Neurology: Cognitively driven impairment of daily living skills as a predictor of Parkinson's disease dementia: a longitudinal cohort study

One-third of people with Parkinson's disease (PDMCI) with mild cognitive impairment (PDMCI) transition to dementia within a few years
.
Markers with high prognostic value for dementia transformation are needed
.
Loss of daily functioning, mainly due to cognitive dysfunction, is the core criterion for diagnosing dementia in Parkinson's disease, and more complex instrumental activities of daily living (IADL) dysfunction begins to appear in the prodromal phase
.
This study assesses phenotypes associated with cognitive IADL impairment and their predictive value
for defining people at high risk of Parkinson's disease dementia.

In addition to genetic and cerebrospinal fluid biomarkers, an observational longitudinal study was conducted, using cognitive and clinical scores
.
The Functional Activity Questionnaire (FAQ) quotient (cut-off ≥1), which indicates more cognitive impairment than exercise-driven impairment of independent living, defines the state of cognitive independent living impairment at
baseline.
Risk ratios (HR) were used to compare the effects of
baseline classification on dementia transformation.

Of the 268 patients with PD assessed at baseline, 108 (40.
3%) had PD-MCI
.
After an average of 3.
78±0.
84 years, 164 patients (61.
2%) were reevaluated
.
At follow-up, 93 (56.
7%) patients had no cognitive impairment, 54 (32.
9%) met PD-MCI criteria, and 17 (10.
4%) developed dementia
.
The heart rate of patients with dementia with baseline cognitive impairment (n=37) was significantly higher than that of PD-MCI patients, but the highest in patients with these two indicators (HR=12.
01, 95%-CI4.
47~32.
22, P<0.
001).

In the follow-up sample, nearly half (n=10, 47.
6%) of patients with cognitive IADL impairment and baseline classification of PDMCI switched to dementia
.
During the study period, baseline status of cognitive IADL impairment was associated
with higher non-exercise load, poorer cognitive performance, and more severe IADL progression.

It is critical
to distinguish between cognitive and motor aspects on ADL function in patients with Parkinson's disease and to monitor cognitive ADL impairment during the prodromal phase of dementia.
Patients with PD-MCI and cognitive IADL disorders may be valuable target groups
for clinical trials aimed at slowing the progression of dementia.

Source: Becker S, Bode M, Brockmann K, et al.
Cognitive-Driven Activities of Daily Living Impairment as a Predictor for Dementia in Parkinson Disease: A Longitudinal Cohort Study [published online].
ahead of print, 2022 Sep 2].
Neurology.
2022; 10.
1212/WNL.
0000000000201201.
doi:10.
1212/WNL.
0000000000201201