P35.10 Longitudinal study of autonomic and cognitive dysfunction in Parkinson’s disease (original) (raw)
Autonomic dysfunction according to disease progression in Parkinson's disease
Parkinsonism & Related Disorders, 2014
Background: Although autonomic dysfunction is common in patients with Parkinson's disease (PD), few data are available regarding its pattern and quantitative severity with increasing Hoehn and Yahr (H&Y) stage. We conducted autonomic function tests to quantify autonomic dysfunction in PD patients and to elucidate its possible relationship with disease progression. Methods: We performed autonomic function tests including Valsalva ratio, heart rate response to deep breathing, quantitative sudomotor axon reflex test, and head-up tilt test in 66 patients with PD. We compared clinical characteristics and results of autonomic function tests between stages, and correlated the proportion of abnormal patients in each test with their H&Y stage. In addition, logistic regression analyses were conducted to examine the contribution of increasing H&Y stage to impairments of each domain of the autonomic nervous system. Results: We found that PD patients with higher disease stage tended to have impairments in cardiovagal and sudomotor domains of the autonomic nervous system. Cardiovagal function was the domain most influenced by disease progression. Our findings also demonstrated that the pattern of sudomotor impairment in PD was similar to that in patients with peripheral autonomic neuropathy. Conclusions: Our study demonstrates that autonomic dysfunction is not only common in early stage PD but it increases in severity with increasing disease stage. Given that the patterns of sudomotor impairments in PD are similar to those in peripheral neuropathy, our data support a previous hypothesis that pathophysiology of PD involves both the central and peripheral nervous systems.
Assessment of autonomic dysfunction in Parkinson's disease: The SCOPA-AUT
Movement Disorders, 2004
We developed a questionnaire to assess autonomic symptoms in patients with Parkinson's disease (PD) and evaluated its reliability and validity. Based on the results of a postal survey in 46 PD patients, 21 multiple system atrophy patients, and 8 movement disorders specialists, items were included according to their frequency, burden, and clinical relevance. The questionnaire was evaluated in 140 PD patients and 100 controls, and test-retest reliability was established in a sample of 55 PD patients. The SCOPA-AUT consists of 25 items assessing the following regions: gastrointestinal (7), urinary (6), cardiovascular (3), thermoregulatory (4), pupillomotor (1), and sexual (2 items for men and 2 items for women) dysfunction. Test-retest reliability was good. Autonomic problems increased significantly with increasing disease severity for all autonomic regions, except sexual dysfunction. We conclude that SCOPA-AUT is a reliable and valid questionnaire that evaluates autonomic dysfunction in PD.
Differential impact of individual autonomic domains on clinical outcomes in Parkinson’s disease
Journal of Neurology
Introduction While autonomic failure is a well-known prognostic factor for more aggressive disease progression in Parkinson’s disease (PD), with a three- to sevenfold higher risk of dementia and death within 10 years after the diagnosis, the individual impact of cardiovascular, gastrointestinal, urogenital, thermoregulatory, and pupillomotor autonomic domains on PD clinical outcomes remains unclear. Objectives We sought to determine the 5-year risk of developing dementia, falls, postural instability, dysarthria, and dysphagia in PD patients with and without autonomic impairment at baseline and to assess the joint and individual association of each autonomic domain on these key functional outcomes. In addition, we aimed to determine the impact of each autonomic domain on activities of daily living (ADLs) and health-related quality of life (HRQoL). Methods We enrolled 65 consecutive PD patients in a 5-year cohort study involving standardized evaluations of autonomic symptoms, orthosta...
Orthostatic hypotension in Parkinson's disease: association with cognitive decline?
International Journal of Geriatric Psychiatry, 2006
Background Orthostatic hypotension is common in Lewy body disorders and may be related to disease progression and the spread of Lewy body pathology. We therefore hypothesize that PD patients with orthostatic hypotension (OH) have a different cognitive profile compared to PD patients without OH. Methods This cross-sectional study included 175 PD patients. Blood pressure (BP) was measured with a validated digital blood pressure monitor and patients with a systolic BP drop of !20 mmHg or a systolic pressure of <90 mm Hg after standing were considered to have OH. Cognition was assessed using MMSE extended by a selection of computerized cognitive tests focusing on reaction time, sustained attention, working memory and episodic verbal and visual memory. Results Eighty-seven (49.7%) of the PD patients had OH. These patients were significantly more impaired in sustained attention and visual episodic memory compared to PD patients without OH. Conclusion We conclude that there are differences in the neuropsychological performance of patients with PD and OH, supporting the hypothesis that OH might be a marker for disease progression and cognitive decline in PD. Ã Significant results when adjusted for age, levodopa dosage and multiple comparisons; SI ¼ sensitivity index.
