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Original Articles
Fasting Plasma Glucose Levels and Longitudinal Motor and Cognitive Outcomes in Parkinson’s Disease Patients
Ko-Eun Choi, Dong-Woo Ryu, Yoon-Sang Oh, Joong-Seok Kim
J Mov Disord. 2024;17(2):198-207.   Published online March 6, 2024
DOI: https://doi.org/10.14802/jmd.23264
  • 629 View
  • 35 Download
AbstractAbstract PDFSupplementary Material
Objective
Hyperglycemia and diabetes mellitus have been identified as poor prognostic factors for motor and nonmotor outcomes in patients with Parkinson’s disease (PD), although there is some controversy with this finding. In the present study, we investigated the effects of fasting plasma glucose (FPG) levels on longitudinal motor and cognitive outcomes in PD patients.
Methods
We included a total of 201 patients who were diagnosed with PD between January 2015 and January 2020. The patients were categorized based on FPG level into euglycemia (70 mg/dL < FPG < 100 mg/dL), intermediate glycemia (100 mg/dL ≤ FPG < 126 mg/dL), and hyperglycemia (FPG ≥ 126 mg/dL), and longitudinal FPG trajectories were analyzed using group-based trajectory modeling. Survival analysis was conducted to determine the time until motor outcome (Hoehn and Yahr stage ≥ 2) and the conversion from normal cognition to mild cognitive impairment.
Results
Among the patient cohort, 82 had euglycemia, 93 had intermediate glycemia, and 26 had hyperglycemia. Intermediate glycemia (hazard ratio 1.747, 95% confidence interval [CI] 1.083–2.816, p = 0.0221) and hyperglycemia (hazard ratio 3.864, 95% CI 1.996–7.481, p < 0.0001) were found to be significant predictors of worsening motor symptoms. However, neither intermediate glycemia (hazard ratio 1.183, 95% CI 0.697–2.009, p = 0.5339) nor hyperglycemia (hazard ratio 1.297, 95% CI 0.601–2.800, p = 0.5078) demonstrated associations with the longitudinal progression of cognitive impairment. Diabetes mellitus, defined by self-reported medical history, was not related to poor motor or cognitive impairment outcomes.
Conclusion
Our results suggest that both impaired glucose tolerance and hyperglycemia could be associated with motor progression in PD patients.
Comparing Montreal Cognitive Assessment Performance in Parkinson’s Disease Patients: Age- and Education-Adjusted Cutoffs vs. Machine Learning
Kyeongmin Baek, Young Min Kim, Han Kyu Na, Junki Lee, Dong Ho Shin, Seok-Jae Heo, Seok Jong Chung, Kiyong Kim, Phil Hyu Lee, Young H. Sohn, Jeehee Yoon, Yun Joong Kim
J Mov Disord. 2024;17(2):171-180.   Published online February 13, 2024
DOI: https://doi.org/10.14802/jmd.23271
  • 737 View
  • 65 Download
AbstractAbstract PDFSupplementary Material
Objective
The Montreal Cognitive Assessment (MoCA) is recommended for general cognitive evaluation in Parkinson’s disease (PD) patients. However, age- and education-adjusted cutoffs specifically for PD have not been developed or systematically validated across PD cohorts with diverse education levels.
Methods
In this retrospective analysis, we utilized data from 1,293 Korean patients with PD whose cognitive diagnoses were determined through comprehensive neuropsychological assessments. Age- and education-adjusted cutoffs were formulated based on 1,202 patients with PD. To identify the optimal machine learning model, clinical parameters and MoCA domain scores from 416 patients with PD were used. Comparative analyses between machine learning methods and different cutoff criteria were conducted on an additional 91 consecutive patients with PD.
Results
The cutoffs for cognitive impairment decrease with increasing age within the same education level. Similarly, lower education levels within the same age group correspond to lower cutoffs. For individuals aged 60–80 years, cutoffs were set as follows: 25 or 24 years for those with more than 12 years of education, 23 or 22 years for 10–12 years, and 21 or 20 years for 7–9 years. Comparisons between age- and education-adjusted cutoffs and the machine learning method showed comparable accuracies. The cutoff method resulted in a higher sensitivity (0.8627), whereas machine learning yielded higher specificity (0.8250).
Conclusion
Both the age- and education-adjusted cutoff methods and machine learning methods demonstrated high effectiveness in detecting cognitive impairment in PD patients. This study highlights the necessity of tailored cutoffs and suggests the potential of machine learning to improve cognitive assessment in PD patients.
Review Article
Subjective Cognitive Complaints in Cognitively Normal Patients With Parkinson’s Disease: A Systematic Review
Jin Yong Hong, Phil Hyu Lee
J Mov Disord. 2023;16(1):1-12.   Published online November 10, 2022
DOI: https://doi.org/10.14802/jmd.22059
  • 3,467 View
  • 322 Download
  • 5 Web of Science
  • 8 Crossref
AbstractAbstract PDF
Subjective cognitive complaints (SCCs) refer to self-perceived cognitive decline and are related to objective cognitive decline. SCCs in cognitively normal individuals are considered a preclinical sign of subsequent cognitive impairment due to Alzheimer’s disease, and SCCs in cognitively normal patients with Parkinson’s disease (PD) are also gaining attention. The aim of this review was to provide an overview of the current research on SCCs in cognitively normal patients with PD. A systematic search found a lack of consistency in the methodologies used to define and measure SCCs. Although the association between SCCs and objective cognitive performance in cognitively normal patients with PD is controversial, SCCs appear to be predictive of subsequent cognitive decline. These findings support the clinical value of SCCs in cognitively normal status in PD; however, further convincing evidence from biomarker studies is needed to provide a pathophysiological basis for these findings. Additionally, a consensus on the definition and assessment of SCCs is needed for further investigations.

