Characteristics of Parkinson’s Disease in Patients with and without Cognitive Impairment

Background: Characterizing patients with Parkinson’s disease (PD) and cognitive impairment is important toward understanding their natural history. Objective: Understand clinical, treatment, and cost characteristics of patients with PD pre- and post-cognitive impairment (memory loss/mild cognitive impairment/dementia or dementia treatment) recognition. Methods: 2,711 patients with PD newly diagnosed with cognitive impairment (index) were identified using administrative claims data. They were matched (1:1) on age and gender to patients with PD and no cognitive impairment (controls). These two cohorts were compared on patient characteristics, healthcare resource utilization, and total median costs for 3 years pre- and post-index using Chi-square tests, t-tests, and Wilcoxon rank-sum tests. Logistic regression was used to identify factors predicting cognitive impairment. Results: Comorbidity indices for patients with cognitive impairment increased during the 6-year study period, especially after the index. Enrollment in Medicare Advantage Prescription Drug plans vs. commercial (OR = 1.60), dual Medicare/Medicaid eligibility (OR = 1.36), cerebrovascular disease (OR = 1.24), and PD medication use (OR = 1.46) were associated with a new cognitive impairment diagnosis (all p < 0.05). A greater proportion of patients with cognitive impairment had hospitalizations and emergency department visits and higher median total healthcare costs than controls for each year pre- and post-index. Conclusion: In patients with PD newly diagnosed with cognitive impairment, comorbidity burden, hospitalizations, emergency department visits, and total costs peaked 1-year pre- and post-identification. These data coupled with recommendations for annual screening for cognitive impairment in PD support the early diagnosis and management of cognitive impairment in order to optimize care for patients and their caregivers.

Download Full-text

Neuroprotective Potential of Peroxisome Proliferator Activated Receptor-αAgonist in Cognitive Impairment in Parkinson’s Disease: Behavioral, Biochemical, and PBPK Profile

PPAR Research ◽

10.1155/2014/753587 ◽

2014 ◽

Vol 2014 ◽

pp. 1-9 ◽

Cited By ~ 15

Author(s):

Dedeepya Uppalapati ◽

Nihar R. Das ◽

Rahul P. Gangwal ◽

Mangesh V. Damre ◽

Abhay T. Sangamwar ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Cognitive Impairment ◽

Neurodegenerative Disorder ◽

Memory Loss ◽

Pbpk Modeling ◽

Pharmacokinetic Parameters ◽

Peroxisome Proliferator ◽

Fenofibric Acid ◽

Peroxisome Proliferator Activated Receptor

Parkinson’s disease (PD) is a common neurodegenerative disorder affecting 1% of the population by the age of 65 years and 4-5% of the population by the age of 85 years. PD affects functional capabilities of the patient by producing motor symptoms and nonmotor symptoms. Apart from this, it is also associated with a higher risk of cognitive impairment that may lead to memory loss, confusion, and decreased attention span. In this study, we have investigated the effect of fenofibrate, a PPAR-αagonist in cognitive impairment model in PD. Bilateral intranigral administration of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) (100 µg/1 µL/side) produced significant cognitive dysfunctions. Fenofibrate treatment at 10, 30, and 100 mg/kg for twenty-five days was found to be neuroprotective and improved cognitive impairment in MPTP-induced PD model as evident from behavioral, biochemical (MDA, GSH, TNF-α, and IL-6), immunohistochemistry (TH), and DNA fragmentation (TUNEL positive cells) studies. Further, physiologically based pharmacokinetic (PBPK) modeling study was performed using GastroPlus to characterize the kinetics of fenofibric acid in the brain. A good agreement was found between pharmacokinetic parameters obtained from the actual and simulated plasma concentration-time profiles of fenofibric acid. Results of this study suggest that PPAR-αagonist (fenofibrate) is neuroprotective in PD-induced cognitive impairment.

Download Full-text

Anxiety is associated with cognitive impairment in newly-diagnosed Parkinson's disease

Parkinsonism & Related Disorders ◽

10.1016/j.parkreldis.2017.01.001 ◽

2017 ◽

Vol 36 ◽

pp. 63-68 ◽

Cited By ~ 19

Author(s):

Nadeeka N.W. Dissanayaka ◽

Rachael A. Lawson ◽

Alison J. Yarnall ◽

Gordon W. Duncan ◽

David P. Breen ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Cognitive Impairment ◽

Newly Diagnosed

Download Full-text

Subjective Cognitive Complaints in Newly-Diagnosed Parkinson’s Disease With and Without Mild Cognitive Impairment

Frontiers in Neuroscience ◽

10.3389/fnins.2021.761817 ◽

2021 ◽

Vol 15 ◽

Author(s):

Chenxi Pan ◽

Jingru Ren ◽

Ping Hua ◽

Lei Yan ◽

Miao Yu ◽

...

