When Paying for Care Becomes a Crisis: Affordability Barriers, Coping Strategies, and Financial Consequences of Chronic Illness in Lagos, Nigeria.

Dementia is a prevalent and serious complication in Parkinson's disease (PD), leading to poorer quality of life, increased need for institutionalized care, and a greater socioeconomic burden. A key strategy to enhance healthcare planning and effectively channel patients into clinical trials is the prediction of dementia risk in PD patients. Although various clinical, imaging, and biological factors have been linked to faster cognitive decline and PD dementia (PDD), the complexity of disease suggests that multivariable models are likely to provide a better prognostic accuracy than a single biomarker. Many of the models proposed to predict PDD require specialized tests or expertise that are not routinely available. Additionally, the majority were developed in either young, non-age-representative patients or prevalent PD. This lack of validation in diverse cohorts further restricts their applicability to the general PD population. The Montreal Parkinson Risk of Dementia Scale (MoPaRDS) is a clinic-based screening tool designed to predict the risk of dementia in PD using eight standardized clinical and demographic items. The applicability of MoPaRDS may vary across different populations and clinical settings and there is limited data on the MoPaRDS performance in PD. In this study, we aim to further validate MoPaRDS in an independent sample of 1108 newly diagnosed patients representative of the general PD population. We use data from up to 10 years of follow-up in six cohorts from the Parkinson's Incidence Cohorts Collaboration (PICC), a project pooling six population-based, prospective cohorts of newly diagnosed patients with PD. We also explore the value of adding two genetic biomarkers, and -ε4, which have been previously associated with an increased risk of developing PDD in our study population. Patients in the study come from PICC, a collaboration between six population-based, Northern European cohorts of newly diagnosed PD recruited between 2000–2013: 140 patients from Cambridgeshire Incidence of Parkinson's disease from General Practitioner to Neurologist (CamPaIGN), 154 from Incidence of Cognitive Impairment in Cohorts with Longitudinal Evaluation-PD (ICICLE-PD), 144 from New Parkinson Patient in Umeå (NYPUM), 190 from Norwegian ParkWest (ParkWest), 279 from Parkinsonism: Incidence, Cognition and Non-motor heterogeneity in Cambridgeshire (PICNICS), and 201 from Parkinsonism Incidence in Northeast Scotland (PINE). Diagnosis was made according to UK Parkinson's Disease Society Brain Bank criteria without exclusion due to family history and all included patients had a confirmed PD diagnosis at the last clinical visit or postmortem. Patients were excluded from the PICC study if they were suspected of secondary parkinsonism (e.g., drug-induced or post-stroke parkinsonism) or other forms of parkinsonism, such as multiple system atrophy, progressive supranuclear palsy, corticobasal degeneration, or dementia with Lewy bodies. Other exclusions included monosymptomatic resting tremor, isolated gait disorder, isolated asymmetric tremor, essential tremor, or Alzheimer's disease. More details can be found in the publications for each cohort.