Cognitive impairments in advanced PD without dementia (original) (raw)
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Cognitive function assessment in idiopathic Parkinson's disease
Arquivos de Neuro-Psiquiatria, 2007
Idiopathic Parkinson's disease (PD) is characterized by reduced nigrostriatal and cortical dopaminergic influence, with changes in movement and, subsequently, behavioral and cognitive disturbances. We studied cognitive impairment in Parkinson's disease by assessing a group of 30 idiopathic Parkinson's disease patients with an average age of 64.23 years (PG group) and compared our findings with those for a control group of 30 patients (CG group). All the patients were submitted to the following assessments: motor function, using the UPDRS; staging, using the Hoehn-Yahr scales (PG group only); depression, using the Montgomery-Asberg scale; attention impairment; verbal fluency (FAR and animals); cognitive function, using the Mini Mental State Examination; visuospatial and executive functions; and clock drawing. In addition to altered motor function in PD patients, we found statistically significant differences between PD patients and controls in terms of cognitive function, verbal, executive and visuospatial functions, and attention deficits. Depression was more prevalent in the PG group.
Link between non-motor symptoms and cognitive dysfunctions in de novo, drug-naive PD patients
Journal of Neurology, 2012
Little is known about the relationship between cognitive dysfunctions and the non-motor complex in subjects with newly diagnosed untreated Parkinson's disease (PD). The aim of this study was to explore the association between non-motor symptoms (NMS) and cognitive dysfunctions in an incident cohort of de novo, drug-naive, PD patients. Sixty-six non-demented, early, untreated PD patients completed a semi-structured interview on NMS and a battery of neuropsychological tests that assess verbal memory, visuospatial abilities, and attention/executive functions. Scores were age-and education-corrected. Patients who failed at least two tests for each cognitive domain were diagnosed as having mild cognitive impairment (MCI). All but three (95.4%) PD patients complained of at least one NMS. A total of 37.8% was diagnosed with MCI. There was a relationship between sleep-NMS and cognitive dysfunctions. Specifically, both REM behavioral sleep disorders (RBD) and insomnia were associated with lower scores on several cognitive tests. Moreover, RBD was closely related to MCI. NMS and MCI are very common even in the early phase of PD, before patients are treated. Given the correlation between sleep disturbances and cognitive impairment, it is possible that sleep symptoms in PD patients might be considered as an early marker of dementia.
Prevalence and Subtypes of Mild Cognitive Impairment in Parkinson’s Disease
Scientific Reports, 2016
The current study examined the prevalence and subtypes of Mild Cognitive Impairment (MCI) in an Australian sample of people with Parkinson's Disease (PD). Seventy participants with PD completed neuropsychological assessments of their cognitive performance, using MDS Task Force Level II diagnostic criteria for PD-MCI. A cutoff score of less than one standard deviation (SD) below normative data determined impaired performance on a neuropsychological test. Of 70 participants, 45 (64%) met Level II diagnostic criteria for PD-MCI. Among those with PD-MCI, 42 (93%) were identified as having multiple domain impairment (28 as amnestic multiple domain and 14 as nonamnestic multiple domain). Single domain impairment was less frequent (2 amnestic/1 nonamnestic). Significant differences were found between the PD-MCI and Normal Cognition groups, across all cognitive domains. Multiple domain cognitive impairment was more frequent than single domain impairment in an Australian sample of people with PD. However, PD-MCI is heterogeneous and current prevalence and subtyping statistics may be an artifact of variable application methods of the criteria (e.g., cut off scores and number of tests). Future longitudinal studies refining the criteria will assist with subtyping the progression of PD-MCI, while identifying individuals who may benefit from pharmacological and nonpharmacological interventions. Parkinson's disease (PD) is now understood as a multifaceted neurodegenerative disorder with heterogeneous motor and non-motor symptoms 1. Approximately 30% of people with PD demonstrate cognitive impairment and up to 50% of those progress to PD-Dementia after more than 10 years of disease duration 2,3. Cognitive impairments in PD comprise four subtypes; amnestic single, amnestic multiple, nonamnestic single and nonamnestic multiple. The four subtypes reflect deficits across five cognitive domains, including: memory, attention/working memory, language, visuospatial, and executive functions 4,5. Several biological and epidemiological risk factors are associated with cognitive deficits in PD, with some studies reporting cognitive impairment is present even at time of diagnosis 6,7. To standardize assessment, the Movement Disorder Society (MDS) Task Force developed new diagnostic criteria for PD-Mild Cognitive Impairment (PD-MCI) 8. Preceding the criteria, most studies adopted the method proposed by Petersen et al. 9 which specifies a decline in memory. PD-MCI is, however, heterogeneous and many people demonstrate impairments across the spectrum of cognitive domains 10. Recent studies adopting the new MDS diagnostic criteria report variable results 11,12. These studies also applied varying diagnostic cut off scores and weighting of tests per cognitive domain, which may influence the reported prevalence of cognitive impairment in PD. The high prevalence and significant impact of cognitive impairment on quality of life for people with PD 13 , indicate that any standardised criteria developed for international use needs to be validated and examined across multiple populations of PD. To date, no study has applied the MDS criteria for PD-MCI to an Australian sample. This study provided a novel application of the MDS Task Force PD-MCI Level II diagnostic criteria to an Australian sample of people with PD. This study also examined PD-MCI frequency differentials at varying diagnostic cut off scores to explore subtype classifications and advance our understanding of cognitive impairments in PD.
