Associations Between Cognitive Functions and Physical Frailty in Patients With Parkinson's Disease.

Wei-Che Lin,Hsiu-Ling Chen,Meng-Hsiang Chen,Cheng-Hsien Lu,Hui-Hsin Tso,Nai-Wen Tsai,Chau-Peng Leong,Po-Cheng Chen,Yu-Chi Huang

doi:10.3389/fnagi.2019.00283

Abstract

Background: Parkinson’s disease (PD) is a neurodegenerative disease manifested by both motor and non-motor dysfunctions and co-existence of cognitive impairment and physical frailty is common. Given that research in this area is limited, a better understanding of associated factors with physical frailty could provide a focused screening method and facilitate early intervention in PD.Methods: Seventy-six patients with idiopathic PD were recruited and Fried’s criteria of physical frailty were used to group all participants. Comprehensive cognitive tests and clinical characteristics were measured, and univariate and multivariate analysis was performed to explore the relationship between clinical factors or neuropsychological functions.Results: Twenty-nine patients with PD (38%) exhibited physical frailty. Compared to PD patients without frailty, PD patients with frailty were older in age and demonstrated worse disease severity and poorer cognitive functions, including attention, executive function, memory, speech and language, and visuospatial function (p < 0.05). Further, stepwise logistic regression analysis revealed that disease severity by the Unified Parkinson’s Disease Rating Scale (UPDRS) total score (OR: 1.065; 95% CI: 1.033–1.099) and executive function (OR: 0.724; 95% CI: 0.581–0.877) were independent risk factors for predicting physical frailty (p = 0.003 and 0.002). The best cut-off points are 46 in UPDRS (sensitivity: 62.1%; specificity: 91.5%).Conclusions: Executive function impairment is an independent risk factor for the development of physical frailty with disease progression. Awareness of such comorbidity might provide a screening tool to facilitate investigation in their underlying etiology and early intervention for frailty prevention.

Highlights

Parkinson’s disease (PD) is one of the most common neurodegenerative diseases (de Lau and Breteler, 2006)
Since aging increases the risk of PD and the risk of developing dementia in PD is approximately five to six times greater than the general population (Hobson and Meara, 2004), we considered that a higher prevalence of cognitive dysfunction, in some specific domain deficits may be associated with a higher incidence of physical frailty in PD patients throughout the disease progression
The mean total scores of Unified Parkinson’s Disease Rating Scale (UPDRS) were significantly higher in PD patients with frailty

Summary

Introduction

Parkinson’s disease (PD) is one of the most common neurodegenerative diseases (de Lau and Breteler, 2006). In addition to physical frailty, non-motor symptoms, such as cognitive impairment and dementia, psychosis, mood disorders, and fatigue (Jankovic, 2008; Barone et al, 2009), are common comorbidities as the disease progresses. It is reasonable to suggest that the possible interaction between the decline in some of the motor and non-motor functions in PD may be important factors in physical frailty. It is important to identify the predicting factors for physical frailty in early stage PD and provide appropriate management to prevent further disease progression. Parkinson’s disease (PD) is a neurodegenerative disease manifested by both motor and non-motor dysfunctions and co-existence of cognitive impairment and physical frailty is common. Given that research in this area is limited, a better understanding of associated factors with physical frailty could provide a focused screening method and facilitate early intervention in PD

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