Home-Based Physical Behavior in Late Stage Parkinson Disease Dementia: Differences between Cognitive Subtypes

Area of Science:

• Neurology
• Gerontology
• Biomedical Engineering

Background:

• Early diagnosis of Parkinson disease dementia (PDD) requires objective home-based tools to detect early-stage dysfunction in activities of daily living (ADL).
• Current diagnostic methods may not adequately capture subtle functional declines in the early stages of PDD.

Purpose of the Study:

• To assess home-based physical behavior using accelerometry.
• To determine if physical behavior patterns can distinguish between Parkinson disease with mild cognitive impairment (PD-MCI) and PDD.

Main Methods:

• A cross-sectional study involving 55 patients with Parkinson disease (PD), classified into cognitively nonimpaired (PD-NC), PD-MCI, or PDD groups.
• Physical behavior was monitored for 3 days using the DynaPort® accelerometer.
• Ordinal logistic regression was used to analyze data, adjusting for motor impairment and depressive symptoms.

Main Results:

• Analysis of 48 patients revealed that PDD patients with ADL impairment exhibited fewer and longer sedentary bouts compared to PD-MCI and PD-NC groups.
• Specific differences in sedentary bout frequency and duration were statistically significant between PDD and both PD-MCI (p=0.01) and PD-NC (p=0.01) groups.
• Cognitive functions, including executive function, visuoconstruction, and attention, showed significant correlations with measured physical activity parameters.

Conclusions:

• Objective assessment of physical behavior, particularly sedentary bout patterns, shows significant potential for discriminating between PD-MCI and PDD.
• Home-based accelerometry offers a promising, non-invasive method for aiding in the early diagnosis and differentiation of cognitive stages in Parkinson disease.