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Original Contribution |

Prognosis of Mild Cognitive Impairment in Early Parkinson Disease:  The Norwegian ParkWest Study

Kenn Freddy Pedersen, MD, PhD; Jan Petter Larsen, MD, PhD; Ole-Bjorn Tysnes, MD, PhD; Guido Alves, MD, PhD
JAMA Neurol. 2013;70(5):580-586. doi:10.1001/jamaneurol.2013.2110.
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Importance Mild cognitive impairment (MCI) is common in Parkinson disease (PD), but the prognostic value of MCI in early PD is unknown.

Objective To examine the course of MCI and its progression to dementia in an incident PD cohort.

Design Prospective longitudinal cohort study.

Setting The Norwegian ParkWest study, an ongoing population-based study of the incidence, neurobiology, and prognosis of PD in western and southern Norway.

Participants A population-based cohort of 182 patients with incident PD monitored for 3 years.

Main Outcomes and Measures Serial neuropsychological tests of attention, executive function, verbal memory, and visuospatial skills were administered at baseline, 1 year, and 3 years. Patients were classified as having MCI and received a diagnosis of dementia according to published consensus criteria.

Results Significantly more patients with MCI than without MCI at baseline (10 of 37 [27.0%] vs 1 of 145 [0.7%]; relative risk, 39.2 [95% CI, 5.2-296.5]; P < .001) progressed to dementia during follow-up. Of those with MCI at baseline, 8 of 37 (21.6%) had MCI that reverted to normal cognition during follow-up. Mild cognitive impairment at the 1-year visit was associated with a similar progression rate to dementia (10 of 36 patients [27.8%]) and reversion rate to normal cognition (7 of 36 [19.4%]). However, among the 22 patients with persistent MCI at baseline and the 1-year visit, 10 (45.5%) developed dementia and only 2 (9.1%) had MCI that reverted to normal cognition by the end of study.

Conclusions and Relevance Mild cognitive impairment at PD diagnosis predicts a highly increased risk for early dementia. Repeated neuropsychological testing increases the prognostic accuracy of MCI with respect to early dementia development in PD.

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Figure. Flowchart summarizing the number and outcome of follow-up assessments in the original ParkWest cohort. MCI indicates mild cognitive impairment; PD, Parkinson disease; and PDD, PD with dementia.

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