Greater cognitive variability in NSD Stage 2 predicts progression to advanced stages in observational study

BackgroundNeuronal synuclein disease (NSD) involves pathological -synuclein presence and often dopaminergic dysfunction, initially preceding overt clinical symptoms. NSD-ISS identifies Stage 2A (no dopaminergic dysfunction) and 2B (dopaminergic dysfunction) as prodromal phases marked by subtle clinical signs without functional impairment. Intraindividual variability/ dispersion (IIV-D), reflecting within-person inconsistency across cognitive tasks, has emerged as a potential marker of early neurodegenerative changes. ObjectivesThis study examined whether IIV-D differentiates NSD Stage 2 participants from healthy controls and predicts progression to more advanced NSD stages. MethodsData from the Parkinsons Progression Markers Initiative were used to assess performance across 11 neuropsychological tests in 934 participants (832 Stage 2; 102 controls). IIV-D was quantified using the total coefficient of variation (CoV) and a domain-specific attention/executive CoV. Group comparisons and logistic regression assessed associations between IIV-D, clinical characteristics, and disease progression. ResultsStage 2 participants exhibited significantly greater CoV than controls (p = .003). Higher IIV-D was associated with worse motor symptoms, non-motor burden, and functional impairment. Among Stage 2 participants, subsequent converters to Stage 3+ (n = 100) had significantly higher total CoV (p = .008) and attention/executive CoV (p = .020) at baseline. CoV independently predicted conversion after one year (OR = 1.44, p = .008), controlling for baseline motor severity. ConclusionsIIV-D, particularly CoV, may be a sensitive cognitive marker of early NSD and predict short-term disease progression. Findings support integrating cognitive dispersion metrics into early detection strategies for prodromal synucleinopathies, though replication is needed to confirm generalizability and clinical utility.