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August 20, 2019; 93 (8) Article

Mild behavioral impairment is linked to worse cognition and brain atrophy in Parkinson disease

Eun Jin Yoon, View ORCID ProfileZahinoor Ismail, Alexandru Hanganu, Mekale Kibreab, Tracy Hammer, Jenelle Cheetham, Iris Kathol, Justyna R. Sarna, Davide Martino, Sarah Furtado, Oury Monchi
First published July 18, 2019, DOI: https://doi.org/10.1212/WNL.0000000000007968
Eun Jin Yoon
From the Department of Clinical Neurosciences (E.J.Y., Z.I., A.H., M.K., T.H., J.C., I.K., J.R.S., D.M., S.F., O.M.) and Departments of Psychiatry and Community Health Sciences (Z.I.), University of Calgary; Hotchkiss Brain Institute (E.J.Y., Z.I., A.H., M.K., T.H., J.C., I.K., J.R.S., D.M., S.F., O.M.), Cumming School of Medicine, Calgary, Alberta; Centre de Recherche (A.H., O.M.), Institut Universitaire de Gériatrie de Montréal; and Department of Psychology (A.H.), University of Montréal, Québec, Canada.
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Zahinoor Ismail
From the Department of Clinical Neurosciences (E.J.Y., Z.I., A.H., M.K., T.H., J.C., I.K., J.R.S., D.M., S.F., O.M.) and Departments of Psychiatry and Community Health Sciences (Z.I.), University of Calgary; Hotchkiss Brain Institute (E.J.Y., Z.I., A.H., M.K., T.H., J.C., I.K., J.R.S., D.M., S.F., O.M.), Cumming School of Medicine, Calgary, Alberta; Centre de Recherche (A.H., O.M.), Institut Universitaire de Gériatrie de Montréal; and Department of Psychology (A.H.), University of Montréal, Québec, Canada.
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  • ORCID record for Zahinoor Ismail
Alexandru Hanganu
From the Department of Clinical Neurosciences (E.J.Y., Z.I., A.H., M.K., T.H., J.C., I.K., J.R.S., D.M., S.F., O.M.) and Departments of Psychiatry and Community Health Sciences (Z.I.), University of Calgary; Hotchkiss Brain Institute (E.J.Y., Z.I., A.H., M.K., T.H., J.C., I.K., J.R.S., D.M., S.F., O.M.), Cumming School of Medicine, Calgary, Alberta; Centre de Recherche (A.H., O.M.), Institut Universitaire de Gériatrie de Montréal; and Department of Psychology (A.H.), University of Montréal, Québec, Canada.
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Mekale Kibreab
From the Department of Clinical Neurosciences (E.J.Y., Z.I., A.H., M.K., T.H., J.C., I.K., J.R.S., D.M., S.F., O.M.) and Departments of Psychiatry and Community Health Sciences (Z.I.), University of Calgary; Hotchkiss Brain Institute (E.J.Y., Z.I., A.H., M.K., T.H., J.C., I.K., J.R.S., D.M., S.F., O.M.), Cumming School of Medicine, Calgary, Alberta; Centre de Recherche (A.H., O.M.), Institut Universitaire de Gériatrie de Montréal; and Department of Psychology (A.H.), University of Montréal, Québec, Canada.
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Tracy Hammer
From the Department of Clinical Neurosciences (E.J.Y., Z.I., A.H., M.K., T.H., J.C., I.K., J.R.S., D.M., S.F., O.M.) and Departments of Psychiatry and Community Health Sciences (Z.I.), University of Calgary; Hotchkiss Brain Institute (E.J.Y., Z.I., A.H., M.K., T.H., J.C., I.K., J.R.S., D.M., S.F., O.M.), Cumming School of Medicine, Calgary, Alberta; Centre de Recherche (A.H., O.M.), Institut Universitaire de Gériatrie de Montréal; and Department of Psychology (A.H.), University of Montréal, Québec, Canada.
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Jenelle Cheetham
From the Department of Clinical Neurosciences (E.J.Y., Z.I., A.H., M.K., T.H., J.C., I.K., J.R.S., D.M., S.F., O.M.) and Departments of Psychiatry and Community Health Sciences (Z.I.), University of Calgary; Hotchkiss Brain Institute (E.J.Y., Z.I., A.H., M.K., T.H., J.C., I.K., J.R.S., D.M., S.F., O.M.), Cumming School of Medicine, Calgary, Alberta; Centre de Recherche (A.H., O.M.), Institut Universitaire de Gériatrie de Montréal; and Department of Psychology (A.H.), University of Montréal, Québec, Canada.
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Iris Kathol
From the Department of Clinical Neurosciences (E.J.Y., Z.I., A.H., M.K., T.H., J.C., I.K., J.R.S., D.M., S.F., O.M.) and Departments of Psychiatry and Community Health Sciences (Z.I.), University of Calgary; Hotchkiss Brain Institute (E.J.Y., Z.I., A.H., M.K., T.H., J.C., I.K., J.R.S., D.M., S.F., O.M.), Cumming School of Medicine, Calgary, Alberta; Centre de Recherche (A.H., O.M.), Institut Universitaire de Gériatrie de Montréal; and Department of Psychology (A.H.), University of Montréal, Québec, Canada.
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Justyna R. Sarna
From the Department of Clinical Neurosciences (E.J.Y., Z.I., A.H., M.K., T.H., J.C., I.K., J.R.S., D.M., S.F., O.M.) and Departments of Psychiatry and Community Health Sciences (Z.I.), University of Calgary; Hotchkiss Brain Institute (E.J.Y., Z.I., A.H., M.K., T.H., J.C., I.K., J.R.S., D.M., S.F., O.M.), Cumming School of Medicine, Calgary, Alberta; Centre de Recherche (A.H., O.M.), Institut Universitaire de Gériatrie de Montréal; and Department of Psychology (A.H.), University of Montréal, Québec, Canada.
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Davide Martino
From the Department of Clinical Neurosciences (E.J.Y., Z.I., A.H., M.K., T.H., J.C., I.K., J.R.S., D.M., S.F., O.M.) and Departments of Psychiatry and Community Health Sciences (Z.I.), University of Calgary; Hotchkiss Brain Institute (E.J.Y., Z.I., A.H., M.K., T.H., J.C., I.K., J.R.S., D.M., S.F., O.M.), Cumming School of Medicine, Calgary, Alberta; Centre de Recherche (A.H., O.M.), Institut Universitaire de Gériatrie de Montréal; and Department of Psychology (A.H.), University of Montréal, Québec, Canada.
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Sarah Furtado
From the Department of Clinical Neurosciences (E.J.Y., Z.I., A.H., M.K., T.H., J.C., I.K., J.R.S., D.M., S.F., O.M.) and Departments of Psychiatry and Community Health Sciences (Z.I.), University of Calgary; Hotchkiss Brain Institute (E.J.Y., Z.I., A.H., M.K., T.H., J.C., I.K., J.R.S., D.M., S.F., O.M.), Cumming School of Medicine, Calgary, Alberta; Centre de Recherche (A.H., O.M.), Institut Universitaire de Gériatrie de Montréal; and Department of Psychology (A.H.), University of Montréal, Québec, Canada.
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Oury Monchi
From the Department of Clinical Neurosciences (E.J.Y., Z.I., A.H., M.K., T.H., J.C., I.K., J.R.S., D.M., S.F., O.M.) and Departments of Psychiatry and Community Health Sciences (Z.I.), University of Calgary; Hotchkiss Brain Institute (E.J.Y., Z.I., A.H., M.K., T.H., J.C., I.K., J.R.S., D.M., S.F., O.M.), Cumming School of Medicine, Calgary, Alberta; Centre de Recherche (A.H., O.M.), Institut Universitaire de Gériatrie de Montréal; and Department of Psychology (A.H.), University of Montréal, Québec, Canada.
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Citation
Mild behavioral impairment is linked to worse cognition and brain atrophy in Parkinson disease
Eun Jin Yoon, Zahinoor Ismail, Alexandru Hanganu, Mekale Kibreab, Tracy Hammer, Jenelle Cheetham, Iris Kathol, Justyna R. Sarna, Davide Martino, Sarah Furtado, Oury Monchi
Neurology Aug 2019, 93 (8) e766-e777; DOI: 10.1212/WNL.0000000000007968

