Objective: The aim of this study is to evaluate the prevalence of CI in a diverse group of PwP from East London, UK and Dhaka, Bangladesh. This study also aims to compare the cultural fairness of standard cognitive instruments with newer alternatives in screening for CI in PwP of different ethnicities.

Background: Cognitive impairment (CI) in Parkinson’s disease (PD) is one of the commonest non-motor symptoms ranging from mild cognitive impairment (PD-MCI) to dementia (PDD). With an annual incidence rate of 10%, dementia is 4-6 times higher in people with Parkinson’s disease (PwP) than healthy controls (HC)

Method:

The London-Dhaka Parkinson’s Cognition Study (LDCS) is a case-control study. Patients with a diagnosis of PD and healthy controls (HC) are recruited from movement disorder clinics at Barts Health NHS Trust, UK and Bangabandhu Sheikh Mujib Medical University Dhaka, Bangladesh. Data collection includes clinical and demographic information, questionnaires (Hoehn & Yahr, CISI-PD, RBDSQ), CI assessment tools (MoCA, RUDAS, Clinical Dementia Rating-CDR, cats and dogs, noise pareidolia test), neuropsychiatric assessment scales (HADS) and biomarker samples (blood).

Results: In Dhaka since January 2023, 120 PwP and 60 HC have been recruited. The mean age (±SD) of PwP is 59.9 (±10.3) years and for controls is 51.3 (±10.2); (p<0.001). Among them 84 (70%) PwP and 33 (55%) HC were male (p=0.068). The Bengali version of the MoCA median (±IQR) scores (out of 30) for PwP was 15 (±9) and for HC was  24(±8.2) respectively with p value of <0.001. CDR median (±IQR)scores for PwP was 0.5 (±0.5) and for HC was 0 respectively with p value of <0.001. Based on MoCA, 66% of Bangladeshi PwP and 20% HC score in the dementia range (p<0.001) in Dhaka. However, based on the CDR, only 26.9% of Bangladeshi PwP and no HC were classified as dementia.

Conclusion:

This study shows that the MoCA, a commonly used screening test for cognitive impairment world-wide, even when administered in Bengali, may under-estimate cognitive performance in certain populations. Better tools for screening for cognitive impairment are needed in under-represented groups for better design of clinical trials for PD dementia.

References: Gonzalez-Latapi P, Bayram E, Litvan I, Marras C. Cognitive Impairment in Parkinson’s Disease: Epidemiology, Clinical Profile, Protective and Risk Factors. Behav Sci (Basel). 2021 May 13;11(5):74. doi: 10.3390/bs11050074. PMID: 34068064; PMCID: PMC8152515.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/assessment-of-cognitive-impairment-in-parkinsons-disease-in-under-represented-ethnic-groups-the-london-dhaka-parkinsons-cognitive-study/