Mild cognitive impairment in Parkinson disease

TLDR

Studies of mild cognitive impairment in Parkinson disease report variable prevalences and profiles, likely due to methodological differences. The study aimed to determine the frequency and profile of MCI in a large multicenter cohort of Parkinson disease patients using a standardized analytic method and common definition. The authors performed standardized assessments of verbal memory, visuospatial, and attentional/executive functions, classifying MCI when a domain z‑score was ≥1.5 SD below controls or normative data. Among 1,346 Parkinson disease patients, 25.8 % met MCI criteria, most commonly involving memory (13.3 %), visuospatial (11.0 %), and attention/executive (10.1 %) domains, with profiles ranging from nonamnestic single‑domain (11.3 %) to amnestic multiple‑domain (4.8 %) MCI, and MCI was linked to older age, male gender, depression, more severe motor symptoms, and advanced disease stage.

Abstract

In studies of mild cognitive impairment (MCI) in Parkinson disease (PD), patients without dementia have reported variable prevalences and profiles of MCI, likely to be due to methodologic differences between the studies.The objective of this study was to determine frequency and the profile of MCI in a large, multicenter cohort of well-defined patients with PD using a standardized analytic method and a common definition of MCI.A total of 1,346 patients with PD from 8 different cohorts were included. Standardized analysis of verbal memory, visuospatial, and attentional/executive abilities was performed. Subjects were classified as having MCI if their age- and education-corrected z score on one or more cognitive domains was at least 1.5 standard deviations below the mean of either control subjects or normative data.A total of 25.8% of subjects (95% confidence interval [CI] 23.5-28.2) were classified as having MCI. Memory impairment was most common (13.3%; 11.6-15.3), followed by visuospatial (11.0%; 9.4-13.0) and attention/executive ability impairment (10.1%; 8.6-11.9). Regarding cognitive profiles, 11.3% (9.7-13.1) were classified as nonamnestic single-domain MCI, 8.9% (7.0-9.9) as amnestic single-domain, 4.8% (3.8-6.1) as amnestic multiple-domain, and 1.3% (0.9-2.1) as nonamnestic multiple-domain MCI. Having MCI was associated with older age at assessment and at disease onset, male gender, depression, more severe motor symptoms, and advanced disease stage.MCI is common in patients with PD without dementia, affecting a range of cognitive domains, including memory, visual-spatial, and attention/executive abilities. Future studies of patients with PD with MCI need to determine risk factors for ongoing cognitive decline and assess interventions at a predementia stage.