI was present in 67% of patients with DLB, 44% of patients with pro-LBD, and 18% of patients with AD. In patients with DLB, CVI was associated with lower Montreal Cognitive Assessment (MoCA) scores and lower sub-scores in visuospatial/executive function, naming, and language. In a multivariable logistic regression model, a diagnosis of DLB or pro-LBD compared to AD, and a lower composite MoCA score in visuospatial/executive function, naming, and language were associated with CVI controlling for age and gender. Among 17 DLB patients who underwent volumetric MRI, patients with CVI (n = 9) demonstrated lower normative volumetric percentiles in the right transverse superior temporal lobe. Conclusion:We provide further evidence that CVI can help differentiate DLB from AD, and we suggest that CVI may be an indicator of cognitive decline and disease progression in DLB.

Keywords: Alzheimer’s disease, biomarkers, color vision, Lewy body disease, presenile dementia

DOI: 10.3233/JAD-190727

Journal: Journal of Alzheimer's Disease, vol. 72, no. 4, pp. 1233-1240, 2019