The role of dynamic Lowenstein occupational therapy and cognitive assessment scale for the elderly with Parkinson's...

Cognitive impairments in Parkinson's disease (PD) commonly affect executive function, attention, and visuospatial abilities. These deficits may precede motor symptoms and are often undetected by screening tools such as the Standardized Mini-Mental State Examination (SMMSE). The utility of the Dynamic Lowenstein Occupational Therapy Cognitive Assessment-Geriatric Version (DLOTCA-G) has not been evaluated in older adults with PD. This study aims to investigate the effectiveness of DLOTCA-G in detecting cognitive deficits in PD patients with and without cognitive impairment.

In this prospective controlled study, 90 participants aged 65 and above were recruited: 30 PD patients with cognitive impairment (PD-CI), 30 PD patients without cognitive impairment (PD-NCI), and 30 healthy controls. All participants underwent cognitive assessment using SMMSE and DLOTCA-G. The total SMMSE score and eight subscales of the DLOTCA-G were analyzed.

Except for the spatial perception score, there was a statistically significant difference between the groups in all DLOTCA-G subscales. The PD-CI group had significantly lower awareness and visuomotor construction scores than the PD-NCI and healthy groups (p < 0.01). The PD-NCI group showed significantly lower awareness and visuomotor construction scores than the healthy group (p < 0.01). Total SMMSE scores showed a moderate positive correlation with orientation, praxis, visuomotor construction, and thinking operations (p < 0.01). In the Parkinson's group (n = 60), SMMSE Orientation correlated strongly with DLOTCA-G Orientation, Visuomotor Construction, and Awareness (p < 0.001). SMMSE Attention/Calculation and Language showed moderate associations with praxis and visuomotor domains (p ≤ 0.001; Table 4).

The results indicate that DLOTCA-G subscales associated with executive function are impaired in individuals with PD, even in the absence of cognitive impairment. These findings suggest that DLOTCA-G may offer a more differentiated cognitive profile than SMMSE across multiple domains, although its comparative sensitivity and diagnostic accuracy require further validation in studies using comprehensive neuropsychological references.

The study was retrospectively registered (registration number NCT06131619), prospective registration prior to participant enrollment was not completed due to logistical reasons. Protocol adherence was maintained throughout the study.