Visuospatial dysfunction indicates an increased risk of rapid dementia conversion in Parkinson's disease

Abstract

INTRODUCTION: The aim of this study was to define cognitive subtypes of early-stage Parkinson's disease (PD) based on temporal evolutionary patterns of domain-specific decline. METHODS: We retrospectively enrolled 474 patients with early-stage PD who underwent detailed neuropsychological testing at initial assessment. Age- and education-specific z-scores from 13 neuropsychological subtests were used to apply Subtype and Stage Inference (SuStaIn) to identify distinct cognitive subtypes. We compared the risk of developing dementia between subtypes. RESULTS: SuStaIn analysis delineated three pd subtypes with cognitive impairment: Subtype 1 (n = 121) with early verbal memory impairment; Subtype 2 (n = 108) with early visuospatial dysfunction; and Subtype 3 (n = 87) with early frontal/executive dysfunction. The remaining 158 patients were classified as a cognitively intact subtype (Subtype 0). Time-dependent Cox regression models showed that the risk of dementia after 3.5 years was highest in Subtype 2. DISCUSSION: Visuospatial dysfunction may be a potential cognitive profile for predicting the risk of rapid dementia conversion in PD.