Higher serum uric acid associates with better cognitive performance and survival in Caribbean parkinsonism

Reduced serum uric acid (UA) has been identified as a risk factor for Parkinson's disease (PD), prompting investigation into its relevance in atypical Parkinsonism (AP). Serum UA levels were measured in a prospective Caribbean cohort (ClinicalTrials.gov: NCT03368300, 03/08/2012) comprising patients with PD (n = 90), AP (n = 167), and healthy controls (n = 124), and associations with clinical variables were assessed. Serum UA levels were significantly lower in patients with PD and AP than in controls (p = 0.004). Across the entire cohort, patients with low UA levels had higher adjusted odds of poor neuropsychological performance, defined as Mini-Mental State Examination score < 24 (OR = 4.7), Mattis Dementia Rating Scale score < 137 (OR = 2.97), and Frontal Assessment Battery score < 13 (OR = 2.79). Survival analyses also revealed significant differences across sex-specific UA tertiles (p = 0.044). In AP, low and intermediate UA levels were associated with higher mortality (p = 0.035). Lower serum UA levels, however, were not associated with overall disease severity or functional dependence. Our findings provide further evidence supporting the relevance of UA to the pathogenesis of neurodegenerative parkinsonism. They may also offer opportunities for risk stratification and the investigation of UA-related interventions in patients with Caribbean parkinsonism.