Abstract
BackgroundUnderstanding the longitudinal course of non-motor symptoms, and finding markers to predict cognitive decline in Parkinson’s disease (PD), are priorities. Previous work has demonstrated that apathy is one of the only behavioural symptoms that differentiates people with PD and intact cognition from those with mild cognitive impairment (MCI-PD). Other psychiatric symptoms emerge as dementia in PD develops.ObjectiveWe explored statistical models of longitudinal change to detect apathy as a behavioural predictor of cognitive decline in PD.MethodsWe followed 104 people with PD intermittently over 2 years, undertaking a variety of motor, behavioural and cognitive measures. We applied a linear mixed effects model to explore behavioural factors associated with cognitive change over time. Our approach goes beyond conventional modelling based on a random-intercept and slope approach, and can be used to examine the variability in measures within individuals over time.ResultsGlobal cognitive scores worsened during the two-year follow-up, whereas the longitudinal evolution of self-rated apathy scores and other behavioural measures was negligible. Level of apathy was negatively (− 0.598) correlated with level of cognitive impairment and participants with higher than average apathy scores at baseline also had poorer cognition. The model indicated that departure from the mean apathy score at any point in time was mirrored by a corresponding departure from average global cognitive score.ConclusionHigh levels of apathy are predictive of negative cognitive and behavioural outcomes over time, suggesting that apathy may be a behavioural indicator of early cognitive decline. This has clinical and prognostic implications.
Highlights
The syndrome of mild cognitive impairment in Parkinson’s disease (PD-MCI) occurs in approximately a quarter of people with PD [3, 57]
While it has been proposed that PD-MCI may remain stable, progress to Parkinson’s disease dementia (PDD) or revert back to PD with intact cognition [31], a recent study found that those who did revert back to having no cognitive impairment were still at higher risk of developing PD-MCI or PDD in the future [41]
Our primary outcome measures were PD-CRS, self-rated Apathy Scale and the apathy sub-scale of NPI. We modelled both the PD-CRS and self-rated Apathy scales as continuous outcomes, while the NPI apathy sub-score was modelled as a binary variable indicating a frequency × severity score greater than 0
Summary
The syndrome of mild cognitive impairment in Parkinson’s disease (PD-MCI) occurs in approximately a quarter of people with PD [3, 57]. Previous work has demonstrated that apathy is one of the only behavioural symptoms that differentiates people with PD and intact cognition from those with mild cognitive impairment (MCI-PD). Results Global cognitive scores worsened during the two-year follow-up, whereas the longitudinal evolution of self-rated apathy scores and other behavioural measures was negligible. Conclusion High levels of apathy are predictive of negative cognitive and behavioural outcomes over time, suggesting that apathy may be a behavioural indicator of early cognitive decline.
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