Cognitive decline in Parkinson’s disease: the impact of the motor phenotype on cognition

Objectives Parkinson’s disease (PD) is the second most common neurodegenerative disorder and is further associated with progressive cognitive decline. In respect to motor phenotype, there is some evidence that akinetic-rigid PD is associated with a faster rate of cognitive decline in general and a greater risk of developing dementia. The objective of this study was to examine cognitive profiles among patients with PD by motor phenotypes and its relation to cognitive function. Methods Demographic, clinical and neuropsychological cross-sectional baseline data of the DEMPARK/LANDSCAPE study, a multicentre longitudinal cohort study of 538 patients with PD were analysed, stratified by motor phenotype and cognitive syndrome. Analyses were performed for all patients and for each diagnostic group separately, controlling for age, gender, education and disease duration. Results Compared with the tremor-dominant phenotype, akinetic-rigid patients performed worse in executive functions such as working memory (Wechsler Memory Scale-Revised backward; p=0.012), formal-lexical word fluency (p=0.043), card sorting (p=0.006), attention (Trail Making Test version A; p=0.024) and visuospatial abilities (Leistungsprüfungssystem test 9; p=0.006). Akinetic-rigid neuropsychological test scores for the executive and attentive domain correlated negatively with non-tremor motor scores. Covariate-adjusted binary logistic regression analyses showed significant odds for PD-mild cognitive impairment for not-determined as compared with tremor-dominant (OR=3.198) and akinetic-rigid PD (OR=2.059). The odds for PD-dementia were significant for akinetic-rigid as compared with tremor-dominant phenotype (OR=8.314). Conclusion The three motor phenotypes of PD differ in cognitive performance, showing that cognitive deficits seem to be less severe in tremor-dominant PD. While these data are cross-sectional, longitudinal data are needed to shed more light on these differential findings.

[1]  D. Berg,et al.  Cognitive changes in prodromal Parkinson's disease: A review , 2017, Movement disorders : official journal of the Movement Disorder Society.

[2]  Jeffrey M. Hausdorff,et al.  IS COGNITIVE DECLINE SIMILAR AMONG PARKINSON’S DISEASE MOTOR SUB-TYPES? A PROSPECTIVE STUDY , 2017 .

[3]  J. Nutt.  Motor subtype in Parkinson's disease: Different disorders or different stages of disease? , 2016, Movement disorders : official journal of the Movement Disorder Society.

[4]  N. Gasson,et al.  Motor Subtype as a Predictor of Future Working Memory Performance in Idiopathic Parkinson's Disease , 2016, PloS one.

[5]  G. Deuschl,et al.  MDS clinical diagnostic criteria for Parkinson's disease , 2015, Movement disorders : official journal of the Movement Disorder Society.

[6]  Jeffrey M. Hausdorff,et al.  Cognitive contributions to gait and falls: Evidence and implications , 2013, Movement disorders : official journal of the Movement Disorder Society.

[7]  J. Jankovic,et al.  How to identify tremor dominant and postural instability/gait difficulty groups with the movement disorder society unified Parkinson's disease rating scale: Comparison with the unified Parkinson's disease rating scale , 2013, Movement disorders : official journal of the Movement Disorder Society.

[8]  Simon B. Eickhoff,et al.  Diminished Activation of Motor Working-Memory Networks in Parkinson's Disease , 2013, PloS one.

[9]  Roger A. Barker,et al.  Cognitive Impairment in Parkinson's Disease: The Dual Syndrome Hypothesis , 2012, Neurodegenerative Diseases.

[10]  M. Mukaka,et al.  Statistics corner: A guide to appropriate use of correlation coefficient in medical research. , 2012, Malawi medical journal : the journal of Medical Association of Malawi.

[11]  U. Bonuccelli,et al.  Mild cognitive impairment and cognitive-motor relationships in newly diagnosed drug-naive patients with Parkinson's disease , 2012, Journal of Neurology, Neurosurgery & Psychiatry.

[12]  Günther Deuschl,et al.  Parkinson’s Disease and Dementia: A Longitudinal Study (DEMPARK) , 2011, Neuroepidemiology.

