Domain-specific cognitive impairment in non-demented Parkinson's disease psychosis

Jared T. Hinkle, Kate Perepezko, Catherine C. Bakker, Ted M. Dawson, Vanessa Johnson, Zoltan Mari, Cherie L. Marvel, Kelly A. Mills, Alexander Pantelyat, Olga Pletnikova, Liana S. Rosenthal, Melissa D. Shepard, Daniel A. Stevens, Juan C. Troncoso, Jiangxia Wang, Gregory M. Pontone

Research output: Contribution to journalArticle

Abstract

Introduction: In Parkinson's disease (PD), psychosis is associated with cognitive impairment that may be more profound in particular cognitive domains. Our goal was to determine whether psychosis in non-demented PD participants is associated with domain-specific cognitive impairment on the Mini-Mental State Exam (MMSE). Methods: The Morris K. Udall Parkinson's Disease Research Center of Excellence Longitudinal Study at Johns Hopkins is a prospective study that was initiated in 1998. Clinical assessments are conducted at two-year intervals at the Johns Hopkins Hospital. We analyzed data from 137 enrolled participants with idiopathic PD. Psychosis diagnoses were established by psychiatrist interview per DSM-IV criteria. An incident dementia diagnosis resulted in exclusion from analysis for that evaluation and any future evaluations in that participant. We used logistic regression with generalized estimated equations (GEE) to model the time-varying relationship between MMSE subscale scores and psychosis, adjusting for potential confounding variables identified through univariable analysis. Results: Thirty-one unique psychosis cases were recorded among non-demented participants. Fifty total evaluations with psychosis present were analyzed. In multivariable regressions, psychosis was associated with lower scores on the orientation (relative odds ratio, rOR: 0.73; 95% CI: 0.58-0.93; p = 0.011), language (rOR: 0.64; 95% CI: 0.48-0.86; p = 0.003), and intersecting pentagon (rOR: 0.43; 95% CI: 0.20-0.92 p = 0.030) subscales of the MMSE. Conclusions: In PD, executive dysfunction, disorientation, and impaired language comprehension may be associated with psychosis. Our findings suggest that the corresponding MMSE subscales may be useful in identifying participants with a higher likelihood of developing psychosis.

Original languageEnglish (US)
JournalInternational Journal of Geriatric Psychiatry
DOIs
StateAccepted/In press - 2017

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Psychotic Disorders
Parkinson Disease
Language
Odds Ratio
Cognitive Dysfunction
Confusion
Confounding Factors (Epidemiology)
Diagnostic and Statistical Manual of Mental Disorders
Psychiatry
Longitudinal Studies
Dementia
Logistic Models
Prospective Studies
Interviews
Research

Keywords

  • Cognitive domains
  • Cognitive impairment
  • Hallucinations
  • MMSE
  • Parkinson's disease
  • Psychosis

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Psychiatry and Mental health

Cite this

@article{96ed063f21854439b543209f9b97f1cd,
title = "Domain-specific cognitive impairment in non-demented Parkinson's disease psychosis",
abstract = "Introduction: In Parkinson's disease (PD), psychosis is associated with cognitive impairment that may be more profound in particular cognitive domains. Our goal was to determine whether psychosis in non-demented PD participants is associated with domain-specific cognitive impairment on the Mini-Mental State Exam (MMSE). Methods: The Morris K. Udall Parkinson's Disease Research Center of Excellence Longitudinal Study at Johns Hopkins is a prospective study that was initiated in 1998. Clinical assessments are conducted at two-year intervals at the Johns Hopkins Hospital. We analyzed data from 137 enrolled participants with idiopathic PD. Psychosis diagnoses were established by psychiatrist interview per DSM-IV criteria. An incident dementia diagnosis resulted in exclusion from analysis for that evaluation and any future evaluations in that participant. We used logistic regression with generalized estimated equations (GEE) to model the time-varying relationship between MMSE subscale scores and psychosis, adjusting for potential confounding variables identified through univariable analysis. Results: Thirty-one unique psychosis cases were recorded among non-demented participants. Fifty total evaluations with psychosis present were analyzed. In multivariable regressions, psychosis was associated with lower scores on the orientation (relative odds ratio, rOR: 0.73; 95{\%} CI: 0.58-0.93; p = 0.011), language (rOR: 0.64; 95{\%} CI: 0.48-0.86; p = 0.003), and intersecting pentagon (rOR: 0.43; 95{\%} CI: 0.20-0.92 p = 0.030) subscales of the MMSE. Conclusions: In PD, executive dysfunction, disorientation, and impaired language comprehension may be associated with psychosis. Our findings suggest that the corresponding MMSE subscales may be useful in identifying participants with a higher likelihood of developing psychosis.",
keywords = "Cognitive domains, Cognitive impairment, Hallucinations, MMSE, Parkinson's disease, Psychosis",
author = "Hinkle, {Jared T.} and Kate Perepezko and Bakker, {Catherine C.} and Dawson, {Ted M.} and Vanessa Johnson and Zoltan Mari and Marvel, {Cherie L.} and Mills, {Kelly A.} and Alexander Pantelyat and Olga Pletnikova and Rosenthal, {Liana S.} and Shepard, {Melissa D.} and Stevens, {Daniel A.} and Troncoso, {Juan C.} and Jiangxia Wang and Pontone, {Gregory M.}",
year = "2017",
doi = "10.1002/gps.4736",
language = "English (US)",
journal = "International Journal of Geriatric Psychiatry",
issn = "0885-6230",
publisher = "John Wiley and Sons Ltd",

