Final published version
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Research output: Contribution to Journal/Magazine › Journal article › peer-review
Research output: Contribution to Journal/Magazine › Journal article › peer-review
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TY - JOUR
T1 - Apathy as a behavioural marker of cognitive impairment in Parkinson's disease
T2 - a longitudinal analysis
AU - Martin, Glen P
AU - McDonald, Kathryn R
AU - Allsop, David
AU - Diggle, Peter J
AU - Leroi, Iracema
PY - 2020/1/1
Y1 - 2020/1/1
N2 - BACKGROUND: Understanding the longitudinal course of non-motor symptoms, and finding markers to predict cognitive decline in Parkinson's disease (PD), are priorities. Previous work has demonstrated that apathy is one of the only behavioural symptoms that differentiates people with PD and intact cognition from those with mild cognitive impairment (MCI-PD). Other psychiatric symptoms emerge as dementia in PD develops.OBJECTIVE: We explored statistical models of longitudinal change to detect apathy as a behavioural predictor of cognitive decline in PD.METHODS: We followed 104 people with PD intermittently over 2 years, undertaking a variety of motor, behavioural and cognitive measures. We applied a linear mixed effects model to explore behavioural factors associated with cognitive change over time. Our approach goes beyond conventional modelling based on a random-intercept and slope approach, and can be used to examine the variability in measures within individuals over time.RESULTS: Global cognitive scores worsened during the two-year follow-up, whereas the longitudinal evolution of self-rated apathy scores and other behavioural measures was negligible. Level of apathy was negatively (- 0.598) correlated with level of cognitive impairment and participants with higher than average apathy scores at baseline also had poorer cognition. The model indicated that departure from the mean apathy score at any point in time was mirrored by a corresponding departure from average global cognitive score.CONCLUSION: High levels of apathy are predictive of negative cognitive and behavioural outcomes over time, suggesting that apathy may be a behavioural indicator of early cognitive decline. This has clinical and prognostic implications.
AB - BACKGROUND: Understanding the longitudinal course of non-motor symptoms, and finding markers to predict cognitive decline in Parkinson's disease (PD), are priorities. Previous work has demonstrated that apathy is one of the only behavioural symptoms that differentiates people with PD and intact cognition from those with mild cognitive impairment (MCI-PD). Other psychiatric symptoms emerge as dementia in PD develops.OBJECTIVE: We explored statistical models of longitudinal change to detect apathy as a behavioural predictor of cognitive decline in PD.METHODS: We followed 104 people with PD intermittently over 2 years, undertaking a variety of motor, behavioural and cognitive measures. We applied a linear mixed effects model to explore behavioural factors associated with cognitive change over time. Our approach goes beyond conventional modelling based on a random-intercept and slope approach, and can be used to examine the variability in measures within individuals over time.RESULTS: Global cognitive scores worsened during the two-year follow-up, whereas the longitudinal evolution of self-rated apathy scores and other behavioural measures was negligible. Level of apathy was negatively (- 0.598) correlated with level of cognitive impairment and participants with higher than average apathy scores at baseline also had poorer cognition. The model indicated that departure from the mean apathy score at any point in time was mirrored by a corresponding departure from average global cognitive score.CONCLUSION: High levels of apathy are predictive of negative cognitive and behavioural outcomes over time, suggesting that apathy may be a behavioural indicator of early cognitive decline. This has clinical and prognostic implications.
U2 - 10.1007/s00415-019-09538-z
DO - 10.1007/s00415-019-09538-z
M3 - Journal article
C2 - 31616991
VL - 267
SP - 214
EP - 227
JO - Journal of Neurology
JF - Journal of Neurology
SN - 0340-5354
IS - 1
ER -