Investigação de teste simplificado de medida da reação pupilar à tropicamida em portadores da doença de Alzheimer

Investigation of a simplified method of measurement of pupillary reaction to tropicamide in patients with Alzheimer's disease

RESUMO

Introdução:

O diagnóstico definitivo da doença de Alzheimer (D A) só é possível mediante exame neuropatológico, sendo que os critérios para diagnóstico clínico se baseiam essencialmente na exclusão de outras causas de demência. Em 1994, Scinto et al. observaram hipersensibilidade pupilar à tropicamida em pacientes com DA, dado compatível com a existência de redução dos níveis de acetilcolina na doença. Entretanto, estudos posteriores não confirmaram esses resultados.

Objetivo:

Avaliar a hipótese de hipersensibilidade pupilar à tropicamida no dignóstico da DA, utilizando para este fim metodologia de simples execução.

Material e Métodos:

Dez pacientes com diagnóstico clínico de DA e dez indivíduos idosos controles completaram o protocolo. As medidas pupilares foram realizadas com o paciente sentado em ambiente com iluminação padronizada, olhando para um ponto focal localizado a seis metros de distância. Utilizou-se régua milimetrada para medir o diâmetro pupilar horizontal antes e após 15 e 30 minutos da instilação de uma gota de tropicamida a 0,02% em cada olho.

Resultados:

Não foram observadas diferenças significativas entre a dilatação pupilar de pacientes e de controles para nenhum dos tempos das medidas ou no percentual de variação total do diâmetro pupilar. Observou-se tendência a valores maiores de dilatação pupilar no grupo de portadores deDA em relação ao grupo controle, embora sem significância estatística.

Conclusões:

O emprego de metodologia simplificada para medida do diâmetro pupilar não permitiu diferenciar pacientes com DA de controles no teste de reação pupilar à tropicamida a 0,02%.

Palavras-chaves:
Doença de Alzheimer; Pupila; Tropicamida

SUMMARY

Background:

Definite diagnosis of Alzheimer's disease (AD) is only possible through neuropathological examination, and criteria for clinical diagnosis are essentially based on exclusion of other dementing conditions. ln 1994, Scinto et ai. observed pupil hypersensitivity to tropicamide in patients with AD, which is compatible with the reduced leveis of acetylcholine in the disease. However, later studies did not confirm these results.

Purpose:

To investigate the hypothesis of pupil hypersensitivity to tropicamide for the diagnosis of AD, using a simple methodology.

Material and Methods:

Ten patients (20 eyes) with clinical diagnosis of AD and ten age-matched contrals completed the study. Pupil measurements were dane with patients and contrals seated in a place with standardized illumination, looking at a focal point six meters away. We have used a millimeter ruler to measure the horizontal pupil diameter before and after 15 and 30 minutes of instillation of one drop of 0.02% tropicamide in each eye.

Results:

There were no significant differences between pupil dilation in patients and contrals for any of the measuring times nor for the percentage of total pupil diameter variation. We have observed a tendency to higher values of pupil dilation in the group of patients with AD when compared to contrals, although without reaching statistical significance.

Conclusion:

In the present study, the use of a simplified methodology for measuring pupil diameter following instillation of 0.02%o tropicamide did not allow differentiation between patients with AD and contrals.

Keywords:
Alzheimer's disease; Pupil; Tropicamide

Texto completo disponível apenas em PDF.

• Serviço de Oftalmologia e Clínica Neurológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP).

REFERÊNCIAS BIBLIOGRÁFICAS

• ¹
  Canadian Study of Health and Aging: study methods and prevalence of dementia. Can Med Assoc J 1994;150:898-913.
• ²
  Nitrini R, Mathias SC, Caramelli P et al. Evaluation of 100 patients with dementia in São Paulo, Brazil: correlations with socioeconomic status and education. Alzheimer Dis Assoc Disord 1995;9:146-51.
• ³
  Jorm A, Korten A, Henderson A. The prevalence of dementia: a quantitative integration of the literature. Acta Psychiatr Scand 1987;76:465-79.
• ⁴
  Khachaturian ZS: Diagnosis of Alzheimer's disease. Arch Neurol 1985;42: 1097-105.
• ⁵
  McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group. Neurology 1984;34:939-44.
• ⁶
  Klatka LA, Schiffer RB, Powers JM, Kazee AM. Incorrect diagnosis of Alzheimer's disease: a clinicopathologic study. Arch Neurol 1996;53:35-42.
• ⁷
  Killiany RJ, Moss MB, Albert MS, Sandor T, Tieman J, Jolesz F. Temporal lobe regions on magnetic resonance imaging identify patients with early Alzheimer's disease. Arch Neurol 1993;50:949-54.
• ⁸
  Buchpiguel CA, Mathias SC, Itaya LY et al. Brain SPECT in dementia: a clinical-scintigraphic correlation. Arq Neuropsiquiatr 1996;54:375-83.
• ⁹
  Arai H, Terajima M, Miura M et al. Tau in cerebrospinal fluid: a potential diagnostic marker in Alzheimer's disease. Ann Neurol 1995;38:649-52.
• ¹⁰
  Whitehouse PJ, Price DL, Clark AW, Coyle JT, DeLong MR. Alzheimer's disease: evidence for selective loss of cholinergic neurons in the nucleus basal is. Ann Neurol 1981;10:122-6.
• ¹¹
  Scinto LFM, Daffner KR, Dressler D et al. A potential noninvasive neurobiological test for Alzheimer's disease. Science 1994;266: 1051-4.
• ¹²
  Scinto LF, Rentz D, Cohen L, Preston L, Daffner K. Pupil dilation as an early marker for AD: longitudinal findings in elderly subjects. Neurobiol Aging 1996; 17(Suppl.):S148.
• ¹³
  Loupe DN, Newman NJ, Green RC et al. Pupillary response to tropicamide in patient with Alzheimer disease. Ophtalmology 1996; 103 :495-503.
• ¹⁴
  Treloar AJ, Assin M, Macdonald AJ. Pupillary response to topical tropicamide as a marker for Alzheimer's disease. Br J Clin Pharmacol 1996;41:256-7.
• ¹⁵
  Litvan I, FitzGibbon EJ. Can tropicamide eye drop response differentiate patients with progressive supranuclear palsy and Alzheimer's disease from healthy control subjects? Neurology 1996;47:1324-6.
• ¹⁶
  Fridh M, Havelius U, Eloffson G, Hindfelt B. The pupillary response to tropicamide in Alzheimer's disease. Acta Ophtalmol Scand 1996;74:276-9.
• ¹⁷
  Arai H, Terajima M, Nakagawa T, Higuchi S, Mochizuki H, Sasaki H. Pupil dilatation assay by tropicamide is modulated by apolipoprotein E epsilon 4 allele dosage in Alzheimer's disease. Neuroreport 1996;7:918-20.
• ¹⁸
  Gómez-Tortosa E, Del Barrio A, Jiménez-Alfaro I. Pupil response to tropicamide in Alzheimer's disease and other neurodegenerative disorders. Acta Neurol Scand 1996;94: 104-9.
• ¹⁹
  Growdon JH, Graefe K, Tennis M, Hayden D, Schoenfeld D, Wray SH. Pupil dilation to tropicamide is not specific for Alzheimer's disease. Arch Neurol 1997;54:841-4.
• ²⁰
  Khatalian C. Dificuldades na realização do teste não invasivo (tropicamida) para diagnóstico da doença de Alzheimer em consultório médico. Gerontologia 1995;3:69-72.[/

Datas de Publicação

• Publicação nesta coleção
  Aug 1998