Prognosis of Mild Cognitive Impairment in Early Parkinson Disease

Pedersen, Kenn Freddy; Larsen, Jan Petter; Tysnes, Ole‐Bjørn; Alves, Guido

doi:10.1001/jamaneurol.2013.2110

Cited by 281 publications

(283 citation statements)

References 50 publications

(48 reference statements)

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“…24 A recent study of patients with early PD and shorter follow-up (3 years) found that 27% of patients with MCI developed dementia during this time period, with older age and both attention and verbal memory deficits predicting decline. 7 Although it has been hypothesized that some MCI subtypes presenting early in the disease course may be stable and not progress to dementia, 25 our findings suggest that if a patient with PD develops incident MCI, progression to dementia may be universal within 5 years. Progression to dementia may be particularly rapid in older patients (the mean age of our cohort at baseline was 69 years), although surprisingly age was not a significant predictor, perhaps due to the narrow age range of our cohort.…”

Section: Discussionmentioning

confidence: 64%

Longitudinal study of normal cognition in Parkinson disease

et al. 2015

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Objective: To report the rates and predictors of progression from normal cognition to either mild cognitive impairment (MCI) or dementia using standardized neuropsychological methods.Methods: A prospective cohort of patients diagnosed with Parkinson disease (PD) and baseline normal cognition was assessed for cognitive decline, performance, and function for a minimum of 2 years, and up to 6. A panel of movement disorders experts classified patients as having normal cognition, MCI, or dementia, with 55/68 (80.9%) of eligible patients seen at year 6. Kaplan-Meier curves and Cox proportional hazard models were used to examine cognitive decline and its predictors. Results:We enrolled 141 patients, who averaged 68.8 years of age, 63% men, who had PD on average for 5 years. The cumulative incidence of cognitive impairment was 8.5% at year 1, increasing to 47.4% by year 6. All incident MCI cases had progressed to dementia by year 5. In a multivariate analysis, predictors of future decline were male sex (p 5 0.02), higher Unified Parkinson's Disease Rating Scale motor score (p # 0.001), and worse global cognitive score (p , 0.001).Conclusions: Approximately half of patients with PD with normal cognition at baseline develop cognitive impairment within 6 years and all new MCI cases progress to dementia within 5 years. Our results show that the transition from normal cognition to cognitive impairment, including dementia, occurs frequently and quickly. Certain clinical and cognitive variables may be useful in predicting progression to cognitive impairment in PD. Nonmotor symptoms are common in Parkinson disease (PD), 1 including mild cognitive impairment (MCI) and dementia (PDD).2 Up to 80% of patients with PD develop dementia long-term, 3 and 20%-30% of patients with PD without dementia meet criteria for MCI. 4 Both PD-MCI and PDD impact negatively on patient quality of life, cost of care, and caregiver burden. 5,6 Longitudinal reports on patients with early PD-MCI show that more than 25% will develop dementia within 3 years, 7 and MCI at disease onset increases risk for development of dementia. 8Another study reported that up to 50% of patients with early PD developed cognitive decline within 5 years, 9 although the sample size was relatively small and lack of cognitive impairment at baseline was defined by Mini-Mental State Examination score only.Structural MRI, and plasma and CSF biomarkers, are associated with cognitive functioning and predict future cognitive decline in PD.1 However, many biomarkers are invasive, costly, and done mainly at academic centers conducting research. Demographic and clinical factors such as age, 10 motor subtypes, 11 and early visuospatial, language, and fluency deficits 12,13 have also been shown to predict future cognitive decline. However, to our knowledge, no research has focused on those patients defined as having normal cognition (NC) at baseline, which allows for examination of the course of cognitive decline from its clinical onset.

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Section: Discussionmentioning

confidence: 64%

Longitudinal study of normal cognition in Parkinson disease

et al. 2015

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“…Until recently, object recognition has not been well studied in PD. Studies using measures such as the Vision Object and Space Perception battery have shown inconsistent findings 36, 37. Recognition of embedded figures may be affected,13 and emotion recognition, a specialized form of object recognition, is impaired 14.…”

Section: Discussionmentioning

confidence: 99%

Assessing cognitive dysfunction in Parkinson's disease: An online tool to detect visuo‐perceptual deficits

et al. 2018

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Background: People with Parkinson's disease (PD) who develop visuo‐perceptual deficits are at higher risk of dementia, but we lack tests that detect subtle visuo‐perceptual deficits and can be performed by untrained personnel. Hallucinations are associated with cognitive impairment and typically involve perception of complex objects. Changes in object perception may therefore be a sensitive marker of visuo‐perceptual deficits in PD. Objective: We developed an online platform to test visuo‐perceptual function. We hypothesised that (1) visuo‐perceptual deficits in PD could be detected using online tests, (2) object perception would be preferentially affected, and (3) these deficits would be caused by changes in perception rather than response bias. Methods: We assessed 91 people with PD and 275 controls. Performance was compared using classical frequentist statistics. We then fitted a hierarchical Bayesian signal detection theory model to a subset of tasks. Results: People with PD were worse than controls at object recognition, showing no deficits in other visuo‐perceptual tests. Specifically, they were worse at identifying skewed images (P < .0001); at detecting hidden objects (P = .0039); at identifying objects in peripheral vision (P < .0001); and at detecting biological motion (P = .0065). In contrast, people with PD were not worse at mental rotation or subjective size perception. Using signal detection modelling, we found this effect was driven by change in perceptual sensitivity rather than response bias. Conclusions: Online tests can detect visuo‐perceptual deficits in people with PD, with object recognition particularly affected. Ultimately, visuo‐perceptual tests may be developed to identify at‐risk patients for clinical trials to slow PD dementia. © 2018 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.

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“…19 Three-year follow-up of 182 participants in the Norwegian ParkWest Study cohort showed that 10 of 37 subjects with PD-MCI at baseline had converted to PDD, compared to one of 145 with normal cognition, a relative risk of 39.2. 20 However, this study also found that 22% of PD-MCI subjects at baseline reverted to normal cognition, implying that PD-MCI can be reversible. The PD-MCI converters were significantly older and had significantly worse scores on tests of executive function at baseline compared to the PD-MCI reverters.…”

Section: Pd Mild Cognitive Impairmentmentioning

confidence: 56%

“…The PD-MCI converters were significantly older and had significantly worse scores on tests of executive function at baseline compared to the PD-MCI reverters. 20 More information is needed to understand the transition between normal cognition, PD-MCI and PDD. PD-MCI and PDD appear to share several risk factors such as level of education, 21 severity of motor deficit 22,23 and male gender.…”

Section: Pd Mild Cognitive Impairmentmentioning

confidence: 99%

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Cognitive deficits in Parkinson’s disease: current perspectives

Cosgrove¹,

Alty²

2018

JPRLS

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Prognosis of Mild Cognitive Impairment in Early Parkinson Disease

Abstract: Importance: Mild cognitive impairment (MCI) is common in Parkinson disease (PD), but the prognostic value of MCI in early PD is unknown. Objective: To examine the course of MCI and its progression to dementia in an incident PD cohort.

Cited by 281 publications

References 50 publications

Longitudinal study of normal cognition in Parkinson disease

Longitudinal study of normal cognition in Parkinson disease

Assessing cognitive dysfunction in Parkinson's disease: An online tool to detect visuo‐perceptual deficits

Cognitive deficits in Parkinson’s disease: current perspectives

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Prognosis of Mild Cognitive Impairment in Early Parkinson Disease

Abstract: Importance: Mild cognitive impairment (MCI) is common in Parkinson disease (PD), but the prognostic value of MCI in early PD is unknown. Objective: To examine the course of MCI and its progression to dementia in an incident PD cohort.

Cited by 281 publications

References 50 publications

Longitudinal study of normal cognition in Parkinson disease

Longitudinal study of normal cognition in Parkinson disease

Assessing cognitive dysfunction in Parkinson's disease: An online tool to detect visuo‐perceptual deficits

Cognitive deficits in Parkinson&rsquo;s disease: current perspectives

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Cognitive deficits in Parkinson’s disease: current perspectives