Association Between Screen-detected Cognitive Dysfunction and Disease Severity in Patients with Parkinson’s disease: A Multicenter Neurological and Behavioral Study

Abstract

Objective: To determine the association between screen-detected cognitive dysfunction and disease severity and identify related neurological and behavioral factors among patients with Parkinson’s disease.

Methods: This multicenter cross-sectional study included 210 adults with Parkinson’s disease attending four tertiary-care hospitals in Pakistan from July 2024 to June 2026. Cognitive performance was assessed using the Montreal Cognitive Assessment (MoCA). Disease severity was measured through the modified Hoehn and Yahr scale and Movement Disorder Society–Unified Parkinson’s Disease Rating Scale Part III (MDS-UPDRS III). Depression and anxiety were screened using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 scale. The MoCA score was analyzed continuously, while a score below 26 indicated screen-detected cognitive dysfunction. Sensitivity analyses used cutoffs of ≤25 and ≤22. Multivariable logistic regression identified independently associated factors.

Results: The mean age was 63.7±9.3 years, and 129 (61.4%) participants were men. Using the primary cutoff, 131 (62.4%) patients had screen-detected cognitive dysfunction. Its frequency increased from 39.4% in Hoehn and Yahr stages 1–1.5 to 88.9% in stages 4–5 (p<0.001). MoCA scores were negatively correlated with MDS-UPDRS III scores, disease duration and disease stage. Older age, limited education, longer disease duration, advanced stage, greater motor impairment and depression were independently associated with cognitive dysfunction.

Conclusion: Lower cognitive performance was common and was associated with increasing neurological severity. Routine cognitive, functional and behavioral screening could support earlier multidisciplinary care in resource-limited hospitals.