Citations

Citations to this article as recorded by  
  • Subjective Cognitive Complaints in Parkinson's Disease: A Systematic Review and Meta‐Analysis
    Mattia Siciliano, Alessandro Tessitore, Francesca Morgante, Jennifer G. Goldman, Lucia Ricciardi
    Movement Disorders.2024; 39(1): 17.     CrossRef
  • Mild cognitive impairment in Parkinson's disease: current view
    Kurt A. Jellinger
    Frontiers in Cognition.2024;[Epub]     CrossRef
  • Neurocognitive Impairment and Social Cognition in Parkinson’s Disease Patients
    Triantafyllos Doskas, Konstantinos Vadikolias, Konstantinos Ntoskas, George D. Vavougios, Dimitrios Tsiptsios, Polyxeni Stamati, Ioannis Liampas, Vasileios Siokas, Lambros Messinis, Grigorios Nasios, Efthimios Dardiotis
    Neurology International.2024; 16(2): 432.     CrossRef
  • Cognitive disorders in Parkinson's disease
    Victor Kholin, Iryna Karaban, Sergiy Kryzhanovskiy, Nina Karasevich, Natalia Melnik, Maryna Khodakovska, Hanna Shershanova, Natalia Movchun
    Ageing & Longevity.2024; (2 2024): 51.     CrossRef
  • Association of Neuropsychiatric Symptom Profiles With Cognitive Decline in Patients With Parkinson Disease and Mild Cognitive Impairment
    Young-gun Lee, Mincheol Park, Seong Ho Jeong, Kyoungwon Baik, Sungwoo Kang, So Hoon Yoon, Han Kyu Na, Young H. Sohn, Phil Hyu Lee
    Neurology.2023;[Epub]     CrossRef
  • Subjective cognitive complaints in patients with progressive supranuclear palsy
    Jun Seok Lee, Jong Hyeon Ahn, Jong Mok Ha, Jinyoung Youn, Jin Whan Cho
    Frontiers in Neurology.2023;[Epub]     CrossRef
  • Daily Emotional Experiences in Persons with Parkinson Disease: Relations to Subjective Cognitive Complaints and Quality of Life
    Karen R. Hebert, Mackenzie Feldhacker
    Physical & Occupational Therapy In Geriatrics.2023; : 1.     CrossRef
  • Pathobiology of Cognitive Impairment in Parkinson Disease: Challenges and Outlooks
    Kurt A. Jellinger
    International Journal of Molecular Sciences.2023; 25(1): 498.     CrossRef
Original Articles
Accuracy of Machine Learning Using the Montreal Cognitive Assessment for the Diagnosis of Cognitive Impairment in Parkinson’s Disease
Junbeom Jeon, Kiyong Kim, Kyeongmin Baek, Seok Jong Chung, Jeehee Yoon, Yun Joong Kim
J Mov Disord. 2022;15(2):132-139.   Published online May 26, 2022
DOI: https://doi.org/10.14802/jmd.22012
  • 3,166 View
  • 137 Download
  • 1 Crossref
AbstractAbstract PDFSupplementary Material
Objective
The Montreal Cognitive Assessment (MoCA) is recommended for assessing general cognition in Parkinson’s disease (PD). Several cutoffs of MoCA scores for diagnosing PD with cognitive impairment (PD-CI) have been proposed, with varying sensitivity and specificity. This study investigated the utility of machine learning algorithms using MoCA cognitive domain scores for improving diagnostic performance for PD-CI.
Methods
In total, 2,069 MoCA results were obtained from 397 patients with PD enrolled in the Parkinson’s Progression Markers Initiative database with a diagnosis of cognitive status based on comprehensive neuropsychological assessments. Using the same number of MoCA results randomly sampled from patients with PD with normal cognition or PD-CI, discriminant validity was compared between machine learning (logistic regression, support vector machine, or random forest) with domain scores and a cutoff method.
Results
Based on cognitive status classification using a dataset that permitted sampling of MoCA results from the same individual (n = 221 per group), no difference was observed in accuracy between the cutoff value method (0.74 ± 0.03) and machine learning (0.78 ± 0.03). Using a more stringent dataset that excluded MoCA results (n = 101 per group) from the same patients, the accuracy of the cutoff method (0.66 ± 0.05), but not that of machine learning (0.74 ± 0.07), was significantly reduced. Inclusion of cognitive complaints as an additional variable improved the accuracy of classification using the machine learning method (0.87–0.89).
Conclusion
Machine learning analysis using MoCA domain scores is a valid method for screening cognitive impairment in PD.