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Abstract

Objective To evaluate the associations of mild behavioral impairment (MBI) with cognitive deficits and patterns of gray matter changes in Parkinson disease (PD).

Methods Sixty patients with PD without dementia and 29 healthy controls underwent a cognitive neuropsychological evaluation and structural MRI scan. MBI was evaluated with the MBI Checklist (MBI-C), a rating scale designed to elicit emergent neuropsychiatric symptoms in accordance with MBI criteria. We divided the patients with PD into 2 groups: 1 group with high MBI-C scores (PD-MBI) and the other with low MBI-C scores (PD-noMBI).

Results Among 60 patients with PD, 20 were categorized as having PD-MBI (33.33%). In healthy controls, no participants met the MBI cut-point threshold. The PD-MBI group had significantly lower Montreal Cognitive Assessment and z scores in all 5 domains and the global score compared to healthy controls and those with PD-noMBI. In addition, all cognitive domains except language and global cognition negatively correlated with the MBI-C total score in all patients with PD. For cortical structures, the PD-MBI group revealed middle temporal cortex thinning and decreased volume compared with the PD-noMBI group, and decreased volume in this area negatively correlated with the MBI-C total score.

Conclusions The impaired cognitive function over all domains and atrophy in the temporal area in the PD-MBI group are in line with posterior cortical circuit deficits in PD, which have been associated with a faster rate of progression to dementia. These initial results suggest that MBI might be an early and important marker for incident cognitive decline and dementia in patients with PD.

Glossary

MBI=
mild behavioral impairment;
MBI-C=
MBI Checklist;
MCI=
mild cognitive impairment;
MoCA=
Montreal Cognitive Assessment;
NPS=
neuropsychiatric symptoms;
PD=
Parkinson disease;
UPDRS-III=
motor section of the Unified Parkinson’s Disease Rating Scale

Footnotes

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

  • Received November 29, 2018.
  • Accepted in final form March 27, 2019.
  • © 2019 American Academy of Neurology
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