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Cognitive impairment in incident, untreated Parkinson disease

The Norwegian ParkWest Study

From The Norwegian Centre for Movement Disorders (D.A., K.B., J.P.L., G.A.), Department of Neurology (J.P.L., G.A.), and Department of Psychiatry (D.A.), Stavanger University Hospital, Stavanger; Department of Neurology (O.B.T.), Haukeland University Hospital, Bergen; and School of Medicine (D.A., J.P.L., O.B.T.), University of Bergen, Norway.

Address correspondence and reprint requests to Prof. Dag Aarsland, The Norwegian Centre for Movement Disorders, Stavanger University Hospital, PO 8100, N-4068 Stavanger, Norway daa{at}sus.no

Background: Little is known regarding the cognitive impairment in subjects with early, drug-naïve Parkinson disease (PD). The aim of this study was to explore the proportion with mild cognitive impairment (MCI) and subtypes in an incidence cohort of untreated PD in Southern and Western Norway.

Methods: A total of 196 non-demented, drug-naive patients who were recruited after an extensive search of all new cases of PD in the area and 201 healthy control subjects completed a battery of neuropsychological tests of verbal memory, visuospatial, and attentional-executive functioning. Subjects were classified as MCI if the age- and education-corrected z-score was falling 1.5 standard deviations below the mean for at least one of the cognitive domains.

Results: The PD group was more impaired on all neuropsychological tests than controls, but the effect sizes were small. The largest effect size was found for verbal memory. A total of 18.9% of the patients with PD were classified as MCI, with a relative risk of 2.1 (1.2–3.6) in PD compared to the control group. Patients with PD with and without MCI did not differ significantly regarding demographic and motor features. Among PD-MCI patients, nearly two-thirds had a non-amnestic MCI subtype, and one third had an amnestic MCI subtype.

Conclusions: The findings demonstrate a twofold increase in the proportion with cognitive impairment in subjects with early, untreated Parkinson disease (PD) compared to controls. This has implications for diagnosis and management of PD.

AD = Alzheimer disease; aMCI-MD = amnestic multiple-domain MCI; aMCI-SD = amnestic single-domain MCI; CVLT-2 = California Verbal Learning Test II; IQCode = Informant Questionnaire on Cognitive decline in the elderly; MADRS = Montgomery and Aasberg Depression Rating Scale; MCI = mild cognitive impairment; MMSE = Mini-Mental State Examination; naMCI-MD = non-amnestic multiple-domain MCI; naMCI-SD = non-amnestic single-domain MCI; PD = Parkinson disease; RR = relative risks; UPDRS = Unified Parkinson’s Disease Rating Scale; VOSP = Visual Object and Space Perception Battery.

Editorial, page 1116

e-Pub ahead of print on November 19, 2008, at www.neurology.org.

*Members of the Norwegian ParkWest Study Group are listed in the appendix.

Funded by the Western Norway Regional Health Authority (grant# 911218) and the Research Council of Norway (grant# 177966).

Disclosure: The authors report no disclosures.

Received May 29, 2008. Accepted in final form September 26, 2008.

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