Early identification of subjective cognitive functional decline among patients with Parkinson’s disease: a longitudinal pilot study

Abstract

Practical methods for early identification of Parkinson’s disease (PD) mild cognitive impairment (PD-MCI) through changes in real-life daily functioning are scarce. The aim of the study was to examine whether the cognitive functional (CF) feature, comprising of seven self-reported Movement Disorder Society’s (MDS) Unified Parkinson’s Disease Rating Scale (UPDRS) items, predicts PD patients’ cognitive functional status after a year. We conducted a 1-year follow-up of 34 PD patients (50–78 year; 70.6% men) suspected of MCI using the following measures: the MDS-UPDRS, UPDRS-CF feature, Beck Depression Inventory (BDI), Montreal Cognitive Assessment (MoCA), Trail Making Test (TMT), Parkinson’s Disease Cognitive Functional Rating Scale (PD-CFRS), and Daily Living Questionnaire (DLQ). The first and second UPDRS-CF feature scores, and additional measures at the 1-year follow-up significantly correlated. Hierarchical regression revealed that the initial MoCA, TMT, and BDI scores predicted the second UPDRS-CF, and the first UPDRS-CF predicted 31% of the second PD-CFRS score variance. Depression moderated the relationship between the first UPDRS-CF score and the DLQ Part A. These results suggest practical, self-reported, daily functional markers for identifying gradual decline in PD patients. They consider the patients’ heterogeneity, underlying cognitive pathology, and implications on daily functioning, health, and well-being.

The impact of psychiatric comorbidity on Parkinson's disease outcomes: a systematic review and meta-analysis

“…The association of depression with subsequent cognitive impairment, disease progression, death, disability, falls or fractures and residential home admission was tested across 6324 participants in 29 studies. 18 , 19 , 20 , 21 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 Depression was significantly associated with cognitive impairment (SMD 0.37 [95% CI 0.10–0.65], p = 0.0085, I 2 27.1%, [ I 2 95% CI 0–35.0]), disease progression (SMD 0.46 [95% CI 0.18–0.74], p = 0.0011, I 2 52.2 [ I 2 95% CI 0–81.1]), and disability (SMD 0.42 [95% CI 0.25–0.60], p = <0.0001, I 2 7.9%, [ I 2 95% CI 0–91.2]). There was no significant association for falls or fractures (SMD −0.28 [95% CI −0.90 to 0.34], p = 0.37, I 2 0%, [ I 2 95% CI 0–99.5]) and death (SMD 0.32 [95% CI −0.56 to 1.20], p = 0.47, I 2 0% [ I 2 95% CI 0–37.0]).…”

Subjective cognitive decline in patients with Parkinson’s disease: an updated review

“…Conversely, a follow-up study by Galtier suggested that PD-SCD patients (36.4%) are at higher risk of converting to dementia than PD without SCD (14.3%) 7.5 years later, and the PD-SCD group showed impairments in visuospatial and visuoperceptual functions, which was linked to thinning of posterior cortices (Galtier et al, 2021), at the same time, PD-SCD showed poor performance in verb naming test in the same longitudinal study (n = 46 PD, n = 20 controls), which suggested the possible linguistic dysfunction in PD-SCD (Galtier et al, 2022). Rosenblum followed up PD-sMCD (n = 25) and found self-reported cognitive decline may be a marker for predicting cognitive ability decline after 1 year (Rosenblum et al, 2022b). Han and colleagues regarded PD-SCD as an intermediate status of PD-NC and PD-MCI, they divided people into three groups: PD-NC (n = 189), PD-SCD (n = 59), PD-MCI (n = 135), the longitudinal study (1-7.5 years) found PD-SCD showed memory impairment and greater reductions in attention and executive function compared with PD-NC, which suggested PD-SCD may be high risk individuals progression to cognitive decline later (Han et al, 2021), and the results were similar to Hong's and Purri's study (Hong et al, 2014a;Purri et al, 2020).…”

Improving Conversations about Parkinson's Dementia

“…8 Barriers to conversations about dementia in the wider population are: (1) the stigma of a dementia diagnosis, including fear around the diagnosis, and worry about social exclusion; (2) the perception that treatment options are limited; and (3) that there is little benefit in early diagnosis of dementia. 9 These factors are likely to be even greater in PD, where there is already a perceived stigma of the diagnosis of PD itself. 10 Barriers to help-seeking for cognitive problems are multifaceted and may be more common in Black and other minoritized ethnic populations.…”

“…Cognitive function in PD was selected as a “community priority of major unmet need” by the PD Foundation Community Choice Research Award Program, 8 and lack of discussion about cognitive change was emphasized in a working group of experts convened in response 8 . Barriers to conversations about dementia in the wider population are: (1) the stigma of a dementia diagnosis, including fear around the diagnosis, and worry about social exclusion; (2) the perception that treatment options are limited; and (3) that there is little benefit in early diagnosis of dementia 9 . These factors are likely to be even greater in PD, where there is already a perceived stigma of the diagnosis of PD itself 10 …”