Objective: We sought to characterize the prevalence of color vision impairment in DLB patients and investigate how color vision impairment in DLB patients was associated with other features of the disease.

Background: Color vision abnormalities have been well-described in PD but rarely in DLB, especially at the office setting.

Methods: We performed a retrospective chart review of patients with DLB, and patients with MCI who were suspected to be in the early phase of DLB (pro-DLB). All patients had an online 15-hue color vision arrangement test as a part of the clinical assessment. The test took less than 2 minutes and the interpretation of results was available by the end of the test as negative or positive for the type of color vision impairment.

Results: The 27 patients included had a median age of 76.7 years and 37% (n= 10) were female. 20 patients with DLB (MoCA=15.8) and 7 with pro DLB ( MoCA=21.6). Only one patient with DLB had a known history of color vision impairment from a young age. New-onset color vision impairment was found in 29% of pro-DLB patients (n=2), and 79% of DLB patients (n=15). The color vision impairment type was as follows: pro-DLB (2 deuteranopia), DLB (10 protanopia, 3 deuteranopia, and 2 tritanopia).

The clinical signs and symptoms of patients with DLB were analyzed to evaluate factors associated with color vision impairment. Of these 20 patients, 75% (n=15) had REM behavior disorder, 80% (n=16) had anosmia, 55% (n=11) had tremor, 55% (n=11) had bradykinesia, 55% (n=11) had rigidity, 65% (n=13) had postural instability, 90% (n=18) had visual hallucinations, and 50% (n=10) had autonomic dysfunction.

Several differences existed between patients with color vision impairment vs. those without in this cohort of 27 patients. Patients with color vision impairment were more likely to have 1 or more Parkinsonian feature (95% vs. 63%, p=0.04), tended towards having lower MOCA scores (mean = 16 vs. 20, p=0.07), and were more likely to have lower visuospatial MOCA scores (2.0 vs. 3.3, p=0.02).

Conclusions: Color vision impairment was found in most patients with DLB and was highly specific for DLB versus Alzheimer’s. Cluster analysis showed that color vision impairment tended to be more prevalent in patients with more features of DLB although was found in less symptomatic DLB and pro-DLB patients as well. Further investigation is needed to determine if incorporation of the 15-hue color test may improve the accuracy of diagnosis of DLB.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/impaired-color-vision-in-patients-with-dlb-or-prodromal-dlb/