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The majority of patients with Parkinson disease (PD) develop dementia, but there is broad variation in the rate of cognitive decline and onset of dementia. Cognitive impairment has important consequences for patients, caregivers, and health-related costs.1 Although symptomatic improvement can be achieved with rivastigmine, drugs that prevent the development of dementia or slow the underlying pathology causing dementia are not available. Identifying risk factors for cognitive decline will facilitate the development of such therapeutics. Current risk factors for cognitive impairment and dementia associated with PD include demographic and clinical features such as older age; more severe parkinsonism, particularly axial postural impairment and gait disturbances; mild and isolated cognitive deficits; and mood disorders.1 However, much of the variability in cognitive decline remains unexplained and there is a need to identify more specific predictors of cognitive functioning based on the underlying pathophysiology.
In this issue of Neurology®, Siderowf and colleagues2 present the first longitudinal study of the relationship between CSF biomarkers and the rate of cognitive decline in patients with PD. Forty-five subjects were assessed annually with the Dementia Rating Scale, a global cognitive scale that is sensitive to the early cognitive changes in PD. A strong relationship with cognitive decline was found …
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