Autonomic Failure, Depression and Anxiety in Parkinson's Disease
British Journal of Psychiatry, 1995
Background. The studytested thehypothesis thatsubjects withParkinson's disease (PD) have more autonomic complaints and more attenuation of autonomic reflexes than controls, and thatbothclusters ofvariables arerelated tothepresence ofanxiety and depression. Method. Thirty-two subjects and 32 healthy controls matched by age and sex were prospectively comparedon psychiatric, cognitive and autonomictests. Results. ‘¿ Autonomic' symptoms:weremorefrequent inPD patients thaninhealthy controls; were not related to age or changes in autonomic reflexes; were significantly associated with depression andanxiety (medication was notrelevant totheassociation); anddidnotcorrelate with motor symptoms. Conclusions. The diagnosis of anxiety and depression in some PD subjects is likely to be a behavioural phenocopy caused by autonomic failure. This explains why antidepressant medication is often unhelpful in PD subjects diagnosed as depressed. Morel (1866) first suggested that anxiety and depression may be related to dysfunction of the ‘¿ ganglionar system'. ‘¿ Dysautonomia' has since been described as being accompanied by â€oe¿ emotional outbursts, agitation, insomnia, depression― (Pearson, 1979). Also, vegetative symptoms correlate with panic attacks in Parkinson's disease (PD) (Vasquez et a!, 1993). However, the nature of the relationship between PD and autonomic failure remains unclear. Oppenheimer (1988) proposed that striatomgral degeneration and olivopontocerebellar atrophy were, in fact, different manifestations of multiple system atrophy (MSA), and reported that about 76% of patients with MSA developed Parkinsomsm. In partial confirmation, a post-mortem study has shown that 24°lo of clinically diagnosed PD subjects are, in fact, suffering from MSA, progressive supranuclear palsy, or Alzheimer's disease (Hughes et a!, 1992). Clinical ascertainment is complicated by the fact that MSA â€oe¿ may present with rapidly progressive Parkinsonism without cerebellar or autonomic disturbance―(Lancet, 1992). Goetz eta! (1986) have reported differences between 32 PD subjects and 10 (unmatched) controls in terms of Valsalva response, supine pulse rate, and postural hypotension, but did not seek to correlate these changes with psychiatric status. Depression is often diagnosed in PD (Starkstein eta!,1990), but thehypothesis thatin some cases it may be a behavioural phenocopy, caused by autonomic failure, has not yet been tested (Berrios & Samuel, 1987). The present studysetout:(a)to compare PD subjects and matched healthy controls on vegetative symptoms and status of autonomic reflexes; and (b)toidentify significant associations between autonomic dysfunction and anxiety and depression. Method Thirty-two subjects with PD and 32 age-matched (±2 years) and sex-matched healthy controls were prospectively studied. The PD patients were randomly selected from the database of the University of Cambridge Department of Psychiatry Parkinson's Disease Project. To be entered into this study, patients were diagnosed both by a consultant neurologist and using standard diagnostic criteria (Zetusky et a!, 1985); some were receiving medication for their PD. The control sample was chosen from the panel of healthy volunteers associated with the Cambridge Medical Research Council's Applied Psychology Unit. The research protocol included the following. General demographic and clinical data were obtainedfrom both samples.
