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Abstract
Objectives To investigate which baseline neuropsychological profile predicts the risk of developing dementia in early-stage Parkinson disease (PD).
Methods We retrospectively reviewed detailed medical records of 350 drug-naive patients with early-stage PD (follow-up >3 years) who underwent a detailed neuropsychological test at initial assessment. Factor analysis was conducted to determine cognitive profiles that yielded 4 cognitive function factors: factor 1, visual memory/visuospatial; factor 2, verbal memory; factor 3, frontal/executive; and factor 4, attention/working memory/language. Subsequently, we assessed the effect of these cognitive function factors on the risk for dementia conversion. We also constructed a nomogram to calculate the risk for developing dementia over a 5-year follow-up period based on these cognitive profiles.
Results Cox regression analysis demonstrated that a higher composite score of factor 1 (hazard ratio [HR] 0.558, 95% confidence interval [CI] 0.427–0.730), factor 2 (HR 0.768, 95% CI 0.596–0.991), and factor 3 (HR 0.425, 95% CI 0.305–0.593) was associated with a lower risk for dementia conversion, while factor 3 had the most predictive power. The nomogram had a fair ability (Heagerty integrated area under the curve 0.763) to estimate the risk for dementia conversion within 5 years. The composite scores of factor 3 contributed more to the occurrence of dementia in PD than those of the other cognitive function factors.
Conclusions These findings suggest that these factor analysis–derived cognitive profiles can be used to predict dementia conversion in early-stage PD. In addition, frontal/executive dysfunction contributes most to the occurrence of dementia in PD.
Glossary
- ADL=
- activities of daily living;
- AIC=
- Akaike information criterion;
- CamPaIGN=
- Cambridgeshire Parkinson's Incidence from General Practitioner to Neurologist;
- CI=
- confidence interval;
- COWAT=
- Controlled Oral Word Association Test;
- HR=
- hazard ratio;
- iAUC=
- integrated area under the curve;
- MCI=
- mild cognitive impairment;
- PD=
- Parkinson disease;
- PDD=
- PD with dementia;
- RCFT=
- Rey Complex Figure Test;
- SNSB=
- Seoul Neuropsychological Screening Battery;
- WMH=
- white matter hyperintensities
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 December 14, 2019.
- Accepted in final form March 30, 2020.
- © 2020 American Academy of Neurology
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