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Cognitive performance and psychiatric symptoms in de novo, untreated Parkinson's disease: results from the PPMI study

Weintraub, D; Simuni, T; Coffey, C; Foster, E; Chahine, L; Litvan, I; Troyer, M; Siderowf, A; Hawkins, K; on behalf of the PPMI Cognitive Behavioral Working Group and PPMI Investigators
MDS: Sydney, Australia
Download Presentation: MDS-2013-Cognitive-Data-Weintraub.pdf
Objective: To determine the frequency and correlates of cognitive impairment and common NPS in a large cohort of early, untreated PD patients and a demographically-comparable group of healthy controls (HCs).
Background: Preliminary studies suggest that cognitive impairment and neuropsychiatric symptoms (NPS) are common in newly diagnosed Parkinson's disease (PD) patients, but previous research has been limited by relatively small samples sizes and homogenous populations.
Methods: Parkinson's Progression Markers Initiative (PPMI) is an international, multi-site, case-control study conducted at 21 academic centers. At baseline participants are recently diagnosed, untreated PD patients or HCs. HCs with cognitive impairment based on a score < 26 on the Montreal Cognitive Assessment (MoCA) were excluded, precluding between-group comparisons on cognitive measures. A detailed cognitive and NPS battery is performed on all subjects. We compared the frequency of NPS in patients and HCs, and describe the cognitive status of the PD cohort.
Results: Currently, 343 PD patients and 164 HCs (approximately 85% of the planned cohort) have enrolled in PPMI. The mean MoCA score for PD patients was 27.1, and using the recommended MoCA cut-off score < 26, 19.2% of PD patients screened positive for cognitive impairment. Controlling for age and gender, PD patients were about twice as likely to have clinically-significant depressive symptoms (OR 5 2.04, p 5 .04) and more severe state and trait anxiety symptoms (p < .001 for both measures). There were no between-group differences in the likelihood of reporting ICD or related behavior symptoms (OR 5 1.25, p 5 .37).
Conclusions: Cognitive impairment and NPS are common manifestations of PD-related disability at the time of diagnosis in the PPMI cohort. In contrast, ICD symptoms are not more common, supporting the probable association between ICD symptoms and dopaminergic therapy in PD