Visual evoked responses in Alzheimer's disease: a review

This review of the literature has shown that a delayed flash P2, in the presence of a normal flash P1 and pattern-reversal P100, can distinguish groups of Alzheimer's patients from groups who are healthy, psychiatrically ill, or suffering from other types of dementia. The VER's usefulness in the individual patient remains undetermined. With today's techniques, too many patients are misclassified. False negatives may result if Alzheimer's patients with visual symptoms are a distinct subgroup. Those with a normal flash VER may have cortical dysfunction outside the visual association areas. This would most likely be in the earliest stages of the disease before the atrophy becomes widespread. It may be that a VER test would only be valid in established disease. Future research should use adequate numbers of patients who are in a single category of mild, moderate or severe, so that the applicability of a VER test in the early stages of the disease can be determined. Strict diagnostic criteria such as the NINCDS-ADRDA guidelines should be used. Patients should be drug free, or at least not taking medications with anticholinergic properties. Flash VER should be obtained using a strobe light with eyes closed, and the pattern VER using a black and white television with a large pattern and high contrast.