Cognitive impairment in Parkinson's disease: Associations between subjective and objective cognitive decline in a large longitudinal study

Parkinsonism Relat Disord. 2020 Nov:80:127-132. doi: 10.1016/j.parkreldis.2020.09.028. Epub 2020 Sep 20.

Abstract

Background: Cognitive decline creates substantial morbidity and cost in Parkinson's disease (PD) and clinicians have limited tools for counseling patients on prognosis. We aimed to use data from a randomized, controlled trial of isradipine in Parkinson's disease (STEADY-PD III) to determine which objective cognitive domain deficits drive patient complaints of cognitive symptoms.

Methods: Neuro-Quality of Life (Neuro-QoL) Cognition: General Concerns (GC), and Cognition: Executive Function (EF) (subjective measures), were administered at baseline, 1, 2, and 3 years in 324 people with PD. Baseline Montreal Cognitive Assessment (MoCA) was divided into 4 domains: visuospatial/executive, memory, attention, and language (objective measures). Spearman rank correlations and multiple regression models adjusted for other clinical variables evaluated associations between baseline Neuro-QoL domains and individual MoCA domains. Multiple regression models evaluated the association between baseline MoCA domain performance and Neuro-QoL change over three years. Cox proportional hazards predicted development of PD-MCI based on baseline and time-varying Neuro-QoL reporting.

Results: Higher MoCA memory performance was associated with better Neuro-QoL-GC (β = 0.75, SE = 0.391, p = 0.05) and Neuro-QoL-EF (β = 0.81, SE = 0.36, p = 0.02) at baseline. There was a trend for baseline MoCA memory to predict the degree of subjective cognitive decline on the Neuro-QoL-EF (β = 0.70, SE = 0.42, p = 0.09). Baseline depression and anticholinergic use were associated with worsened Neuro-QoL-EF and Neuro-QoL-GC. Increasing subjective cognitive complaints in Neuro-QoL-EF were associated with development of PD-MCI over 3 years of follow-up (HR = 0.95, CI = 0.90-1.0, p = 0.039).

Conclusions: Objective memory impairment may be a stronger predictor than executive or visuospatial dysfunction for the presence of subjective cognitive complaints in early PD.

Keywords: Cognitive impairment; Parkinson's disease; Patient-reported outcomes.

Publication types

  • Clinical Trial, Phase III
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Calcium Channel Blockers / administration & dosage
  • Cognitive Dysfunction / diagnosis*
  • Cognitive Dysfunction / etiology
  • Cognitive Dysfunction / physiopathology*
  • Depression / etiology
  • Depression / physiopathology
  • Diagnostic Self Evaluation
  • Executive Function / physiology
  • Female
  • Humans
  • Isradipine / administration & dosage
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Parkinson Disease / complications
  • Parkinson Disease / drug therapy
  • Parkinson Disease / physiopathology*
  • Patient Reported Outcome Measures*
  • Quality of Life

Substances

  • Calcium Channel Blockers
  • Isradipine