Nonmotor Symptoms and Cognitive Decline in de novo Parkinson's Disease.
BACKGROUND
Cognitive impairments are common in Parkinson's disease (PD). Despite its clinical importance, the development of dementia is still difficult to predict. In this study, we investigated the possible associations between non-motor symptoms and the risk of developing dementia within a 2-year observation period in PD.


METHODS
A total of 80 patients with PD participated in this study. Nonmotor symptoms (the Nonmotor Symptoms Questionnaire), PD status (Unified Parkinson's Disease Rating Scale), depression (Geriatric d Depression Scale or Montgomery-Asberg Depression Scale), stereopsis and severity of nonmotor symptoms (Non-motor symptoms scale) were assessed. Global cognitive function (Mini-Mental State Examination) were evaluated at baseline and 2 years later.


RESULTS
Presence of depression, vivid dreaming, REM sleep behavior disorders, hyposmia, abnormal stereopsis, non-smoking and postural instability/ gait disturbance phenotype were associated with a significantly more rapid decline of Mini-Mental State Examination. Logistic regression analyses demonstrated that depression (odds ratio=13.895), abnormal stereopsis (odds ratio=10.729), vivid dreaming (odds ratio=4.16), REM sleep behavior disorders (odds ratio=5.353) and hyposmia (odds ratio=4.911) were significant independent predictors of dementia risk within 2 years. Postural instability/ gait disturbance phenotype and age >62 years were also independent predictors of dementia risk (odd ratio=38.333, odds ratio=10.625).


CONCLUSIONS
We suggest that depression, vivid dreaming, REM sleep behavior disorders, hyposmia and abnormal stereopsis are closely associated with cognitive decline, and that presence of these nonmotor symptoms predict the subsequent development of Parkinson's disease dementia.
1Department of Neurology and Parkinson's Disease Centre,Korea University Guro Hospital,Korea University College of Medicine,Seoul,Korea.
Kyum-Yil
KY
Kwon
1Department of Neurology and Parkinson's Disease Centre,Korea University Guro Hospital,Korea University College of Medicine,Seoul,Korea.
Sung Hoon
SH
Kang
1Department of Neurology and Parkinson's Disease Centre,Korea University Guro Hospital,Korea University College of Medicine,Seoul,Korea.
Minjik
M
Kim
1Department of Neurology and Parkinson's Disease Centre,Korea University Guro Hospital,Korea University College of Medicine,Seoul,Korea.
Hye Mi
HM
Lee
1Department of Neurology and Parkinson's Disease Centre,Korea University Guro Hospital,Korea University College of Medicine,Seoul,Korea.
Ji Wan
JW
Jang
2Parkinson/Alzheimer Center,Department of Neurology,Asan Medical Center,University of Ulsan College of Medicine,Seoul,Korea.
Ju Yeon
JY
Kim
1Department of Neurology and Parkinson's Disease Centre,Korea University Guro Hospital,Korea University College of Medicine,Seoul,Korea.
Seon-Min
SM
Lee
1Department of Neurology and Parkinson's Disease Centre,Korea University Guro Hospital,Korea University College of Medicine,Seoul,Korea.
Seong-Beom
SB
Koh
D000368:Aged; D000369:Aged, 80 and over; D010054:Brief Psychiatric Rating Scale; D003072:Cognition Disorders / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D003704:Dementia / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D000857:Olfaction Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D010300:Parkinson Disease / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology