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Feasibility and Diagnostic Potential of Multimodal Neuro-Ophthalmic Biomarkers in Young-Onset Dementia and Functional Cognitive Disorder

Year: 2026

Type: article

Abstract: Purpose: To evaluate the feasibility and diagnostic utility of neuro-ophthalmic biomarkers as objective, culture-fair tools for distinguishing young-onset dementia (YOD) from functional cognitive disorder (FCD). Design: A cross-sectional observational study. Participants: = 16). Methods: Participants underwent point-of-care neuro-ophthalmic assessments, including virtual reality-based eye tracking (BulbiCAM) to measure saccadic and pupillary responses, and handheld electroretinography (ERG) (RETeval) to assess retinal ganglion cell function. Main Outcome Measures: Saccadic latency (horizontal and vertical), pupillometric parameters (constriction acceleration and velocity, relative afferent pupillary defect, and baseline diameter), and ERG photopic negative response (PhNR) amplitude and latency. Results: = 0.02), and similarly showed a stepwise decline from controls through FCD to YOD. Constriction acceleration showed the strongest single-marker performance (area under the curve [AUC] = 0.83), followed by horizontal saccadic latency (AUC = 0.77). Combining these 2 measures improved discrimination (AUC = 0.84), with high specificity (92.6%). Electroretinography PhNR measures showed nonsignificant trends toward reduced amplitude and delayed latency in cognitively impaired groups. Participant feedback supported feasibility, with over 93% reporting comfort and acceptability. Conclusions: Noninvasive neuro-ophthalmic assessments are feasible in memory clinic settings and show promise as rapid, objective, and culture-fair biomarkers for early detection of YOD. Dynamic pupillometry and saccadic latency, in particular, demonstrate potential for differentiating YOD from nondementia conditions, while their combined model showed high specificity, supporting possible value as a rule-in adjunct in clinical assessment. Larger, longitudinal studies are required to validate diagnostic thresholds and clinical implementation. Financial Disclosures: The author has no/the authors have no proprietary or commercial interest in any materials discussed in this article.

Source: Ophthalmology Science

DOI: 10.1016/j.xops.2026.101410