Predicting cognitive decline with non-clinical markers in Parkinson's disease (PRECODE-2)

Area of Science:

• Neurology
• Neuroimaging
• Biomarker Research

Background:

• Cognitive impairment (CI) is a common non-motor symptom in Parkinson's disease (PD).
• Predicting the onset and progression of CI in early PD is crucial for patient management.
• Baseline predictors for CI in de novo PD patients require further elucidation.

Purpose of the Study:

• To determine if baseline [¹²³I]FP-CIT SPECT and cerebrospinal fluid (CSF) markers can predict cognitive impairment in Parkinson's disease patients.
• To establish a risk profile for early PD patients susceptible to cognitive decline.

Main Methods:

• Analysis of 262 de novo PD patients from the Parkinson's Progression Markers Initiative database.
• Stratification into cognitive impairment groups based on MoCA scores and neuropsychological testing at 36-month follow-up.
• Evaluation of baseline CSF Aβ42, CSF total tau, and caudate [¹²³I]FP-CIT SPECT uptake as predictive variables.

Main Results:

• 41.2% of PD patients developed CI by 36 months.
• Reduced baseline CSF Aβ42, elevated CSF total tau, and reduced caudate [¹²³I]FP-CIT SPECT uptake were significant predictors of CI.
• Patients with these biomarker profiles had a 65% risk of developing CI within 36 months.

Conclusions:

• A specific profile of reduced CSF Aβ42, increased CSF total tau, and reduced caudate [¹²³I]FP-CIT SPECT uptake identifies early PD patients at high risk for CI.
• These findings support the association of low CSF Aβ42, elevated CSF total tau, and reduced dopaminergic integrity with cognitive decline in PD.
• This risk profile can aid in the early identification and management of cognitive impairment in Parkinson's disease.