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October 13, 2015; 85 (15) Article

Longitudinal study of normal cognition in Parkinson disease

Kara Pigott, Jacqueline Rick, Sharon X. Xie, Howard Hurtig, Alice Chen-Plotkin, John E. Duda, James F. Morley, Lama M. Chahine, Nabila Dahodwala, Rizwan S. Akhtar, Andrew Siderowf, John Q. Trojanowski, Daniel Weintraub
First published September 11, 2015, DOI: https://doi.org/10.1212/WNL.0000000000002001
Kara Pigott
From the Departments of Neurology (K.P., J.R., H.H., A.C.-P., J.E.D., J.F.M., L.M.C., N.D., R.S.A., D.W.), Pathology and Laboratory Medicine (J.Q.T.), and Psychiatry (D.W.), Perelman School of Medicine at the University of Pennsylvania; the Department of Biostatistics and Epidemiology (S.X.X.), University of Pennsylvania; Philadelphia Veterans Affairs Medical Center (J.E.D., J.F.M., D.W.); and Avid Radiopharmaceuticals (A.S.), Philadelphia, PA.
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Jacqueline Rick
From the Departments of Neurology (K.P., J.R., H.H., A.C.-P., J.E.D., J.F.M., L.M.C., N.D., R.S.A., D.W.), Pathology and Laboratory Medicine (J.Q.T.), and Psychiatry (D.W.), Perelman School of Medicine at the University of Pennsylvania; the Department of Biostatistics and Epidemiology (S.X.X.), University of Pennsylvania; Philadelphia Veterans Affairs Medical Center (J.E.D., J.F.M., D.W.); and Avid Radiopharmaceuticals (A.S.), Philadelphia, PA.
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Sharon X. Xie
From the Departments of Neurology (K.P., J.R., H.H., A.C.-P., J.E.D., J.F.M., L.M.C., N.D., R.S.A., D.W.), Pathology and Laboratory Medicine (J.Q.T.), and Psychiatry (D.W.), Perelman School of Medicine at the University of Pennsylvania; the Department of Biostatistics and Epidemiology (S.X.X.), University of Pennsylvania; Philadelphia Veterans Affairs Medical Center (J.E.D., J.F.M., D.W.); and Avid Radiopharmaceuticals (A.S.), Philadelphia, PA.
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Howard Hurtig
From the Departments of Neurology (K.P., J.R., H.H., A.C.-P., J.E.D., J.F.M., L.M.C., N.D., R.S.A., D.W.), Pathology and Laboratory Medicine (J.Q.T.), and Psychiatry (D.W.), Perelman School of Medicine at the University of Pennsylvania; the Department of Biostatistics and Epidemiology (S.X.X.), University of Pennsylvania; Philadelphia Veterans Affairs Medical Center (J.E.D., J.F.M., D.W.); and Avid Radiopharmaceuticals (A.S.), Philadelphia, PA.
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Alice Chen-Plotkin
From the Departments of Neurology (K.P., J.R., H.H., A.C.-P., J.E.D., J.F.M., L.M.C., N.D., R.S.A., D.W.), Pathology and Laboratory Medicine (J.Q.T.), and Psychiatry (D.W.), Perelman School of Medicine at the University of Pennsylvania; the Department of Biostatistics and Epidemiology (S.X.X.), University of Pennsylvania; Philadelphia Veterans Affairs Medical Center (J.E.D., J.F.M., D.W.); and Avid Radiopharmaceuticals (A.S.), Philadelphia, PA.
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John E. Duda
From the Departments of Neurology (K.P., J.R., H.H., A.C.-P., J.E.D., J.F.M., L.M.C., N.D., R.S.A., D.W.), Pathology and Laboratory Medicine (J.Q.T.), and Psychiatry (D.W.), Perelman School of Medicine at the University of Pennsylvania; the Department of Biostatistics and Epidemiology (S.X.X.), University of Pennsylvania; Philadelphia Veterans Affairs Medical Center (J.E.D., J.F.M., D.W.); and Avid Radiopharmaceuticals (A.S.), Philadelphia, PA.
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James F. Morley
From the Departments of Neurology (K.P., J.R., H.H., A.C.-P., J.E.D., J.F.M., L.M.C., N.D., R.S.A., D.W.), Pathology and Laboratory Medicine (J.Q.T.), and Psychiatry (D.W.), Perelman School of Medicine at the University of Pennsylvania; the Department of Biostatistics and Epidemiology (S.X.X.), University of Pennsylvania; Philadelphia Veterans Affairs Medical Center (J.E.D., J.F.M., D.W.); and Avid Radiopharmaceuticals (A.S.), Philadelphia, PA.
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Lama M. Chahine
From the Departments of Neurology (K.P., J.R., H.H., A.C.-P., J.E.D., J.F.M., L.M.C., N.D., R.S.A., D.W.), Pathology and Laboratory Medicine (J.Q.T.), and Psychiatry (D.W.), Perelman School of Medicine at the University of Pennsylvania; the Department of Biostatistics and Epidemiology (S.X.X.), University of Pennsylvania; Philadelphia Veterans Affairs Medical Center (J.E.D., J.F.M., D.W.); and Avid Radiopharmaceuticals (A.S.), Philadelphia, PA.
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Nabila Dahodwala
From the Departments of Neurology (K.P., J.R., H.H., A.C.-P., J.E.D., J.F.M., L.M.C., N.D., R.S.A., D.W.), Pathology and Laboratory Medicine (J.Q.T.), and Psychiatry (D.W.), Perelman School of Medicine at the University of Pennsylvania; the Department of Biostatistics and Epidemiology (S.X.X.), University of Pennsylvania; Philadelphia Veterans Affairs Medical Center (J.E.D., J.F.M., D.W.); and Avid Radiopharmaceuticals (A.S.), Philadelphia, PA.
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Rizwan S. Akhtar
From the Departments of Neurology (K.P., J.R., H.H., A.C.-P., J.E.D., J.F.M., L.M.C., N.D., R.S.A., D.W.), Pathology and Laboratory Medicine (J.Q.T.), and Psychiatry (D.W.), Perelman School of Medicine at the University of Pennsylvania; the Department of Biostatistics and Epidemiology (S.X.X.), University of Pennsylvania; Philadelphia Veterans Affairs Medical Center (J.E.D., J.F.M., D.W.); and Avid Radiopharmaceuticals (A.S.), Philadelphia, PA.
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Andrew Siderowf
From the Departments of Neurology (K.P., J.R., H.H., A.C.-P., J.E.D., J.F.M., L.M.C., N.D., R.S.A., D.W.), Pathology and Laboratory Medicine (J.Q.T.), and Psychiatry (D.W.), Perelman School of Medicine at the University of Pennsylvania; the Department of Biostatistics and Epidemiology (S.X.X.), University of Pennsylvania; Philadelphia Veterans Affairs Medical Center (J.E.D., J.F.M., D.W.); and Avid Radiopharmaceuticals (A.S.), Philadelphia, PA.
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John Q. Trojanowski
From the Departments of Neurology (K.P., J.R., H.H., A.C.-P., J.E.D., J.F.M., L.M.C., N.D., R.S.A., D.W.), Pathology and Laboratory Medicine (J.Q.T.), and Psychiatry (D.W.), Perelman School of Medicine at the University of Pennsylvania; the Department of Biostatistics and Epidemiology (S.X.X.), University of Pennsylvania; Philadelphia Veterans Affairs Medical Center (J.E.D., J.F.M., D.W.); and Avid Radiopharmaceuticals (A.S.), Philadelphia, PA.
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Daniel Weintraub
From the Departments of Neurology (K.P., J.R., H.H., A.C.-P., J.E.D., J.F.M., L.M.C., N.D., R.S.A., D.W.), Pathology and Laboratory Medicine (J.Q.T.), and Psychiatry (D.W.), Perelman School of Medicine at the University of Pennsylvania; the Department of Biostatistics and Epidemiology (S.X.X.), University of Pennsylvania; Philadelphia Veterans Affairs Medical Center (J.E.D., J.F.M., D.W.); and Avid Radiopharmaceuticals (A.S.), Philadelphia, PA.
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Citation
Longitudinal study of normal cognition in Parkinson disease
Kara Pigott, Jacqueline Rick, Sharon X. Xie, Howard Hurtig, Alice Chen-Plotkin, John E. Duda, James F. Morley, Lama M. Chahine, Nabila Dahodwala, Rizwan S. Akhtar, Andrew Siderowf, John Q. Trojanowski, Daniel Weintraub
Neurology Oct 2015, 85 (15) 1276-1282; DOI: 10.1212/WNL.0000000000002001

