Objective: To determine cognitive profiles in a Parkinson‘s Disease-Mild Cognitive Impairment (PD-MCI) cohort, and study the relationship between baseline cognitive phenotype and subsequent cognitive decline.

Background: The range of cognitive deficits in PD-MCI is variable; identification of patterns of these deficits in PD-MCI may aid to predict subsequent decline and guide therapeutic interventions to improve the natural pathologic course.

Method: 139 persons with PD-MCI,(diagnosis:MDS Task Force Level 2 criteria) were recruited from 6 movement disorders clinics and followed up annually for 5 years. A comprehensive cognitive test battery of10 tests was administered at all visits. Cognitive profiles were determined at baseline by cluster analyses. We calculated a global cognitive zscore at all visits by averaging zscores for all tests, and a Reliable Cognitive Change (RCC) related to the baseline per test (0=Change absent,1=present) at each follow-up visit. RCC was calculated using the reliable change index method, which takes into account measurement error, practice effects and regression to the mean and determines whether an observed change falls outside the 95% CI for change based on normative samples. Cognitive decline was determined by 1.change in global cognitive zscore (linear mixed-effects models), and 2. time to first RCC in any cognitive test (Survival analysis). All analyses were adjusted for age, sex and education.

Results: Mean age of the sample was 70.2±6.2 years, mean education was 15.7±2.8 years, and 34% were women. We identified 4 clusters of cognitive profiles at baseline, characterized by 1.executive(n=44), 2.visuospatial(n=26), 3.executive & visuospatial(n=50), and 4.global cognitive impairment(n=19). Compared to cluster 1, those in cluster 3 (β=-0.63, 95%CI: -0.84,-0.41,p-value <0.0010) and 4 (β=-1.74, 95%CI: -2.03,-1.45, p-value <0.001) showed a significant decline in global cognitive z-scores. Of the 117 individuals included in the survival analysis, 63 developed an RCC over 1074.7 personyears. Persons in cluster 3 (hazard ratio=1.82, 95%CI: 0.99, 3.35), p-value 0.052; mean time to event=2.3 yrs) and 4 (hazard ratio=2.42, 95%CI: 0.99, 5.92, p-value 0.052; mean time to event=1.7 yrs) showed a trend of having a higher risk of developing an RC compared to cluster 1(mean time to event=2.8 yrs).

Conclusion: Identification of cognitive profiles in PD-MCI patients may help predict their cognitive trajectory overtime.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/cognitive-profiles-at-presentation-and-subsequent-cognitive-decline-in-pd-mci/