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.
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.
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.
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.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Papagno C, Trojano L (2018) Cognitive and behavioral disorders in Parkinson’s disease: an update. I: cognitive impairments. Neurol Sci 39(2):215–223. https://doi.org/10.1007/s10072-017-3154-8
Aarsland D, Bronnick K, Williams-Gray C, Weintraub D, Marder K, Kulisevsky J, Santangelo G (2010) Mild cognitive impairment in Parkinson disease: a multicenter pooled analysis. Neurology 75(12):1062–1069. https://doi.org/10.1212/WNL.0b013e3181f39d0e
Wen MC, Chan LL, Tan LC, Tan EK (2017) Mild cognitive impairment in Parkinson’s disease: a distinct clinical entity? Transl Neurodegener 6(1):24. https://doi.org/10.1186/s40035-017-0094-4
Hely MA, Reid WG, Adena MA, Halliday GM, Morris JG (2008) The Sydney multicenter study of Parkinson’s disease: the inevitability of dementia at 20 years. Mov Disord 23(6):837–844. https://doi.org/10.1002/mds.21956
Fernandez HH, Crucian GP, Okun MS, Price CC, Bowers D (2005) Mild cognitive impairment in Parkinson’s disease: the challenge and the promise. Neuropsychiatr Dis Treat 1(1):37–50. https://doi.org/10.2147/nedt.126.96.36.199295
Litvan I, Aarsland D, Adler CH, Goldman JG, Kulisevsky J, Mollenhauer B, Weintraub D (2011) MDS Task Force on mild cognitive impairment in Parkinson’s disease: critical review of PD-MCI. Mov Disord 26(10):1814–1824. https://doi.org/10.1002/mds.23823
Roheger M, Kalbe E, Liepelt-Scarfone I (2018) Progression of cognitive decline in Parkinson’s disease. J Parkinsons Dis 8(2):183–193. https://doi.org/10.3233/JPD-181306
Bäckström D, Granåsen G, Domellöf ME, Linder J, Mo SJ, Riklund K, Forsgren L (2018) Early predictors of mortality in parkinsonism and Parkinson disease: a population-based study. Neurology 91(22):e2045–e2056. https://doi.org/10.1212/WNL.0000000000006576
Jones JD, Mangal P, Lafo J, Okun MS, Bowers D (2016) Mood differences among Parkinson’s disease patients with mild cognitive impairment. J Neuropsychiatry Clin Neurosci 28(3):211–216. https://doi.org/10.1016/j.parkreldis.2017.12.006
Jones JD, Kuhn TP, Szymkowicz SM (2018) Reverters from PD-MCI to cognitively intact are at risk for future cognitive impairment: analysis of the PPMI cohort. Parkinsonism Relat Disord 47:3–7. https://doi.org/10.1016/j.parkreldis.2017.12.006
Goldman JG, Holden SK, Litvan I, McKeith I, Stebbins GT, Taylor JP (2018) Evolution of diagnostic criteria and assessments for Parkinson’s disease mild cognitive impairment. Mov Disord 33(4):503–510. https://doi.org/10.1002/mds.27323
Galtier I, Nieto A, Lorenzo JN, Barroso J (2019) Subjective cognitive decline and progression to dementia in Parkinson’s disease: a long-term follow-up study. J Neurol 266(3):745–754. https://doi.org/10.1007/s00415-019-09197-0
Hong JY, Sunwoo MK, Chung SJ, Ham JH, Lee JE, Sohn YH, Lee PH (2014) Subjective cognitive decline predicts future deterioration in cognitively normal patients with Parkinson’s disease. Neurobiol Aging 35(7):1739–1743. https://doi.org/10.1016/j.neurobiolaging.2013.11.017
Orfei MD, Assogna F, Pellicano C, Pontieri FE, Caltagirone C, Pierantozzi M, Spalletta G (2018) Anosognosia for cognitive and behavioral symptoms in Parkinson’s disease with mild dementia and mild cognitive impairment: frequency and neuropsychological/neuropsychiatric correlates. Parkinsonism Relat Disord 54:62–67. https://doi.org/10.1016/j.parkreldis.2018.04.015
Mitchell AJ (2008) The clinical significance of subjective memory complaints in the diagnosis of mild cognitive impairment and dementia: a meta-analysis. Int J Geriatr Psychiatry J Psychiatry Late Life Allied Sci 23(11):1191–1202. https://doi.org/10.1002/gps.2053
