title: Pupillary cholinergic hypersensitivity predicts cognitive decline in community dwelling elders.
abstract: Previous research demonstrated that it is possible to distinguish patients with probable Alzheimer's disease from age-matched controls based on an exaggerated pupil dilation response to dilute tropicamide. The research reported here employed a prospective longitudinal design to follow over time (2-4 years) a sample of 55 community dwelling elders with and without an exaggerated pupil response using the pupil assay and a comprehensive battery of neuropsychological tests sensitive to pre-clinical AD. Discrete time survival modeling was used to assess the ability of the assay to predict a pattern of cognitive decline consistent with early AD. Analysis showed that there is an increased risk (odds ratio of 3) with a hypersensitive pupil response (>/=13% increase in pupil diameter over baseline diameter) for developing significant cognitive impairment in areas of memory attention and language in a pattern, consistent with pre-clinical Alzheimer's disease. When controlling for ApoE allele type the odds ratio for pupil response as a risk factor increased to 4. The analysis also found that an exaggerated pupil response was a significant (p=.02) predictor of cognitive decline. This analysis of longitudinal data has shown that over time an exaggerated response on the pupil assay is a significant independent risk factor for developing pre-clinical Alzheimer's disease. The risk for developing pre-clinical Alzheimer's disease is increased four-fold.
authors.affiliation: Laboratory of Higher Cortical Functions, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA. leonard_scinto@hms.harvard.edu
authors.forename: Leonard F M
authors.initials: LF
authors.lastname: Scinto
mesh_terms: D000109:Acetylcholine / Q000494:pharmacology*; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology*; D003072:Cognition Disorders / Q000175:diagnosis*; D005260:Female; D006801:Humans; D006967:Hypersensitivity / Q000503:physiopathology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D012025:Reflex, Pupillary / Q000187:drug effects* / Q000502:physiology*; D012111:Residence Characteristics
chemical_list: D000109:Acetylcholine