Self-reported autonomic symptoms in Parkinson's disease: properties of the SCOPA-AUT scale
PubMed, 2017
Background and aim: Autonomic symptoms in Parkinson's disease (PD) are very common and contribute to the severity of patient's disability. We evaluated the occurrence of autonomic symptoms in Greek patients with PD utilizing the Scales for Outcomes in Parkinson's Disease-Autonomic questionnaire (SCOPA-AUT), a specific 23-item self-completed questionnaire for the assessment of autonomic dysfunction in patients with PD. Subjects and methods: One hundred and sixty-one PD patients and forty matched controls were enrolled in the study. Clinical assessment was performed with the Hoehn and Yahr scale. Patients completed a demographic questionnaire, the Non-Motor Symptoms Questionnaire (NMSQuest), the Parkinson's Disease Questionnaire (PDQ-39) and the SCOPA-AUT scale which was properly translated into Greek and validated for the study. Results: SCOPA-AUT scale showed a good reliability profile and correlated well with other measures for non-motor symptoms and health-related quality measures in PD patients. PD patients scored higher than controls in the total SCOPA -AUT score (mean score 11.9 versus 6.4). Patients reported problems in many items of the SCOPA-AUT, but the most common autonomic symptoms emerged in the Urinary and the Gastrointestinal domains. Especially sialorrhea, constipation, straining for defecation, incontinence and nocturia differentiated patients from controls. Furthermore, mean total SCOPA-AUT score correlated with duration and severity of the disease. Conclusion: Autonomic symptoms in PD are too important to remain undetected. By incorporating into everyday practice the use of suitable and reliable questionnaires, physicians will be able to adequately detect and manage these symptoms. Hippokratia 2016, 20(2):115-120.
Cognitive decline in early Parkinson's disease
Movement Disorders, 2009
Data on the prevalence and severity of cognitive impairment among patients with newly diagnosed idiopathic Parkinson's disease (PD) is limited. Using a prospectively collected clinical database, we studied the longitudinal trend of mini-mental state examination (MMSE) change and baseline factors predictive for MMSE decline. One hundred six patients with mean age of 61.2 years and mean baseline MMSE of 27.8 ± 2.3 were studied. MMSE increased by 0.4 points/year among patients without cognitive decline (n = 73) and decreased by 2.39 points/year among patients with cognitive decline (n = 33). Univariate analysis demonstrated education, age of diagnosis, depression, and diabetes mellitus to be associated with cognitive decline. Motor scores and hallucination were not associated with cognitive decline. Multivariate analysis demonstrated higher level of education to be protective (HR = 0.91, 95% CI 0.82-0.99, P = 0.047) and depression having borderline significance in predicting cognitive decline (HR = 2.00, 95% CI 0.97-4.15, P = 0.061). We found that 31% of newly diagnosed idiopathic PD patients have measurable cognitive decline at an early stage of disease. Higher education is protective while depression may be predictive of cognitive decline.
Association Between Autonomic Impairment and Structural Deficit in Parkinson Disease
Medicine, 2016
Patients with Parkinson disease (PD) have impaired autonomic function and altered brain structure. This study aimed to evaluate the relationship of gray matter volume (GMV) determined by voxel-based morphometry (VBM) to autonomic impairment in patients with PD.Whole-brain VBM analysis was performed on 3-dimensional T1-weighted images in 23 patients with PD and 15 sex- and age-matched healthy volunteers. The relationship of cardiovascular autonomic function (determined by survey) to baroreflex sensitivity (BRS) (determined from changes in heart rate and blood pressure during the early phase II of the Valsalva maneuver) was tested using least-squares regression analysis. The differences in GMV, autonomic parameters, and clinical data were correlated after adjusting for age and sex.Compared with controls, patients with PD had low BRS, suggesting worse cardiovascular autonomic function, and smaller GMV in several brain locations, including the right amygdala, left hippocampal formation,...
Cognitive Decline in Patients with Parkinson’s Disease
Romanian Journal of Neurology
The goal of our study was to assess the cognitive state in patients with Parkinson′s disease (PD). We studied 62 patients (30 men and 32 women, mean age 71.1± 4.5 years and mean educational level 11.5 ± 1 years). They were admitted to the Clinic of Neurology from Craiova between January 2015 – January 2016 for Parkinson’s disease. All the patients met the diagnostic criteria for Parkinson′s disease. In this study we included only patients in stage I and II on Hoehn and Yahr scale. 35 patients were in stage I and 27 patients in stage II. The patients were treated with levo-dopa monotherapy or dopaminergic agonists monotherapy. We have also included in our study a control group composed of 70 control subjects with the same range of educational level and age. To assess the cognitive state we tested the patients using Cambridge Cognitive Examination (CAMCOG) and the revised version of the Addenbrooke′s Cognitive Examination (ACE-R) at baseline, after 6 months and one year later. For the...
