Domain‐specific cognitive impairment in non‐demented Parkinson's disease psychosis |
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| Authors: | Jared T. Hinkle Kate Perepezko Catherine C. Bakker Ted M. Dawson Vanessa Johnson Zoltan Mari Cherie L. Marvel Kelly A. Mills Alexander Pantelyat Olga Pletnikova Liana S. Rosenthal Melissa D. Shepard Daniel A. Stevens Juan C. Troncoso Jiangxia Wang Gregory M. Pontone |
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| Affiliation: | 1. Medical Scientist Training Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA;2. Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA;3. Morris K. Udall Parkinson's Disease Research Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA;4. Movement Disorders Division, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA;5. Neuroregeneration and Stem Cell Programs, Institute for Cell Engineering, Baltimore, MD, USA;6. Solomon H. Snyder Department of Neuroscience, Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA;7. Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA;8. Cognitive Neuroscience Division, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA;9. Clinical and Neuropathology Core, Johns Hopkins University School of Medicine, Baltimore, MD, USA;10. Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA |
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| Abstract: | Introduction In Parkinson's disease (PD), psychosis is associated with cognitive impairment that may be more profound in particular cognitive domains. Our goal was to determine whether psychosis in non‐demented PD participants is associated with domain‐specific cognitive impairment on the Mini‐Mental State Exam (MMSE). Methods The Morris K. Udall Parkinson's Disease Research Center of Excellence Longitudinal Study at Johns Hopkins is a prospective study that was initiated in 1998. Clinical assessments are conducted at two‐year intervals at the Johns Hopkins Hospital. We analyzed data from 137 enrolled participants with idiopathic PD. Psychosis diagnoses were established by psychiatrist interview per DSM‐IV criteria. An incident dementia diagnosis resulted in exclusion from analysis for that evaluation and any future evaluations in that participant. We used logistic regression with generalized estimated equations (GEE) to model the time‐varying relationship between MMSE subscale scores and psychosis, adjusting for potential confounding variables identified through univariable analysis. Results Thirty‐one unique psychosis cases were recorded among non‐demented participants. Fifty total evaluations with psychosis present were analyzed. In multivariable regressions, psychosis was associated with lower scores on the orientation (relative odds ratio, rOR: 0.73; 95% CI: 0.58–0.93; p = 0.011), language (rOR: 0.64; 95% CI: 0.48–0.86; p = 0.003), and intersecting pentagon (rOR: 0.43; 95% CI: 0.20–0.92 p = 0.030) subscales of the MMSE. Conclusions In PD, executive dysfunction, disorientation, and impaired language comprehension may be associated with psychosis. Our findings suggest that the corresponding MMSE subscales may be useful in identifying participants with a higher likelihood of developing psychosis. Copyright © 2017 John Wiley & Sons, Ltd. |
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| Keywords: | Parkinson's disease psychosis cognitive impairment MMSE cognitive domains hallucinations |
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