Citations

Citations to this article as recorded by  
  • Comparing Montreal Cognitive Assessment Performance in Parkinson’s Disease Patients: Age- and Education-Adjusted Cutoffs vs. Machine Learning
    Kyeongmin Baek, Young Min Kim, Han Kyu Na, Junki Lee, Dong Ho Shin, Seok-Jae Heo, Seok Jong Chung, Kiyong Kim, Phil Hyu Lee, Young H. Sohn, Jeehee Yoon, Yun Joong Kim
    Journal of Movement Disorders.2024; 17(2): 171.     CrossRef
Constipation is Associated With Mild Cognitive Impairment in Patients With de novo Parkinson’s Disease
Sung Hoon Kang, Jungyeun Lee, Seong-Beom Koh
J Mov Disord. 2022;15(1):38-42.   Published online November 17, 2021
DOI: https://doi.org/10.14802/jmd.21074
  • 4,324 View
  • 317 Download
  • 2 Web of Science
  • 3 Crossref
AbstractAbstract PDF
Objective
The association between gastrointestinal (GI) symptoms and cognitive profile in patients with Parkinson’s disease (PD) at diagnosis remains unclear, although GI symptoms and cognitive impairment are highly prevalent in patients with PD. We investigated the relationship between constipation and cognitive status. We also aimed to identify the correlation between constipation and each neuropsychological dysfunction.
Methods
A total of 427 patients with de novo Parkinson’s disease with normal cognition (PD-NC, n = 170) and Parkinson’s disease with mild cognitive impairment (PD-MCI, n = 257) at Korea University Guro Hospital in Seoul, Korea were included. All patients underwent comprehensive neuropsychological tests and completed the Non-Motor Symptoms Scale (NMSS). The frequency and severity of constipation were assessed using the NMSS GI symptoms scale, we used logistic regression analysis and partial correlation analysis to determine the associations between constipation score, MCI, and each neuropsychological dysfunction.
Results
Frequent and severe constipation was associated with MCI in patients with PD at diagnosis regardless of disease severity. Specifically, constipation was related to poor performance in frontal-executive and visuospatial functions after controlling for age and sex.
Conclusion
Our findings may provide an understanding of constipation as a marker associated with cognitive impairment in individuals with PD. Therefore, the evaluation of cognitive function is warranted in PD patients with constipation, while further studies are necessary to investigate the detailed mechanism of our results.