Edmonds EC, Delano-Wood L, Galasko DR, Salmon DP, Bondi MW (2015) Subtle cognitive decline and biomarker staging in preclinical Alzheimer’s disease. J Alzheimers Dis 47(1):231–242. https://doi.org/10.3233/JAD-150128
Thomas KR, Edmonds EC, Eppig J, Salmon DP, Bondi MW, Alzheimer’s Disease Neuroimaging Initiative (2018) Using neuropsychological process scores to identify subtle cognitive decline and predict progression to mild cognitive impairment. J Alzheimers Dis 64(1):195–204. https://doi.org/10.3233/JAD-180229
Thomas KR, Eppig J, Edmonds EC, Jacobs DM, Libon DJ, Au R, Bondi MW (2018) Word-list intrusion errors predict progression to mild cognitive impairment. Neuropsychology 32(2):235. https://doi.org/10.1037/neu0000413
Thomas KR, Bangen KJ, Weigand AJ, Edmonds EC, Wong CG, Cooper S, Alzheimer’s Disease Neuroimaging Initiative (2020) Objective subtle cognitive difficulties predict future amyloid accumulation and neurodegeneration. Neurology 94(4):e397–e406. https://doi.org/10.1212/WNL.0000000000008838
Jones JD, Burroughs M, Apodaca M, Bunch J (2019) Greater intraindividual variability in neuropsychological performance predicts cognitive impairment in de novo Parkinson’s disease. Neuropsychology. https://doi.org/10.1037/neu0000577
Brønnick K, Alves G, Aarsland D, Tysnes O, Larsen J (2011) Verbal memory in drug-naive, newly diagnosed Parkinson’s disease. The retrieval deficit hypothesis revisited. Neuropsychology 25(1):114–124. https://doi.org/10.1037/a0020857
Higginson C, Wheelock V, Carroll K, Sigvardt K (2005) Recognition memory in Parkinson’s disease with and without dementia: evidence inconsistent with the retrieval deficit hypothesis. J Clin Exp Neuropsychol 27(4):516–528. https://doi.org/10.1080/13803390490515469
Weintraub D, Doshi J, Koka D, Davatzikos C, Siderowf AD, Duda JE, Clark CM (2011) Neurodegeneration across stages of cognitive decline in Parkinson disease. Arch Neurol 68(12):1562–1568. https://doi.org/10.1001/archneurol.2011.725
Anderson AE, Jones JD, Thaler NS, Kuhn TP, Singer EJ, Hinkin CH (2018) Intraindividual variability in neuropsychological performance predicts cognitive decline and death in HIV. Neuropsychology 32(8):966. https://doi.org/10.1037/neu0000482
Bangen KJ, Weigand AJ, Thomas KR, Delano-Wood L, Clark LR, Eppig J, Bondi MW (2019) Cognitive dispersion is a sensitive marker for early neurodegenerative changes and functional decline in nondemented older adults. Neuropsychology 33(5):599. https://doi.org/10.1037/neu0000532
Wyman-Chick KA, Martin PK, Weintraub D, Sperling SA, Erickson LO, Manning CA, Barrett MJ (2018) Selection of normative group affects rates of mild cognitive impairment in Parkinson’s disease. Mov Disord 33(5):839–843. https://doi.org/10.1002/mds.27335
Zanchi D, Giannakopoulos P, Borgwardt S, Rodriguez C, Haller S (2017) Hippocampal and amygdala gray matter loss in elderly controls with subtle cognitive decline. Front Aging Neurosci 9:50. https://doi.org/10.3389/fnagi.2017.00050
Jones JD, Kurniadi NE, Kuhn TP, Szymkowicz SM, Bunch J, Rahmani E (2019) Depressive symptoms precede cognitive impairment in de novo Parkinson’s disease patients: analysis of the PPMI cohort. Neuropsychology. https://doi.org/10.1037/neu0000583
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.
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.
Conflicts of interest
The authors declare that they have no competing interest.
The study was approved by the institutional review board at each site.
Consent to participate
Participants provided informed consent prior to all study activities.
Availability of data and material
About this article
Cite this article
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
- Parkinson’s disease
- Mild cognitive impairment
- Early detection
- Cognitive dysfunction