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Mild Cognitive Impairment and Neuropsychiatric Symptoms in Early, Untreated Parkinson Disease: Results from the PPMI Study

Weintraub, D; Simuni, T; Coffey, C; Caspell-Garcia, C; Foster, E; Barone, P; Leverenz, J; Burn, D; Eberling, J; Chahine, L; Litvan, I; Troyer, M; Siderowf, A; Aarsland, D; Hawkins, K; The PPMI Cognitive Behavioral Working Group; The Parkinson\'s Progression Marker Initiative
 
2014-06-10
MDS: Stockholm, Sweden
Download Presentation: 903 PPMI-baseline-MDS2014-poster-Cog.pdf
 
Abstract:
Objective:
To determine the frequency and correlates of neuropsychiatric symptoms (NPS) and cognitive performance in de novo, untreated Parkinson's disease (PD) patients compared with the general population.

Background:
Both NPS and cognitive impairment are common in PD and impact significantly on disease course, quality of life, and caregiver burden. Preliminary research suggests that mild cognitive deficits are not uncommon at the time of diagnosis, but there is limited knowledge about NPS at disease onset and how this compares with the general population.

Methods:
Parkinson's Progression Markers Initiative (PPMI) is an international study of de novo, untreated (at enrollment) PD patients and healthy controls (HCs). At baseline, participants were assessed for global cognition (the Montreal Cognitive Assessment) and symptoms of depression, anxiety, psychosis, impulse control disorders (ICDs), and apathy.

Results:
423 PD patients and 196 HCs provided baseline data, with no between-group differences in demographic characteristics. 21% of PD patients met a screening cut-off for mild cognitive impairment (MoCA score <26), and higher age, male sex, being non-Caucasian and higher UPDRS motor score predicted worse cognitive performance. PD patients were more depressed than HCs (p<0.001), with 14% meeting a screening cut-off for clinically significant depressive symptoms. PD patients also experienced more anxiety (p<0.001) and apathy (p<0.001) than HCs. Psychosis was uncommon in PD (3%), and there was no between-group difference in ICD symptoms (p=0.51).

Conclusions:
Multiple NPS are more common in de novo, untreated PD patients compared with the general population with the exclusion of the symptoms driven by dopamine replacement therapy (ICD and psychosis). Importantly, up to one-fifth of de novo PD patients may experience mild cognitive impairment. Additional analyses of this cohort will examine neurobiological predictors of NPS and cognitive deficits, as well as follow the course of symptoms over time.