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Subjective Cognitive and Communicative Complaints and Health-Related Quality of Life in Parkinson's Disease with and without Mild Cognitive Impairment
Quejas subjetivas cognitivas y comunicativas y Calidad de Vida Relacionada con la Salud en la Enfermedad de Parkinson con y Sin Deterioro Cognitivo Leve
Alberto Jaramillo-Jimeneza,b,c,d,e,1,
Corresponding author
alberto.jaramilloj@udea.edu.co

Corresponding author.
, Yamile Bocanegrab,c,1, Omar Buriticáb, David Antonio Pineda Salazarb,c, Leonardo Moreno Gómezf, Carlos Andrés Tobón Quinteroc,g, Daniel Camilo Aguirre-Acevedob,c, Melissa Sierra Castrillonb,c, Daniel Vasquezb, Juan Esteban Velez-Hernandezb, Miguel Germán Bordaa,e,h, Elkin García-Cifuentesb,h, David Fernando Aguillónb,c, Lucía Madrigal-Zapatab, Dag Aarslanda,i, Francisco Loperab
a Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway
b Grupo de Neurociencias de Antioquia, Universidad de Antioquia, School of Medicine, Medellín, Colombia
c Grupo Neuropsicología y Conducta, Universidad de Antioquia, School of Medicine, Medellín, Colombia
d Semillero de Investigación SINAPSIS, Universidad de Antioquia, School of Medicine, Medellín, Colombia
e Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
f Unidad de Neurología, Hospital Pablo Tobón Uribe, Medellín, Colombia
g Área de investigación e Innovación, Institución Prestadora de Servicios de Salud (IPS Universitaria), Medellín, Colombia
h Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana, Bogotá, Colombia
i Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Correlation between the global HRQoL and the Cognition and Communication dimensions&#46; 95&#37;CI&#58; 95&#37; confidence interval&#59; FDR&#58; false discovery ratio&#59; PD- nMCI&#58; Parkinson&#39;s disease without mild cognitive impairment&#59; PD-MCI&#58; Parkinson&#39;s disease with mild cognitive impairment&#59; PDQ-39&#58; Parkinson&#39;s Disease Questionnaire-39&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Parkinson&#39;s disease &#40;PD&#41; is one of the most prevalent neurodegenerative diseases and is primarily related to motor symptoms&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">1</span></a> However&#44; cognitive decline in PD patients has been highlighted among other non-motor symptoms due to its high prevalence&#44; and its negative effects on wellbeing and prognosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">2&#44;3</span></a> Mild cognitive impairment &#40;MCI&#41; due to PD &#40;PD-MCI&#41; is present in approximately 36&#37; of the PD cases&#44; even at the early stages of the disease&#44; and it has been identified as a risk factor for progression to PD dementia &#40;PDD&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">1&#44;3</span></a> In PD patients with normal cognition&#44; the presence of subjective cognitive complaints seems to be an indicator of the subsequent onset of MCI and functional decline&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">4</span></a> On the other hand&#44; up to 89&#37; of PD patients present speech difficulties such as dysarthria&#44; hypophonia&#44; and loss of articulation&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">11</span></a> Also&#44; language disorders at the pragmatic level have been reported in PD&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">12</span></a> Therefore&#44; speech and language disorders could generate subjective communication complaints related to language impairment at the phonemic and pragmatic level&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">As evidence-based medicine perspectives have emphasized the importance of patient-reported outcome measures in chronic diseases&#44; the health-related quality of life &#40;HRQoL&#41; has become a crucial target in neurodegenerative diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">5</span></a> The HRQoL is a multidimensional construct including physical and mental health&#44; social&#44; emotional&#44; and other domains&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">6</span></a> Thus&#44; this patient-centered approach considers the patient&#39;s beliefs&#44; ideas&#44; and subjective perception of health&#44; as well as the implications of the disease symptoms over satisfaction and individual well-being&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">7</span></a> However&#44; the perception of mental health &#40;especially of subjective cognitive complaints&#41; could be affected by several factors in PD patients&#44; such as mood symptoms&#44;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">8</span></a> lack of knowledge about the cognitive symptoms related to PD&#44;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">9</span></a> and lack of self-awareness for cognitive deficits &#40;i&#46;e&#46; anosognosia&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">10</span></a> Given the possible confounder effect of anosognosia in advanced stages of PD &#40;i&#46;e&#46; PDD&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">10</span></a> evaluating the impact of subjective cognitive and communicative complaints on HRQoL in earlier stages of PD &#40;i&#46;e&#46; MCI&#41; is valuable for a better understanding of the determinants of HRQoL&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Few preliminary studies have compared the HRQoL in PD patients with and without MCI&#44;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">11</span></a> thus&#44; our first objective is to compare the HRQoL in PD patients with and without MCI&#46; In addition&#44; we are not aware of studies exploring the relationship between self-perceived cognition-communication difficulties and HRQoL&#46; Therefore&#44; our second objective is to explore the potential relationships between the subjective cognitive and communicative complaints&#44; and HRQoL in PD patients with and without MCI&#46; We hypothesize that PD patients with MCI will have a worse HRQoL&#44; and they will report more subjective cognitive and communicative complaints that will be correlated