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Research paper
Cognitive decline in Parkinson’s disease: the impact of the motor phenotype on cognition
  1. Jennifer Wojtala1,2,
  2. Ines Ann Heber1,
  3. Petra Neuser3,
  4. Julia Heller1,2,
  5. Elke Kalbe4,
  6. Sarah P Rehberg4,
  7. Alexander Storch5,6,
  8. Katharina Linse5,
  9. Christine Schneider5,
  10. Susanne Gräber7,
  11. Daniela Berg7,8,
  12. Judith Dams9,
  13. Monika Balzer-Geldsetzer9,10,
  14. Rüdiger Hilker-Roggendorf4,
  15. Carola Oberschmidt11,
  16. Simon Baudrexel11,
  17. Karsten Witt12,
  18. Nele Schmidt8,
  19. Günther Deuschl7,
  20. Brit Mollenhauer13,
  21. Claudia Trenkwalder13,
  22. Inga Liepelt-Scarfone7,
  23. Annika Spottke14,
  24. Sandra Roeske14,
  25. Ullrich Wüllner14,
  26. Hans-Ulrich Wittchen15,16,
  27. Oliver Riedel17,
  28. Richard Dodel9,10,
  29. Jörg B Schulz1,2,
  30. Kathrin Reetz1,2
  1. 1 Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, Aachen, Germany
  2. 2 JARA-Brain Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Aachen, Germany
  3. 3 Coordinating Center for Clinical Trials, Philipps-University of Marburg, KKS Marburg, Marburg, Germany
  4. 4 Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), University Hospital Cologne, Cologne, Germany
  5. 5 Division of Neurodegenerative Diseases, Department of Neurology, Technische Universität Dresden, Dresden, Germany
  6. 6 Department of Neurology, University of Rostock, Rostock, Germany
  7. 7 German Center of Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research (DZNE), Tübingen, Germany
  8. 8 Department of Neurology, Christian Albrecht University, Kiel, Germany
  9. 9 Department of Neurology, Philipps University Marburg, Marburg, Germany
  10. 10 Department of Geriatric Medicine, University Hospital Essen, Essen, Germany
  11. 11 Department of Neurology, J.W. Goethe University, Frankfurt/Main, Germany
  12. 12 Research Center Neurosensory Science, Department of Neurology, School of Medicine and Health Sciences - European Medical School,University Oldenburg, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
  13. 13 Paracelsus-Elena Clinic, Centre of Parkinsonism and Movement Disorders, Department of Neurology (BM) and Department of Neurosurgery (CT), Paracelsus-Elena Clinic, University Medical Center Goettingen, Kassel, Germany
  14. 14 Department of Neurology, University Hospital Bonn, and German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
  15. 15 Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
  16. 16 Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität, München, München, Germany
  17. 17 Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
  1. Correspondence to Professor Kathrin Reetz, Department of Neurology, RWTH Aachen University, Aachen, 52074, Germany; kreetz{at}


Objectives Parkinson’s disease (PD) is the second most common neurodegenerative disorder and is further associated with progressive cognitive decline. In respect to motor phenotype, there is some evidence that akinetic-rigid PD is associated with a faster rate of cognitive decline in general and a greater risk of developing dementia.

The objective of this study was to examine cognitive profiles among patients with PD by motor phenotypes and its relation to cognitive function.

Methods Demographic, clinical and neuropsychological cross-sectional baseline data of the DEMPARK/LANDSCAPE study, a multicentre longitudinal cohort study of 538 patients with PD were analysed, stratified by motor phenotype and cognitive syndrome. Analyses were performed for all patients and for each diagnostic group separately, controlling for age, gender, education and disease duration.

Results Compared with the tremor-dominant phenotype, akinetic-rigid patients performed worse in executive functions such as working memory (Wechsler Memory Scale-Revised backward; p=0.012), formal-lexical word fluency (p=0.043), card sorting (p=0.006), attention (Trail Making Test version A; p=0.024) and visuospatial abilities (Leistungsprüfungssystem test 9; p=0.006). Akinetic-rigid neuropsychological test scores for the executive and attentive domain correlated negatively with non-tremor motor scores. Covariate-adjusted binary logistic regression analyses showed significant odds for PD-mild cognitive impairment for not-determined as compared with tremor-dominant (OR=3.198) and akinetic-rigid PD (OR=2.059). The odds for PD-dementia were significant for akinetic-rigid as compared with tremor-dominant phenotype (OR=8.314).

Conclusion The three motor phenotypes of PD differ in cognitive performance, showing that cognitive deficits seem to be less severe in tremor-dominant PD. While these data are cross-sectional, longitudinal data are needed to shed more light on these differential findings.

  • Mild cognitive impairment
  • tremor-dominant
  • akinetic-rigid
  • cognitive profiles
  • cross-sectional

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  • Contributors Manuscript: Writing of the first draft: JW; Review and critique: all other authors. Research project: Conception, organisation and execution: all authors except JW, PN, JD. Statistical analysis: Design: JW, IAH, PN, KR, JD; Execution: JW, IAH, PN, KR, JD.

  • Funding The DEMPARK study was funded by an unrestricted grant from Novartis and a grant from the International ParkinsonFonds (Deutschland) GmbH (IPD). The continuation of the study (LANDSCAPE) is funded by the German Ministry for Education and Research (BMBF 01GI1008C). KR was funded by the German Federal Ministry of Education and Research (BMBF 01GQ1402).

  • Competing interests GD has received lecture fees from Boston Scientific and has been serving as a consultant for Boston Scientific. He received royalties from Thieme Publishers. He is a government employee and receives through his institution funding for his research from the German Research Council, the German Ministry of Education and Research, and Medtronic. KW received reimbursement of congress fees from BIAL and Desitin; and grants from the Federal Ministry of Education and Research and the German Research Foundation.

  • Patient consent Not required.

  • Ethics approval The study was conducted in compliance with the Helsinki Declaration (1997; The study protocol was approved by the Ethics Committee of the Philipps University Marburg (approval number 178/07) in March 2009 and subsequently by the local ethics committees of the participating hospitals.

  • Provenance and peer review Not commissioned; externally peer reviewed.