2025 American Academy of Neurology Abstract Website

Objective:

To explore cognitive function in PwPD and identify differences in PwPD with and without psychosis.

Background:

Parkinson's Disease (PD) psychosis (PDP) is present in about 20% of patients with PD (PwPD). Psychosis can manifest as visual, auditory or multi-sensory illusions. Computerized cognitive testing (CCT) can identify cognitive change/impairment. Patient reported outcomes (PRO) can identify issues left unaddressed during routine care. The Scale for the Assessment of Positive Symptoms for Parkinson's Disease Psychosis (SAPS-PD) PRO is a validated measure to assess the presence of psychosis in PwPD. The relationship of cognition and PDP is not well understood. Improved recognition of PDP and treatment timing could improve clinical outcomes.

Design/Methods:

A retrospective cross-sectional analysis of cognitive subdomain scores was performed in PwPD who completed CCT and PRO. NeuroTrax is a CCT which objectively quantifies cognition into 7 cognitive domains (CD). T-tests assuming unequal variances (p<0.05) were utilized to evaluate the difference in SAPS-PD scores and mean scores of CDs between PwPD who experienced psychosis and those who did not. Cohen’s D analyses were performed to determine the degree of significance.

Results:

255 PwPD (72± 9 years; 41.6% female) were included. A significant difference was determined across SAPS-PD and all CDs except motor function. Significant p-values and respective Cohen’s D values identified were: SAPS-PD (p=0.0000026796, d=-1.11612), Global Cognitive Score(p=0.0037699, d=0.462799252), Memory(p=0.000618214, d=0.54899), Executive Function(p=0.003161274, d=0.475634), Visual Spatial(p=0.000775034, d=0.539145), Verbal Function(p=0.00455448, d=0.46667), Attention(p=0.002395711, d=0.5058), and Information Processing Speed(p=0.036625168, d=0.398734194). Motor Function(p=0.293897605, d=0.179013) was not found to have a significant difference between groups.

Conclusions:

Significant differences in cognitive function were found across multiple CD. Cognitive impairment with or without psychosis can result in adverse outcomes. Improved clinician awareness and recognition of such disability in PwPD can provide opportunities for earlier intervention to avoid adverse outcomes. Phenotyping cognitive trajectories in PwPD can provide additional insight into treatment needs.