Neural correlates of distinct cognitive phenotypes in early Parkinson's disease

Cognitive decline is common in Parkinson's disease (PD), but changes can occur in a variety of cognitive domains. The lack of a single cognitive phenotype complicates diagnosis and tracking. In an earlier study we used a data-driven approach to identify distinct cognitive phenotypes of early PD. Here we identify the morphometric brain differences between those different phenotypes compared with cognitively normal PD participants.

Six different cognitive classes were included (Weak, Typical, Weak-Visuospatial/Strong-Memory, Weak-Visuospatial, Amnestic, Strong). Structural differences between each class and the Typical class were assessed by deformation-based morphometry.

The different groups evidenced different patterns of atrophy. Weak class had frontotemporal and insular atrophy; Weak-Visuospatial/Strong-Memory class had frontotemporal, insular, parietal, and putamen atrophy; Weak-Visuospatial class had Rolandic operculum; Amnestic class had left frontotemporal, occipital, parietal and insular atrophy when compared to the Typical class. The Strong class did not have any atrophy but had significant differences in left temporal cortex in comparison to the Typical class.

Structural neuroimaging differences are evident in PD patients with distinct cognitive phenotypes even very early in the disease process prior to the emergence of frank cognitive impairment. Future studies will elucidate whether these have prognostic value in identifying trajectories toward dementia, or if they represent groups sensitive to different treatments.