Contrast sensitivity impairment in drug-naïve Parkinson’s disease patients associates with early cognitive decline



To investigate the contrast sensitivity function in drug-naïve Parkinson’s disease (PD) patients and its predictive value with longitudinal follow-up data.


We included newly diagnosed non-demented PD patients who performed contrast sensitivity test between 2013 and 2014. Contrast sensitivity function at drug-naïve state in PD patients was compared with age-matched normal control data of our center. Correlation between contrast sensitivity function and parkinsonian motor and non-motor features including the Mini-Mental State Exam (MMSE) score at the time of diagnosis were analyzed by linear regression. With longitudinal follow-up data after initiating anti-parkinsonian therapy, the risk conferred on subsequent visual hallucinations and cognitive impairment requiring anti-dementia drugs was analyzed by dichotomizing PD group based on the initial contrast sensitivity function.


Forty-eight patients were finally included, and mean follow-up periods were 43 months. Contrast sensitivity function in drug-naïve PD patients was significantly worse than controls. Contrast sensitivity function correlated with sleep disturbance (p = 0.001) and global cognitive status reflected by the MMSE score (p = 0.020). It also associated with further decline in the MMSE during the follow-ups (p = 0.029). Patients with below average contrast sensitivity function at the time of diagnosis showed higher risk of cognitive decline requiring anti-dementia drugs (adjusted odds ratio = 4.68, p = 0.04) and of visual hallucinations (adjusted odds ratio = 12.54, p = 0.04) than those above average function during the follow-up.


Contrast sensitivity impairment in drug-naïve PD patients associates with clinical demand for therapeutic intervention of cognitive decline as well as development of visual hallucinations in the early course of the disease.

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  1. 1.

    Goetz CG, Tilley BC, Shaftman SR, Stebbins GT, Fahn S, Martinez-Martin P, Poewe W, Sampaio C, Stern MB, Dodel R, Dubois B, Holloway R, Jankovic J, Kulisevsky J, Lang AE, Lees A, Leurgans S, LeWitt PA, Nyenhuis D, Olanow CW, Rascol O, Schrag A, Teresi JA, van Hilten JJ, LaPelle N, Movement Disorder Society UPDRS Revision Task Force (2008) Movement Disorder Society-sponsored revision of the unified Parkinson’s disease rating scale (MDS-UPDRS): scale presentation and clinimetric testing results. Mov Disord Off J Mov Disord Soc 23:2129–2170

    Article  Google Scholar 

  2. 2.

    Postuma RB, Aarsland D, Barone P, Burn DJ, Hawkes CH, Oertel W, Ziemssen T (2012) Identifying prodromal Parkinson’s disease: pre-motor disorders in Parkinson’s disease. Mov Disord 27:617–626

    Article  PubMed  Google Scholar 

  3. 3.

    Chaudhuri KR, Healy DG, Schapira AH (2006) Non-motor symptoms of Parkinson’s disease: diagnosis and management. Lancet Neurol 5:235–245

    Article  PubMed  Google Scholar 

  4. 4.

    Bodis-Wollner I (2009) Retinopathy in Parkinson disease. J Neural Transm 116:1493

    Article  PubMed  Google Scholar 

  5. 5.

    Bulens C, Meerwaldt JD, van der Wildt GJ, Keemink CJ (1986) Contrast sensitivity in Parkinson’s disease. Neurology 36:1121–1125

    CAS  Article  PubMed  Google Scholar 

  6. 6.

    Pieri V, Diederich NJ, Raman R, Goetz CG (2000) Decreased color discrimination and contrast sensitivity in Parkinson’s disease. J Neurol Sci 172:7–11.

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    Price MJM, Feldman RG, Adelberg D, Kayne H (1992) Abnormalities in color vision and contrast sensitivity in Parkinson’s disease. Neurology. 42:887–890

    CAS  Article  PubMed  Google Scholar 

  8. 8.

    Hutton JT, Morris JL, Elias JW (1993) Levodopa improves spatial contrast sensitivity in Parkinson’s disease. Arch Neurol 50:721–724

    CAS  Article  PubMed  Google Scholar 

  9. 9.

    Jones RD, Donaldson IM, Timmings PL (1992) Impairment of high-contrast visual acuity in Parkinson’s disease. Mov Disord 7:232–238.

    CAS  Article  PubMed  Google Scholar 

  10. 10.

    Arden GB (1978) The importance of measuring contrast sensitivity in cases of visual disturbance. Br J Ophthalmol 62:198–209

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Ward ME, Gelfand JM, Lui L-Y, Ou Y, Green AJ, Stone K, Pedula KL, Cummings SR, Yaffe K (2018) Reduced contrast sensitivity among older women is associated with increased risk of cognitive impairment. Ann Neurol 83:730–738.

    Article  PubMed  PubMed Central  Google Scholar 

  12. 12.

    Adam CR, Shrier E, Ding Y, Glazman S, Bodis-Wollner I (2013) Correlation of inner retinal thickness evaluated by spectral-domain optical coherence tomography and contrast sensitivity in Parkinson disease. J Neuroophthalmol 33:137–142.

    Article  PubMed  Google Scholar 

  13. 13.

    Diederich NJ, Goetz CG, Raman R, Pappert EJ, Leurgans S, Piery V (1998) Poor visual discrimination and visual hallucinations in Parkinson’s disease. Clin Neuropharmacol 21:289–295

    CAS  PubMed  Google Scholar 

  14. 14.

