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. 2023 Oct;13(10):e3218.
doi: 10.1002/brb3.3218. Epub 2023 Aug 13.

Longitudinal follow up of data-driven cognitive subtypes in Parkinson's disease

Dana Pourzinal  1 , Jihyun Yang  1 , Kumareshan Sivakumaran  1 , Katie L McMahon  2 , Leander Mitchell  3 , John D O'Sullivan  1   4 , Gerard J Byrne  1   5 , Nadeeka N Dissanayaka  1   3   4
Affiliations

Longitudinal follow up of data-driven cognitive subtypes in Parkinson's disease

Dana Pourzinal et al. Brain Behav. 2023 Oct.

Abstract

Aim: The dual syndrome hypothesis proposes that there are two cognitive subtypes in Parkinson's disease (PD): a frontal subtype with executive/attention impairment and gradual cognitive decline, and a posterior-cortical subtype with memory/visuospatial deficits and rapid cognitive decline. We aimed to compare the rate of global cognitive decline between subtypes derived using data-driven methods and explore their longitudinal performance within specific cognitive domains to better understand the prognosis of each subtype.

Method: Frontal, posterior-cortical, globally impaired, and cognitively intact PD subtypes were identified at baseline using k-means clustering (N = 85), and 29 participants (34%) returned for follow-up assessments on average 4.87 years from baseline. Linear mixed effects models compared progression of subtypes on global cognition; psychological symptoms; parkinsonism; and the memory, attention, executive, language, and visuospatial cognitive domains.

Results: The frontal subtype was lost to attrition. While rate of change in parkinsonism, anxiety, and apathy differed between subtypes, there was no difference in the rate of global cognitive decline. However, the posterior-cortical subtype declined most rapidly in verbal memory, card sorting, trail making, and judgement of line orientation (JLO), while the cognitively intact group declined most rapidly on verbal memory and semantic fluency. The globally impaired subtype declined most rapidly in JLO, although this should be interpreted with caution due to high attrition.

Conclusion: Despite limited sample size, the present study supports the differential progression of the posterior-cortical subtype compared to cognitively intact and globally impaired PD. These results encourage further, large-scale longitudinal investigations of cognitive subtypes in PD.

Keywords: Parkinson's disease; clinical neuropsychology; cognitive impairment; mild cognitive impairment.

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Conflict of interest statement

The authors declare no conflicts of interests.

Figures

FIGURE 1
FIGURE 1
Recruitment flowchart indicating reasons for attrition.
FIGURE 2
FIGURE 2
Change in global cognition over time by subtype.
FIGURE 3
FIGURE 3
Change in depression, anxiety, apathy and parkinsonism measures over time by subtype. GDS, Geriatric Depression Scale; PAS, Parkinson's Anxiety Scale; SAS, Starkstein Apathy Scale; UPDRS, Movement Disorders Society Unified Parkinson's Disease Rating Scale.
FIGURE 4
FIGURE 4
Change in memory domain measures over time by subtype.
FIGURE 5
FIGURE 5
Change in language domain measures over time by subtype.
FIGURE 6
FIGURE 6
Change in attention domain measures over time by subtype.
FIGURE 7
FIGURE 7
Change in executive domain measures over time by subtype.
FIGURE 8
FIGURE 8
Change in visuospatial domain measures over time by subtype.
See this image and copyright information in PMC

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