The Level 1 evaluation included a systematic questionnaire regarding cognitive symptoms and their effect on an array of daily activities, including the pill questionnaire from the MDS dementia criteria, 9, 14 the Mini-Mental State Examination, 9 and the Montreal Cognitive Assessment. If patients declined a neuropsychological examination, MDS Level 1 criteria were used (except that depression was not considered an exclusion criterion, unless pseudodementia was diagnosed by the evaluating neurologist 15). Dementia was diagnosed according to Level 2 MDS criteria for PD dementia, 14 defined as impairment on ≥2 cognitive domains on neuropsychological testing with significant functional impairment. Subsequently, follow-up neuropsychological evaluations were offered to all patients. 12 To address this deficit, we assessed a broad array of potential clinical risk factors for dementia in a 4.5-year prospective cohort study, focusing especially on nonmotor features such as sleep disorders, autonomic dysfunction, and special sensory dysfunction.Ĭopy of the Rey-O figure, Block Design from Wechsler Adult Intelligence Scale III (scaled score), and Bells Test assessed visuospatial abilities. The only nonmotor variables found in prospective studies to predict dementia in PD are REM sleep behavior disorder (RBD), 9, 10 baseline cognitive impairment, 11 and olfaction. By contrast, nonmotor features have not been extensively studied as possible dementia predictors. Some studies also find that motor features, such as the akinetic-rigid Parkinson subtype, 8 are associated with increased risk. Advanced age is the most established risk factor for dementia. Identifying the factors predictive of PD dementia is not only important in identifying high-risk patients for appropriate counseling and planning future care, but also in recognizing early cognitive impairment for targeted therapeutic interventions (e.g., clinical trials). 4, – 6 An incidence rate of approximately 100 per 1,000 patient-years, more than 5 times that of age-matched controls, has been estimated. 1, – 3 The prevalence of dementia in PD ranges between 24% and 50% and accounts for about 3% to 4% of all dementia in the population. Among baseline motor variables, proportion of gait involvement (OR = 1.12, p = 0.023), falls (OR = 3.02, p = 0.042), and freezing (OR = 2.63, p = 0.013), as well as the Purdue Pegboard Test (OR = 0.67, p = 0.049) and alternate tap test (OR = 0.97, p = 0.033) predicted dementia.ĭementia is among the most devastating nonmotor features of Parkinson disease (PD), causing severe decline in quality of life, increased caregiver burden, increased mortality, and often institutionalization. Abnormal color vision increased dementia risk (OR = 3.3, p = 0.014), but olfactory dysfunction did not. Those with baseline mild cognitive impairment had increased dementia risk (OR = 22.5, p 10 mm Hg increased dementia odds 7-fold (OR = 7.3, p = 0.002). Patients destined to develop dementia were older and more often male (odds ratio = 3.64, p = 0.023). Of 80 patients, 27 (34%) developed dementia.
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