BackgroundAssociation between heavy metals and Parkinson’s disease (PD) is well noted, but studies regarding heavy metal levels and non-motor symptoms of PD, such as PD’s dementia (PD-D), are lacking.MethodsIn this retrospective cohort study, we compared five serum heavy metal levels (Zn, Cu, Pb, Hg, and Mn) of newly diagnosed PD patients (n= 124). Among 124 patients, 40 patients were later converted to Parkinson’s disease dementia (PD-D), and 84 patients remained without dementia during the follow-up time. We collected clinical parameters of PD and conducted correlation analysis with heavy metal levels. PD-D conversion time was defined as the initiation time of cholinesterase inhibitors. Cox proportional hazard models were used to identify factors associated with dementia conversion in PD subjects.ResultsZn deficiency was significant in the PD-D group than in the PD without dementia group (87.53 ± 13.20 vs. 74.91 ± 14.43,p< 0.01). Lower serum Zn level was significantly correlated with K-MMSE and LEDD at 3 months (r= −0.28,p< 0.01;r= 0.38,p< 0.01). Zn deficiency also contributed to a shorter time to dementia conversion (HR 0.953, 95% CI 0.919 to 0.988,p< 0.01).ConclusionThis clinical study suggests that a low serum Zn level can be a risk factor for developing PD-D and could be used as a biological marker for PD-D conversion.