Levodopa Response and Cognitive Function in Parkinson's Disease: An Analysis of Patients Evaluated for Deep Brain Stimulation
Anjali Varghese1, Umar Yazdani4, William Goette2, Ann Gordon1, Frederick Hitti3, Shilpa Chitnis5, Nader Pouratian3, Laura Lacritz2, Vibhash Sharma4
1Neurology, 2Psychiatry, 3Neurosurgery, University of Texas Southwestern Medical Center, 4University of Texas Southwestern Medical Center, 5UT Tyler School of Medicine
Objective:
To assess the association between levodopa response and cognitive function, measured by Montreal Cognitive Assessment (MoCA) and Dementia Rating Scale-2 (DRS-2), in patients with advanced Parkinson’s disease (PD).
Background:
Levodopa response (LR) supports the clinical diagnosis of PD and is used to predict motor outcomes following deep brain stimulation (DBS). However, the relationship between LR and cognitive performance remains unclear. Understanding this relationship may help with evaluating patient outcomes and treatment planning, particularly when considering advanced treatment options.
Design/Methods:

We reviewed data from patients with PD evaluated for DBS, including OFF/ON levodopa motor scores and cognitive assessments (MoCA and/or DRS-2). Patients were grouped based on %LR: Low (<30%), Moderate (30-50%), and Good (>50%). Differences in MoCA and DRS-2 scores among groups were analyzed using the Kruskal-Wallis test with Dunn’s post-hoc comparisons. Spearman’s correlation assessed the relationship between %LR and cognitive measures, and generalized linear models (GLM) were used to adjust for age and disease duration.

Results:

A total of 279 patients (mean age: 64.1 years, disease duration: 9.2 years) were included. Of these, 240 had MoCA scores (mean±SD: 25.8±3.4) and 203 had DRS-2 scores (mean±SD: 135.6± 6.2) available. MoCA scores were significantly different among groups (p=0.001), with the Good response group having higher scores compared to the Low (p=0.003) and Moderate (p=0.018) groups. DRS-2 scores showed no significant differences (p=0.231) across groups. There was a positive correlation between %LR and MoCA scores (rho=0.28, p<0.001), while %LR and DRS-2 scores showed no significant correlation. After adjusting for age and disease duration, GLM showed %LR was significantly associated with MoCA (p<0.001), while its effect on DRS-2 was smaller (p=0.041).

Conclusions:

Levodopa response is associated with cognitive function, particularly as measured by MoCA. Further longitudinal studies may provide insights into whether motor response to levodopa can predict cognitive function over time. 

 

 

10.1212/WNL.0000000000211855
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