Practical clinical measures highlight cognition-balance associations in Parkinson's disease

Introduction

Cognitive impairment in people with Parkinson’s disease (PD) is associated with balance deficits and fall risk. Despite this, cognition is not routinely assessed by rehabilitation professionals. Establishing associations between specific domains of balance and cognition in PD using practical clinical measures could help inform evaluation and intervention by clinicians.

Research Question

Is there a relationship between subsections of the Montreal Cognitive Assessment (MoCA) and Mini Balance Evaluation Systems Test (MiniBESTest) in people with PD that could inform clinical practice?

Methods

One hundred and eight participants were included in this cross-sectional study (83.3 % male, mean age 70 ± 8.3). Motor function, balance, and cognition were assessed using the Unified Parkinson’s Disease Rating Scale Part III: Motor Examination, MiniBESTest, and MoCA, respectively. Pearson correlations, Spearman’s rho correlations, and multiple regression analysis were used to assess relationships.

Results

Statistically significant positive correlations were found between MoCA and MiniBESTest total and subsection scores. The strongest correlation between domains of balance and cognition was between MoCA Delayed Recall and MiniBESTest Dynamic Gait (rho=0.441, p < 0.001), which were also the strongest predictors of performance on the other measure (the MiniBESTest and MoCA, respectively).

Significance

Associations between domains of balance and cognition in PD can be demonstrated without a full battery of cognitive tests. The MoCA (an easy-to-use measure of global cognition) and MiniBESTest (a commonly used balance measure for PD) are sensitive to these associations and easily incorporated into clinical practice. Alternatively, delayed recall and dynamic gait can be quickly assessed and have potential as fall risk screens themselves. These associations could be used to inform both dual task and cognitive training in PD.