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Long-Term Dementia Risk in Parkinson Disease.

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  • 1From the Departments of Neurology (J.G., A.S.C.-P., N.D., J.M., A.D.S., A.W.W., D.W.) and Psychiatry (E.M., D.W.), and Biostatistics and Epidemiology (S.X.X.), University of Pennsylvania, Philadelphia; Department of Biostatistics (C.G., C.C.-G., C.S.C.), University of Iowa; Department of Psychiatry (R.D.D.), Rutgers University, Newark, NJ; Department of Old Age Psychiatry (D.A.), Kings College London, UK; Neurological Institute (R.N.A.), Tel Aviv Sourasky Medical Center, Israel; Department of Neurology (R.N.A.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (M.J.B.), Virginia Commonwealth University, Richmond, VA; Department of Neurology (L.C.), University of Pittsburgh, PA; The Michael J. Fox Foundation for Parkinson's Research (J.L.E.), New York, NY; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders (A.J.E.), Department of Neurology, University of Cincinnati; Cleveland Clinic (J.B.L.), Neurological Institute, Lou Ruvo Center for Brain Health, OH; Department of Neuroscience (I.L.), University of California San Diego; Parkinson's Disease Research, Education and Clinical Center (PADRECC) (J.M., D.W.), Crescenz Veteran's Affairs Medical Center, Philadelphia, PA; Department of Neurology (I.H.R.), University of Rochester, NY; Department of Neurology (L.R.), Johns Hopkins University, Baltimore, MD; and Department of Neurology (T.S.), Northwestern University, Chicago, IL; Departments of Neurology and Psychiatry and Behavioral Sciences (M.K.Y.), Baylor College of Medicine, Houston, TX.

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Dementia in Parkinson disease (PD) appears less common and later-onset than previously thought. New research indicates lower long-term dementia risk in PD patients from large, prospective studies.

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Area of Science:

  • Neurology
  • Neuroscience
  • Geriatrics

Background:

  • Previous studies suggested dementia affects up to 80% of Parkinson disease (PD) patients.
  • These earlier studies often had small sample sizes and methodological limitations.
  • Current understanding of long-term dementia risk in PD requires updated investigation.

Purpose of the Study:

  • To determine the long-term risk of dementia in individuals with Parkinson disease.
  • To re-evaluate dementia prevalence using data from large, ongoing, prospective, observational studies.
  • To compare dementia incidence across different cohorts and diagnostic criteria.

Main Methods:

  • Utilized data from the Parkinson's Progression Markers Initiative (PPMI) and a University of Pennsylvania PD cohort.
  • Recruited de novo, untreated PD participants for PPMI and a convenience cohort for Penn.
  • Employed interval-censored survival analysis for time to dementia diagnosis, using cognitive assessments and expert consensus.

Main Results:

  • In the PPMI cohort, 10-year dementia probability ranged from 9% to 15%.
  • The Penn cohort showed a median time to dementia of 15 years, with 47% diagnosed.
  • Estimated dementia probability at 10 years was 27%, rising to 50% at 15 years and 74% at 20 years in the Penn cohort.

Conclusions:

  • Findings suggest dementia in Parkinson disease occurs less frequently than previously reported.
  • Dementia in PD may develop later in the disease course.
  • Results challenge older estimates and highlight the need for updated research on PD dementia risk.