Response of the pupil to tropicamide is not a reliable test for Alzheimer disease

Objective: To confirm the putative hypersensitivity of the pupil to a weak mydriatic in persons with Alzheimer dementia. Design: Twenty patients with Alzheimer dementia and 20 control subjects were examined. Automated binocular infrared pupillography was performed in the dark after instillation of 0.01% tropicamide or placebo. Ocular penetration of eye drops was assessed simultaneously using 2% fluorescein sodium as a tracer. Setting: Rochester, Minn. Subjects: Twenty patients and 20 cognitively normal central subjects from the Alzheimer's Disease Patient Registry of the Mayo Clinic, Rochester, Minn. Main Outcome Measure: Percent change in the diameter of the pupil following topical ocular instillation of a diluted concentration of the mydriatic drug tropicamide and penetration of topically applied fluorescein into the aqueous humor. Results: No statistically significant difference was found between patients with Alzheimer disease and control subjects in either the mydriatic response of the pupil or in the rate of penetration of topically applied fluorescein. Conclusion: No evidence of pupillary hypersensitivity to an anticholinergic mydriatic drug was found in patients with Alzheimer disease or any evidence that this putative hypersensitivity could be used as an early, simple diagnostic test for Alzheimer disease.