with a worse HRQoL&#46; Our exploratory results may contribute to the patient-centered approach enhancing the comprehension of the effects of MCI over self-perceived mental health and HRQoL in PD patients&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Sample selection</span><p id="par0020" class="elsevierStylePara elsevierViewall">This is a secondary analysis of the project &#8220;Procesamiento del lenguaje de acci&#243;n en pacientes con enfermedad ganglio-basal desde una perspectiva neuropsicol&#243;gica y neurofisiol&#243;gica&#8221; &#40;&#8220;Action language processing in patients with basal-ganglia disease from a neuropsychological and neurophysiological perspective&#8221;&#41; carried out at the Universidad de Antioquia &#40;University of Antioquia&#41; in 2015&#44; recruiting a convenience sample of PD patients from the outpatient service of the Grupo de Neurociencias de Antioquia &#40;Neurosciences group of Antioquia&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">12</span></a> The study had the approval of the Ethical Research Committee of the Universidad de Antioquia &#40;Certificate No&#46; 15-10-569&#41;&#44; and all participants signed an informed consent form before enrolment in the study&#46; The data was handled and kept following national health and data privacy protocols&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">We included 29 PD patients without MCI &#40;PD-nMCI&#41; and 11 PD patients with MCI &#40;PD-MCI&#41;&#46; Participants with parkinsonian syndromes other than PD&#44; other major neurological or psychiatric disorders&#44; and dementia &#40;based on impairment in cognition and function&#41;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">13</span></a> were excluded&#46; Detailed criteria regarding PD and MCI diagnosis are stated below&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Clinical assessment</span><p id="par0030" class="elsevierStylePara elsevierViewall">A team of two neurologists and one trained physician &#40;general practitioner&#41; determined the PD diagnosis following the Movement Disorder Society clinical diagnostic criteria&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">14</span></a> The Hoehn &#38; Yahr scale<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">15</span></a> and the Unified Parkinson&#39;s Disease Rating Scale part III &#40;UPDRS-III&#41;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">16</span></a> were used for evaluating the severity of the disease and motor symptoms&#44; respectively&#46; Levodopa Equivalent Daily Dose &#40;LEDD&#41; was determined from the individual medication of patients&#44; all patients had received stable antiparkinsonian treatment during at least 4 weeks before evaluations&#46; All assessments were completed in phase &#8216;On&#8217; of levodopa treatment&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The PD-nMCI patients had a Montreal Cognitive Assessment score &#40;MoCA&#41; of 23 or above &#40;according to validation in the Colombian population<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">17&#44;18</span></a>&#41;&#46; The PD-MCI patients were diagnosed following the level one task force criteria of the Movement Disorders Society<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">19</span></a> &#40;i&#46;e&#46; observed or self-reported gradual cognitive decline in the clinical or neuropsychological examination&#44; MoCA<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>23&#44; and no significant cognition-related functional decline&#41;&#46; In those who reported subjective cognitive complaints&#44; the evaluator examined carefully if the difficulties are related to functional decline &#40;i&#46;e&#46; impairs the ability of the patient to perform instrumental or basic activities of daily living&#41;&#46; The latter was assessed using the Barthel Index<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">20</span></a> and Lawton &#38; Brody scale&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">21</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">All the neuropsychological tests &#40;i&#46;e&#46; Neuropsychiatric Inventory&#44; MoCA&#44; Lawton &#38; Brody&#44; Barthel&#44; and HRQoL scale&#41; were performed by a team of 3 trained psychologists who also confirmed PD-MCI diagnosis and absence of exclusion criteria &#40;i&#46;e&#46; dementia&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Since anosognosia could influence subjective cognitive or communicative complaints&#44; due to the lack of awareness deficits&#44;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">10</span></a> we evaluated anosognosia especially in the PD-MCI group through the clinical examination but none of the patients presented this symptom&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Health-related quality of life</span><p id="par0050" class="elsevierStylePara elsevierViewall">HRQoL was assessed with a specific scale for PD&#44; the Parkinson&#39;s Disease Questionnaire-39 &#40;PDQ-39&#41;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">22</span></a> due to its reliability&#44; psychometric properties&#44; validation across different countries&#44; and translations in many languages&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">8</span></a>&#46; The questionnaire consists of 39 items grouped in eight dimensions &#40;i&#46;e&#46; mobility&#44; activities of daily living&#44; emotional wellbeing&#44; stigma&#44; social support&#44; cognition&#44; communication&#44; and bodily discomfort&#41; and an averaged summary index of the 8 dimensions of PDQ-39 &#40;PDQ-39 SI&#41; that provides a measure of the global HRQoL&#46; Each of the 39 items was scored using a 5-point Likert scale&#44; ranging from &#8220;never&#8221; to &#8220;always&#47;cannot do at all&#8221;&#46; Therefore&#44; a higher score in PDQ-39 indicates a poor HRQoL&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">22</span></a> To avoid mistakes while filling up the PDQ-39&#44; the evaluator marked the patients&#8217; answers in the form&#44; and clarified any item if