Association between vestibuloocular reflex suppression during smooth movements of the head and attention deficit in progressive supranuclear palsy

With head movement, suppression of vestibular inputs during visual exploration is necessary not only for re-orienting gaze, but also to direct attention to new visual targets. People with progressive supranuclear palsy (PSP) have difficulty suppressing the vestibuloocular reflex (VOR) and it was hypothesized that the magnitude of VOR suppression deficit correlates with the degree of degradation of attention and visuospatial performance. We evaluated cognitive and visuomotor function in 8 subjects with PSP (4 men and 4 women; ages 59-83 years). Gaze control was studied by measuring the accuracy of eye-head coordination during passive vertical and horizontal head-on-trunk movements. Fixation was assessed when subjects viewed either an earth-fixed or head-fixed target. A gaze fixation score (GFS) was calculated to represent the amount of error between eye and head movement in each plane (eye-head root mean square error normalized to the range of head rotation). The vertical but not horizontal GFS during attempted suppression of the VOR was significantly related to attention (r = -0.70; P = 0.05) and visuospatial ability (r = -0.76; P = 0.03). These findings suggest that the ability to suppress the VOR during vertical smooth movements of the head is associated with the magnitude of cognitive deficit in PSP.