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Baseline cognitive profile is closely associated with long-term motor prognosis in newly diagnosed Parkinson’s disease

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Abstract

Objectives

To investigate the association between cognitive function at baseline and the progression of motor disability in Parkinson’s disease (PD).

Methods

We consecutively enrolled 257 drug-naïve patients with early-stage PD (follow-up > 2 years) who underwent a detailed neuropsychological test at initial assessment. Factor analysis was conducted to yield four cognitive function factors and composite scores thereof: Factor 1 (visual memory/visuospatial), Factor 2 (verbal memory), Factor 3 (frontal/executive), and Factor 4 (attention/working memory/language). The global cognitive composite score of each patient was calculated based on these factors. Subsequently, we assessed the effect of baseline cognitive function on long-term motor outcomes, namely levodopa-induced dyskinesia (LID), wearing-off, freezing of gait (FOG), and rate of longitudinal increases in levodopa-equivalent dose (LED).

Results

Cox regression analysis demonstrated that higher Factor 3 (frontal/executive) composite scores (i.e., better cognitive performance) were associated with early development of LID [hazard ratio (HR), 1.507; p = 0.003], whereas higher Factor 1 (visual memory/visuospatial) composite scores (i.e., better cognitive performance) were associated with a lower risk for FOG (HR 0.683; p = 0.017). We noted that higher global cognitive composite scores were associated with a lower risk for developing FOG (HR 0.455; p = 0.045). The linear mixed model demonstrated that higher global cognitive composite scores and better cognitive performance in visual memory/visuospatial function were associated with slower longitudinal increases in LED.

Conclusions

These findings suggest that baseline cognitive profiles have prognostic implications on several motor aspects in patients with PD.

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Acknowledgements

This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT and Future Planning (NRF-2019R1A2C2085462) and the Ministry of Education (NRF-2018R1D1A1B07048959).

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Authors and Affiliations

  1. Department of Neurology, Yonsei University College of Medicine, 50, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea

    Seok Jong Chung, Han Soo Yoo, Yang Hyun Lee, KyoungWon Baik, Jin Ho Jung, Byoung Seok Ye, Young H. Sohn & Phil Hyu Lee

  2. Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea

    Seok Jong Chung

  3. Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea

    Hye Sun Lee

  4. Department of Neurology, Inje University Busan Paik Hospital, Busan, South Korea

    Jin Ho Jung

  5. Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea

    Phil Hyu Lee

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  1. Seok Jong Chung
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  2. Han Soo Yoo
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  9. Phil Hyu Lee
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Contributions

SJC and PHL conceived the study. SJC, HSY, HSL, YHL, KWB, and JHJ acquired and analyzed the data. SJC and PHL wrote the manuscript. HSY, HSL, YHL, KWB, JHJ, BSY, and YHS revised the manuscript for important intellectual content. All authors read and approved the manuscript.

Corresponding author

Correspondence to Phil Hyu Lee.

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Conflicts of interest

The authors declare no financial or other conflicts of interest.

Ethical approval

This study was approved by the Institutional Review Board of Yonsei University Severance Hospital. The need for informed consent was waived because of the retrospective nature of the study.

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Chung, S.J., Yoo, H.S., Lee, H.S. et al. Baseline cognitive profile is closely associated with long-term motor prognosis in newly diagnosed Parkinson’s disease. J Neurol 268, 4203–4212 (2021). https://doi.org/10.1007/s00415-021-10529-2

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  • DOI: https://doi.org/10.1007/s00415-021-10529-2

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