Educational level and cognitive impairment in patients with Parkinson disease
Neurologia i Neurochirurgia Polska, 2011
B Ba ac ck kg gr ro ou un nd d a an nd d p pu ur rp po os se e: : Parkinson disease (PD) is a risk factor for dementia. In addition, specific cognitive deficits can occur in PD patients without dementia. A patient's level of education could have an influence on the development of cognitive impairment in PD. The aim of this study was to examine the relationship between the level of education and cognitive performance in non-demented patients with PD. M Ma at te er ri ia al l a an nd d m me et th ho od ds s: : Thirty-seven consecutive, nondemented PD patients and 40 healthy controls fulfilled the inclusion criteria and were enrolled in the case-control study. Each of the controls and PD patients were classified, for the purpose of this study, into one of three groups (low, intermediate, higher), categorized by the number of years of education. There were no differences in education and age between the controls and PD patients. All of the subjects were evaluated with a battery of neuropsychological tests: Mini-Mental State Examination, Trail Making Tests, Stroop Test, Mental Rotation Test, and Verbal Fluency Test. R Re es su ul lt ts s: : Less (low and intermediate) education was correlated with poor results from tests. The comparison of all groups of PD patients and controls demonstrated that PD subjects received lower test scores, especially for the low and intermediate groups. However, no statistically significant difference was reached between educationally advanced PD patients and the appropriate control subjects. C Co on nc cl lu us si io on ns s: : As compared to the controls, most non-demented PD patients presented executive-type cognitive dysfunction. The higher educational level, however, was associated
Frequency of Cognitive Impairment in Patients with Parkinson’s Disease
Cureus
Introduction More than its motor symptoms, cognitive impairment is being increasingly identified as a cause of worse functional outcome, morbidity and mortality, and caregiver dependence in Parkinson's disease (PD). The aim of this study was to identify the frequency of cognitive decline and evaluate the factors associated with it. Methods In this cross-sectional study, 124 PD patients fulfilling the United Kingdom Parkinson's Disease Society Brain Bank Clinical Diagnostic Criteria were included. Motor and non-motor symptoms were recorded. Disease duration, age at the time of onset, and severity of disease on Hoehn and Yahr Scale (HY scale) were recorded. Data was entered and analyzed using SPSSs v. 22.0. Results The ratio of men to women was 7.2:1. The mean age of the participants was 64 ± 10 years (range: 38-82 years). Rigidity (n = 121; 97.5%), bradykinesia (n = 119; 95.9%), and tremor (n = 11; 90.3%) were the three most common symptoms. Cognitive impairment was present in 45 (36.3%) patients. Cognitive decline was more frequent in patients of age less than 50 years at the time of disease onset (p < 0.00001) and in those with disease duration more than 10 years (p = 0.00001). Patients with longer disease duration had more severe disease (stage III or above on HY scale; p = 0.008). Conclusion Motor symptoms such as rigidity, bradykinesia, and tremor remain the most frequent clinical presentation among Pakistani Parkinson's patients. One-third of these patients have cognitive dysfunction. Early age at the time of disease onset and longer duration of disease were associated with cognitive impairment.
The Lancet Neurology, 2010
Cognitive impairment in patients with Parkinson's disease is gaining increased clinical signifi cance owing to the relative success of therapeutic approaches to the motor symptoms of this disorder. Early investigations contributed to the concept of subcortical dementia associated with bradyphrenia and cognitive rigidity. For cognition in parkinsonian disorders, this notion developed into the concept of mild cognitive impairment and fronto-executive dysfunction in particular, driven mainly by dopaminergic dysmodulation and manifesting as defi cits in fl exibility, planning, working memory, and reinforcement learning. However, patients with Parkinson's disease could also develop a syndrome of dementia that might depend on non-dopaminergic, cholinergic cortical dysfunction. Recent fi ndings, supplemented by advances in neuroimaging and genetic research, reveal substantial heterogeneity in the range of cognitive defi cits in patients with Parkinson's disease. Remediation and management prospects for these cognitive defi cits are based on neuropharmacological and cognitive rehabilitation approaches.
Frontiers in Aging Neuroscience
Background: Cognitive impairment in Parkinson's disease (PD) includes a spectrum varying from Mild Cognitive Impairment (PD-MCI) to PD Dementia (PDD). The main aim of the present study is to evaluate the incidence of PD-MCI, its rate of progression to dementia, and to identify demographic and clinical characteristics which predict cognitive impairment in PD patients. Methods: PD patients from a large hospital-based cohort who underwent at least two comprehensive neuropsychological evaluations were retrospectively enrolled in the study. PD-MCI and PDD were diagnosed according to the Movement Disorder Society criteria. Incidence rates of PD-MCI and PDD were estimated. Clinical and demographic factors predicting PD-MCI and dementia were evaluated using Cox proportional hazard model. Results: Out of 139 enrolled PD patients, 84 were classified with normal cognition (PD-NC), while 55 (39.6%) fulfilled the diagnosis of PD-MCI at baseline. At follow-up (mean follow-up 23.5 ± 10.3 months) 28 (33.3%) of the 84 PD-NC at baseline developed MCI and 4 (4.8%) converted to PDD. The incidence rate of PD-MCI was 184.0/1000 pyar (95% CI 124.7-262.3). At multivariate analysis a negative association between education and MCI development at follow-up was observed (HR 0.37, 95% CI 0.15-0.89; p = 0.03). The incidence rate of dementia was 24.3/1000 pyar (95% CI 7.7-58.5). Out of 55 PD-MCI patients at baseline, 14 (25.4%) converted to PDD, giving an incidence rate of 123.5/1000 pyar (95% CI 70.3-202.2). A five time increased risk of PDD was found in PD patients with MCI at baseline (RR 5.09, 95% CI 1.60-21.4). Conclusion: Our study supports the relevant role of PD-MCI in predicting PDD and underlines the importance of education in reducing the risk of cognitive impairment.