An international study with the participation of physicians from the AP-HP Paris public hospitals network and researchers from Inserm, UPMC and CNRS within the Brain & Spine Institute (ICM) has identified a clinical-genetic score to predict cognitive impairment in Parkinson’s disease sufferers. Cognitive impairment is one of the most debilitating characteristics to manifest in certain patients with the disease. The ability to predict its emergence within ten years of the onset of Parkinson’s is of major importance for their treatment and for the set-up of targeted clinical trials.
This study, published in The Lancet Neurology and funded notably by the National Institutes of Health (NIH), brings together U.S. teams from Harvard Medical School and Brigham and Women’s Hospital (Boston).
After several years of living with Parkinson’s, patients can suffer cognitive impairment in addition to the movement disorders characteristic of the disease. In their study, the researchers built an algorithm to identify those patients most subject to this impairment. It was developed using clinical and genetic data from 9 cohorts of patients with Parkinson’s from Europe and North America, i.e. roughly 3,200 patients who were followed over a 30-year period, from 1986 to 2016.
In France, the DIG-PD cohort, sponsored by AP-HP and coordinated by Prof. Jean-Christophe Corvol from the Department of Neurology and Head of the Clinical Investigation Center at Pitié Salpêtrière Hospital, is part of the project, which is called “Drug Interaction With Genes in Parkinson’s Disease – DIG-PD”. In the French cohort, over 400 patients were followed annually for 6 years.
A number of factors were taken into account and analyzed. Age at disease onset, motor and cognitive severity, education level, sex, depression, as well as β-glucocerebrosidase gene mutation status turned out to be the biggest predictors of cognitive impairment and were included in the prediction model developed by the researchers. The study also revealed that education could play a role in the onset of impairment and that this factor could be associated with potential patient “cognitive reserve”.
Based on this data, the clinical score developed by the researchers precisely and reproducibly predicts the onset of cognitive disorders within 10 years of that of Parkinson’s disease. It was developed thanks to the clinical and genetic analysis of the 9 cohorts, i.e. the analysis of over 25,000 associated elements of data.
This tool is of considerable importance for the prognosis of cognitive impairment in patients with Parkinson’s disease. It could also be used to identify more precisely those at high risk of developing such disorders to enable them to anticipate treatment or participate in targeted clinical trials.
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Prediction of cognition in Parkinson’s disease with a clinical–genetic score: a longitudinal analysis of nine cohorts Ganqiang Liu, Joseph J Locascio, Jean-Christophe Corvol, Brendon Boot, Zhixiang Liao, Kara Page, Daly Franco, Kyle Burke, Iris E Jansen, Ana Trisini-Lipsanopoulos, Sophie Winder-Rhodes, Caroline M Tanner, Anthony E Lang, Shirley Eberly, Alexis Elbaz, Alexis Brice, Graziella Mangone, Bernard Ravina, Ira Shoulson, Florence Cormier-Dequaire, Peter Heutink, Jacobus J van Hilten, Roger A Barker, Caroline H Williams-Gray, Johan Marinus, Clemens R Scherzer* The Lancet Neurology, June 16, 2017 http://dx.doi.org/10.1016/S1474-4422(17)30122-9