Cluster analysis of cognitive performance in a sample of patients with Parkinson's disease
Carolina Pinto Souza; Guiomar Nascimento Oliveira; Maria Paula Foss; Vitor Tumas
keywords: Parkinson's disease, cognitive impairment, dementia, mild cognitive impairment, cluster analysis.
BACKGROUND: Cognitive impairment is a common feature of Parkinson's disease (PD). The diagnoses of mild cognitive impairment (MCI) in patients with PD implies an increased risk for later development of dementia, however, it is unclear whether a specific type of cognitive loss confers increased risk for faster cognitive decline.
OBJECTIVE: Determine whether it was possible to identify distinct cognitive phenotypes in a sample of patients with PD.
METHODS: A cross-sectional evaluation of 100 patients with PD recruited from a movement disorders clinic was conducted. The patients were evaluated using the simplified motor score of the UPDRS, the Hoehn and Yahr, Schwab and England, Geriatric Depression Scale, Pfeffer Functional Activities Questionnaire, Clinical Dementia Rating Scale, Mini-Mental State Examination, clock drawing test, digit span, word list battery of CERAD, Frontal Assessment Battery and verbal fluency test. We classified the patients as having normal cognition (PDNC), MCI (PDMCI) or dementia (PDD). Data were analyzed using the chi-square test, non-parametric statistics and cluster analysis.
RESULTS: There were 40 patients with PDD, 39 with PDMCI and 21 with PDNC. Patients with PDD were older, had longer disease duration, lower education and lower MMSE scores. Cluster analysis showed 3 general distinct cognitive profiles that represented a continuum from mild to severe impairment of cognition, without distinguishing specific cognitive profiles.
CONCLUSION: Cognitive impairment in PD occurs progressively and heterogeneously in most patients. It is unclear whether the definition of the initial phenotype of cognitive loss can be used to establish the cognitive prognosis of patients.