}

TY - JOUR

T1 - Domain-specific cognitive impairment in non-demented Parkinson's disease psychosis

AU - Hinkle, Jared T.

AU - Perepezko, Kate

AU - Bakker, Catherine C.

AU - Dawson, Ted M.

AU - Johnson, Vanessa

AU - Mari, Zoltan

AU - Marvel, Cherie L.

AU - Mills, Kelly A.

AU - Pantelyat, Alexander

AU - Pletnikova, Olga

AU - Rosenthal, Liana S.

AU - Shepard, Melissa D.

AU - Stevens, Daniel A.

AU - Troncoso, Juan C.

AU - Wang, Jiangxia

AU - Pontone, Gregory M.

PY - 2017

Y1 - 2017

N2 - Introduction: In Parkinson's disease (PD), psychosis is associated with cognitive impairment that may be more profound in particular cognitive domains. Our goal was to determine whether psychosis in non-demented PD participants is associated with domain-specific cognitive impairment on the Mini-Mental State Exam (MMSE). Methods: The Morris K. Udall Parkinson's Disease Research Center of Excellence Longitudinal Study at Johns Hopkins is a prospective study that was initiated in 1998. Clinical assessments are conducted at two-year intervals at the Johns Hopkins Hospital. We analyzed data from 137 enrolled participants with idiopathic PD. Psychosis diagnoses were established by psychiatrist interview per DSM-IV criteria. An incident dementia diagnosis resulted in exclusion from analysis for that evaluation and any future evaluations in that participant. We used logistic regression with generalized estimated equations (GEE) to model the time-varying relationship between MMSE subscale scores and psychosis, adjusting for potential confounding variables identified through univariable analysis. Results: Thirty-one unique psychosis cases were recorded among non-demented participants. Fifty total evaluations with psychosis present were analyzed. In multivariable regressions, psychosis was associated with lower scores on the orientation (relative odds ratio, rOR: 0.73; 95% CI: 0.58-0.93; p = 0.011), language (rOR: 0.64; 95% CI: 0.48-0.86; p = 0.003), and intersecting pentagon (rOR: 0.43; 95% CI: 0.20-0.92 p = 0.030) subscales of the MMSE. Conclusions: In PD, executive dysfunction, disorientation, and impaired language comprehension may be associated with psychosis. Our findings suggest that the corresponding MMSE subscales may be useful in identifying participants with a higher likelihood of developing psychosis.

AB - Introduction: In Parkinson's disease (PD), psychosis is associated with cognitive impairment that may be more profound in particular cognitive domains. Our goal was to determine whether psychosis in non-demented PD participants is associated with domain-specific cognitive impairment on the Mini-Mental State Exam (MMSE). Methods: The Morris K. Udall Parkinson's Disease Research Center of Excellence Longitudinal Study at Johns Hopkins is a prospective study that was initiated in 1998. Clinical assessments are conducted at two-year intervals at the Johns Hopkins Hospital. We analyzed data from 137 enrolled participants with idiopathic PD. Psychosis diagnoses were established by psychiatrist interview per DSM-IV criteria. An incident dementia diagnosis resulted in exclusion from analysis for that evaluation and any future evaluations in that participant. We used logistic regression with generalized estimated equations (GEE) to model the time-varying relationship between MMSE subscale scores and psychosis, adjusting for potential confounding variables identified through univariable analysis. Results: Thirty-one unique psychosis cases were recorded among non-demented participants. Fifty total evaluations with psychosis present were analyzed. In multivariable regressions, psychosis was associated with lower scores on the orientation (relative odds ratio, rOR: 0.73; 95% CI: 0.58-0.93; p = 0.011), language (rOR: 0.64; 95% CI: 0.48-0.86; p = 0.003), and intersecting pentagon (rOR: 0.43; 95% CI: 0.20-0.92 p = 0.030) subscales of the MMSE. Conclusions: In PD, executive dysfunction, disorientation, and impaired language comprehension may be associated with psychosis. Our findings suggest that the corresponding MMSE subscales may be useful in identifying participants with a higher likelihood of developing psychosis.

KW - Cognitive domains

KW - Cognitive impairment

KW - Hallucinations

KW - MMSE

KW - Parkinson's disease

KW - Psychosis

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DO - 10.1002/gps.4736

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