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Investigating Physical and Cognitive Changes over Two Years in Patients with Moderate to Late Stage Parkinson’s Disease in Northumbria

L. Macdonald, I. Sayers, S. Dempsey, W. Gray, A. Hand, R. Walker (North Shields, United Kingdom)

Meeting: 2019 International Congress

Abstract Number: 964

Keywords: Cognitive dysfunction, Timed Up and Go test

Session Information

Date: Tuesday, September 24, 2019

Session Title: Parkinsonisms and Parkinson-Plus

Session Time: 1:45pm-3:15pm

Location: Agora 3 West, Level 3

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

To cite this abstract in AMA style:

L. Macdonald, I. Sayers, S. Dempsey, W. Gray, A. Hand, R. Walker. Investigating Physical and Cognitive Changes over Two Years in Patients with Moderate to Late Stage Parkinson’s Disease in Northumbria [abstract]. Mov Disord. 2019; 34 (suppl 2). https://www.mdsabstracts.org/abstract/investigating-physical-and-cognitive-changes-over-two-years-in-patients-with-moderate-to-late-stage-parkinsons-disease-in-northumbria/. Accessed July 9, 2025.
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