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Abstract
Objective To assess the relationship between the development of levodopa-induced dyskinesia (LID) and longitudinal changes in cognition.
Methods In this retrospective cohort study, we recruited 119 patients with Parkinson disease (PD) who underwent baseline and follow-up neuropsychological evaluations and were treated with levodopa for >5 years. On the basis of LID development, the patients were classified as patients with LID (PD-LID+, n = 38) or without LID (PD-LID−, n = 81) within 5 years of levodopa administration. After adjusting for age, sex, years of education, body mass index, motor severity at baseline, and levodopa increment per year, we compared the rates of cognitive decline using linear mixed model and dementia conversion using survival analysis between the groups.
Results Neuropsychological performances and the percentage of patients with mild cognitive impairment (MCI) at baseline did not differ between the groups. The PD-LID+ group showed faster declines in frontal executive function (p = 0.002) and global cognitive function. The conversion rate to dementia was significantly higher in the PD-LID+ group than in the PD-LID− group (adjusted hazard ratio [HR] 3.94, 95% confidence interval [CI] 1.76–8.82). Patients with MCI in the PD-LID+ group had a higher risk of PD dementia conversion than those with normal cognition (adjusted HR 6.08, 95% CI 1.25–29.56) or MCI (adjusted HR 4.05, 95% CI 1.14–14.43) in the PD-LID− group.
Conclusions These results demonstrated that LID was closely associated with the progression of cognitive decline, especially frontal executive dysfunction, and the development of PD dementia.
Glossary
- ADL=
- activities of daily living;
- BMI=
- body mass index;
- CDR-SOB=
- Clinical Dementia Rating–Sum of Boxes;
- CI=
- confidence interval;
- COWAT=
- Controlled Oral Word Association Test;
- 18F-FP-CIT=
- N-(3-[18F]fluoropropyl)-2β-carbon ethoxy-3β-(4-iodophenyl) nortropane;
- HR=
- hazard ratio;
- LED=
- levodopa-equivalent dose;
- LID=
- levodopa-induced dyskinesia;
- MCI=
- mild cognitive impairment;
- MMSE=
- Mini-Mental State Examination;
- MTA=
- mesial temporal atrophy;
- PD=
- Parkinson disease;
- PDD=
- Parkinson disease dementia;
- RBD=
- REM sleep behavior disorder;
- RCFT=
- Rey-Osterrieth Complex Figure Test;
- UPDRS=
- Unified Parkinson’s Disease Rating Scale;
- WMH=
- white matter hyperintensities
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
- Received August 30, 2018.
- Accepted in final form November 21, 2018.
- © 2019 American Academy of Neurology
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