Objective: To assess differences in cognitive reserve (CR) between motor subtypes of patients with Parkinson’s disease (PD).

Background: Motor subtypes in patients with PD have been suggested to have prognostic value. Patients with the postural instability/gait disorder (PIGD) subtype may present with faster progression and worse prognosis, in both motor and non-motor aspects, particularly cognitive impairment (CI).[1] Cognitive reserve has been suggested as a potential protective factor for cognitive impairment in PD,[2] but its relationship to motor subtypes remains understudied.

Method: Cross-sectional study. Consecutive patients with clinical diagnosis of PD were recruited from the outpatient Movement Disorders Clinic at our Hospital. Patients underwent clinical evaluation using MDS-UPDRS parts I, II, and III; with motor subtypes classified as PIGD and non-PIGD (including tremor dominant, TD; and indeterminate, IND) as described by Stebbins et al. Cognitive status was evaluated using Montreal Cognitive Assessment (MoCA), whereas cognitive reserve was evaluated through the Cognitive Reserve Index questionnaire (CRIq), and classified according to the total score in Low (<70), Medium (70-84), Medium (85-114), Medium-High (115-130), and High (>130). Demographic characteristics and CRIq scores between motor subtypes were compared using one-way ANOVA.

Results: We included 103 patients, whose baseline characteristics are presented in Table 1. Patients with PIGD subtype had significantly longer disease duration and lower MDS-UPDRS III scores; there were no significant differences in CRIq score and Cognitive Reserve (Table 2) Overall, CRIq score was associated with years of education (r=0.70, p<0.01) and MoCA score (r=0.30, p<0.01). In patients with PIGD subtype, CRIq score was correlated with years of education (r=0.71, p<0.01) and MDS-UPDRS Part I (r=-0.41, p<0.01), but not with MoCA score (r=0.25, p=0.11).

Conclusion: We found no differences in cognitive reserve scores between subtypes of Parkinson’s disease. However, in patients with PIGD, there was an inverse correlation with non-motor aspects of daily living. Further studies with prospective evaluation of CR, stratifying patients according to disease duration are necessary to elucidate the relationship between motor subtype and CR.

References: 1. Wojtala J, Heber IA, Neuser P, et al. Declive cognitivo en la enfermedad de Parkinson: el impacto del fenotipo motor en la cognición. J Neurol Neurosurg Psychiatry 2019;90(2):171-179.
2.Gu L, Xu H. Efecto de la reserva cognitiva en la función cognitiva en la enfermedad de Parkinson. Neurol Sci 2022;43(7):4185-4192.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/cognitive-reserve-and-motor-subtypes-of-parkinsons-disease/