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Association between mild parkinsonian signs and mild cognitive impairment in a community

From The Gertrude H. Sergievsky Center (Drs. Louis, Schupf, Manly, Marder, Tang, and Mayeux), Department of Neurology (Drs. Louis, Marder, and Mayeux), Taub Institute for Research on Alzheimer’s Disease and the Aging Brain (Drs. Louis, Marder, and Mayeux), and Department of Psychiatry (Drs. Marder and Mayeux), College of Physicians and Surgeons, and Divisions of Epidemiology (Drs. Schupf and Mayeux) and Biostatistics (Dr. Tang), Mailman School of Public Health, Columbia University, New York; and Laboratory of Epidemiology (Dr. Schupf), New York State Institute for Basic Research in Developmental Disabilities, Staten Island, NY.

Address correspondence and reprint requests to Dr. Elan Louis, Unit 198, Neurological Institute, 710 West 168th Street, New York, NY 10032; e-mail: EDL2{at}columbia.edu

Background: Mild parkinsonian signs (MPS) are associated with prevalent and incident dementia but it is not known whether they are associated with mild cognitive impairment (MCI).

Objective: To determine whether MPS and specific MPS (changes in axial function, rigidity, tremor) are associated with MCI in nondemented community-dwelling older people in northern Manhattan, NY.

Methods: Participants underwent neurologic assessment, including a modified motor portion of the Unified Parkinson Disease Rating Scale. MCI was diagnosed in nondemented participants who had cognitive impairment based on neuropsychological testing and no functional impairment. Participants with MCI were classified as having MCI with memory impairment (MCI+M) vs MCI without memory impairment (MCI-M).

Results: MCI was present in 608 (27.3%) of 2,230 participants, including 255 participants with MCI+M and 353 with MCI-M; 1,622 participants did not have MCI. MPS were present in 369 (16.5%) of 2,230 participants. In a univariate logistic regression model, odds of MCI+M (vs no MCI) were 51% higher in participants with MPS compared to those with no MPS (OR = 1.51, 95% CI = 1.09 to 2.09, p = 0.01). Multivariate models yielded similar results (OR = 1.45, 95% CI = 1.03 to 2.05, p = 0.03). Rigidity was present in a higher proportion of participants with MCI+M compared to participants without MCI.

Conclusions: Mild parkinsonian signs, especially rigidity, are associated with amnestic mild cognitive impairment. Mild parkinsonian signs and mild cognitive impairment may share similar pathogeneses. Whether this involves Alzheimer-type pathology, Lewy bodies, or vascular changes in the basal ganglia or basal ganglia circuitry deserves further investigation in postmortem studies.

Supported by Federal grants NIH AG07232 and R01 NS42859.

Received October 7, 2004. Accepted in final form December 1, 2004.

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