Citations

Citations to this article as recorded by  
  • Defecation after magnesium supplementation enhances cognitive performance in triathletes
    Chen-Chan Wei, M. Brennan Harris, Mengxin Ye, Andrew Nicholls, Ahmad Alkhatib, Luthfia Dewi, Chi-Yang Huang, Chia-Hua Kuo
    Sports Medicine and Health Science.2024;[Epub]     CrossRef
  • Constipation in Parkinson's Disease
    Eamonn M. M. Quigley
    Seminars in Neurology.2023; 43(04): 562.     CrossRef
  • Interactions between gut microbiota and Parkinson's disease: The role of microbiota-derived amino acid metabolism
    Wang Wang, Shujun Jiang, Chengcheng Xu, Lili Tang, Yan Liang, Yang Zhao, Guoxue Zhu
    Frontiers in Aging Neuroscience.2022;[Epub]     CrossRef
Increased Mortality in Young-Onset Parkinson’s Disease
Eldbjørg Hustad, Tor Åge Myklebust, Sasha Gulati, Jan O. Aasly
J Mov Disord. 2021;14(3):214-220.   Published online July 29, 2021
DOI: https://doi.org/10.14802/jmd.21029
  • 22,001 View
  • 318 Download
  • 8 Web of Science
  • 8 Crossref
AbstractAbstract PDF
Objective
Few studies have followed Parkinson’s disease (PD) patients from the time of diagnosis to the date of death. This study compared mortality in the Trondheim PD cohort to the general population, investigated causes of death and analyzed the associations between mortality and age at disease onset (AAO) and cognitive decline defined as Montreal Cognitive Assessment (MoCA) score below 26.
Methods
The cohort was followed longitudinally from 1997. By the end of January 2020, 587 patients had died. Comparisons to the Norwegian population were performed by calculating standardized mortality ratios (SMRs). Survival curves were estimated using the standard Kaplan-Meier estimator, and multivariable Cox proportional hazard models were estimated to investigate associations.
Results
SMR was 2.28 [95% confidence interval (CI): 2.13–2.44] for the whole cohort. For participants with AAO 20–39 years, the SMR was 5.55 (95% CI: 3.38–8.61). Median survival was 15 years (95% CI: 14.2–15.5) for the whole cohort. Early-onset PD (EOPD) patients (AAO < 50 years) had the longest median survival time. For all groups, there was a significant shortening in median survival time and an almost 3-fold higher age- and sex-adjusted hazard ratio for death when the MoCA score decreased below 26.
Conclusion
PD patients with an AAO before 40 years had a more than fivefold higher mortality rate compared to a similar general population. EOPD patients had the longest median survival; however, their life expectancy was reduced to a greater degree than that of late-onset PD patients. Cognitive impairment was strongly associated with mortality in PD.

