MedicalResearch.com Interview with:
Benjamin Dawson, B.Sc.
MD Candidate 2020
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Dementia in Parkinson’s Disease is one of its most feared complications, and may happen eventually to most patients if they reached advanced age. Identifying those at especially high risk of dementia has important potential implications – it would facilitate clinical counselling, it has treatment implications (e.g. knowing a person is likely to get dementia in the near future would probably steer you away from certain medications and towards others). Most critically, it can help select patients for trials to prevent dementia.
While several factors that show high risk for dementia in Parkinson’s disease have previously been described, these have yet to shape patient-care, either because they are not very strong predictors, or they are not user-friendly. So, we designed a very simple clinical screening tool, called the Montreal Parkinson’s Risk of Dementia Scale (MoPaRDS). It took predictors of dementia that were established from large-scale studies and boiled them down into a simple 8-point scale that uses information that you can get in a simple office visit. The 8 predictors were being over 70, being male, having a blood pressure drop with standing, showing early mild cognitive changes, having a symmetric bilateral disease (that is, one side not clearly worse than the other), experiencing falls or freezing, having experienced hallucinations, and having symptoms of REM sleep behavior disorder (‘acting out’ the dreams at night).
When we tested the scale in a combined cohort of 607 patients with Parkinson’s (of whom 70 developed dementia over mean follow-up of 4.4-years) a positive MoPaRDS screen (≥4 out of 8 items) identified 14-fold increased risk of dementia compared to a negative screen. We recommend dividing the scale into three categories; low-, intermediate- and high-risk. Those in the highest score group (MoPaRDS, 6-8) had a 14.9% risk of developing dementia each year, while those with the lowest scores (MoPaRDS, 0-3) had only 0.6% annual risk. So, these simple measures can be pretty powerful predictors of dementia.
MedicalResearch.com: What should readers take away from your report?
Response: Although no scale is perfect, we now have some pretty simple methods to predict dementia risk in Parkinson’s patients. For neurologists treating these patients, it’s important to be aware of the medium-term dementia risk to help plan treatment. And for those who will be able to plan dementia-prevention trials, we hope this will help identify those most likely to benefit from treatment.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: First of all, this is a starting point – there are other variables that one could use to predict dementia – if we continue to expand the list, we can get increasingly precise estimates. Second, now that there is a simple tool to identify dementia, we have to try and do something about it. There are several treatments in early-phase testing that have potential to prevent PD dementia – we need to start testing them!
MedicalResearch.com: Is there anything else you would like to add?
Response: No disclosures related to this paper. Treatment options for Parkinson’s disease dementia remain limited and it our hope that our findings will help a bit in doing something about this awful complication of Parkinson’s.
Dawson BK, Fereshtehnejad S, Anang JBM, Nomura T, Rios-Romenets S, Nakashima K, Gagnon J, Postuma RB. Office-Based Screening for Dementia in Parkinson DiseaseThe Montreal Parkinson Risk of Dementia Scale in 4 Longitudinal Cohorts. JAMA Neurol. Published online March 26, 2018. doi:10.1001/jamaneurol.2018.0254
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