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Abstract

Objective: To report the rates and predictors of progression from normal cognition to either mild cognitive impairment (MCI) or dementia using standardized neuropsychological methods.

Methods: A prospective cohort of patients diagnosed with Parkinson disease (PD) and baseline normal cognition was assessed for cognitive decline, performance, and function for a minimum of 2 years, and up to 6. A panel of movement disorders experts classified patients as having normal cognition, MCI, or dementia, with 55/68 (80.9%) of eligible patients seen at year 6. Kaplan-Meier curves and Cox proportional hazard models were used to examine cognitive decline and its predictors.

Results: We enrolled 141 patients, who averaged 68.8 years of age, 63% men, who had PD on average for 5 years. The cumulative incidence of cognitive impairment was 8.5% at year 1, increasing to 47.4% by year 6. All incident MCI cases had progressed to dementia by year 5. In a multivariate analysis, predictors of future decline were male sex (p = 0.02), higher Unified Parkinson's Disease Rating Scale motor score (p ≤ 0.001), and worse global cognitive score (p < 0.001).

Conclusions: Approximately half of patients with PD with normal cognition at baseline develop cognitive impairment within 6 years and all new MCI cases progress to dementia within 5 years. Our results show that the transition from normal cognition to cognitive impairment, including dementia, occurs frequently and quickly. Certain clinical and cognitive variables may be useful in predicting progression to cognitive impairment in PD.

GLOSSARY

BNT=
Boston Naming Test;
DRS-2=
Dementia Rating Scale–2;
HVLT-R=
Hopkins Verbal Learning Test–Revised;
MCI=
mild cognitive impairment;
NC=
normal cognition;
PD=
Parkinson disease;
PDD=
Parkinson disease dementia;
UPDRS=
Unified Parkinson's Disease Rating Scale

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Supplemental data at Neurology.org

  • Editorial, page 1268

  • Received January 14, 2015.
  • Accepted in final form May 7, 2015.
  • © 2015 American Academy of Neurology
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