Citations

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  • Tinetti balance performance is associated with mortality in older adults with late-onset Parkinson’s disease: a longitudinal study
    Louise Laurent, Pierre Koskas, Janina Estrada, Mélanie Sebbagh, Sophie Lacaille, Agathe Raynaud-Simon, Matthieu Lilamand
    BMC Geriatrics.2023;[Epub]     CrossRef
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    Environment International.2023; 173: 107852.     CrossRef
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    Movement Disorders Clinical Practice.2023;[Epub]     CrossRef
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    Frontiers in Pharmacology.2022;[Epub]     CrossRef
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    R. M. Y. Wong, R. W. K. Ng, W. W. Chau, W. H. Liu, S. K. H. Chow, C. Y. Tso, N. Tang, W.-H. Cheung
    Osteoporosis International.2022; 33(10): 2185.     CrossRef
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    Matthew J. Farrer
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The MMSE and MoCA for Screening Cognitive Impairment in Less Educated Patients with Parkinson’s Disease
Ji In Kim, Mun Kyung Sunwoo, Young H. Sohn, Phil Hyu Lee, Jin Y. Hong
J Mov Disord. 2016;9(3):152-159.   Published online September 21, 2016
DOI: https://doi.org/10.14802/jmd.16020
  • 20,761 View
  • 406 Download
  • 37 Web of Science
  • 38 Crossref
AbstractAbstract PDF
Objective
To explore whether the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) can be used to screen for dementia or mild cognitive impairment (MCI) in less educated patients with Parkinson’s disease (PD).
Methods
We reviewed the medical records of PD patients who had taken the Korean MMSE (K-MMSE), Korean MoCA (K-MoCA), and comprehensive neuropsychological tests. Predictive values of the K-MMSE and K-MoCA for dementia or MCI were analyzed in groups divided by educational level.
Results
The discriminative powers of the K-MMSE and K-MoCA were excellent [area under the curve (AUC) 0.86–0.97] for detecting dementia but not for detecting MCI (AUC 0.64–0.85). The optimal screening cutoff values of both tests increased with educational level for dementia (K-MMSE < 15 for illiterate, < 20 for 0.5–3 years of education, < 23 for 4–6 years, < 25 for 7–9 years, and < 26 for 10 years or more; K-MoCA < 7 for illiterate, < 13 for 0.5–3 years, < 16 for 4–6 years, < 19 for 7–9 years, < 20 for 10 years or more) and MCI (K-MMSE < 19 for illiterate, < 26 for 0.5–3 years, < 27 for 4–6 years, < 28 for 7–9 years, and < 29 for 10 years or more; K-MoCA < 13 for illiterate, < 21 for 0.5–3 years, < 23 for 4–6 years, < 25 for 7–9 years, < 26 for 10 years or more).
Conclusion
Both MMSE and MoCA can be used to screen for dementia in patients with PD, regardless of educational level; however, neither test is sufficient to discriminate MCI from normal cognition without additional information.

Citations

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    Kyeongmin Baek, Young Min Kim, Han Kyu Na, Junki Lee, Dong Ho Shin, Seok-Jae Heo, Seok Jong Chung, Kiyong Kim, Phil Hyu Lee, Young H. Sohn, Jeehee Yoon, Yun Joong Kim
    Journal of Movement Disorders.2024; 17(2): 171.     CrossRef
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    Na-Young Shin, Bo-Hyun Kim, Eunkyeong Yun, Uicheul Yoon, Jong-Min Lee, Young Hee Sung, Eung Yeop Kim
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    Journal of Movement Disorders.2020; 13(3): 205.     CrossRef
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  • Pesticide exposure and cognitive decline in a rural South Korean population
    Jae-Yeop Kim, Sung-jin Park, Sung-Kyung Kim, Chang-Soo Kim, Tae-Hei Kim, Seong-Ho Min, Sung-Soo Oh, Sang-Baek Koh, Stephen D. Ginsberg
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  • Cut-off points of the Portuguese version of the Montreal Cognitive Assessment for cognitive evaluation in Parkinson’s disease
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Correlation of Sleep Disturbance and Cognitive Impairment in Patients with Parkinson’s Disease
Eun Ja Kim, Joon Hyun Baek, Dong Jin Shin, Hyeon-Mi Park, Yeong-Bae Lee, Kee-Hyung Park, Dong Hoon Shin, Young Noh, Young Hee Sung
J Mov Disord. 2014;7(1):13-18.   Published online April 30, 2014
DOI: https://doi.org/10.14802/jmd.14003
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AbstractAbstract PDF
Objective: Cognitive impairment is a common nonmotor symptom of Parkinson’s disease (PD) and is associated with high mortality, caregiver distress, and nursing home placement. The risk factors for cognitive decline in PD patients include advanced age, longer disease duration, rapid eye movement sleep behavior disorder, hallucinations, excessive daytime sleepiness, and nontremor symptoms including bradykinesia, rigidity, postural instability, and gait disturbance. We conducted a cross-sectional study to determine which types of sleep disturbances are related to cognitive function in PD patients.
Methods: A total of 71 PD patients (29 males, mean age 66.46 ± 8.87 years) were recruited. All patients underwent the Mini- Mental State Examination (MMSE) and the Korean Version of the Montreal Cognitive Assessments (MoCA-K) to assess global cognitive function. Sleep disorders were evaluated with the Stanford Sleepiness Scale, Epworth Sleepiness Scale, Insomnia Severity Index (ISI), Pittsburg Sleep Quality Index, and Parkinson’s Disease Sleep Scale in Korea (PDSS).
Results: The ISI was correlated with the MMSE, and total PDSS scores were correlated with the MMSE and the MoCA-K. In each item of the PDSS, nocturnal restlessness, vivid dreams, hallucinations, and nocturnal motor symptoms were positively correlated with the MMSE, and nocturnal restlessness and vivid dreams were significantly related to the MoCA-K. Vivid dreams and nocturnal restlessness are considered the most powerful correlation factors with global cognitive function, because they commonly had significant correlation to cognition assessed with both the MMSE and the MoCA-K.

