Abstract
ObjectiveAnxiety, depression, and apathy are the most common neuropsychiatric symptoms in Parkinson's disease (PD) patients. They impair cognitive functioning and have a profound impact on quality of life. This follow-up study aims to investigate the predictive value of anxiety, depression, and apathy on the development of Mild Cognitive Impairment (MCI) in PD patients.MethodsTwenty-nine cognitively unimpaired PD patients (mean age 68.2 SD ± 7.12 years; 13 women) participated in this study. At Baseline (BL) levels of apathy (Apathy Evaluation Scale, AES), depression (Beck Depression Inventory, BDI-II), and anxiety (Beck Anxiety Inventory, BAI), were assessed. Cognitive status was reassessed three years later according to MCI/non-MCI status. For statistics, we used binary logistic regression and receiver operating characteristic curve (ROC) analysis to examine anxiety, apathy, and depression at BL as a predictor of MCI status three years later.ResultsEight of the 29 patients developed MCI. Anxiety level at BL was found to predict MCI status at three-year follow-up (OR = 1.20, CI = 1.02–1.41, p = 0.02), while depression (OR = 1.16, CI = 0.93–1.47, p = 0.20) and apathy (OR = 1.06, CI = 0.92–1.23, p = 0.40) did not predict MCI status. The area under the ROC curve (AUC) of BAI for discriminating PD-non-MCI from PD-MCI was 0.79 (CI = 0.61–0.98). The optimal classification threshold yielded a sensitivity of 75.0 % and a specificity of 76.2 %. Neither apathy nor depression at BL discriminated between PD-non-MCI patients from PD-MCI three years later.ConclusionsThis study shows an association between anxiety and the development of MCI in PD patients, although the association between apathy, depression, and MCI did not reach a significant level.
Highlights
Non-motor symptoms (NMS) in patients with Parkinson’s disease (PD), such as neuropsychiatric symptoms, sleep disturbances, autonomic dysfunctions, and sensory impairments, can occur more than a decade before the onset of motor symptoms
This study aims to investigate whether future development of mild cognitive impairment (MCI) is predicted by Baseline (BL) levels of anxiety, depression and/or apathy in a longitudinal study [2]
Patients were excluded if they had MCI, based on the Movement Society Task Force Level II criteria according to Litvan et al [5] insufficient knowledge of the German language, severe neurological disease other than PD
Summary
Non-motor symptoms (NMS) in patients with Parkinson’s disease (PD), such as neuropsychiatric symptoms, sleep disturbances, autonomic dysfunctions, and sensory impairments, can occur more than a decade before the onset of motor symptoms They progress slowly; and, may add up to a major disability. NMS are common in all stages of Parkinson’s disease [1] Often they have a greater impact on the quality of life of patients and caregivers than motor symptoms [2, 3]. As another NMS, ∼27 to 53% of PD patients develop mild cognitive impairment (MCI), which is defined as an intermediate stage between unimpaired cognition and the state of dementia [4]. Anxiety may have a greater impact on the quality of life than depression and apathy [7]
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