necessary&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Based on previously reported methods&#44;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">23</span></a> we analyzed the Cognition dimension as a measure of subjective cognitive complaints&#44; and the Communication dimension was used as a measure of subjective communicative complaints&#46; High scores in the Cognition or Communication dimension indicates high subjective cognitive or communication difficulties reported by the patient&#46; The Cognition dimension includes 4 items &#40;items 30-33&#41; of the PDQ-39&#44; such as impaired concentration&#44; memory complaints&#44; and cognitive fluctuations &#40;e&#46;g&#46;&#44; Had problems with your concentration when reading&#44; watching TV&#44; etc&#46;&#63;&#59; Felt your memory was bad&#63;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">22</span></a> The Communication dimension includes 3 items &#40;items 34-36&#41; of the PDQ-39 that point out speech and communication problems &#40;e&#46;g&#46;&#44; Had difficulty with your speech&#63;&#59; Felt unable to communicate with people properly&#63;&#59; Felt ignored by people&#63;&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Finally&#44; the PDQ-39 SI was taken as our outcome variable&#44; indicating the global HRQoL&#46; To face the circularity problems when analyzing the influence of a dimension over the summary index of the PDQ-39&#44; we adjusted the PDQ-39 SI excluding the items of the Cognition or Communication dimension as appropriate &#40;see &#8220;Statistical analysis&#8221;&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Statistical analysis</span><p id="par0065" class="elsevierStylePara elsevierViewall">Demographic and clinical group differences were assessed using Mann-Whitney&#39;s U for continuous variables&#44; and the Chi-square test for categorical variables&#46; Group differences in clinical and demographic variables &#40;i&#46;e&#46; age&#44; years of education&#44; gender&#44; and motor symptoms&#41; were explored to evaluate the homogeneity between groups&#44; and the effect size was calculated using the Wilcoxon r statistic &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>Z&#47;&#8730;N&#41; for continuous variables<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">24</span></a>&#44; and the phi coefficient &#8212;&#966;&#61;&#8730;&#40;X<span class="elsevierStyleSup">2</span>&#47;N&#41;&#8212; for categorical variables&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">25</span></a> Given the possible confounder effect of motor symptoms due to heterogeneity between PD-nMCI and PD-MCI groups&#44; we controlled the subsequent analyses for the score of the UPDRS-III&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">For our first objective&#44; group differences of the non-adjusted PDQ-39 SI were evaluated and its effect size was calculated using the Wilcoxon r statistic&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">24</span></a> An additional analysis of the group differences in each of the eight dimensions of PDQ-39 was also performed&#44; and these resulting p-values were corrected for multiple testing using the false discovery rate &#40;FDR&#41; method setting a significance threshold of &#46;05&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">26</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">For our second objective&#44; non-parametric bivariate correlations between the Cognition dimension score and an adjusted PDQ-39 SI &#40;excluding the items of the Cognition dimension&#41; were performed following previous methods&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">27</span></a> Similarly&#44; to explore the correlations between the score of the Communication dimension and PDQ-39 SI&#44; we computed an adjusted summary index &#40;PDQ-39 SI&#41; excluding the items of the Communication dimension to avoid circularity issues&#46; Each correlation model was performed separately in both groups&#44; and the resulting <span class="elsevierStyleItalic">P</span>-values of these correlations were corrected for multiple testing using the FDR method&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">In addition&#44; given the differences in motor symptoms &#40;UPDRS-III&#41;&#44; the results of the latter correlation models were checked in each group using non-parametric partial correlations controlling for the effect of UPDRS-III&#46; These resulting <span class="elsevierStyleItalic">P</span>-values were also corrected for multiple testing &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Previous reports suggested a possible confounder effect of depression or anxiety in the self-perception of cognition difficulties&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">8&#44;28</span></a> Thus&#44; we used the Neuropsychiatric Inventory &#40;NPI&#41;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">29</span></a> to measure depression and anxiety symptoms based on synoptic scores &#40;i&#46;e&#46; frequency &#215; severity&#41; of the corresponding items&#46; In each group&#44; we conducted non-parametric bivariate correlations between the PDQ-39 variables &#40;i&#46;e&#46; Cognition and Communication dimensions&#44; as well as each of the adjusted summary indexes of the PDQ-39&#41;&#44; and the NPI scores of depression and anxiety&#44; in order to examine these potential confounders &#40;<a class="elsevierStyleCrossRef" href="#sec0090">Table 1 of the supplementary material</a>&#41;&#46; Additional non-parametric partial correlations controlling for the effect of depression&#44; anxiety&#44; as well as the combined effect of depression&#44; anxiety&#44; and motor symptoms&#44; were explored &#40;<a class="elsevierStyleCrossRef" href="#sec0090">Table 2 of the supplementary material</a>&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Non-parametric bivariate correlations between the Cognition and Communication dimensions&#44; and the non-adjusted PDQ-39 SI&#44; were also conducted to explore the dimension-total correlations as part of the psychometric characteristics of the instrument &#40;<a class="elsevierStyleCrossRef" href="#sec0090">Table 3 of the supplementary material</a>&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Given the possible effect of our sample size in the <span class="elsevierStyleItalic">P</span>-values&#44; and to provide a better scale for measuring the amount of information the test supplies against the hypothesis&#44; we rescaled all the <span class="elsevierStyleItalic">P</span>-values into Shannon information values &#40;S-values&#41; following previously described methods&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">30</span></a> Statistical analyses were performed using SPSS &#40;version 25&#41;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">31</span></a> and JASP &#40;version 0&#46;13&#46;1&#46;0&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">32</span></a></p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results</span><p id="par0100" class="elsevierStylePara elsevierViewall">40 patients were included&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarizes the characteristics of PD-MCI and PD-nMCI patients&#44; showing homogeneity between groups except for the MoCA test &#40;used for classification of the cognitive status of the groups&#41;&#44; and motor symptoms&#46; The latter can be seen in the higher UPDRS-III score of the PD-MCI group&#46; We did not find significant differences for age&#44; neuropsychiatric symptoms &#40;NPI Total&#41;&#44; nor depression &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;939&#59; r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8211;&#46;012&#41; or anxiety scores &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;397&#59; r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8211;&#46;134&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Differences in global HRQoL</span><p id="par0105" class="elsevierStylePara elsevierViewall">The median score of the PDQ-39 SI in the PD-nMCI group was 13&#46;6&#44; and in the PD-MCI group was 29&#46;3&#46; The PDQ-39 SI scores were higher in PD-MCI patients &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;030&#41;&#44; exhibiting a moderate effect size of the difference &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8211;&#46;342&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">figure 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Patients diagnosed with PD-MCI reported higher scores in all the dimensions of PDQ-39 &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Differences were found in three dimensions after correction for multiple testing &#40;i&#46;e&#46; Cognition&#44; Communication&#44; and Bodily discomfort&#41;&#46; Estimations of the effect size showed large differences in the Cognition dimension&#46; A moderate effect size of the difference was found in the Communication&#44; and Bodily discomfort dimensions&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Self-perceived cognition and its relation to HRQoL</span><p id="par0115" class="elsevierStylePara elsevierViewall">The median &#91;interquartile range&#93; cognition-adjusted PDQ-39 SI in the PD-nMCI group was 15&#46;6 &#91;6&#46;43-28&#46;99&#93;&#44; and in the PD-MCI group was 30&#46;48 &#91;10&#44;12-43&#44;63&#93;&#44; as reported in <a class="elsevierStyleCrossRef" href="#sec0090">figure 2J of the supplementary material</a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0010">Figure 2A</a> depicts the bivariate non-parametric correlation between the Cognition dimension and the Cognition-adjusted PDQ-39 SI &#40;i&#46;e&#46; excluding the items of the Cognition dimension&#41;&#46; After correction for multiple testing&#44; significant strong correlations were seen in the PD-MCI group but not in the PD-nMCI group&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">Similar findings were observed when controlling the correlations for the group differences in motor symptoms &#40;UPDRS-III&#41;&#46; The Cognition dimension and the global HRQoL &#40;i&#46;e&#46; cognition-adjusted PDQ-39 SI&#41; were significantly correlated only in the PD-MCI group&#44; as reported in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Self-perceived communication and its relation to HRQoL</span><p id="par0130" class="elsevierStylePara elsevierViewall">The median &#91;interquartile range&#93; Communication-adjusted PDQ-39 SI in the PD-nMCI group was 12&#46;86 &#91;6&#46;43-27&#46;80&#93;&#44; and in the PD-MCI group was 29&#46;88 &#91;12&#46;80-43&#46;33&#93;&#44; as showed in <a class="elsevierStyleCrossRef" href="#sec0090">figure 2K of the supplementary material</a>&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0010">Figure 2B</a> shows the bivariate correlation between the Communication dimension and the Communication-adjusted PDQ-39 SI &#40;i&#46;e&#46; excluding the items of the Communication dimension&#41;&#46; Significant correlations were seen in both groups after correcting for multiple testing&#46; However&#44; the PD-MCI group exhibited strong correlations while the PD-nMCI had moderate correlations&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the results of these correlations when controlling for motor symptoms &#40;UPDRS-III&#41;&#46; The Communication dimension and the global HRQoL &#40;i&#46;e&#46; communication-adjusted PDQ-39 SI&#41; were significantly correlated only in the PD-MCI group&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Effect of depression and anxiety symptoms over self-perceived cognition or communication difficulties and global HRQoL</span><p id="par0145" class="elsevierStylePara elsevierViewall">As we did not find group differences in depression or anxiety scores&#44; we did not adjust the main correlation models for these confounders&#46; In spite of it&#44; we explored in each group the correlation of these symptoms&#44; and the PDQ-39 dimensions&#44; adjusted and unadjusted PDQ-39 summary indexes&#46; Given the exploratory nature of these correlations&#44; we did not perform correction for multiple testing&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">As showed in <a class="elsevierStyleCrossRef" href="#sec0090">Table 