Lifestyle Factors, Comorbidities Influence Cognition in Early Parkinson Disease

elderly man, parkinson disease
Close Up Of Senior Man Suffering With Parkinsons Diesease
Researchers sought to explore the associations between cognitive status, comorbidities, metabolic variables, and lifestyle variables in patients with Parkinson disease from the COPPADIS study.

A cross-sectional study found potentially modifiable comorbidities and lifestyle factors which may contribute to the cognitive profile of patients with early Parkinson disease (PD). These findings were published in BMC Neurology.

Cognitive impairment has been associated with late PD; however, recent data has suggested that some patients with early PD exhibit cognitive changes.

To better assess cognitive pattens in early PD, data were sourced from the COhort of Patients with PArkinson’s DIsease in Spain (COPPADIS) which was an observational nationwide study with a 5-year follow-up. Patients with PD (N=533) were assessed for comorbidities, lifestyle characteristics, and cognitive performance.

The study population was aged mean 62.5±8.6 years, PD had lasted 5.52±6 months, Unified PD Rating Scale (UPDRS-III) was 21.9±11, L-dopa daily dose (LDD) was 527±420, and PD-Cognitive Rating Scale (PD-CRS) was 91.8±15.4.

Stratified by cognitively preserved PD (PD-NC; n=393), PD with mild cognitive impairment (PD-MCI; n=114), and PD with dementia (PDD; n=26) status, PD-MCI and PDD groups were older (P <.001) and the PD-NC cohort had achieved higher education (c2 <.001). Overall, there was a negative correlation between education and age (r, -0.410; P <.001).

The PD-MCI cohort had worse PD-CRS scores compared with PD-NC (t[507], 34.2; P <.001) and PDD had poor cognition compared with PD-MCI (t[140], 15.6; P <.001) and PD-NC (t[419], 32.1; P <.001).

The prevalence of hypertension was highest among the PD-MCI (45.6%) compared with PDD (34.6%; P <.05) and PD-NC (30.3%; P <.005) groups. Hypertension increased risk for PD-MCI (odds ratio [OR], 1.9; 95% CI, 1.2-2.9). A similar pattern was observed for diabetes with PD-MCI (OR, 3.1; 95% CI, 1.6-6.1) and PDD (OR, 2.1; 95% CI, 0.6-6.4) risk.

Higher PD-CRS scores were associated with younger age (b, -0.416; P <.001), education level (b, -0.451; P <.001), and lower UPDRS-III score (b, -0.102; P <.05).

PD-CRS total score associated with vitamin B12 (b, 0.169; P <.05), homocysteine (b, -0.194; P <.05), and iron (b, 0.177; P <.05) levels.

Stratified by group, the strongest predictors for PD-MCI were age (b, 0.091; P <.001), education level (b, -1.06; P <.001), and dysphoria (b, 0.058; P <.01) and for PDD were age (b, 0.102; P <.05), education (b, -2; P <.001), UPDRS-III (b, 0.056; P <.05), and severity of apathy (b, 0.197; P <.05).

This study was limited by not including brain structural data and its effects on cognition.

“We extend previous findings regarding the positive and negative influence of various comorbidities and lifestyle factors on cognitive status in early PD patients, and reinforce the need to identify and treat potentially modifiable variables with the intention of exploring the possible improvement of the global cognitive status of patients with PD,” the researchers concluded.

These data indicated that there are potential modifiable features which contribute to cognitive performance among patients with early PD. Additional study is needed to assess whether any of these factors may be interventional targets.


Martínez-Horta S, Bejr-Kasem H, Horta-Barba A, et al. Identifying comorbidities and lifestyle factors contributing to the cognitive profile of early Parkinson’s disease. BMC Neurol. December 8, 2021. doi:10.1186/s12883-021-02485-1