Conclusions: We found a correlation between global cognitive function and sleep disturbances, including vivid dreams and nocturnal restlessness, in PD patients.

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The Characteristics of Cognitive Impairment in Parkinson’s Disease and Recognition of Cognitive Symptom by Questionnaire
Hee Young Shin, Won Yong Lee, Kun-Woo Park
J Mov Disord. 2008;1(1):38-46.
DOI: https://doi.org/10.14802/jmd.08007
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AbstractAbstract PDF
Objective:

Parkinson’s disease (PD) is characterized by motor and non-motor symptoms including cognitive, autonomic, sleep, and sensory disturbances. Cognitive impairment may occur in up to 80% of PD patients, and dementia in approximately 30%. The purpose of this study is to evaluate the frequency of cognitive impairment and the characteristics of cognitive deficits and to know the possibility of early detection of cognitive deficits in outpatient clinics with the questionnaire for patients and caregivers.

Methods:

A total of 129 consecutive patients with idiopathic Parkinson’s disease were visited movement clinic from March 2006 to August 2006. Eighty-five patients performed cognitive test and questionnaires. All patients had motor symptoms with Hoehn and Yahr stage 0.5 to 3 (mean: 1.98±0.617), and evaluated with cognition by K-MMSE (Korean version of Mini-mental status examination), 7-MS (7-minutes screen test), and demographic features.

Results:

The frequency of cognitive impairment in PD patients was 44.7% (38/85), among them thirty (78.9%) patients complained memory disturbance. The characteristics of cognitive test were retrieval defect in memory, visuospatial dysfunction and categorical word fluency. With questionnaire, the complaint of memory decline and difficulties in activity of daily living (ADL) w ere important points of cognitive deficit in PD patients. However questionnaire did not showed significant correlation between complain of memory decline and cognitive deficit, only regular check with cognitive function test revealed the patient’s early cognitive impairment.

Conclusions:

The cognitive impairment was frequent in PD patients. The characteristics of cognitive testing w ere retrieval defect in memory function and frontal executive dysfunction.

Mild Cognitive Impairment in Parkinson’s Disease
Jae Woo Kim, Hee Young Jo, Min Jeong Park, Sang-Myung Cheon
J Mov Disord. 2008;1(1):19-25.
DOI: https://doi.org/10.14802/jmd.08004
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AbstractAbstract PDF
Background

To determine the frequency of mild cognitive impairment (MCI) of Parkinson’s disease (PD, PDMCI) and its subtypes among non-demented PD patients, and to identify the influence of the age and presenting symptom on the development of PDMCI.

Methods:

A total 141 non-demented PD patients underwent a comprehensive neuropsychological assessment including attention, language, visuospatial, memory and frontal functions. PDMCI was defined by neuropsychological testing and was classified into five subtypes. Patients were divided into two groups (tremor vs. akinetic-rigid type) for presenting symptom and three groups according to the age. Neuropsychological performance of patients was compared with normative data.

Results:

Almost half (49.6%) of non-demented PD patients had impairment in at least one domain and can be considered as having PDMCI. Executive type of PDMCI was the most frequent and amnestic, visuospatial, linguistic and attention types followed in the order of frequency. The population of PDMCI was increasing as the age of disease onset was higher. Whereas the frequency of executive and amnestic types of PDMCI was comparable in younger group, executive type was the most frequent in older group. The patients with tremor dominant type performed worse on tests, particularly on attention test.

Conclusions:

MCI was common even in the early stage of PD and the subtype was diverse. Unlike MCI developing Alzheimer’s disease later, executive type of PDMCI was the most common. Age was an important risk factor for development of MCI in PD. The concept of MCI should be introduced in PD.

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