Keyword(s):

Risk Factors ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Logistic Regression ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Cognitive Status ◽

Newly Diagnosed ◽

Cognitive Complaints ◽

Subjective Cognitive Complaints

Background: Subjective cognitive complaints (SCCs) and mild cognitive impairment (MCI) are common among patients with Parkinson’s disease (PD). However, the relationship between SCCs and MCI is not well understood. Herein, we aimed to investigate whether there are any differences in the prevalence and risk factors of SCCs between early PD patients with and without MCI.Methods: Overall, 108 newly diagnosed, untreated PD patients underwent comprehensive neuropsychological assessments. PD patients with mild cognitive impairment (PD-MCI) were diagnosed according to the MCI level II criteria. Furthermore, SCCs were measured with the Cognitive Complaints Interview (CCI). Logistic regression analysis, after adjusting for confounding variable, was performed in order to investigate risk factors of SCCs in PD-MCI patients and PD patients with normal cognition (PD-NC).Results: Furthermore, 42 (42.3%) participants reported SCCs and 53 (53.5%) participants were diagnosed with PD-MCI. The prevalence of SCCs in PD-MCI and PD-NC participants was 30.3% and 12.1%, respectively. Logistic regression analyses revealed that the presence of SCCs in PD-MCI group was significantly associated with Non-Motor Symptoms Questionnaire (NMSQ) score (OR = 1.340, 95%CI = 1.115−1.610, p = 0.002), while the presence of SCCs in PD-NC group was significantly associated with time of Stroop Color-Word Test card C (OR = 1.050, 95%CI = 1.009−1.119, p = 0.016).Conclusion: SCCs are frequent among patients with early PD. The prevalence and risk factor of SCCs are distinct in PD with and without MCI. These findings suggest that SCCs in early PD with different cognitive status appear to have different pathogenicity.

Download Full-text

Clinical variables and biomarkers in prediction of cognitive impairment in patients with newly diagnosed Parkinson's disease: a cohort study

The Lancet Neurology ◽

10.1016/s1474-4422(16)30328-3 ◽

2017 ◽

Vol 16 (1) ◽

pp. 66-75 ◽

Cited By ~ 135

Author(s):

Anette Schrag ◽

Uzma Faisal Siddiqui ◽

Zacharias Anastasiou ◽

Daniel Weintraub ◽

Jonathan M Schott

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Cohort Study ◽

Cognitive Impairment ◽

Newly Diagnosed ◽

Clinical Variables

Download Full-text

Mild Cognitive Impairment in newly diagnosed Parkinson's disease: A longitudinal prospective study

Parkinsonism & Related Disorders ◽

10.1016/j.parkreldis.2015.08.024 ◽

2015 ◽

Vol 21 (10) ◽

pp. 1219-1226 ◽

Cited By ~ 69

Author(s):

Gabriella Santangelo ◽

Carmine Vitale ◽

Marina Picillo ◽

Marcello Moccia ◽

Sofia Cuoco ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Prospective Study ◽

Newly Diagnosed

Download Full-text

Evolution of Initial Pharmacologic Treatment of Newly Diagnosed Parkinson’s Disease Patients over a Decade in Singapore

Parkinson s Disease ◽

10.1155/2020/6293124 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Shermyn Neo ◽

