Objective: To evaluate cognitive decline in people living with PD (PwP), to determine to which degree different neuropsychiatric symptoms are risk factors for cognitive decline by assessing the decrease in MoCA scores, and to explore the proportional relationship between the alteration in MoCA scores and the perceived cognitive impairment reported by PwP.

Background: Neuropsychiatric symptoms are key non-motor features in PD, often appearing before motor symptoms. Anxiety, depression, and apathy commonly co-occur with PD, potentially leading to cognitive decline and PD dementia, affecting the quality of life in PwP. [1] Anxiety, including panic attacks, and social anxiety, and apathy, marked by diminished interest, impact PwP’s well-being and cognitive function. [2]

Method: This observational, cross-sectional, analytical study enrolled Mexican PwP with at least two visits. Sociodemographic variables included age, gender, years of PD evolution, education, current medications, and socioeconomic status. Clinical assessment included the Mexican version of the Montreal Cognitive Assessment (v8.3), the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS), and MDS-MNS. Patients were stratified into two cohorts: (I) those exhibiting a decline in MoCA scores following their second visit, and (II) those maintaining stable MoCA scores post-second visit. Spearman correlation analysis was applied to explore the association between these cohorts and self-reported perceptions of cognitive deterioration among PD patients using the MDS-UPDRS.

Results: 109 PwP (56.8% males) were included. The mean age was 63.63±14.07 years, the mean PD evolution was 7.43±5.51 years, and the mean education was 10.53±4.72 years. MoCA total score was 21.57±4.75 points. The linear regression model showed statistical significance for schooling years (β=0.4043, p<0.001), age (β=-0.0930, p=0.006), and psychosis symptoms (β=-0.2388, p=0.011).

Conclusion: Our study highlights the significant impact of neuropsychiatric symptoms on cognitive performance in Mexican PwP. Specifically, we found that lower levels of education, older age, and the presence of psychosis symptoms were associated with poorer performance on the MoCA. These findings underscore the importance of considering neuropsychiatric symptoms in the assessment and management of cognitive decline in PwP.

References: 1.- Toloraia K, Meyer A, Beltrani S, Fuhr P, Lieb R, Gschwandtner U. Anxiety, Depression, and Apathy as Predictors of Cognitive Decline in Patients With Parkinson’s Disease-A Three-Year Follow-Up Study. Front Neurol. 2022 Feb 8;13:792830. doi: 10.3389/fneur.2022.792830. PMID: 35211081; PMCID: PMC8860828.

2.- Dujardin, K., Sockeel, P., Delliaux, M., Destée, A. and Defebvre, L. (2009), Apathy may herald cognitive decline and dementia in Parkinson’s disease†. Mov. Disord., 24: 2391-2397.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/exploring-the-root-of-cognitive-decline-in-people-living-with-parkinsons-disease-an-analysis-of-moca-scores-neuropsychiatric-symptoms-and-patient-reported-outcomes/