Objective: To study perceptions of cognitive function across ethnic groups by comparing a subjective rating with an objective assessment for patients with PD (PWP).

Background: Previous literature reports variation in cognition among different races. While the evidence for Asian PWP is mixed, Black and Hispanic PWP have higher rates of cognitive decline than White PWP [1]. Less awareness of cognitive impairment among Black and Hispanic populations may contribute to this disparity [2]. The Montreal Cognitive Assessment (MoCA) is a cognitive screen that is often used in PD populations, but can be influenced by factors such as age, education, and mood [3]. The Unified Parkinson’s Disease Rating Scale (UPDRS) Part 1 Item 1 asks participants to rate their intellectual impairment (0=none, 4=severe).

Method: Data from the Spot study at Columbia University Irving Medical Center was analyzed. Two ethnicity groups, 138 White and 138 non-White PWP (53 Black, 54 Asian, 31 Other), were matched by age and disease duration through logistic regression to estimate propensity scores and nearest neighbor matching. The Wilcoxon Rank-Sum Test was used to compare the distribution of total MoCA scores between ethnicities, as they did not have a normal distribution. Multiple linear regression was then used to study the relationship between total MoCA score and UPDRS Part 1 Item 1 score by ethnicity. Education, a potential confounder, was included as a covariate in this analysis.

Results: White PWP had significantly higher MoCA scores than non-White PWP (p<0.001) [Figure 1]. The linear regression model was significant overall (F(4,271)=17.22), p<0.001), with R²=0.1909. Education was a high predictor of MoCA scores (β=1.2, p<0.001) independent of ethnicity. With increasing UPDRS Item 1 scores, the MoCA scores of non-White PWP showed a steeper decline than White PWP (Non-White β=-1.84, p=0.0019; White β=0.04, p=0.93) [Figure 2].

Conclusion: White and non-White PWP perceived their cognitive changes differently. In non-White PWP, higher ratings of self-perceived cognitive dysfunction correlated with lower MoCA scores, whereas for White PWP higher ratings of self-perceived cognitive dysfunction did not correlate with a change in MoCA scores. Non-White PWP showed a higher concordance of self-reported cognitive changes with MoCA scores compared to White PWP. Further analysis is needed to explore potential factors contributing to these differences.

Figure 1: Total MoCA scores between ethnicities

Figure 2: MoCA and UPDRS between ethnicities.

References: [1] Jang Y, Haley WE, Choi EY, Franco Y. Racial/Ethnic Differences in Correspondence Between Subjective Cognitive Ratings and Cognitive Impairment. The American Journal of Geriatric Psychiatry. 2022;30(5):627-635. doi:10.1016/j.jagp.2021.10.015
[2] Bugallo-Carrera C, Dosil-Díaz C, Pereiro AX, Anido-Rifón L, Gandoy-Crego M. Factors that indicate performance on the MoCA 7.3 in healthy adults over 50 years old. BMC Geriatr. 2024;24:482. doi:10.1186/s12877-024-05102-1
[3] Ben-Joseph A, Marshall CR, Lees AJ, Noyce AJ. Ethnic Variation in the Manifestation of Parkinson’s Disease: A Narrative Review. Journal of Parkinson’s Disease. 2019;10(1):31-45. doi:10.3233/JPD-191763

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MDS Abstracts - https://www.mdsabstracts.org/abstract/variations-of-self-perceived-cognitive-changes-by-ethnicity-in-parkinsons-disease-patients/