Objective: Investigate changes in timed up and go (TUG), grip strength, MoCA and MMSE scores and explore which areas of cognition are most commonly affected.

Background: Parkinson’s disease (PD) patients face both motor and non-motor symptoms, with non-motor shown to have a greater impact on quality of life[1]. Studies suggest that the Montreal Cognitive Assessment (MoCA) is more sensitive than the Mini Mental State Exam (MMSE) for detecting cognitive decline in PD[2]. There is less evidence for which areas of cognition are most often affected. Grip strength has been shown to be a better predictor of decline in function compared to gait and balance[3].

Method: The Northumbria Care Needs Project is a longitudinal study investigating the care requirements of Hoehn and Yahr score III-V PD patients. Only patients with complete baseline and follow-up data were included.  We assessed changes in TUG, grip strength, MoCA and MMSE scores, and explored which areas of cognition were most commonly affected. This was over a two-year follow up period, between November 2016 and January 2018. TUG was defined as normal (≤10 seconds), good (≤20 seconds) or problematic (>20 seconds). Decline in grip strength was compared against patient’s MDS-UPDRS scores for hand movements.

Results: Of the 162 patients enrolled 99 completed two-year follow up. There were 64 patients completing cognitive assessment. The mean percentage decrease in total scores was 10% in the MMSE and 39% in the MoCA. Using the MoCA, 50% of patients showed decreased scores in the visuospatial/executive and delayed recall sections, whilst only 9% showed decreasing scores in the naming section. Grip strength was assessed in 55 patients, with an overall mean decline in grip strength. However, very few showed a decline in hand movement (question 3.5 on the MDS-UPDRS rating scale) (11% right hand, 7% left hand), with the majority improving (47% right hand, 65% left hand).  For the 99 patients in whom TUG was assessed, 33% decreased, 15% improved and 52% showed no change (57% of this group were rated as being “problematic” at baseline).

Conclusion: Cognitive decline is more apparent on testing with the MoCA than the MMSE. Visuospatial/executive function and delayed recall are most, and naming difficulty least, commonly affected.  There was no link between decline in grip strength and assessment of hand movements by MDS-UPDRS scale.

References: 1. Martinez-Martin P, Rodriguez-Blazquez C, Kurtis MM, Chaudhuri KR. The impact of non-motor symptoms on health-related quality of life of patients with Parkinson’s disease. Movement Disorders. 2011;26(3):399–406. 2. Nazem S, Siderowf AD, et al. Montreal Cognitive Assessment Performance in Patients with Parkinsons Disease with ”Normal” Global Cognition According to Mini-Mental State Examination Score. Journal of the American Geriatrics Society. 2009; 57(2):304–8. 3. Jones GR, Roland KP, Neubauer NA, Jakobi JM. Handgrip Strength related to Long-Term Electromyography: Application for Assessing Functional Decline in Parkinson’s Disease. Archives of Physical Medicine and Rehabilitation 2017;98(2):347-352

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MDS Abstracts - https://www.mdsabstracts.org/abstract/investigating-physical-and-cognitive-changes-over-two-years-in-patients-with-moderate-to-late-stage-parkinsons-disease-in-northumbria/