Objective: To identify visual measures that relate to higher risk of dementia in Parkinson’s Disease (PD).

Background: Dementia affects 50% of people with PD within 10 years of diagnosis. There are no robust measures to identify patients at highest risk. We have previously shown that visuo-perceptual deficits are linked with cognitive involvement in PD(1). Retinal thinning is found in PD, but whether this relates to dementia in PD is not known. Here, we examine visuo-perceptual measures, alongside retinal imaging and relate these scores to risk of cognitive involvement in PD.

Methods: Our study includes 105 people with PD and 35 age-matched controls. Here we present data for the first 44 participants, 24 with PD (mean age=63.1, SD=9.0; mean disease duration=4.7 years, SD=2.9) and 20 controls (mean age=67.5; SD=10.0). Participants underwent detailed neuropsychology, assessment of PD (MDS-UPDRS), smell testing and ophthalmic assessment (visual acuity, pressure, ophthalmology review). Visuo-perceptual measures included biological motion and Hooper’s Visual Organisation Test (HVOT). Optical Coherence Tomography (OCT, Heidelberg Spectralis) was used to assess optic disk Retinal Nerve Fibre Layer (RNFL) thickness. Risk of cognitive involvement was calculated using a recently described algorithm (combining age, UPSIT, depression and REM sleep behaviour scores; 2). We compared visuo-perception and retinal thickness in PD patients at risk of dementia (PD-AR) and PD at lower risk (PD-N).

Results: 8 PD patients were at higher risk of dementia (PD-AR). PD-AR performed worse on biological motion detection (PD-AR mean=8.78, SD=8.45, PD-N mean=20.64, SD=13.55), t(22)=2.25, p=.035. There was also a trend for PD-AR participants to have poorer HVOT scores (mean=23.25, SD=4.03) compared with PD-N (mean=25.25, SD=1.91). PD-AR patients also showed more retinal thinning (M = 60.50, SD =8.65) than PD-N patients (M = 72.94, SD =12.94), with poorer visuo-perceptual scores associated with thinner inferior nasal RNFL r(7) = .792, p=.019. Data collection is still underway and results with the full dataset of 140 patients will be reported.

Conclusions: Visual testing including visuo-perception and retinal measures show potential to identify patients at risk of dementia in PD. These will be validated in future longitudinal studies.

References: 1. Weil, R.S, Schwarzkopf D.S. et al. (2018). Assessing cognitive dysfunction in Parkinson’s disease: An online tool to detect visuo-perceptual deficits. Movement Disorders, in press. 2. Schrag, A., Siddiqui, U.F., Anastasiou, Z., Weintraub, D., & Schott, J.M. (2017). Clinical variables and biomarkers in prediction of cognitive impairment in patients with newly diagnosed Parkinson’s disease: A cohort study. Lancet Neurology, 16, 66–75. DOI: 10.1016/S1474-4422(16)30328-3.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/using-vision-to-predict-dementia-in-parkinsons-disease/