Objective: To compare clinical and imaging features in de-novo Parkinson’s disease (PD) with stable, remitting, and non-remitting cognition over 5 years follow-up.

Background: Mild cognitive impairment is common even in early, de-novo PD (PD-MCI), and most patients develop dementia during disease courses; however, some PD-MCI patients remain stable or may even revert to normal cognition. Predictors for these different trajectories are unknown.

Method: A total of 397 sporadic de-novo PD patients were obtained from the Parkinson’s Progression Markers Initiative (www.ppmi-info.org/access-dataspecimens/download-data), of whom 240 patients completed every annual evaluation for five years. According to their MoCA scores, we classified patients into three groups: stable normal cognition (CN) (MoCA at every time-point≥26), remitting cognitive function (CR) (MoCA<26 at any visit but≥26 at year five), and non-remitting cognitive decline (CNR) (MoCA<26 at year five). We compared baseline clinical features and dopamine transporter striatal binding ratios (SBR).

Results: 104 (43%) of 240 patients had MoCA scores in the normal range at every evaluation, while 136 scored below 26. Of the latter 68 (28%) reverted from PD-MCI to cognitively normal, while 68 (28%) scored below 26 points at year five. Both CR and CNR groups scored higher on the MDS-UPDRS part III and had lower UPSIT scores than the CN group. The CNR group was older (p<0.001), scored higher on the RBD screening questionnaire than both groups (p<0.02), and higher on the SCOPA than CN (p=0.003). Furthermore, CNR had a lower SBR than CR (p<0.04). CR and CNR groups had higher rates of diffuse malignant subtype than CN (p<0.02). Logistic regression analysis revealed that the CR group had lower UPSIT (p=0.008, odds ratio 0.95) and higher MDS-UPDRS part III (p=0.024, odds ratio 1.05) than CN.

Conclusion: Baseline predictors of cognitive dysfunction during follow-up, including lower olfactory and higher motor burden, are consistent with previous studies and were also seen in CR. Non-remitting cognitive dysfunction was associated with RBD and autonomic dysfunction. SBR was lower in the CNR than the CR group. The diffuse malignant subtype was more common in both CR and CNR compared to the CN group.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-characteristics-in-de-novo-pd-patients-with-reversible-vs-progressive-cognitive-dysfunction-during-long-term-follow-up/