Sheng Yong Aidan Wong ◽

Hwee Lan Ng ◽

Wei Li ◽

Kay Yaw Tay ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Drug Effects ◽

Patient Characteristics ◽

Temporal Analysis ◽

Prescribing Patterns ◽

Newly Diagnosed ◽

Drug Prescribing ◽

National Guidelines ◽

Logistic Regression Models

Objective. The aim of this study is to compare Parkinson’s disease (PD) treatment practices by movement disorder (MD) specialists across a decade, and to determine the factors that influence drug choice for the motor symptoms of PD in newly diagnosed drug-naïve patients. Methods. This prospective temporal analysis included patients seen at the National Neuroscience Institute in Singapore and diagnosed with PD by MD specialists in the years 2007 and 2017. Primary outcomes were use of specific PD drugs and changes in drug-prescribing patterns. Descriptive analyses and multivariable logistic regression models determined the extent to which patient characteristics were associated with type of PD treatment. Results. Of 230 patients with PD (mean (SD) age, 66.7 (10.3) years), 131 (57.0%) were male. From 2007 to 2017, the use of ergot dopamine agonists and anticholinergics decreased from 19.3% to 2.0% (P<0.001) and from 12.0% to 2.7% (P=0.004), respectively. The use of monoamine oxidase B inhibitors (MAOBI) increased from 13.3% to 25.2% (P=0.033). The use of levodopa (LD)-sparing strategies decreased nonsignificantly from 33.7% to 24.5% (P=0.133). Overall, 196 (85.2%) patients were initiated on symptomatic monotherapy, with LD being the most commonly prescribed. MAOBI was the most common drug used in combination therapy. Age ≤70 (adjusted OR, 11.9; 95% CI, 4.5–31.5) and Hoehn and Yahr (HY) stage <2 (adjusted OR, 3.4; 95% CI, 1.5–7.7) were independent factors for LD-sparing strategies. Non-LD prescriptions (13 of 92; 14.1%) were more likely to be discontinued compared to LD ones (6 of 149; 4.0%) (P=0.005). Conclusions. Drug-prescribing patterns in PD have changed significantly through the last decade, influenced by emerging evidence and reports of adverse drug effects. Choosing drugs based on the patient’s age and disease severity remain sound guiding principles across the years. It is important that international and national guidelines for pharmacotherapy in PD be updated consistently throughout different socioeconomic settings to optimize care.

Download Full-text

Analysis among cognitive profiles and gray matter volume in newly diagnosed Parkinson's disease with mild cognitive impairment

Journal of the Neurological Sciences ◽

10.1016/j.jns.2014.09.049 ◽

2014 ◽

Vol 347 (1-2) ◽

pp. 210-213 ◽

Cited By ~ 14

Author(s):

Sang Woo Noh ◽

Yong Hee Han ◽

Chi Woong Mun ◽

Eun Joo Chung ◽

Eung Gyu Kim ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Gray Matter ◽

Gray Matter Volume ◽

Cognitive Profiles ◽

Newly Diagnosed ◽

Matter Volume

Download Full-text

Resting-State Network Connectivity in Newly Diagnosed Drug-Naïve Parkinson’s Disease Patients With Mild Cognitive Impairment

10.21203/rs.3.rs-428251/v1 ◽

2021 ◽

Author(s):

Yanbing Hou ◽

Qianqian Wei ◽

Ruwei Ou ◽

Lingyu Zhang ◽

Xiaoqin Yuan ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Resting State ◽

Large Scale ◽

Rating Scale ◽

Fmri Data ◽

Newly Diagnosed ◽

Drug Naïve

Abstract Background: Cognitive impairment (CI) is one of the most frequent non-motor features in Parkinson's disease (PD). The frequency of mild cognitive impairment (MCI) was reported to exceed 40% in a large cohort of newly diagnosed PD patients.Method: Resting-state functional MRI (rs-fMRI) data was collected in 47 newly diagnosed drug-naïve PD patients (including 28 PD patients with MCI (PD-MCI subgroup) and 19 PD patients with cognitively unimpaired (PD-CU subgroup)) and 28 age- and sex-matched healthy controls (HCs). Independent component analysis (ICA) can decompose rs-fMRI data into resting state networks (RSNs). Brain intra- and inter-network alterations were investigated in RSNs among PD-MCI, PD-CU, and HCs groups.Results: Seven large-scale brain networks were extracted. The default mode network (DMN), visual network (VN) and sensorimotor network (SMN) were selectively vulnerable in the PD-MCI subgroup relative to the HC group. In PD-MCI patients, the reduced functional connectivity (FC) within the DMN was positively correlated with brief visuospatial memory test-revised (BVMT-R) scores (memory function); the reduced FC within the VN was positively correlated with clock copying test (CCT) scores (visuospatial function). In whole PD patients, the reduced FC within the SMN was negatively correlated with the Unified PD Rating Scale (UPDRS) part III scores. Moreover, FC between the SMN and limbic network, and between the ventral attention network (VAN) and VN were more prone to be damaged in PD patients.Conclusions: The DMN, VN and SMN were disrupted in PD-MCI patients. FC between the SMN and limbic network, and between the VAN and VN were also impaired in PD patients. The impaired intra- and inter-connectivity could provide further insights into the pathophysiological alterations of brain connectivity in newly diagnosed drug-naïve PD.

Download Full-text