1 of the supplementary material</a>&#44; none of the groups exhibited significant correlations between the depression or anxiety scores and the analyzed PDQ-39 scores &#40;i&#46;e&#46; Cognition&#44; Communication&#44; PDQ-39 SI&#44; cognition-adjusted PDQ-39 SI&#44; and communication-adjusted PDQ-39 SI&#41;&#46; Depression only showed significant strong correlations in the PD-MCI group with the Emotional well-being dimension &#40;&#961;&#61;&#46;62&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;002&#41;&#46; In the PD-nMCI group&#44; depression was significantly correlated with the stigma &#40;&#961;&#61;&#46;479&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;009&#41; and the social support dimensions &#40;&#961;&#61;&#46;545&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;002&#41;&#46; Anxiety scores were not correlated with any of the PDQ-39 variables in none of the groups &#40;<a class="elsevierStyleCrossRef" href="#sec0090">Table 1 of the supplementary material</a>&#41;&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Finally&#44; we explored non-parametric partial correlations between the Cognition and Communication dimensions&#44; and the adjusted PDQ-39 SI&#44; these correlations were controlled for depression&#44; anxiety and the combination of motor and mood symptoms &#40;<a class="elsevierStyleCrossRef" href="#sec0090">Table 2 of the supplementary material</a>&#41;&#46; In the PD-MCI group&#44; our findings regarding the relationship between the Cognition and Communication dimension and the adjusted PDQ-39 SI remain consistent after controlling the correlation models for all the possible confounders&#46; Also&#44; the PD-nMCI group exhibited significant correlations between the Communication-adjusted PDQ-39 SI and the Communication dimension after &#40;<a class="elsevierStyleCrossRef" href="#sec0090">Table 2 of the supplementary material</a>&#41;&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Discussion</span><p id="par0160" class="elsevierStylePara elsevierViewall">This work explored the relationship between the HRQoL and the subjective cognitive and communicative complaints in PD patients with and without MCI&#46; Our results showed that subjective cognitive and communicative complaints are significantly correlated with the HRQoL in PD-MCI patients&#44; but not in the PD-nMCI group&#46; Therefore&#44; assessing the HRQoL and the subjective cognitive and communicative complaints might be useful to quantify important patient-reported outcomes in PD patients&#44;<a class="elsevierStyleCrossRefs" href="#bib0385"><span class="elsevierStyleSup">33&#44;34</span></a> especially those with MCI&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Cognitive decline has been recognized as an important factor that impacts negatively the HRQoL in PD patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">3&#44;35&#8211;37</span></a> We found a poorer HRQoL in the PD-MCI group with the largest effect size of the difference in the Cognition dimension of HRQoL&#46; One preliminary work has tried to determine what can be considered &#8220;minimally important differences in HRQoL&#8221; using the PDQ-39&#44; showing that those differences vary across the PDQ-39 dimensions&#46;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">38</span></a> Thus&#44; in our study&#44; the observed differences between PD-MCI and PD-nMCI in the PDQ-39 SI&#44; the Cognition&#44; and the Communication dimensions seem to be considered important for the patients&#46;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">38</span></a> Also&#44; in line with our findings&#44; preliminary reports have shown worse HRQoL in PD patients with an abnormal cognitive screening test&#44;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">36</span></a> those with PD-amnestic MCI&#44;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">37</span></a> as well as those with more severe MCI&#46;<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">39</span></a> By contrast&#44; other studies found non-significant differences in the Cognition dimension or the global HRQoL when comparing PD patients with and without MCI&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">11&#44;28</span></a> However&#44; their conclusions only can be generalized to populations with a high level of education &#40;&#62;15 years&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">11</span></a> In our case&#44; the median years of education was below 15 years in both groups&#46; Therefore&#44; even if cross-sectional evidence suggests that low education level does not impact the HRQoL in PD patients&#44;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">36</span></a> further research including larger and heterogeneous samples will elucidate the effect of education over subjective cognitive complaints and HRQoL in PD-MCI patients&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Beyond&#44; multiple factors can affect the scores of the Cognition dimension&#58; Lack of awareness of the cognitive deficits &#40;i&#46;e&#46; anosognosia&#41; that emerges in severe cognitive decline &#40;i&#46;e&#46; PD dementia&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">10</span></a> Other mental health factors such as anxiety&#44; depression&#44; and optimism seem to explain the worsening in the Cognition subscale and the HRQoL better than the neuropsychological performance&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">8&#44;28</span></a> Comparable results were described in PD patients with normal cognition&#58; the higher the depressive symptoms&#44; the higher the subjective cognitive complaints&#46;<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">35</span></a> However&#44; our results did not show significant correlations between depression or anxiety and the HRQoL nor the Cognition or Communication dimensions&#46; Also&#44; our findings regarding the relationship between HRQoL and subjective cognitive and communicative complaints were consistent in the PD-MCI group after controlling for depression&#44; anxiety&#44; and