Predictors of cognitive impairment in an early stage Parkinson's disease cohort

Michele T. M. Hu*, Konrad Szewczyk-Krolikowski, Paul Tomlinson, Kannan Nithi, Michal Rolinski, Clara Murray, Kevin Talbot, Klaus P. Ebmeier, Clare E. Mackay, Yoav Ben-Shlomo

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)

75 Citations (Scopus)

Abstract

The impact of Parkinson's disease (PD) dementia is substantial and has major functional and socioeconomic consequences. Early prediction of future cognitive impairment would help target future interventions. The Montreal Cognitive Assessment (MoCA), the Mini-Mental State Examination (MMSE), and fluency tests were administered to 486 patients with PD within 3.5 years of diagnosis, and the results were compared with those from 141 controls correcting for age, sex, and educational years. Eighteen-month longitudinal assessments were performed in 155 patients with PD. The proportion of patients classified with normal cognition, mild cognitive impairment (MCI), and dementia varied considerably, depending on the MoCA and MMSE thresholds used. With the MoCA total score at screening threshold, 47.7%, 40.5%, and 11.7% of patients with PD were classified with normal cognition, MCI, and dementia, respectively; by comparison, 78.7% and 21.3% of controls had normal cognition and MCI, respectively. Cognitive impairment was predicted by lower education, increased age, male sex, and quantitative motor and non-motor (smell, depression, and anxiety) measures. Longitudinal data from 155 patients with PD over 18 months showed significant reductions in MoCA scores, but not in MMSE scores, with 21.3% of patients moving from normal cognition to MCI and 4.5% moving from MCI to dementia, although 13.5% moved from MCI to normal; however, none of the patients with dementia changed their classification. The MoCA may be more sensitive than the MMSE in detecting early baseline and longitudinal cognitive impairment in PD, because it identified 25.8% of those who experienced significant cognitive decline over 18 months. Cognitive decline was associated with worse motor and non-motor features, suggesting that this reflects a faster progressive phenotype.
Original languageEnglish
Pages (from-to)351-359
Number of pages9
JournalMovement Disorders
Volume29
Issue number3
DOIs
Publication statusPublished - Mar 2014

Bibliographical note

© 2013 The Authors. International Parkinson and Movement Disorder Society published by Wiley Periodicals, Inc.

Keywords

  • Parkinson's disease
  • mild cognitive impairment
  • dementia
  • Mini-Mental State Examination
  • Montreal Cognitive Assessment
  • SOCIETY TASK-FORCE
  • MINI-MENTAL-STATE
  • DIAGNOSTIC-CRITERIA
  • OLFACTORY DYSFUNCTION
  • ODOR IDENTIFICATION
  • ALZHEIMERS-DISEASE
  • PURDUE PEGBOARD
  • SCREENING TOOL
  • NORMATIVE DATA
  • OLDER-ADULTS

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