Objective: To assess the utility of commonly used cognitive screening tools in predicting the transition to mild cognitive impairment (MCI) and/or dementia (PDD) in Parkinson’s disease (PD).

Background: Much research has been dedicated to cognitive impairment frequently associated with PD. Prior studies have compared the sensitivities of commonly used screening tools for identification of cognitive impairment in PD, but little research has been done regarding the utility of these tools in predicting cognitive progression.

Methods: We retrospectively reviewed data collected from 489 patients with UKBB-defined PD enrolled in the Pacific Udall Center. At the time of enrollment, a full neuropsychological assessment was completed, as well as three cognitive screening measures: Mini Mental Status Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Mattis Dementia Rating Scale (DRS). Diagnosis of motor and cognitive status, including PD-MCI or PDD, was made via clinical diagnostic consensus.

Three-hundred eleven initially non-demented participants completed at least one follow up visit (average follow up = 2.7 years). Baseline sensitivity and specificity for the three screening measures were determined using standard cutoff scores. To assess the relationship between the cognitive screening measures and subsequent progression of cognitive symptoms, separate logistic regression models were performed for conversion from no cognitive impairment to PD-MCI, and from PD-MCI to PDD.

Results: At baseline, of the three screening tests, the MoCA demonstrated the highest sensitivity for both MCI (67.3% vs. 25.9% for the DRS and 6.2% for the MMSE) and PDD (85.1% vs. 55.4% for the DRS and 20.2% for the MMSE). After controlling for demographic and clinical factors, none of the screening measures were associated with conversion from no cognitive impairment to PD-MCI. However, poorer baseline MoCA performance was significantly associated with conversion from MCI to PDD (OR = 1.23, SE = 0.11, CI 1.03-1.48, p=0.019).

Conclusions: Of the three screening tools, the MoCA was the most sensitive for identifying baseline cognitive impairment, and lower initial performance on the MoCA was associated with subsequent conversion from PD-MCI to PDD. This study provides additional support for the use of the MoCA as a primary screening tool for cognitive impairment and prediction of conversion to dementia in patients with PD.

References: Hu, M et al, Predictors of Cognitive Impairment in an Early Stage Parkinson’s Disease Cohort. Movement Disorders 2014. 29(3); 351-9.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/prediction-of-cognitive-progression-in-parkinsons-disease-using-three-cognitive-screening-measures/