The frequency and associated risk factors for dementia in patients with Parkinson's disease

K. Marder, M. X. Tang, L. Cote, Y. Stern and R. Mayeux
Gertrude H. Sergievsky Center, Department of Neurology, College of Physicians and Surgeons, New York, NY, USA.

OBJECTIVES: To estimate the frequency and determine the risk factors for incident dementia in community-dwelling patients with Parkinson's disease (PD) and in control subjects. DESIGN: Prospective cohort study. During a 3.5-year period, 140 patients with idiopathic PD without evidence of dementia and 572 nondemented control subjects were identified in the community of Washington Heights-Inwood in New York, NY. All subjects underwent neurological and neuropsychological evaluations and follow-up examinations. RESULTS: Twenty-seven patients with PD (19.2%) became demented throughout 2 years, as compared with 87 (15.2%) of the control subjects. The relative risk (RR) for the development of dementia with PD was 1.7 (95% confidence interval [CI], 1.1 to 2.7) after adjusting for age, education, and gender. Predictive features of incident dementia were an extrapyramidal score greater than 25 (RR, 3.56; 95% CI, 1.4 to 8.9) and a Hamilton Depression Rating Scale score greater than 10 (RR, 3.55; 95% CI, 1.6 to 7.9). CONCLUSION: Patients with PD, especially those with severe extrapyramidal signs, have almost twice the risk for the development of dementia than do community-dwelling control subjects.