Objective: To evaluate executive function across cognitive stages of Parkinson’s disease and examine its association with functional impairment.

Background: Executive dysfunction is one of the most common cognitive impairments in Parkinson’s disease (PD) and may contribute to loss of independence in daily activities. Instrumental activities of daily living (IADL) are an important marker of functional decline in neurodegenerative disorders. However, the contribution of executive dysfunction to functional impairment in PD remains unclear.

Method: This cross-sectional study included patients with Parkinson’s disease spectrum attending a tertiary neurology center in Jakarta, Indonesia. Executive function was assessed using Trail Making Test A (TMT-A), Trail Making Test B (TMT-B), verbal fluency, and Clock Drawing Test (CDT). Global cognition was evaluated using the Montreal Cognitive Assessment Indonesia version (MoCA-Ina). Executive dysfunction was defined as impairment in at least two executive tests. Functional status was assessed using the Functional Activities Questionnaire (FAQ) and Instrumental Activities of Daily Living (IADL). Group differences were analyzed using Kruskal–Wallis tests, Spearman correlations, and logistic regression.

Results: A total of 57 patients were included (mean age 67.7 ± 8.6 years; 78.9% male). Based on cognitive classification, 10 patients (17.5%) had PD-MCI and 47 (82.5%) had Parkinson’s disease dementia (PDD). Executive dysfunction was present in 77.2% of participants. Significant differences were observed across cognitive stages for TMT-A completion time (p = 0.011), verbal fluency (p = 0.013), and CDT scores (p = 0.029). Executive function correlated with global cognition, including TMT-A (r = −0.524, p < 0.001), verbal fluency (r = 0.680, p < 0.001), and CDT (r = −0.813, p < 0.001). Patients with executive dysfunction had higher odds of functional impairment measured by FAQ (OR 6.0, 95% CI 1.54–23.33; p = 0.010), with similar associations for IADL impairment (p = 0.035).

Conclusion: Executive dysfunction is highly prevalent across the Parkinson’s disease spectrum and is strongly associated with impairment in everyday functioning. Early identification of executive deficits may help identify patients at risk for loss of independence.

References: 1. Bode M, Kalbe E, Liepelt-Scarfone I. Cognition and Activity of Daily Living Function in people with Parkinson’s disease. Journal of Neural Transmission. 2024 Oct;131(10):1159-86.
2. Foster ER, Doty T. Cognitive correlates of instrumental activities of daily living performance in Parkinson disease without dementia. Archives of rehabilitation research and clinical translation. 2021 Sep 1;3(3):100138.
3. Becker S, Boettinger O, Sulzer P, Hobert MA, Brockmann K, Maetzler W, Berg D, Liepelt-Scarfone I, Alzheimer’s Disease Neuroimaging Initiative. Everyday function in Alzheimer’s and Parkinson’s patients with mild cognitive impairment. Journal of Alzheimer’s Disease. 2021 Jan 5;79(1):197-209.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/executive-dysfunction-as-a-determinant-of-functional-impairment-in-parkinsons-disease/