motor symptoms&#44; but the relationship of HRQoL and Communication dimension in the PD-nMCI group seems to be significant&#46; We are aware that these results should be interpreted with caution since the NPI is not a specific instrument for mood disorders&#44; and future studies with specific protocols will contribute to unveil the role of mood disorders as determinants of HRQoL in PD&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">It has been proposed that the Cognition dimension &#40;specifically the attention and memory items&#41; could be valuable measures of how the patients subjectively rate their cognitive performance and should be examined as an endpoint and predictor of cognitive decline in larger studies&#46;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">40</span></a> In addition to the Cognition dimension&#44; we have evaluated the Communication dimension &#40;i&#46;e&#46; phonetic and pragmatic level of language&#41;&#46; In line with our findings&#44; preliminary reports have suggested increased subjective communication difficulties in PD-MCI patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">11&#44;28</span></a> Also&#44; the prognostic impact of the subjective cognitive complaints has been recently evaluated in PD patients with normal cognition&#44; showing that subjective cognitive complaints have been associated with greater decline in cognition-related functional abilities&#44; suggesting that subjective cognitive complaints may be a sensitive indicator of the cognitive decline in PD&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">4</span></a> Therefore&#44; consider&#236;ng the subjective cognitive and communicative complaints as well as HRQoL in PD patients with and without MCI&#44; may lead the clinicians to a more comprehensive patient-centered approach with relevant prognostic implications&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">The PDQ-39 is an instrument that has been widely applied in clinical research to assess the HRQoL and the multiple dimensions of this construct&#44; demonstrating acceptability&#44; internal consistency&#44; and a holistic approach to both motor and non-motor symptoms of PD&#46;<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">41</span></a> Nevertheless&#44; the validity of the Cognition dimension as a subjective measure of cognitive abilities has been questioned since some of the items are not directly related to cognition &#40;such as presence of hallucinations&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0420"><span class="elsevierStyleSup">40&#44;42</span></a> Further research analyzing the meaningful items of the Communication and Cognition dimensions as well as the PDQ-39 SI could represent an important patient-reported outcome measure&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Several limitations to this study should be considered when interpreting our results&#46; The small convenience sample size can affect the external validity of our results and the statistical power&#44; it also precluded us from the use of other statistical methods better suited for larger samples&#46; In order to get the external validity of our results&#44; the authors encourage future research to reproduce our exploratory findings&#46; Also&#44; the lack of follow-up reduces the possibility of establishing causal effects&#46; Besides&#44; given the retrospective nature of our study&#44; we did not use a specific measure for subjective cognitive and communicative complaints&#44; nor specific tests for anosognosia or mood symptoms&#46; Additionally&#44; the subtle nonsignificant age difference in our groups should be considered as a potential bias&#46; However&#44; few publications have evaluated the HRQoL in the Colombian population&#44;<a class="elsevierStyleCrossRefs" href="#bib0435"><span class="elsevierStyleSup">43&#44;44</span></a> and this is the first work examining the impact of subjective cognitive and communicative complaints on HRQoL in PD-MCI patients&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conclusions</span><p id="par0190" class="elsevierStylePara elsevierViewall">HRQoL seems to be affected in PD-MCI patients&#44; and it might be influenced by greater subjective cognitive and communicative complaints&#46; Thus&#44; including patient-reported measures of HRQoL&#44; and providing cognitive and speech rehabilitation&#44; as well as psychotherapeutic strategies&#44; to face the cognitive and communicative deficits of the patients&#44; could enhance the patient-centered approach in PD&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Funding</span><p id="par0195" class="elsevierStylePara elsevierViewall">This work was supported by the Research Development Committee &#40;CODI&#41; - Universidad de Antioquia &#40;University of Antioquia&#41;&#44; Colombia&#44; under the research project&#58; <span class="elsevierStyleItalic">&#8220;Procesamiento del lenguaje de acci&#243;n en pacientes con enfermedad ganglio-basal desde una perspectiva neuropsicol&#243;gica y neurofisiol&#243;gica&#8221;</span> &#40;grant reference PRG-2014-768&#41;&#46; In addition&#44; this paper represents independent research supported by the Norwegian government&#44; through hospital owner Helse Vest &#40;Western Norway Regional Health Authority&#41;&#44; and was partly funded by the National Institute for Health Research &#40;NIHR&#41; Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King&#39;s College London&#46; The views expressed are those of the authors and not necessarily those of the NHS&#44; the NIHR or the Department of Health and Social Care&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Conflicts of interests</span><p id="par0200" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interests to declare&#46; The sponsor has no role in the collection&#44; analysis&#44; interpretation of the data&#44; and writing of the final manuscript&#46;</p></span></span>"
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              "titulo" => "Self-perceived communication and its relation to HRQoL"
