Dementia Research Centre, Institute of Neurology, University College London, London, UK.
National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, UK.
J Neurol Neurosurg Psychiatry. 2023 Sep;94(9):742-750. doi: 10.1136/jnnp-2023-331083. Epub 2023 Apr 20.
Dementia 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.
We 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.
Patients 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).
In 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.
痴呆是帕金森病（PD）的常见且具有破坏性的症状。视觉功能和视网膜结构都可能成为帕金森痴呆的预测指标，但缺乏纵向证据。
我们前瞻性地检查了 100 名 PD 患者和 29 名对照者的高级视觉（斜视容忍度和生物运动）和视网膜厚度（谱域光学相干断层扫描），并在基线、18 个月和 36 个月进行了纵向认知评估。我们使用线性混合效应模型检查了视觉和视网膜基线测量值是否可以预测纵向认知评分，以及它们是否可以使用时间到结果方法预测痴呆、死亡和虚弱的发生。
PD 患者的基线视觉表现越差，综合认知评分越低（β=0.178，SE=0.05，p=0.0005），并且认知随时间的下降幅度越大（β=0.024，SE=0.001，p=0.013）。较差的视觉表现也预测了更高的痴呆（χ²（1）=5.2，p=0.022）和不良结局（χ²（1）=10.0，p=0.002）的发生概率。PD 患者的神经节细胞-内丛状层的视网膜厚度基线值不能预测认知评分或认知随时间的变化（β=-0.013，SE=0.080，p=0.87；β=0.024，SE=0.001，p=0.12）。
在我们深入表型的纵向队列中，视觉功能障碍预测了 PD 中的痴呆和不良结局。相反，视网膜厚度预测痴呆的能力较弱。这支持了帕金森痴呆进展的机制模型，其起始于皮质结构，并显示出视觉测试在临床试验中分层的潜力。
