Re-evaluation of tropicamide in the pupillary response test for Alzheimer’s disease

In 1994, a pupillary response test using very dilute (0.01%) tropicamide, a cholinergic antagonist, evoked remarkable pupil dilation in subjects with Alzheimer’s disease (AD) and has since been considered a diagnostic tool for AD. However, since this test was first reported, there have been studies suggesting it cannot provide a differential diagnosis of AD. Thus, the present study re-evaluated the pupillary dilation of AD (n=17) and non-AD (n=20) subjects at a 0.01% concentration of tropicamide and found that non-AD subjects, including young subjects, showed the same extent of pupil dilation as AD subjects. Furthermore, there was no significant difference between the average dilation rate of the two groups (P>0.05). When the tropicamide concentration was diluted to half of the initial concentration and performed for AD (n=14), vascular dementia (VD) (n=14), and young (n=16) subjects, the AD subjects showed a large dilation (mean pupil dilation rate: 133.8±15%) while the non-AD subjects did not show hypersensitivity to the new concentration of eye drops (105.4±9%). These differences in pupillary dilation between AD and non-AD patients were statistically significant (P<0.001). Based on these results, the most effective cutoff point of 0.005% tropicamide for differential diagnosis was 114.5% of the average pupil dilation rate for 60 min.