Objective: This study aimed to evaluate the prevalence of CI in a diverse group of patients with PD in Dhaka, Bangladesh. This study also aimed to compare the cultural fairness of standard cognitive instruments with newer alternatives in screening for CI.

Background: Cognitive impairment (CI) in Parkinson’s disease (PD) is a common non-motor symptom and 2.5 – 6 times more common in PD patients than in age matched healthy individuals. About 30% of newly diagnosed PD patients report subjective memory issues, while approximately 20% exhibit mild cognitive impairment (MCI) [1].

Method: The London-Dhaka Parkinson’s Cognition Study (LDCS) is a case-control study. Patients with a diagnosis of PD and healthy controls (HC) are recruited from Bangabandhu Sheikh Mujib Medical University Dhaka, Bangladesh. Data collection includes clinical and demographic information, questionnaires ((MDS-UPDRS, Hoehn & Yahr, CISI-PD, RBDSQ), CI assessment tools (MoCA, RUDAS, Clinical Dementia Rating-CDR, cats and dogs test), neuropsychiatric assessment scales (HADS, noise pareidolia test) and biospecimen collection (blood).

Results: In this study, we preliminarily analyzed 182 people with PD and 79 healthy controls (HC). The mean age (±SD) of PwP was 59.9 (±10.5) years and for controls was 53.6 (±10.6); (p<0.001). Among them, 130 (71.8%) patients and 41 (51.9%) HC were male (p=0.003). The average age at symptom onset for PD was 55.8 years (+10.6). The Bengali version of the MoCA median (±IQR) scores (out of 30) for patients with PD was 16 (±10.8) and for HC was 24(±6.5) respectively (p-value <0.001). CDR median (±IQR) scores for PD were 0.5 (±0.5) and for HC were 0 respectively (p-value <0.001). RUDAS median (±IQR) scores for PD were 22 (±8) and for HC 26(±4.5) respectively (p-value <0.001). Based on MoCA and CDR, 90.5% and 88.8% of Bangladeshi patients with PD and 57% and 18.2% HC would be categorized as having cognitive impairment (score less than 26 for MOCA and 0.5 or more for CDR) (p<0.001). However, based on the RUDAS 59.2% of Bangladeshi patients and 20.3% HC were categorized as having cognitive impairment (less than 22).

Conclusion: This study suggests that widely used cognitive impairment screening tests, even when conducted in Bengali, may underestimate cognitive abilities in specific populations. Improved screening tools are necessary for underrepresented groups.

References: Aarsland, D., Batzu, L., Halliday, G.M. et al. Parkinson disease-associated cognitive impairment. Nat Rev Dis Primers 7, 47 (2021). https://doi.org/10.1038/s41572-021-00280-3

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MDS Abstracts - https://www.mdsabstracts.org/abstract/assessment-of-cognitive-impairment-in-parkinsons-disease-in-bangladeshi-patients-in-dhaka-as-part-of-the-london-dhaka-parkinsons-cognition-study/