Cognitive-Driven Activities of Daily Living Impairment as a Predictor for Dementia in Parkinson Disease

Abstract

Objectives:One-third of Parkinson’s disease (PD) patients with mild cognitive impairment (PD-MCI) convert to dementia within a few years. Markers with a high prognostic value for dementia conversion are needed. Loss of everyday function primarily caused by cognitive dysfunction is the core criterion for the diagnosis of PD dementia, with an onset of more complex instrumental activities of daily living (IADL) dysfunction in the prodromal stage. This study evaluated the phenotype associated with cognitive IADL impairment and its predictive value for defining a high-risk group for PD dementia.Methods:An observational longitudinal study using cognitive and clinical scores in addition to genetic and CSF biomarkers was conducted. The Functional Activities Questionnaire (FAQ) quotient (cut-off ≥1), indicating more cognitive than motor-driven IADL impairment, defined cognitive IADL impairment status at baseline. Hazard ratios (HR) were used to compare the impact of baseline classifications on dementia conversion.Results:Of 268 patients with PD assessed at baseline, 108 (40.3%) had PD-MCI. After a period of 3.78±0.84 years, 164 (61.2%) patients were re-assessed. At follow-up, 93 (56.7%) patients had no cognitive impairment, 54 (32.9%) fulfilled PD-MCI criteria, and 17 (10.4%) had developed dementia. The HR of baseline cognitive IADL impairment (n=37) for dementia conversion was descriptively higher than for PD-MCI, but highest in patients with both markers (HR=12.01, 95%-CI 4.47-32.22, p<0.001). In the follow-up sample, nearly half of patients (n=10, 47.6%) with baseline classification of cognitive IADL impairment and PD-MCI converted to dementia. Baseline status of cognitive IADL impairment was associated with higher non-motor burden, worse cognitive performance, and more severe IADL progression over the study period.Conclusion:The importance of differentiating between cognitive and motor aspects on ADL function in PD and monitoring cognitive ADL impairment in the prodromal stage of dementia is paramount. Patients with PD-MCI and cognitive IADL impairment may be a valuable target group for clinical trials aiming to slow down development of dementia.Trial Registration Information:ClinicalTrials.gov NCT03687203.Classification of Evidence:This study provides Class II evidence that impairment of cognitive activities of daily living is associated with progression from mild cognitive impairment to dementia among patients with Parkinson's disease.

Social support and cognitive function in Chinese older adults who experienced depressive symptoms: is there an age difference?

“…Cognitive function-associated sociodemographic variables, health behaviors, and health status variables were considered as covariates in our analysis, which have previously been reported to be associated with cognitive function among older adults (Durazzo et al, 2014;Koch et al, 2019;Lutsey et al, 2019;Zhang et al, 2020;Becker et al, 2022;Li et al, 2022;Nerobkova et al, 2022;Yu et al, 2022;Zhang et al, 2022;Bloomberg et al, 2023;Du et al, 2023). Sociodemographic variables included gender (male or female), age (60-69 years, 70-79 years, or ≥ 80 years), education level (illiterate/primary school, junior school, senior high school, or college or above), marital status (unmarried/divorced/widowed or married), living arrangement (alone or with others), household income (≤ 5,000, 5,001 -10,000, or > 10,000).…”

Author Response: Cognitive-Driven Activities of Daily Living Impairment as a Predictor for Dementia in Parkinson Disease: A Longitudinal Cohort Study

“…Our study showed that Parkinson patients with mild cognitive impairment and cognitive IADL impairment were at a higher risk of developing dementia. 1 Thus, we argue that the MoCA and the FAQ cognition score should be used together, not separately, to inform clinical trials.…”

“…We appreciate the comment by Dr. Kasten on our article. 1 Regarding the question of whether the Montreal Cognitive Assessment (MoCA) and the cognition subscore of the Functional Activities Questionnaire (FAQ) correlate, we found weak-to-moderate correlations at baseline ( r = −0.28, p < 0.001, 95% CI −0.41 to −0.13) and follow-up ( r = −0.40, p < 0.001, 95% CI −0.53 to −0.26). However, it is important to keep in mind that the FAQ items comprising the cognition score were originally chosen based on correlations with the MoCA.…”

Editorial: Activities of daily living and everyday functioning: From normal aging to neurodegenerative diseases

“…An even steeper decline in ADLs can be expected in people at risk of developing neurodegenerative or other types of diseases (Buchman et al, 2009 ; Gill et al, 2013 ). Deficits in ADLs due to cognitive impairment are increasingly discussed as a risk factor for dementia in older age and neurodegenerative diseases (Verlinden et al, 2016 ; Becker et al, 2022 ; Jang et al, 2022 ; Ng et al, 2022 ), indicating a need for sensitive assessments, especially in mild stages of ADL difficulty. ADLs are affected by multiple factors such as physical fitness, cognitive ability, and mental health (Cahn et al, 1998 ; Tam et al, 2008 ; Christensen et al, 2013 ).…”