Visual dysfunction is a better predictor than retinal thickness for dementia in Parkinson's disease
Naomi Hannaway, Angeliki Zarkali, Louise-Ann Leyland, Fion Bremner, Jennifer M Nicholas, Siegfried K Wagner, Matthew Roig, Pearse A Keane, Ahmed Toosy, Jeremy Chataway, Rimona Sharon Weil, Naomi Hannaway, Angeliki Zarkali, Louise-Ann Leyland, Fion Bremner, Jennifer M Nicholas, Siegfried K Wagner, Matthew Roig, Pearse A Keane, Ahmed Toosy, Jeremy Chataway, Rimona Sharon Weil
Abstract
Background: 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.
Methods: 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.
Results: 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).
Conclusions: 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.
Keywords: Parkinson's disease; cognition; dementia; vision.
Conflict of interest statement
Competing interests: RSW has received honoraria from GE Healthcare and Britannia, as well as speaking honoraria from the Shirley Ryan Ability Lab. PAK has received honoraria from Alimera, AbbVie, Apellis, Boehringer-Ingleheim, Thea, Bayer and Gyroscope, as well as consulting fees from DeepMind. PAK participates on data safety monitoring /advisory boards for RetinAI, Novartis, Roche, AbbVie, Boehringer-Ingleheim and Apellis. PAK also holds stock with Big Medical Picture, stock options with Bitfount, and holds a patent: Google US10198832B2.
© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.
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References
- Williams-Gray CH, Mason SL, Evans JR, et al. . The campaign study of Parkinson’s disease: 10-year outlook in an incident population-based cohort. J Neurol Neurosurg Psychiatry 2013;84:1258–64. 10.1136/jnnp-2013-305277
- Aarsland D, Andersen K, Larsen JP, et al. . Risk of dementia in Parkinson’s disease: a community-based, prospective study. Neurology 2001;56:730–6. 10.1212/wnl.56.6.730
- Dauphinot V, Garnier-Crussard A, Moutet C, et al. . Determinants of medical direct costs of care among patients of a memory center. J Prev Alzheimers Dis 2021;8:351–61. 10.14283/jpad.2021.16
- van Dyck CH, Swanson CJ, Aisen P, et al. . Lecanemab in early Alzheimer’s disease. N Engl J Med 2023;388:9–21. 10.1056/NEJMoa2212948
- Weil RS, Schrag AE, Warren JD, et al. . Visual dysfunction in Parkinson’s disease. Brain 2016;139:2827–43. 10.1093/brain/aww175
- Harnois C, Di Paolo T. Decreased dopamine in the retinas of patients with Parkinson’s disease. Invest Ophthalmol Vis Sci 1990;31:2473–5.
- Beach TG, Carew J, Serrano G, et al. . Phosphorylated α-synuclein-immunoreactive retinal neuronal elements in Parkinson’s disease subjects. Neurosci Lett 2014;571:34–8. 10.1016/j.neulet.2014.04.027
- Balasubramanian R, Gan L. Development of retinal amacrine cells and their dendritic stratification. Curr Ophthalmol Rep 2014;2:100–6. 10.1007/s40135-014-0048-2
- Živković M, Dayanir V, Stamenović J, et al. . Retinal ganglion cell/inner plexiform layer thickness in patients with Parkinson’s disease. Folia Neuropathol 2017;55:168–73. 10.5114/fn.2017.68584
- Polo V, Satue M, Rodrigo MJ, et al. . Visual dysfunction and its correlation with retinal changes in patients with Parkinson’s disease: an observational cross-sectional study. BMJ Open 2016;6:e009658. 10.1136/bmjopen-2015-009658
- Anang JBM, Gagnon J-F, Bertrand J-A, et al. . Predictors of dementia in Parkinson disease: a prospective cohort study. Neurology 2014;83:1253–60. 10.1212/WNL.0000000000000842
- Leyland L-A, Bremner FD, Mahmood R, et al. . Visual tests predict dementia risk in Parkinson disease. Neurol Clin Pract 2020;10:29–39. 10.1212/CPJ.0000000000000719
- Zarkali A, McColgan P, Leyland L-A, et al. . Visual dysfunction predicts cognitive impairment and white matter degeneration in Parkinson’s disease. Mov Disord 2021;36:1191–202. 10.1002/mds.28477
- Weil RS, Winston JS, Leyland L-A, et al. . Neural correlates of early cognitive dysfunction in Parkinson’s disease. Ann Clin Transl Neurol 2019;6:902–12. 10.1002/acn3.767
- Hamedani AG, Abraham DS, Maguire MG, et al. . Visual impairment is more common in Parkinson’s disease and is a risk factor for poor health outcomes. Mov Disord 2020;35:1542–9. 10.1002/mds.28182
- Han G, Han J, Han K, et al. . Visual acuity and development of Parkinson’s disease: a nationwide cohort study. Mov Disord 2020;35:1532–41. 10.1002/mds.28184
- Bohnen NI, Koeppe RA, Minoshima S, et al. . Cerebral glucose metabolic features of Parkinson disease and incident dementia: longitudinal study. J Nucl Med 2011;52:848–55. 10.2967/jnumed.111.089946
- Sung MS, Choi S-M, Kim J, et al. . Inner retinal thinning as a biomarker for cognitive impairment in de novo Parkinson’s disease. Sci Rep 2019;9:11832. 10.1038/s41598-019-48388-7
- Murueta-Goyena A, Del Pino R, Galdós M, et al. . Retinal thickness predicts the risk of cognitive decline in Parkinson disease. Ann Neurol 2021;89:165–76. 10.1002/ana.25944
- Oxtoby NP, Leyland L-A, Aksman LM, et al. . Sequence of clinical and neurodegeneration events in Parkinson’s disease progression. Brain 2021;144:975–88. 10.1093/brain/awaa461
- Zhang J-R, Cao Y-L, Li K, et al. . Correlations between retinal nerve fiber layer thickness and cognitive progression in Parkinson’s disease: a longitudinal study. Parkinsonism Relat Disord 2021;82:92–7. 10.1016/j.parkreldis.2020.11.025
- Huang L, Zhang D, Ji J, et al. . Central retina changes in Parkinson’s disease: a systematic review and meta-analysis. J Neurol 2021;268:4646–54. 10.1007/s00415-020-10304-9
- Hughes AJ, Daniel SE, Kilford L, et al. . Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry 1992;55:181–4. 10.1136/jnnp.55.3.181
- Liu G, Locascio JJ, Corvol J-C, et al. . Prediction of cognition in Parkinson’s disease with a clinical-genetic score: a longitudinal analysis of nine cohorts. Lancet Neurol 2017;16:620–9. 10.1016/S1474-4422(17)30122-9
- Tomlinson CL, Stowe R, Patel S, et al. . Systematic review of levodopa dose equivalency reporting in Parkinson’s disease. Mov Disord 2010;25:2649–53. 10.1002/mds.23429
- Goetz CG, Tilley BC, Shaftman SR, et al. . Movement disorder society-sponsored revision of the unified Parkinson’s disease rating scale (MDS-UPDRS): scale presentation and Clinimetric testing results. Mov Disord 2008;23:2129–70. 10.1002/mds.22340
- Weil RS, Pappa K, Schade RN, et al. . The cats-and-dogs test: a tool to identify visuoperceptual deficits in Parkinson’s disease. Mov Disord 2017;32:1789–90. 10.1002/mds.27176
- Saygin AP. Superior temporal and premotor brain areas necessary for biological motion perception. Brain 2007;130:2452–61. 10.1093/brain/awm162
- Jaywant A, Shiffrar M, Roy S, et al. . Impaired perception of biological motion in Parkinson’s disease. Neuropsychology 2016;30:720–30. 10.1037/neu0000276
- Miller LE, Saygin AP. Individual differences in the perception of biological motion: links to social cognition and motor imagery. Cognition 2013;128:140–8. 10.1016/j.cognition.2013.03.013
- Tewarie P, Balk L, Costello F, et al. . The OSCAR-IB consensus criteria for retinal OCT quality assessment. PLoS One 2012;7:e34823. 10.1371/journal.pone.0034823
- Cruz-Herranz A, Balk LJ, Oberwahrenbrock T, et al. . The APOSTEL recommendations for reporting quantitative optical coherence tomography studies. Neurology 2016;86:2303–9. 10.1212/WNL.0000000000002774
- Vidal-Jordana A, Pareto D, Cabello S, et al. . Optical coherence tomography measures correlate with brain and spinal cord atrophy and multiple sclerosis disease-related disability. Eur J Neurol 2020;27:2225–32. 10.1111/ene.14421
- Litvan I, Goldman JG, Tröster AI, et al. . Diagnostic criteria for mild cognitive impairment in Parkinson’s disease: movement disorder Society Task force guidelines. Mov Disord 2012;27:349–56. 10.1002/mds.24893
- Bates D, Mächler M, Bolker B, et al. . Fitting linear mixed-effects models using lme4. J Stat Softw 2015;67:1–48. 10.18637/jss.v067.i01
- Kuznetsova A, Brockhoff PB, Christensen RHB. lmertest package: tests in linear mixed effects models . J Stat Soft 2017;82:1–26. 10.18637/jss.v082.i13
- Chrysou A, Jansonius NM, van Laar T. Retinal layers in Parkinson’s disease: a meta-analysis of spectral-domain optical coherence tomography studies. Parkinsonism Relat Disord 2019;64:40–9. 10.1016/j.parkreldis.2019.04.023
- Lee J-Y, Ahn J, Yoon EJ, et al. . Macular ganglion-cell-complex layer thinning and optic nerve integrity in drug-naïve Parkinson’s disease. J Neural Transm (Vienna) 2019;126:1695–9. 10.1007/s00702-019-02097-7
- Adalbert R, Coleman MP. Review: axon pathology in age-related neurodegenerative disorders. Neuropathol Appl Neurobiol 2013;39:90–108. 10.1111/j.1365-2990.2012.01308.x
- McKendrick AM, Chan YM, Nguyen BN. Spatial vision in older adults: perceptual changes and neural bases. Ophthalmic Physiol Opt 2018;38:363–75. 10.1111/opo.12565
- Schrag A, Siddiqui UF, Anastasiou Z, et al. . Clinical variables and biomarkers in prediction of cognitive impairment in patients with newly diagnosed Parkinson’s disease: a cohort study. Lancet Neurol 2017;16:66–75. 10.1016/S1474-4422(16)30328-3
- Malek N, Weil RS, Bresner C, et al. . Features of GBA-associated Parkinson’s disease at presentation in the UK tracking Parkinson’s study. J Neurol Neurosurg Psychiatry 2018;89:702–9. 10.1136/jnnp-2017-317348
- Alves JN, Westner BU, Højlund A, et al. . Structural and functional changes in the retina in Parkinson’s disease. J Neurol Neurosurg Psychiatry 2023;94:448–56. 10.1136/jnnp-2022-329342
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