• Naomi Hannaway, Angeliki Zarkali, Louise-Ann Leyland, Fion Bremner, Jennifer M Nicholas, Siegfried K Wagner, Matthew Roig, Pearse A Keane, Ahmed Toosy, Jeremy Chataway, and Rimona Sharon Weil.
• Dementia Research Centre, Institute of Neurology, University College London, London, UK.
• J. Neurol. Neurosurg. Psychiatr. 2023 Sep 1; 94 (9): 742750742-750.

BackgroundDementia is a common and devastating symptom of Parkinson's disease (PD). Visual function and retinal structure are both emerging as potentially predictive for dementia in Parkinson's but lack longitudinal evidence.MethodsWe prospectively examined higher order vision (skew tolerance and biological motion) and retinal thickness (spectral domain optical coherence tomography) in 100 people with PD and 29 controls, with longitudinal cognitive assessments at baseline, 18 months and 36 months. We examined whether visual and retinal baseline measures predicted longitudinal cognitive scores using linear mixed effects models and whether they predicted onset of dementia, death and frailty using time-to-outcome methods.ResultsPatients with PD with poorer baseline visual performance scored lower on a composite cognitive score (β=0.178, SE=0.05, p=0.0005) and showed greater decreases in cognition over time (β=0.024, SE=0.001, p=0.013). Poorer visual performance also predicted greater probability of dementia (χ² (1)=5.2, p=0.022) and poor outcomes (χ² (1) =10.0, p=0.002). Baseline retinal thickness of the ganglion cell-inner plexiform layer did not predict cognitive scores or change in cognition with time in PD (β=-0.013, SE=0.080, p=0.87; β=0.024, SE=0.001, p=0.12).ConclusionsIn our deeply phenotyped longitudinal cohort, visual dysfunction predicted dementia and poor outcomes in PD. Conversely, retinal thickness had less power to predict dementia. This supports mechanistic models for Parkinson's dementia progression with onset in cortical structures and shows potential for visual tests to enable stratification for clinical trials.© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.

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