title: Cognitive impairment in Parkinson's disease: Association between patient-reported and clinically measured outcomes.
abstract: In Parkinson's disease, the association between objective and patient-reported measures of cognitive dysfunction is unknown and highly relevant to research and clinical care.
  
  
  
  To determine which cognitive domain-specific Montreal Cognitive Assessment (MoCA) subscores are most strongly associated with patient-reported cognitive impairment on question 1 (Q1) of the Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS).
  
  
  
  We analyzed data from 759 PD participants and 481 persons without PD with in a retrospective, cross sectional analysis using data from the NINDS Parkinson's Disease Biomarkers Program (PDBP), a longitudinal, multicenter biomarker study. The relationship between a patient-reported cognitive rating (MDS-UPDRS q1.1) and objective cognitive assessments (MoCA) was assessed using multinomial logistic regression modeling and the outcomes reported as conditional odds ratios (cOR's) representing the relative odds of a participant reporting cognitive impairment that is "slight" versus "normal" on MDS-UPDRSq1.1 for a one unit increase in a MoCA sub-score, adjusted for age and education.
  
  
  
  In PD participants, changes in visuospatial-executive performance and memory had the most significant impact on subjective cognitive impairment. A 1-point increase in visuospatial-executive function decreased the chance of reporting a MDS-UPDRS Q1 score of "slight" versus "normal" by a factor of 0.686 (p < 0.001) and each 1 point improvement in delayed recall decreased the odds of reporting "slight" cognitive impairment by a factor of 0.836 (p < 0.001).
  
  
  
  Conversion from a PD patient's report of "normal" to "slight" cognitive impairment may be associated with changes in visuospatial-executive dysfunction and memory more than other cognitive domains.
authors.affiliation: Movement Disorders Division, Dept. of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Meyer 6-181, Baltimore, MD, 21287, United States; Corresponding author. Johns Hopkins Dept. of Neurology, 600 N. Wolfe Street, Meyer 6-181D, Baltimore, MD, 21287, United States. Electronic address: kmills16@jhmi.edu.
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Mills
authors.affiliation: Movement Disorders Division, Dept. of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Meyer 6-181, Baltimore, MD, 21287, United States; Morris K. Udall Parkinson's Disease Research Center, Johns Hopkins University School of Medicine, 10751 Fall Road, Suite 250, Lutherville, MD 21093, Baltimore, MD, United States.
authors.forename: Zoltan
authors.initials: Z
authors.lastname: Mari
authors.affiliation: Movement Disorders Division, Dept. of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Meyer 6-181, Baltimore, MD, 21287, United States; Morris K. Udall Parkinson's Disease Research Center, Johns Hopkins University School of Medicine, 10751 Fall Road, Suite 250, Lutherville, MD 21093, Baltimore, MD, United States.
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Pontone
authors.affiliation: Movement Disorders Division, Dept. of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Meyer 6-181, Baltimore, MD, 21287, United States; Morris K. Udall Parkinson's Disease Research Center, Johns Hopkins University School of Medicine, 10751 Fall Road, Suite 250, Lutherville, MD 21093, Baltimore, MD, United States.
authors.forename: Alexander
authors.initials: A
authors.lastname: Pantelyat
authors.affiliation: Morris K. Udall Parkinson's Disease Research Center, Johns Hopkins University School of Medicine, 10751 Fall Road, Suite 250, Lutherville, MD 21093, Baltimore, MD, United States.
authors.forename: Angela
authors.initials: A
authors.lastname: Zhang
authors.affiliation: Morris K. Udall Parkinson's Disease Research Center, Johns Hopkins University School of Medicine, 10751 Fall Road, Suite 250, Lutherville, MD 21093, Baltimore, MD, United States.
authors.forename: Nadine
authors.initials: N
authors.lastname: Yoritomo
authors.affiliation: Morris K. Udall Parkinson's Disease Research Center, Johns Hopkins University School of Medicine, 10751 Fall Road, Suite 250, Lutherville, MD 21093, Baltimore, MD, United States.
authors.forename: Emma
authors.initials: E
authors.lastname: Powers
authors.affiliation: Division of Medical Psychology, Dept. of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Meyer 218, Baltimore, MD, 21287, United States.
authors.forename: Jason
authors.initials: J
authors.lastname: Brandt
authors.affiliation: Movement Disorders Division, Dept. of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Meyer 6-181, Baltimore, MD, 21287, United States; Morris K. Udall Parkinson's Disease Research Center, Johns Hopkins University School of Medicine, 10751 Fall Road, Suite 250, Lutherville, MD 21093, Baltimore, MD, United States; Neuroregeneration and Stem Cell Programs, Institute for Cell Engineering, United States; Solomon H. Snyder Department of Neuroscience, United States; Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, 21205, United States.
authors.forename: Ted M
authors.initials: TM
authors.lastname: Dawson
authors.affiliation: Movement Disorders Division, Dept. of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Meyer 6-181, Baltimore, MD, 21287, United States; Morris K. Udall Parkinson's Disease Research Center, Johns Hopkins University School of Medicine, 10751 Fall Road, Suite 250, Lutherville, MD 21093, Baltimore, MD, United States.
authors.forename: Liana S
authors.initials: LS
authors.lastname: Rosenthal
mesh_terms: D000368:Aged; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology*; D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D056344:Executive Function / Q000502:physiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008568:Memory / Q000502:physiology; D008875:Middle Aged; D009483:Neuropsychological Tests; D017063:Outcome Assessment, Health Care; D010300:Parkinson Disease / Q000150:complications* / Q000523:psychology*; D057566:Self Report; D013028:Space Perception / Q000502:physiology
keywords: Cognition; Mild cognitive impairment; Parkinson's; Patient-reported