Cognitive decline, postural instability, and aspiration pneumonia are major complications of advanced PD. Visual dysfunction has been implicated in PD dementia risk, but longitudinal data is sparse. Few studies have examined visual dysfunction as a predictor of broader PD-related outcomes.

In 2015, we collected data on a comprehensive battery of visual function measures in a cohort study (T0) comparing early non-demented PD (PD-NDs) and age-matched controls. At 10-year follow ups (T10), we determined PD-NDs’ clinical outcomes through retrospective chart review in disease duration, dementia, aspiration pneumonia, freezing of gait, falls, and mortality. Chi-square and T-tests were used to evaluate correlations of T0 visual performance and T10 outcomes.

Thirty-six PD-NDs (age 70.7 ± 9.8 years; 94% males; median disease duration 4 years) and 41 controls (age 67.7 ± 4.0 years; 76% males) from SAVAHCS completed evaluation at T0. PD-NDs exhibited deficits in low level vision (contrast sensitivity, color vision), ventral visual pathway (configural/feature-based processing of faces), dorsal visual pathway (cancellation tasks, King-Devick test, object/people search), and top-down executive control (anti-saccade and flanker tasks). At T10, abnormal anti-saccade demonstrated the strongest predictive value, correlating with time to aspiration pneumonia, injurious falls, dementia, and death. Low-level vision dysfunction was associated with time to aspiration pneumonia and mortality. Dorsal pathway dysfunction was linked to dementia and mortality. Ventral pathway dysfunction correlated with presence of aspiration pneumonia and time to freezing of gait. Statistical significance was determined at p < 0.05.

Multiple early visual function deficits predicted adverse 10-year PD outcomes, with abnormal anti-saccade showing the most consistent associations. Larger studies with more robust patient sample sizes are needed to further validate these findings and support the role of these visual measures in prognosis and care planning.