The importance of cognitive decline in Parkinson’s disease (PD), which eventually progresses to dementia (PD-D) in the majority of surviving patients, has been widely recognised during the last decade. PD-D is associated with a twofold increase in mortality, increased caregiver strain and increased healthcare costs. Thus, early and correct identification of the PD patients with a risk of dementia is a challenging problem of neurology, which has led to the suggestion of various markers of cognitive decline in PD. If validated, these markers would offer the opportunity for disease modification and therapeutic intervention at a critical early stage of the illness, when the viable neuronal population is greater.
The focus of this thesis was to assess how various factors – quantitative electroencephalography (qEEG) changes, genetics, deep brain stimulation (DBS), olfactory function, etc. – may be related with the risk of cognitive decline in PD patients. We performed four clinical studies with various design. These studies included PD patients who were dementia-free on inclusion, and control participants.
Principal findings are the following: (1) increase of global median relative power theta (4–8 Hz), executive and working memory dysfunction are independent prognostic markers of severe cognitive decline in PD patients over a period of 3 years. (2) DBS of the subthalamic nuclei in a group of PD patients with mean age 63.2 years, in comparison with a group of younger patients (52.9 years), causes higher incidence of psychiatric events over 2 years of observation. However, these events were transient and did not outweigh the benefits of surgery. (3) Worsening of verbal fluency performance is an early cognitive outcome of DBS of the subthalamic nuclei in PD patients. (4) Among early appearing non-motor signs of Parkinson’s disease, alteration of olfaction but not EEG spectrum correlates with motor function. (5) A composite score approach seems to be a realistic goal in the search for biomarkers of severe cognitive decline.