Assessment of cognition in Parkinson's disease
Neurology, 2003
To develop a short, practical instrument that is sensitive to the specific cognitive deficits in Parkinson's disease (PD) for comparing groups in research situations and for assessing change in cognitive functioning over time. Methods: A literature search was conducted to identify the most frequently affected cognitive domains in PD and to select candidate items for the initial scale. This scale was tested in 85 patients and 75 age-, education-, and sex-matched control subjects. Items that met predefined criteria for data quality, reproducibility, and discriminative properties were included in the final scale. Results: The final scale, the SCOPA-COG (SCales for Outcomes of PArkinson's disease-cognition), consists of 10 items with a maximum score of 43, with higher scores reflecting better performance. The test-retest reliability of the total score was 0.78 (intraclass correlation coefficient) and ranged from 0.40 to 0.75 for individual items (weighted). Cronbach's ␣ was 0.83. Construct validity of the scale was supported by the expected correlations with the CAMCOG (Cambridge Cognitive Examination) and the Mini-Mental State Examination (MMSE) and by differences found between groups of participants classified by dementia status and between patients grouped by disease severity. The scale showed a clear trend toward lower cognition scores for patients with more advanced PD. The coefficient of variation of the SCOPA-COG was higher than that of the CAMCOG or the MMSE, indicating a better ability to detect differences between individuals. Conclusion: The SCOPA-COG is a short, reliable, and valid instrument that is sensitive to the specific cognitive deficits in PD.
One Year Follow-Up Study on Cognitive Performances in Patients with Parkinson's Disease
Romanian Journal of Neurology, 2009
The goal of our study was to assess the cognitive state in patients with Parkinson's disease (PD). We studied 58 patients ( 23 men and 35 women, mean age 70,1± 4,5 years and mean educational level 11,9 ±1 years). They were admitted to the Clinic of Neurology from Craiova between March 2007- March 2008 for Parkinson Disease. All the patients met the diagnostic criteria for Parkinson's Disease. In this study we included only patients in stage I and II on Hoehn and Yahr scale. Thirty-two patients were in stage I and 26 patients in stage II. The patients were treated with levo-dopa monotherapy, dopaminergic agonists monotherapy, or levodopa associated with dopaminergic agonists. We have also included in our study a control group composed of 62 control subjects with the same range of educational level and age. To assess the cognitive state we tested the patients using Mini Mental State Examination (MMSE) and the revised version of the Addenbrooke's Cognitive Examination (ACE-...
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.
Folia Medica, 2013
The last twenty years have witnessed a surge of interest in the autonomic symptoms in Parkinson's disease (PD) and the possibilities to diagnose and treat them. The specialized questionnaire assessing the autonomic symptoms in Parkinson's disease (SCOPA-AUT) has been validated and available in English, Dutch and Spanish. In this study we aim at evaluating the validity, reliability and applicability of the Bulgarian version of SCOPA-AUT (SCOPA-AUT-BG ). PATIENTS AND METHODS: The study included 55 patients with idiopathic PD (mean age 64.4 ± 8.9 yrs), and 40 healthy controls (mean age 58.5 ± 9.4 yrs). Clinical severity and disease stage were assessed by United Parkinson's disease rating scale (UPRDS) and Hoen and Yahr (H&Y). Thirty-two of the PD patients completed SCOPA-AUT-BG again after a 7-day interval. Questionnaire reliability was analyzed by determining the internal consistency, homogeneity, discriminatory and construct validity and test-retest reliability. RESULTS: Analyses showed good internal consistency of the summary evaluation of SCOPA-AUT-BG (coeffi cient alpha of Cronbach = 0.79), which indicates the high reliability of the questionnaire. The lowest Cronbach's alpha coeffi cient (0.53) was found for the subscale "cardiovascular functions". A dominant role belongs to the subscales for gastrointestinal and urinary functions (Cronbach's Alpha > 0.7), where a signifi cantly high correlation of PD with the UPDRS scale was observed. We found high test-retest reliability based on the responses associated with dysfunction of the gastrointestinal, urinary, thermoregulatory and pupillary autonomic systems. The correlation of the results of SCOPA-AUT-BG with UPDRS is higher than that with H&Y, and the construct validity is high except for the cardiovascular and pupillomotor functions subscales. CONCLUSION: The results of this study show that SCOPA-AUT-BG is a valid and reliable specialized questionnaire to evaluate autonomic function in patients with Parkinson's disease. Using it allows for more detailed clinical evaluation of these patients and justifi es the need to refer them to specialized examination of autonomic functions.
