Objective: To determine the association between baseline modifiable comorbidities, including cardiovascular disease risk factors, mood disorders, and sleep characteristics, and the rate of change in cognitive performance in Parkinson’s disease (PD).

Background: Cognitive impairment (CI) is one of the most feared and debilitating complications of PD, with as many as 80% of patients developing dementia by 20 years disease duration. There is currently no therapy to prevent CI in PD; however, identification of modifiable factors that affect the rate of progression could provide opportunities for early intervention.

Method: The Parkinson’s Progression Markers Initiative (PPMI) dataset was assessed for cardiovascular disease risk factors, mood disorders, and sleep characteristics. Cognitive performance was evaluated by the Montreal Cognitive Assessment (MoCA). Associations between baseline comorbidities and baseline MoCA were determined by multiple regressions. Linear mixed effects models were created to examine the association between baseline factors and change in MoCA score over time.

Results: There were no associations between baseline comorbidities and baseline cognition. Longitudinal models demonstrated an association between faster decline in MoCA and five baseline characteristics, including Body Mass Index (BMI) (β -0.009, p 0.039), as well as scales measuring anxiety (β -0.005, p <0.0001), depression (β-0.034, p <0.0001), sleepiness (β -0.017, p 0.003), and REM sleep behavior disorder (RBD)  (β -0.037, p <0.0001).  Upon testing for focal cognitive domains, RBD was associated with faster decline in the Hopkins Verbal Learning test (HVLT) (β-0.028, p <0.0001), the Symbol Digit Modalities Test (SDMT) (β-0.122, p <0.0001), and Letter Number Sequencing (β-0.015, p 0.009). Sleepiness was also associated with faster decline in the HVLT (β-0.013, p 0.008) and the SDMT (β-0.056, p 0.001). BMI and anxiety were both associated with faster decline in the SDMT (β-0.038, p 0.002) and (β-0.009, p 0.007), respectively.

Conclusion: The presence of medical comorbidities at baseline is associated with faster rate of CI over time in patients with PD. This association identifies potential opportunities for early intervention that could slow the rate of progression of cognitive decline in PD.

Preliminary data was presented as an abstract at the MDS International Congress September 2019

References: [1] Hely MA Reid WG, Adena MA, et al. The Sydney multicenter study of Parkinson’s disease: the inevitability of dementia at 20 years. Mov Disord. 2008. Apr 30;23(6):837-44.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/modifiable-comorbidities-associated-with-rate-of-cognitive-decline-in-parkinsons-disease/