Excessive daytime sleepiness increases dementia risk in cognitively unimpaired Parkinson’s disease patients over 12 years
Abstract
Abstract Background Excessive daytime sleepiness (EDS) is a common non-motor symptom of Parkinson’s disease (PD) that often precedes diagnosis. Although EDS has been proposed as a predictor of cognitive decline, evidence linking it to specific cognitive deficits remains inconsistent. Objective This study investigated whether EDS increases the risk of conversion from cognitively normal (PD-CN) to mild cognitive impairment (PD-MCI) or dementia (PDD) and whether it relates to executive function and processing speed decline. Methods We analyzed data from 1147 initially cognitively normal PD participants with and without MCI and 266 cognitively normal older adults (CN) across 12 years. EDS was measured using the Epworth Sleepiness Scale (ESS) and cognition was assessed with the MoCA, Trail Making Test A and B, verbal fluency test, Symbol Digit Modality Test and the Letter-Number Sequencing. Cox proportional hazards models assessed conversion risk across three transitions. Mixed-effect linear regressions with FDR correction examined associations between ESS and cognitive performance over time in PD and CN participants. All models controlled for demographics, medication, PD severity, sleep and neuropsychiatric symptoms. Results Higher ESS scores were associated with greater risk of PD-CN to PDD conversion and with declining processing speed over time. Greater REM sleep behavior disorder was associated with higher risk of PD-CN to PD-MCI conversion. No significant association…
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