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NPJ Parkinsons Dis. 2018 Jun 26;4:19. doi: 10.1038/s41531-018-0055-3. eCollection 2018.

Cognitive impairment in Parkinson's disease: a report from a multidisciplinary symposium on unmet needs and future directions to maintain cognitive health.

Author information

1
1Department of Neurological Sciences, Section of Parkinson Disease and Movement Disorders, Rush University Medical Center, Chicago, IL USA.
2
Parkinson's Foundation, New York, NY USA.
3
3Department of Medicine, University of Alberta, Edmonton, AB Canada.
4
4Department of Neurology, University of Pennsylvania, Philadelphia, PA USA.
5
5Department of Psychiatry, Rutgers The State University of New Jersey, New Brunswick, NJ USA.
6
6Department of Physical Therapy and Athletic Training and Center for Neurorehabilitation, Boston University, Boston, MA USA.
7
7Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL USA.
8
8Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's disease, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON Canada.
9
9University of South Florida, Tampa, FL USA.
10
10Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN USA.
11
11Department of Health and Aging, Rush University Medical Center, Chicago, IL USA.
12
12Department of Medicine, University of Pennsylvania, Philadelphia, PA USA.
13
13Department of Neurology, Division of Neuropsychology, University of Miami, Miami, FL USA.
14
14Department of Neurology, University of Maryland School of Medicine, Baltimore, MD USA.
15
15Department of Clinical and Health Psychology, University of Florida, Gainesville, FL USA.
16
16Department of Clinical Nutrition, College of Health Sciences, Rush University Medical Center, Chicago, IL USA.
17
17Department of Neurology, Boston University Medical Campus, Boston, MA USA.
18
18Department of Clinical Neuropsychology and Center for Neuromodulation, Barrow Neurological Institute, Phoenix, AZ USA.
19
19Department of Neurology, University of Iowa, and Neurology Service, Iowa City, Veterans Affairs Health Care Systen, Iowa City, IA USA.
20
Illinois, USA.
21
Colorado, USA.

Abstract

People with Parkinson's disease (PD) and their care partners frequently report cognitive decline as one of their greatest concerns. Mild cognitive impairment affects approximately 20-50% of people with PD, and longitudinal studies reveal dementia in up to 80% of PD. Through the Parkinson's Disease Foundation Community Choice Research Award Program, the PD community identified maintaining cognitive function as one of their major unmet needs. In response, a working group of experts across multiple disciplines was organized to evaluate the unmet needs, current challenges, and future opportunities related to cognitive impairment in PD. Specific conference goals included defining the current state in the field and gaps regarding cognitive issues in PD from patient, care partner, and healthcare professional viewpoints; discussing non-pharmacological interventions to help maintain cognitive function; forming recommendations for what people with PD can do at all disease stages to maintain cognitive health; and proposing ideas for how healthcare professionals can approach cognitive changes in PD. This paper summarizes the discussions of the conference, first by addressing what is currently known about cognitive dysfunction in PD and discussing several non-pharmacological interventions that are often suggested to people with PD. Second, based on the conference discussions, we provide considerations for people with PD for maintaining cognitive health and for healthcare professionals and care partners when working with people with PD experiencing cognitive impairment. Furthermore, we highlight key issues and knowledge gaps that need to be addressed in order to advance research in cognition in PD and improve clinical care.

Conflict of interest statement

J.G.G. has received consulting/advisory board honoraria from Acadia, Aptinyx, Biogen; grants/research support from Acadia, Biotie (site PI), Consolidated Anti-Aging, National Institutes of Health, National Parkinson Foundation, Michael J. Fox Foundation, Rush University; honoraria from American Academy of Neurology, International Parkinson and Movement Disorder Society, MedEdicus; and salary from Rush University Medical Center. B.A.V. has received salary from the Parkinson’s Foundation. R.C. has received research funding from the Canadian Institutes for Health Research (CIHR), Alberta Innovates Solutions, the Alzheimer Society of Canada, University of Alberta Hospital Foundation, and National Institutes of Health and is a site investigator for a pharmaceutical trial sponsored by Axovant (back up site); served on the Scientific advisory board for Michael J. Fox Foundation, the Parkinson’s Disease Foundation, Parkinson Canada, Editorial board for Frontiers in Aging Neurosciences, Dementia and Geriatric Cognitive Disorders, Parkinsonism and Related Disorders, and as safety monitor/scientific advisor for a Harvard University/Tel Aviv University trial of DCTMS and a Western University investigator initiated pharmaceutical trial. N.D. has received grant/research support from the National Institutes of Health, Parkinson’s Foundation, Michael J. Fox Foundation, Parkinson Council, Biotie, Abbvie and salary from the University of Pennsylvania. R.D. has received grant/research support from the Michael J. Fox Foundation, the Parkinson’s Unity Walk, the Veteran Affairs Administration, and the Parkinson’s Foundation; consulting fees from the Michael J. Fox Foundation and the University of Delaware; and salary from Rutgers University. T.E. has received grant/research support from the National Institutes of Health, American Parkinson Disease Association and salary support from Boston University. J.E.G. has received grant/research support from the National Institutes of Health, Florida Department of Health, the Harry T. Mangurian Foundation, and the Association for Frontotemporal Degeneration, serves as a scientific advisor for Axovant, Biogen, Eisai, and Eli Lilly; receives licensing fees from Pfizer, Lilly, Axovant, and Quintiles; conducts on-going clinical trials funded by Biogen, Axovant, and Janssen, and serves on the editorial boards of Neurodegenerative Disease Management, Alzheimer’s Disease and Associated Disorders, and Acta Neuropathologica. C.M. has received grant/research support from The Michael J. Fox Foundation, Canadian Institutes of Health Research, Movement Disorders Society; National Institutes of Health; served as a consultant to Accorda Therapeutics; received honoraria from EMD Serono, steering committee for National Parkinson Foundation; and salary from the University Health Network. J. Edwards serves on Data Safety Monitoring Boards on National Institutes of Health grants awarded to Posit Science Inc. She previously served as a limited consultant to Posit Science Inc. in 2007, and has worked as a consultant to Wilson Sonsini Goodrich & Rosati. J.F. has received grant support from the Patient Centered Outcomes Research Institute, National Institutes of Health, and salary from Mayo Clinic, Rochester, MN. J.K. serves as a site PI for clinical trials sponsored by Novartis and Lilly and as a consultant to John Hancock. L.S. has received grant/research support from the National Institutes of Health, the Michael J. Fox Foundation, and Biotie/Acorda. G.S. has received grant support from the Patient Centered Outcomes Research Institute and National Institutes of Health and the Florida Department of Health; consulting fees from Novartis, the NFL Concussion Settlement Program and book royalties; and salary from the University of Florida, Gainesville. C.T. has received grant/research support from National Institutes of Health; consulting/advisory board honoraria from UpToDate Inc., Viocare Food Intake Advisory Board; and salary from Rush University Medical Center. C.A.T. has received grant/research support from the National Institutes of Health and salary support from Boston University. E.U. has received grant/research support from Michael J. Fox Foundation, National Institutes of Health, Department of Veterans Affairs; honoraria from the American Academy of Neurology; and salary from University of Iowa and Department of Veterans Affairs. The remaing authors declare no competing interests.

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