    Lee J-Y, Kim JM, Ahn J, Kim H-J, Jeon BS, Kim TW (2014) Retinal nerve fiber layer thickness and visual hallucinations in Parkinson’s disease. Mov Disord Off J Mov Disord Soc 29:61–67.

    Article  Google Scholar 

  15. 15.

    Pesudovs K, Hazel CA, Doran RML, Elliott DB (2004) The usefulness of Vistech and FACT contrast sensitivity charts for cataract and refractive surgery outcomes research. Br J Ophthalmol 88:11–16.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    LeGates TA, Fernandez DC, Hattar S (2014) Light as a central modulator of circadian rhythms, sleep and affect. Nat Rev Neurosci 15:443–454.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    Hwang CK, Chaurasia SS, Jackson CR, Chan GC-K, Storm DR, Iuvone PM (2013) Circadian rhythm of contrast sensitivity is regulated by a dopamine-neuronal PAS-domain protein 2-adenylyl cyclase 1 signaling pathway in retinal ganglion cells. J Neurosci 33:14989–14997.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  18. 18.

    Niemeyer JE, Paradiso MA (2017) Contrast sensitivity, V1 neural activity, and natural vision. J Neurophysiol 117:492–508.

    Article  Google Scholar 

  19. 19.

    Elliott D, Whitaker D, MacVeigh D (1990) Neural contribution to spatiotemporal contrast sensitivity decline in healthy ageing eyes. Vis Res 30:541–547.

    CAS  Article  Google Scholar 

  20. 20.

    Ridder A, Müller MLTM, Kotagal V, Frey KA, Albin RL, Bohnen NI (2017) Impaired contrast sensitivity is associated with more severe cognitive impairment in Parkinson disease. Parkinsonism Relat Disord 34:15–19.

    CAS  Article  PubMed  Google Scholar 

  21. 21.

    Moes E, Lombardi KM (2009) The relationship between contrast sensitivity, gait, and reading speed in Parkinson’s disease. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 16:121–132.

    Article  PubMed  Google Scholar 

  22. 22.

    Satue M, Rodrigo MJ, Obis J, Vilades E, Gracia H, Otin S, Fuertes MI, Alarcia R, Crespo JA, Polo V, Larrosa JM, Pablo LE, Garcia-Martin E (2017) Evaluation of progressive visual dysfunction and retinal degeneration in patients with Parkinson’s disease. Investig Opthalmol Vis Sci 58:1151.

    Article  Google Scholar 

  23. 23.

    Polo V, Rodrigo MJ, Garcia-Martin E, Otin S, Larrosa JM, Fuertes MI, Bambo MP, Pablo LE, Satue M (2017) Visual dysfunction and its correlation with retinal changes in patients with Alzheimer’s disease. Eye. 31:1034–1041.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  24. 24.

    Ortuño-Lizarán I, Beach TG, Serrano GE, Walker DG, Adler CH, Cuenca N (2018) Phosphorylated α-synuclein in the retina is a biomarker of Parkinson’s disease pathology severity. Mov Disord 33:1315–1324.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  25. 25.

    Shah TM, Gupta SM, Chatterjee P, Campbell M, Martins RN (2017) Beta-amyloid sequelae in the eye: a critical review on its diagnostic significance and clinical relevance in Alzheimer’s disease. Mol Psychiatry 22:353–363.

    CAS  Article  PubMed  Google Scholar 

  26. 26.

    Lenka A, Hegde S, Jhunjhunwala KR, Pal PK (2016) Interactions of visual hallucinations, rapid eye movement sleep behavior disorder, and cognitive impairment in Parkinson’s disease: a review. Parkinsonism Relat Disord 22:1–8.

    Article  PubMed  Google Scholar 

  27. 27.

    Fereshtehnejad S-M, Postuma RB (2017) Subtypes of Parkinson’s disease: what do they tell us about disease progression? Curr Neurol Neurosci Rep 17:34–10.

    CAS  Article  PubMed  Google Scholar 

  28. 28.

    Kulisevsky J, Pagonabarraga J (2009) Cognitive impairment in Parkinson’s disease: tools for diagnosis and assessment. Mov Disord 24:1103–1110.

    Article  Google Scholar 

  29. 29.

    Richman J, Spaeth GL, Wirostko B (2013) Contrast sensitivity basics and a critique of currently available tests. J Cataract Refract Surg 39:1100–1106.

    Article  PubMed  Google Scholar 

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This work was supported by a National Research Foundation (NRF) grant funded by the Ministry of Education, Science and Technology (MEST) in Korea (NRF-2018R1C1B3008971) and by a clinical research grant-in-aid from the Seoul Metropolitan Government-Seoul National University (SMG-SNU) Boramae Medical Center (03–2015-8).

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Correspondence to Jee-Young Lee.

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SB Hong, J.-Y. Lee, J. Ahn, D Yoo, JY Shin, and B. Jeon report there are no potential conflict of interest related to this work.

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Hong, S.B., Ahn, J., Yoo, D. et al. Contrast sensitivity impairment in drug-naïve Parkinson’s disease patients associates with early cognitive decline. Neurol Sci 41, 1837–1842 (2020).

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  • Parkinson’s disease
  • Contrast sensitivity
  • Cognition