Beyond PD-MCI: objectively defined subtle cognitive decline predicts future cognitive and functional changes

Abstract

Objective

Cognitive impairment is prevalent among individuals with Parkinson’s disease (PD). Effort has been made to identify individuals at risk for cognitive decline and dementia. Objectively-defined subtle cognitive decline (Obj-SCD) is a novel classification that may identify individuals at risk for cognitive decline prior to a diagnosis of mild cognitive impairment (MCI). We examined the utility of Obj-SCD criteria to predict future cognitive decline and difficulties with activities of daily living (ADLs) among individuals with PD.

Method

The sample included 483 individuals newly diagnosed with PD. Participants were followed for a five-year span with yearly visits where they completed neuropsychological tests. Participants were categorized as cognitively normal (CN), the newly proposed Obj-SCD, PD-MCI or Parkinson’s disease dementia (PDD). Analyses determined if utilization of Obj-SCD criteria predicted subsequent cognitive impairment and difficulties with ADLs.

Results

At baseline, 372 (77%) participants were classified as CN, 40 (8.3%) classified as Obj-SCD, and 71 (14.7%) classified as PD-MCI. Analyses revealed that relative to the CN group, participants classified as Obj-SCD at baseline, were more likely to develop PD-MCI or PDD within 5 years (odds ratio 2.413; 95% confidence interval 1.215–4.792). Furthermore, the Obj-SCD represented an intermediate level of impairment, relative to the CN and PD-MCI groups, on an independent measure of cognition (Montreal Cognitive Assessment) and ADL.

Conclusions

Findings provide evidence that Obj-SCD criteria can identify individuals at risk for cognitive decline and impairments in ADL. Obj-SCD criteria may identify individuals at risk for cognitive impairment who are not detected by PD-MCI criteria.

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Acknowledgements

Joseph Bunch was supported by NIH T34GM083883. Kelsey Thomas was supported by the U.S. Department of Veterans Affairs Clinical Sciences Research and Development Service (Career Development Award-2 1IK2CX001865) and the Alzheimer’s Association (AARF-17-528918). Data used in the preparation of this article were obtained from the Parkinson’s Progression Markers Initiative (PPMI) database (http://www.ppmi-info.org/data). For up-to-date information on the study, visit http://www.ppmi-info.org. PPMI—a public–private partnership—is funded by the Michael J. Fox Foundation for Parkinson’s Research and funding partners, including AbbVie, Avid Radiopharmaceuticals, Biogen Idec, BioLegend, Bristol-Meyers Squibb, GE Healthcare, Genentech, GlaxoSmithKline, Eli Lilly and Company, Lundbeck, Merck, Meso Scale Discovery, Pfizer Inc., Piramal Imaging, Roche group, Sanofi-Genzyme, Servier, Takeda, TEVA, and UCB. We would like to thank the CSUSB Institute for Child Development and Family Relations, and the Faculty Center for Excellence for supporting the publication of this paper with funded writing time.

Funding

Joseph Bunch was supported by NIH T34GM083883. Kelsey Thomas was supported by the U.S. Department of Veterans Affairs Clinical Sciences Research and Development Service (Career Development Award-2 1IK2CX001865) and the Alzheimer’s Association (AARF-17-528918). Data used in the preparation of this article were obtained from the Parkinson’s Progression Markers Initiative (PPMI) database (http://www.ppmi-info.org/data). For up-to-date information on the study, visit http://www.ppmi-info.org. PPMI—a public–private partnership—is funded by the Michael J. Fox Foundation for Parkinson’s Research and funding partners, including AbbVie, Avid Radiopharmaceuticals, Biogen Idec, BioLegend, Bristol-Meyers Squibb, GE Healthcare, Genentech, GlaxoSmithKline, Eli Lilly and Company, Lundbeck, Merck, Meso Scale Discovery, Pfizer Inc., Piramal Imaging, Roche group, Sanofi-Genzyme, Servier, Takeda, TEVA, and UCB.

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JJ: Conceptualization, analysis, interpretation, drafting; CU: analysis, drafting; JB: analysis, drafting; KT: conceptualization, interpretation, revision.

Corresponding author

Correspondence to Jacob D. Jones.

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The authors declare that they have no competing interest.

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The study was approved by the institutional review board at each site.

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Participants provided informed consent prior to all study activities.

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https://www.ppmi-info.org/.

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Jones, J.D., Uribe, C., Bunch, J. et al. Beyond PD-MCI: objectively defined subtle cognitive decline predicts future cognitive and functional changes. J Neurol 268, 337–345 (2021). https://doi.org/10.1007/s00415-020-10163-4

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Keywords

  • Parkinson’s disease
  • Mild cognitive impairment
  • Dementia
  • Early detection
  • Cognitive dysfunction
  • Neuropsychology