Neural correlates and predictors of subjective cognitive decline in patients with Parkinson's disease

Background Subjective cognitive decline (SCD) may occur very early in the course of Parkinson's disease (PD) before the onset of objective cognitive decline. Data on neural correlates and determinants of SCD in PD are rare. Objective The aim of the present study was to identify neural correlates as well as sociodemographic, clinical, and neuropsychological predictors of SCD in patients with PD. Methods We retrospectively analyzed 30 patients with PD without cognitive impairment (23% female, 66.90 +/- 7.20 years, UPDRS-III: 19.83 +/- 9.29), of which n= 12 patients were classified as having no SCD (control group, PD-CG) and n= 18 as having SCD (PD-SCD). Neuropsychological testing and 18-fluoro-2-deoxyglucose positron emission tomography (FDG-PET) were conducted. SCD was assessed using a questionnaire covering multiple cognitive domains. Results SCD subscores differed significantly between PD-CG and PD-SCD and correlated significantly with other scales measuring related concepts. FDG-PET whole-brain voxel-wise regression analysis revealed hypometabolism in middle frontal, middle temporal, and occipital areas, and the angular gyrus as neural correlates of SCD in PD. Next to this hypometabolism, depressive symptoms were an independent significant determinant of SCD in a stepwise regression analysis (adjusted R-2 = 50.3%). Conclusion This study strengthens the hypothesis of SCD being an early manifestation of future cognitive decline in PD and, more generally, early pathological changes in PD. The early identification of the vulnerability for future cognitive decline constitutes the basis for successful prevention and delay of this non-motor symptom.

Automated summary

This study identified neural correlates, sociodemographic, clinical, and neuropsychological predictors of subjective cognitive decline (SCD) in Parkinson's disease (PD) patients. It found that hypometabolism in certain brain areas, along with depressive symptoms, were significant determinants of SCD. The early identification of vulnerability for future cognitive decline is crucial for successful prevention and delay of non-motor symptoms in PD.