Objective: To investigate the associations between cognitive impairment and cognitive decline in different domains and FOG status using multiple neuropsychological tests.

Background: Freezing of gait (FOG) and cognitive impairment are the most common and serious motor and non-motor symptoms of Parkinson’s disease (PD), respectively. Understanding the associations of FOG with global cognition and specific cognitive domains can help formulate specific interventions for PD individuals with comorbidities of FOG and cognitive impairment.

Method: This study included 374 and 691 participants from a Chinese cohort and the Parkinson’s Progression Markers Initiative (PPMI), respectively. All participants underwent FOG assessment and neuropsychological tests, with 592 (85.7%) individuals enrolled for longitudinal measurements from the PPMI. Global cognitive scales included the China-Modified Mini-Mental State Examination (CM-MMSE) and Montreal Cognitive Assessment (MoCA), while the specific cognitive scales were the Hopkins Verbal Learning Test (HVLT), Judgment of Line Orientation, Letter Number Sequencing (LNS), Semantic Fluency Test, and Symbol Digit Modality Test (SDMT). Cross-sectional and longitudinal associations between cognition and FOG status were evaluated using multivariate-adjusted models.

Results: Worse cognitive performance was observed in freezers compared with non-freezers in both cohorts. At baseline, freezers had lower scores in the total CM-MMSE (p<0.001), MoCA (p<0.001), LNS (p=0.025), semantic fluency test (p=0.017), and SDMT (p=0.013). Additionally, patients with FOG were at a higher risk of cognitive impairment progression (HR=2.00, 95%CI=1.20-3.33), and mixed-effects linear models indicated that freezers had faster cognitive decline, including MoCA (p<0.001), HVLT immediate recall (p=0.031), LNS (p=0.025), and SDMT (p=0.015). Spearman rank correlation demonstrated that FOG progression was associated with an accelerated decline in cognition (all p<0.010).

Conclusion: FOG is a reliable predictive indicator for monitoring global cognition and specific cognitive domains, as well as cognitive decline in individuals with PD, which can be an intervention target in PD therapy.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/freezing-of-gait-can-predict-cognitive-decline-in-parkinsons-disease/