The aim of this study was to study the rate and predictors of cognitive decline in a large and representative sample of patients with Parkinson's Disease (PD) during 8 years.
Methods: The sample was an epidemiological cohort of patients with PD from Rogaland County, Norway. Motor, cognitive and psychiatric symptoms were rated using standardized scales at Visit 1, and four (Visit 2) and 8 (Visit 3) years later. Change on the Mini-Mental State Examination (MMSE) was the primary outcome measure. Two population-based cohorts of patients with Alzheimer’s disease and healthy controls from Odense, Denmark, were followed for five years and included for comparison.
Results: 129 PD patients (57% female),were included, with mean (SD) age 70.0 (8.1), duration of disease 8.6 (4.9) years, and Hoehn & Yahr stage 2.2 (0.9) at Visit 1. Mean MMSE declined from 27.3(5.7) to 23.8(8.0) at Visit 2 and to 19.2 (9.8) at Visit 3. Patients with dementia at Visit 2 (PDD; n=49) declined 9.2 (6.8) and 10.9 (6.8) during the two periods, compared with -0.1 (2.7) and 5.4 (6.3) in those without dementia at Visit 2. The mean annual decline on MMSE (2.3; SD=1.7) in PDD was not different from that in AD (mean 2.6; SD=3.7; n=49) (p=0.6), but significantly different from healthy controls (0.1; SD=0.4; n=1,613)(p<.001). Using a mixed effects model, hallucinations (p<0.01) and more severe non-dopaminergic motor symptoms (p<0.01) at Visit 1 were significant predictors of more rapid cognitive decline in PD.
Conclusions: The mean annual decline on MMSE in PD was 1 point. Patients with PD and dementia had an annual decline of 2.7 points, similar to the decline in patients with AD. Hallucinations and more severe motor symptoms not related to dopaminergic systems predicted more rapid cognitive decline in patients with PD
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