[13]  L. Clare,et al.  Executive functions in Parkinson's disease: Systematic review and meta‐analysis , 2011, Movement disorders : official journal of the Movement Disorder Society.

[14]  R. Barker,et al.  Mild cognitive impairment in Parkinson disease , 2010, Neurology.

[15]  Thomas Foltynie,et al.  The distinct cognitive syndromes of Parkinson's disease: 5 year follow-up of the CamPaIGN cohort. , 2009, Brain : a journal of neurology.

[16]  C. Caltagirone,et al.  Dopamine and cognitive functioning in de novo subjects with Parkinson's disease: Effects of pramipexole and pergolide on working memory , 2009, Neuropsychologia.

[17]  S. S. Kollias,et al.  Morphological differences in Parkinson’s disease with and without rest tremor , 2009, Journal of Neurology.

[18]  Pasquale Calabrese,et al.  Screening for cognitive deficits in Parkinson's disease with the Parkinson neuropsychometric dementia assessment (PANDA) instrument , 2008 .

[19]  E. Tolosa,et al.  Diagnostic procedures for Parkinson's disease dementia: Recommendations from the movement disorder society task force , 2007, Movement disorders : official journal of the Movement Disorder Society.

[20]  E. Tolosa,et al.  Clinical diagnostic criteria for dementia associated with Parkinson's disease , 2007, Movement disorders : official journal of the Movement Disorder Society.

[21]  D. Aarsland,et al.  Changes in motor subtype and risk for incident dementia in Parkinson's disease , 2006, Movement disorders : official journal of the Movement Disorder Society.

[22]  I. McKeith,et al.  Motor subtype and cognitive decline in Parkinson’s disease, Parkinson’s disease with dementia, and dementia with Lewy bodies , 2006, Journal of Neurology, Neurosurgery & Psychiatry.

[23]  R. Petersen.  Mild cognitive impairment as a diagnostic entity , 2004, Journal of internal medicine.

[24]  J. Obeso,et al.  Challenges in Parkinson's disease: restoration of the nigrostriatal dopamine system is not enough , 2004, The Lancet Neurology.

[25]  T. Tombaugh.  Trail Making Test A and B: normative data stratified by age and education. , 2004, Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

[26]  D. Aarsland,et al.  Prevalence and characteristics of dementia in Parkinson disease: an 8-year prospective study. , 2003, Archives of neurology.

[27]  E. Mori.  [Dementia with Lewy bodies]. , 2000, Nihon Ronen Igakkai zasshi. Japanese journal of geriatrics.

[28]  D P Salmon,et al.  A normative study of Nelson's (1976) modified version of the Wisconsin Card Sorting Test in healthy older adults. , 1999, The Clinical neuropsychologist.

[29]  E. Lesaffre,et al.  A frequency and correlation analysis of motor deficits in Parkinson patients. , 1998, Disability and rehabilitation.

[30]  R. Fitzpatrick,et al.  The development and validation of a short measure of functioning and well being for individuals with Parkinson's disease , 1995, Quality of Life Research.

[31]  M. Mega,et al.  The Neuropsychiatric Inventory , 1994, Neurology.

[32]  J. Hughes,et al.  Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases. , 1992, Journal of neurology, neurosurgery, and psychiatry.

[33]  N Butters,et al.  Episodic and semantic memory: a comparison of amnesic and demented patients. , 1987, Journal of clinical and experimental neuropsychology.

[34]  J. Yesavage,et al.  Geriatric Depression Scale (GDS): Recent evidence and development of a shorter version. , 1986 .

[35]  A. Lees,et al.  Cognitive deficits in the early stages of Parkinson's disease. , 1983, Brain : a journal of neurology.

[36]  A. Antonini,et al.  MoCA vs. MMSE sensitivity as screening instruments of cognitive impairment in PD, MSA and PSP patients , 2016 .

[37]  C. Aebi.  Validierung der neuropsychologischen Testbatterie CERAD-NP : eine Multi-Center Studie , 2002 .