Cognitive impairment in Parkinson's disease: Association between patient-reported and clinically measured outcomes

Interesting to see that these are the bits that patients notice when cognition starts to deteriorate... I always feel that patients have a bit of agnosia, at least for the motor features, and I wonder if its the same for cognition...

Parkinsonism Relat Disord. 2016 Sep 27. pii: S1353-8020(16)30383-2. doi: 10.1016/j.parkreldis.2016.09.025. [Epub ahead of print]

Mills KA, Mari Z, Pontone GM, Pantelyat A, Zhang A, Yoritomo N, Powers E, Brandt J, Dawson TM, Rosenthal LS.

http://linkinghub.elsevier.com/retrieve/pii/S1353-8020(16)30383-2

BACKGROUND:

In Parkinson's disease, the association between objective and patient-reported measures of cognitive dysfunction is unknown and highly relevant to research and clinical care.

OBJECTIVE:

To determine which cognitive domain-specific Montreal Cognitive Assessment (MoCA) subscores are most strongly associated with patient-reported cognitive impairment on question 1 (Q1) of the Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS).

METHODS:

We analyzed data from 759 PD participants and 481 persons without PD with in a retrospective, cross sectional analysis using data from the NINDS Parkinson's Disease Biomarkers Program (PDBP), a longitudinal, multicenter biomarker study. The relationship between a patient-reported cognitive rating (MDS-UPDRS q1.1) and objective cognitive assessments (MoCA) was assessed using multinomial logistic regression modeling and the outcomes reported as conditional odds ratios (cOR's) representing the relative odds of a participant reporting cognitive impairment that is "slight" versus "normal" on MDS-UPDRSq1.1 for a one unit increase in a MoCA sub-score, adjusted for age and education.

RESULTS:

In PD participants, changes in visuospatial-executive performance and memory had the most significant impact on subjective cognitive impairment. A 1-point increase in visuospatial-executive function decreased the chance of reporting a MDS-UPDRS Q1 score of "slight" versus "normal" by a factor of 0.686 (p < 0.001) and each 1 point improvement in delayed recall decreased the odds of reporting "slight" cognitive impairment by a factor of 0.836 (p < 0.001).

CONCLUSIONS:

Conversion from a PD patient's report of "normal" to "slight" cognitive impairment may be associated with changes in visuospatial-executive dysfunction and memory more than other cognitive domains.