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An 8-Year Prospective Study

Dag Aarsland, MD, PhD; Kjeld Andersen, MD, PhD; Jan P. Larsen, MD, PhD; Anette Lolk, MD, PhD

Arch Neurol. 2003;60:387-392.

Background  Few longitudinal studies of dementia in Parkinson disease (PD) have been reported, and the proportion of patients with PD who eventually develop dementia is unknown.

Objective  To examine the 8-year prevalence, characteristics, and risk factors of dementia in patients with PD.

Methods  Patients were recruited from an epidemiological study of PD in the county of Rogaland, Norway, using explicit criteria for PD. Subjects with cognitive impairment at disease onset were excluded. A semistructured caregiver-based interview, cognitive rating scales, and neuropsychological tests were used to diagnose dementia according to criteria from the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition at baseline and 4 and 8 years later. A population-based sample of 3295 subjects in the municipality of Odense, Denmark, was used as a comparison group and examined at baseline and after 2 and 5 years.

Results  We included 224 patients with PD (116 women). At baseline, 51 patients (26%) had dementia. Fifty-five patients died, and 10 refused follow-up without their dementia status known. Forty-three and 28 new cases of dementia were identified at the 4- and 8-year evaluations, respectively. The 4-year prevalence of dementia in PD was nearly 3 times higher than in the non-PD group. The 8-year prevalence in PD was 78.2% (95% confidence interval [CI], 71.1-84.0). Risk factors for dementia were hallucinations before baseline (odds ratio [OR] = 3.1; 95% CI, 1.6-6.2) and akinetic-dominant or mixed tremor/akinetic PD (OR = 3.3; 95% CI, 1.2-8.5).

Conclusions  More than three quarters of this representative PD cohort developed dementia during the 8-year study period. Early hallucinations and akinetic-dominant PD were associated with an increased risk of dementia.

Per Kragh-Sørensen, MD, DMSc

From the Section of Geriatric Psychiatry, Psychiatric Clinic (Dr Aarsland), and Department of Neurology (Dr Larsen), Central Hospital of Rogaland, Stavanger, Norway; the Institutes of Psychiatry (Dr Aarsland) and Neurology (Dr Larsen), University of Bergen, Bergen, Norway; and the Department of Psychiatry, Odense University Hospital, Odense, Denmark (Drs Andersen, Lolk, and Kragh-Sørensen).

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