Autonomic dysfunction in recent onset and advanced Parkinson's disease
Clinical Neurology and Neurosurgery, 1988
Autonomic nervous dysfuu~tion is a well known complication of Parkinson's disease. Autonomic symptoms occur with increasing frequency during the course of the disease. Cardiovascular reflex tests have been used in order to study the type and the severity of autonomic nervous dysfunction in Parkinson's disease. Many authors have found that the baroreflex function measured by the Valsalva manoeuvre is unaffected in Parkinson's diseaseEe3, but other authors have found a decreased response to the Valsalva pro-cedure4s5. Sachs et a1.6 found that there is no difference in heart rate response (Valsaiva ratio) to Valsalva manoeuvre but Turkka7 found that RR-interval variation during the Valsalva test was clearly decreased. There have been only a few reports regarding the heart rate variation induced by normal or deep breathing. All authors have found that respiratory sinus arrhythmia is decreased in Parkinson's dis-ease6-9.10 It has been claimed that orthostatic hypotension is connected with Parkinson's disease-in some cases3*4t9, but other authors have found no difference in the magnitude of orthostatic hypotension when compared with healthy controls'.2*6. Goetz et ~1.~ found that immediate orthostatic systolic blood pressure drop increased in parkinsonian patients compared with controls, but after prolonged standing there was no remaining difference.
Predictors of cognitive impairment in an early stage Parkinson's disease cohort
Movement Disorders, 2014
A B S T R AC T : The impact of Parkinson's disease (PD) dementia is substantial and has major functional and socioeconomic consequences. Early prediction of future cognitive impairment would help target future interventions. The Montreal Cognitive Assessment (MoCA), the Mini-Mental State Examination (MMSE), and fluency tests were administered to 486 patients with PD within 3.5 years of diagnosis, and the results were compared with those from 141 controls correcting for age, sex, and educational years. Eighteen-month longitudinal assessments were performed in 155 patients with PD. The proportion of patients classified with normal cognition, mild cognitive impairment (MCI), and dementia varied considerably, depending on the MoCA and MMSE thresholds used. With the MoCA total score at screening threshold, 47.7%, 40.5%, and 11.7% of patients with PD were classified with normal cognition, MCI, and dementia, respectively; by comparison, 78.7% and 21.3% of controls had normal cognition and MCI, respectively. Cognitive impairment was predicted by lower education, increased age, male sex, and quantitative motor and non-motor (smell, depression, and anxiety) measures. Longitudinal data from 155 patients with PD over 18 months showed significant reductions in MoCA scores, but not in MMSE scores, with 21.3% of patients moving from normal cognition to MCI and 4.5% moving from MCI to dementia, although 13.5% moved from MCI to normal; however, none of the patients with dementia changed their classification. The MoCA may be more sensitive than the MMSE in detecting early baseline and longitudinal cognitive impairment in PD, because it identified 25.8% of those who experienced significant cognitive decline over 18 months. Cognitive decline was associated with worse motor and non-motor features, suggesting that this reflects a faster progressive phenotype. V C 2014 International Parkinson and Movement Disorder Society Cognitive impairment and dementia are common in Parkinson's disease (PD), with a long-term cumulative prevalence of 80% for PD dementia (PDD). 1 The impact of PDD is substantial and has a major impact on independence, nursing home admission, psychiatric comorbidity, care-giver burden, and mortality. 2-4 Consequently, there is interest in a potential transition stage-PD with mild cognitive impairment (PD-MCI) ---
A review article in Cognitive deficits in Parkinson’s Disease
Journal of Experimental and Clinical Neurosciences
Parkinson's disease (PD) is a common, progressive, disabling, neurodegenerative disorder, that apart from well-known motor symptoms, reveals a wide spectrum of non-motor features, that are now widely accepted as part of the clinical aspect, and cognitive decline is a very important part of these non-motor presentations. The diagnosis of cognitive decline in PD can be extremely challenging, remaining largely based on clinical and cognitive assessments. Expert work groups have issued diagnostic criteria and methods for PD dementia and cognitive impairment. This manuscript has gathered relevant data in order to obtain an updated review regarding cognitive deficit in PD, from mild stages to dementia. This article has summarized clinical features, diagnostic methods, and therapeutic issues of cognitive decline in PD.