Objective: To compare the change in cognitive performance in Parkinson disease (PD) patients over time based on excessive daytime sleepiness (EDS), and to determine if EDS is a useful predictor of future deficiencies in specific cognitive domains.

Background: There have been numerous studies evaluating predictive factors for dementia in PD, though few have analyzed longitudinal data for specific neuropsychological assessments (Jester et al., 2020).

Method: Over four years, 116 PD patients were evaluated with yearly motor assessments, neuropsychological testing, and psychiatric assessments. Patients with dementia were excluded. Patients were dichotomized on the basis of Epworth Sleepiness Scale (ESS) scores, and were characterized as having EDS if ESS was ≥10.1 A piece-wise random coefficient regression (PRCR) ANOVA was completed with regard to EDS status and time for each neuropsychological test. This process was repeated with confounders. Finally, a multivariate regression model was performed using EDS status and the same confounders with regard to the both cognitive test score and its yearly change.

Results: There was a significant decline in MoCA scores in years 2-3 in EDS subjects compared to normal while controlling for confounding factors (p=0.036), though globally there was no significant difference in models (p=0.131). The regression analysis did not show a significant correlation between EDS subjects and MoCA scores.

There was a significant association of Trails B score with EDS status, when adjusted for confounders (p=0.003). EDS was also significantly associated with HVLT delayed recall when adjusted for confounders (p=0.008), and the adjusted model for HVLT delayed recall with respect to EDS status was also significantly different than normal (p=0.021).Similarly, the multivariate regression analysis demonstrated EDS status as a significant predictor of HVLT delayed recall score when controlling for confounders (p=0.029), and was also significant with regard to yearly change in HVLT delayed recall score (p=0.028).

Conclusion: Cognitive change in PD is complex, and requires detailed analysis with regard to specific neuropsychological tests and their respective cognitive domains. EDS demonstrates a clear association with cognitive decline in certain domains, and may be clinically useful to predict future cognitive changes.

References: Dylan J. Jester, Soomi Lee, Victor Molinari & Ladislav Volicer (2020) Cognitive deficits in Parkinson’s disease with excessive daytime sleepiness: a systematic review, Aging & Mental Health, 24:11, 1769-1780, DOI: 10.1080/13607863.2019.1660852

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MDS Abstracts - https://www.mdsabstracts.org/abstract/excessive-daytime-sleepiness-as-a-predictor-of-cognitive-decline-in-parkinson-disease/