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
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Serviço de Oftalmologia e Clínica Neurológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP).
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Datas de Publicação
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Publicação nesta coleção
Aug 1998