Cognitive Predictors of Quality of Life in Parkinson’s Disease: A Three-year Longitudinal Study
Katharine Henry1, Sara Trach1, Joseph Flanigan1, James Patrie2, Madaline Harrison1, Matthew Barrett3, Binit Shah1, Renzo Figari-Jordan1, Maria Rossetti1, William Dalrymple1
1University of Virginia Health System, 2University of Virginia Public Health Sciences, 3Virginia Commonwealth University
Objective:
We sought to determine the cognitive markers associated with decreasing quality of life (QOL) in patients with Parkinson’s disease (PwP) over time with the aim to better assess meaningful cognitive performance and cognitive interventions in PwP in the future.
Background:
Parkinson’s disease (PD) is associated with worsened QOL over time. While cross-sectional studies show a relationship between cognitive functioning and QOL, few longitudinal studies exist investigating the relationship of cognitive performance with QOL in PwP.
Design/Methods:
We recruited PwP without dementia from a movement disorders clinic at an academic medical center. Participants were followed annually for three years, with motor and neuropsychological assessments at each visit. QOL was measured using the Parkinson’s Disease Questionnaire-39 (PDQ-39). We assessed cognitive performance, including Montreal Cognitive Assessment (MoCA) screening performance, verbal fluency via the Controlled Oral Word Association test (COWA), scanning/working memory via the Trail Making Test (specifically, Trails B-A) and immediate/delayed recall via the Hopkins Verbal Learning Test (HVLT). Education level, trial year, and level of depression, as measured via the Beck Depression Inventory II (BDI-II) were analyzed as potential confounders. Using random coefficient regression, we investigated the association between cognitive performance markers and changes in QOL in PwP over three years.
Results:
105 participants enrolled at baseline, and 67 patients completed three years of follow up. Mean PDQ-39 scores increased from 16.0 at baseline to 19.8 at year three. In multivariate analysis, worse trails B-A performance was uniquely associated with worsened QOL over time (p<0.001), while education level, COWA, MoCA, HTLV performance were not.
Conclusions:
Deterioration in rote memory and executive function are associated with worsening quality of life over time in PwP, while worsened verbal fluency and recall are not. This study suggests that cognitive training targeting rote memory and executive function could be beneficial for improved QoL in PwP.