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              "titulo" => "Effect of depression and anxiety symptoms over self-perceived cognition or communication difficulties and global HRQoL"
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            0 => "Enfermedad de Parkinson"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Mild Cognitive Impairment &#40;MCI&#41; is common in Parkinson&#39;s Disease &#40;PD&#41;&#46; Few studies have compared the Health-Related Quality of Life &#40;HRQoL&#41; in patients with and without MCI due to PD &#40;PD-MCI&#41;&#44; and its correlation to patients&#8217; subjective cognitive and communicative difficulties has not been explored&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We aimed to compare HRQoL in PD-MCI and PD without MCI &#40;PD-nMCI&#41;&#44; and explore its possible relationship to subjective cognitive and communicative complaints&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We included 29 PD-nMCI and 11 PD-MCI patients&#46; The HRQoL was assessed with the Parkinson&#39;s Disease Questionnaire-39 &#40;PDQ-39&#41;&#58; its Cognition dimension was used as a measure of subjective cognitive complaints&#44; its Communication dimension for subjective communicative complaints&#44; and the summary index &#40;PDQ-39 SI&#41; as an indicator of HRQoL&#46; Non-parametric partial correlations between the Cognition and Communication dimensions&#44; and the adjusted PDQ-39 SI were conducted&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">PD-MCI patients had greater subjective cognitive and communicative complaints and worse HRQoL than PD-nMCI patients&#46; In the PD-MCI group&#44; both subjective cognitive and communicative complaints exhibited significant direct correlations with the adjusted HRQoL scores&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">HRQoL seems to be affected in PD-MCI&#44; and it might be influenced by greater subjective cognitive and communicative complaints&#46; Including patient-reported outcome measures of HRQoL&#44; and providing cognitive and speech rehabilitation&#44; as well as psychotherapeutic strategies to face these deficits can enhance the patient-centred approach in PD&#46;</p></span>"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducci&#243;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El deterioro cognitivo leve &#40;DCL&#41; es frecuente en la enfermedad de Parkinson &#40;EP&#41;&#46; Pocos estudios han comparado la calidad de vida relacionada con la salud &#40;CVRS&#41; en pacientes con DCL debido a EP &#40;EP-DCL&#41; sin explorar la relaci&#243;n entre la CVRS y las quejas subjetivas cognitivas y comunicativas de los pacientes&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Comparar la CVRS en EP-DCL y EP sin DCL &#40;EP-nDCL&#41; explorando sus posibles relaciones con las quejas subjetivas cognitivas y comunicativas&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se incluy&#243; a 29 EP-DCL y 11 EP-nDCL&#46; La CVRS se evalu&#243; con el cuestionario PDQ-39&#58; su dimensi&#243;n Cognici&#243;n se us&#243; como medida de las quejas subjetivas cognitivas&#59; su dimensi&#243;n Comunicaci&#243;n&#44; como medida de las quejas subjetivas comunicativas y su puntuaci&#243;n resumen &#40;PDQ-39 SI&#41;&#44; como indicador de CVRS&#46; Se realizaron correlaciones parciales no param&#233;tricas entre el PDQ-39 SI ajustado y las dimensiones Cognici&#243;n y Comunicaci&#243;n&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Los pacientes EP-DCL presentaron una peor CVRS y mayores quejas subjetivas cognitivas y comunicativas&#46; En el grupo EP-DCL&#44; tanto las quejas subjetivas cognitivas como las comunicativas mostraron correlaciones directas significativas con la puntuaci&#243;n de CVRS ajustada&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">La CVRS de los pacientes con EP-DCL parece estar afectada e influida por las quejas subjetivas en cognici&#243;n y comunicaci&#243;n&#46; Incluir los resultados de CVRS reportados por los pacientes&#44; proveer rehabilitaci&#243;n cognitiva y del lenguaje y estrategias de psicoterapia para afrontar dichos d&#233;ficit podr&#237;a mejorar el abordaje centrado en el paciente en la EP&#46;</p></span>"
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">PD-nMCI&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">PD-MCI&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>-value<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Effect size<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63 &#91;54-66&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65 &#91;60-69&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;225&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&#46;192&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gender &#40;F&#47;M&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#47;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;528<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;115<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Education &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;693&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8211;&#46;063&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Years since diagnosis of PD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;394&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&#46;135&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LEDD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">600 &#91;350-800&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">750 &#91;300-1048&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;379&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&#46;139&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hoehn &#38; Yahr&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#91;2-2&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#91;2-2&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;854&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&#46;029&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UPDRS-III score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27 &#91;22-31&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35 &#91;28-41&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;030&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&#46;343&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MoCA total score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#91;26-28&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#91;19-23&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&#46;771&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NPI total score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#91;1-9&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#91;0-19&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;428&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&#46;126&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">PD-nMCI &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">PD-MCI &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>-value &#40;FDR&#41;<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">S</span>-value&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Effect size<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mobility&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;5 &#91;5-30&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 &#91;15&#44;0-70&#44;0&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;064 &#40;&#46;127&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&#46;293&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Activities of Daily Living&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">25 &#91;12&#44;5-37&#44;5&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;3 &#91;16&#44;7-70&#44;8&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#46;167 &#40;&#46;268&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">2&#46;58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&#46;218&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Emotional wellbeing&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">33&#46;3 &#91;4&#44;2-66&#44;7&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#46;179 &#40;&#46;205&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8211;&#46;213&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Stigma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#91;0-37&#44;5&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;5 &#91;0-25&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;662 &#40;&#46;662&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&#46;069&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Social support&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0 &#91;0-0&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0 &#91;0-8&#44;3&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;172 &#40;&#46;229&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&#46;216&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cognition&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0 &#91;12&#46;50-12&#44;5&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#46;3 &#91;12&#44;5-43&#44;8&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;001 &#40;&#46;005&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&#46;542&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Communication&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;3 &#91;0-16&#44;7&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 &#91;16&#44;7-41&#44;7&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;007 &#40;&#46;029&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&#46;424&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bodily discomfort&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;3 &#91;0-16&#44;7&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;3 &#91;16&#44;7-41&#44;7&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;017 &#40;&#46;046&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&#46;376&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">FDR&#58; false discovery ratio&#59; PD-MCI&#58; Parkinson&#39;s disease with mild cognitive impairment&#59; PD-nMCI&#58; Parkinson&#39;s disease without mild cognitive impairment&#59; UPDRS-III&#58; Unified Parkinson&#39;s Disease Rating Scale part III &#40;motor subscale&#41;&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Dimension&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t" scope="col">Group&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Correlation with adjusted PDQ-39 Summary Index<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">a</span></a></th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Partial &#40;controlling for&#41; UPDRS-III</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Coefficient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>-value &#40;FDR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">S</span>-value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cognition</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PD-MCI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;728&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;017 &#40;&#46;034&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PD-nMCI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;477 &#40;&#46;477&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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        "texto" => "<p id="par0205" class="elsevierStylePara elsevierViewall">We want to thank all the participants and their families&#44; researchers that collaborated&#44; the Research Development Committee &#40;CODI&#41; and Young Researchers program at Universidad de Antioquia&#44; as well as the staff and facilities provided by Grupo de Neurociencias de Antioquia &#40;GNA&#41;&#44; Grupo Neuropsicolog&#237;a y Conducta &#40;GRUNECO&#41;&#44; Semillero SINAPSIS &#40;research incubator program&#41; and the School of Medicine at the Universidad de Antioquia in Colombia&#44; as well to the Centre for age-related medicine &#40;SESAM&#41; in Norway&#46;</p>"
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ISSN: 25303120
Original language: English
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