The Value Of Nystagmus View In The Differential Diagnosis Of Parkinson’s Disease,Multiple System Atrophy And Progressive Supranuclear Palsy

Objective:All three neurodegenerative disorders,Parkinson’s disease(PD),Multiple system atrophy(MSA),and Progressive supranuclear palsy(PSP),have autonomic symptoms as part of their clinical presentations.It is crucial to enhance the early differential diagnosis of PD,MSA,and PSP since the overlapping clinical presentations,lack of specialized test,and biological markers make it difficult to distinguish between PD,MSA,and PSP.The bedside assessment and laboratory recording of nystagmus,involuntary eye movements such as nystagmus and sweep,smooth tracking movements,and optokinetic nystagmus are all included in the oculomotor examination.Current studies had shown that all three diseases have ocular motility disorders,and the study of oculomotor views for the differential diagnosis of patients with PD,MSA and PSP is an almost entirely new field.Therefore,by comparing the differences in various parameters of nystagmus view between patients with PD,MSA and PSP,this study aims to find specific and objective indicators for the early clinical identification of these three disorders.Methods:From April 2021 to October 2022,131 patients with PD(PD group),28 patients with MSA(MSA group),and 23 patients with PSP(PSP group)were admitted to the Department of Neurology at Shanxi Bethune Hospital in Shanxi Province.100 physically healthy examiners from the same time period served as the control group.All subjects underwent nystagmus views,with the primary variables being optokinetic nystagmus(OPK)gain,smooth tracking(SP)gain,sweep speed,sweep latency,and sweep accuracy.General data from the four groups were gathered,and each group’s clinical diagnostic and nystagmus view findings were compared in order to determine the differences of nystagmus parameters between the PD,MSA,and PSP groups.The prevalence of PD,MSA,and PSP were analyzed along with the characteristics of eye movements in the three groups using multi-factor logistic regression analysis.Finally,the diagnostic effectiveness and differential diagnostic value of the nystagmus view indexes for PD,MSA,and PSP were examined in relation to the subject’s working characteristic(ROC).Results:1.Basic clinical information: PSP patients were older than MSA and PD patients,and the PD,MSA,and PSP groups were all older than the normal control group(P<0.05).Across the four groups,there was no gender difference(P>0.05).the duration of disease was shorter in MSA and PSP patients than in PD patients(P<0.05).Patients with MSA and PSP had higher H-Y scores than those in the PD group(P<0.05).In the comparison of the UPDRS scores for PD,MSA,and PSP,there was no difference(P>0.05).MMSE scores were lower in the groups with PD,MSA,and PSP than they were in the normal control group(P<0.05),and patients with MSA,PSP had lower MMSE scores and more significant cognitive impairment.2.The peak velocity of the left and right sweep,accuracy of the left and right sweep,SP gain,vertical upward and downward 20% gain,horizontal left and right 20% gain,and latency of the left and right sweep were all reduced in the PD,MSA,and PSP groups when compared to the control group(P<0.05).Leftward and rightward sweep peak velocities were significantly lower and sweep latency was considerably longer in the PSP group than in the PD and MSA groups,respectively(P<0.05);The vertical upward and downward 20% gain was significantly smaller in the PSP patients than in the PD and MSA groups(P<0.05),and the SP gain was significantly higher in the PD group than in the MSA and PSP groups.3.SP gain was an important factor in determining the occurrence of PD and MSA disease(P <0.05);leftward latency,rightward latency,SP gain,vertical upward 20% gain,and vertical downward 20% gain were important factors in determining the occurrence of PD and PSP disease.The vertical upward 20% gain,vertical downward 20% gain,SP gain,leftward latency,rightward latency,and vertical upward 20% gain were significant indicators of the presence of MSA and PSP illness(P <0.05).4.ROC curve study outcomes.4.1 ROC analysis for PD and MSA disease diagnostic discrimination: The findings indicated that SP gain had a good diagnostic value with an AUC of 0.736,a sensitivity of0.657,and a specificity of 0.741.4.2 ROC analysis for diagnostic differentiation of the PD and PSP groups: The findings indicated that the diagnostic value of leftward,rightward,SP gain,vertical upward 20%gain,and vertical downward 20% gain were high,and that the combined test of the five indicators had an AUC of 0.970,sensitivity 0.896,and specificity 0.998,which was superior to the single indicator test of PD and PSP.4.3 Diagnostic discrimination between the MSA and PSP categories using ROC analysis:The findings demonstrated that the diagnostic value of leftward latency,rightward latency,SP gain,vertical upward 20% gain,and vertical downward 20% gain were high while the combined test of the five indicators had a better AUC of 0.985,sensitivity of0.914,and specificity of 0.999,which was superior to the single indicator test of PD and PSP.Conclusion:1.A decline in peak left and right sweep velocity,left and right sweep accuracy,SP gain,vertical up and down 20% gain,horizontal left and right 20% gain,and prolonged left and right sweep latency were all signs of oculomotor deficits in patients with PD,MSA,and PSP.The peak velocity of the leftward and rightward sweep was significantly lower in the PSP group than in the PD group,and the sweep latency was noticeably longer than in the PD and MSA groups.The SP gain was also significantly higher in the PD group than in the MSA and PSP groups,and the vertical upward and downward 20% gain was noticeably lower in the PSP patients than in the PD and MSA groups.2.SP increase has a significant impact on separating the PD and MSA groups and can successfully separate PD from MSA.3.The influencing factors to distinguish the PSP and PD groups are leftward latency,rightward latency,SP gain,vertical upward 20% gain,and vertical downward 20% gain.All of these factors can effectively distinguish PD and PSP,and the combined diagnosis is more effective in differential diagnosis.4.The influencing elements to identify MSA and PSP include leftward latency,rightward latency,SP gain,vertical upward 20% gain,and vertical downward 20% gain.All of these characteristics may successfully distinguish MSA and PSP,and the combination diagnosis is more effective in differential diagnosis.