Pathologic Correlates of Dementia in Individuals with Lewy Body Disease (original) (raw)
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Parkinson's disease dementia – A diminished role for the Lewy body
Parkinsonism & Related Disorders, 2009
The literature currently views Lewy bodies as central in the pathogenesis of Parkinson's disease dementia (PDD) when Alzheimer's disease (AD) or vascular pathology is not present. Because the neuropathology of PDD is not well understood, the pathological features of PDD were characterized in eighteen PD brain specimens using published criteria for AD, Diffuse Lewy Body Disease (DLBD), and Vascular Disease as a framework. Among the PD dementia (n = 16) subjects, 3 (19%) did not have LBs outside of the brain stem, nor AD or vascular pathology. In two additional cases, one did have rare LBs in the neocortex and cingulate gyrus. However, these two cases did not meet the diagnostic criteria for DLBD. Beyond these 5 cases, the remaining PD dementia subjects fitted a classical pathological profile consistent with AD (38%), vascular disease (12.5%), DLBD (6%), or a combination of these pathologies (12.5%). The findings from this study do not support the hypothesis that LBs are the main substrate for dementia in PD. More research with a larger sample size is needed to determine whether the LB may be a secondary phenomenon and/or an "innocent-bystander". The entire role of the LB in PD dementia is again brought into question.
Clinical diagnostic criteria for dementia associated with Parkinson's disease
Movement Disorders, 2007
Dementia has been increasingly more recognized to be a common feature in patients with Parkinson's disease (PD), especially in old age. Specific criteria for the clinical diagnosis of dementia associated with PD (PD-D), however, have been lacking. A Task Force, organized by the Movement Disorder Study, was charged with the development of clinical diagnostic criteria for PD-D. The Task Force members were assigned to sub-committees and performed a systematic review of the literature, based on pre-defined selection criteria, in order to identify the epidemiological, clinical, auxillary, and pathological features of PD-D. Clinical diagnostic criteria were then developed based on these findings and group consensus. The incidence of dementia in PD is increased up to six times, point-prevelance is close to 30%, older age and akinetic-rigid form are associated with higher risk. PD-D is characterized by impairment in attention, memory, executive and visuo-spatial functions, behavioral symptoms such as affective changes, hallucinations, and apathy are frequent. There are no specific ancillary investigations for the diagnosis; the main pathological correlate is Lewy body-type degeneration in cerebral cortex and limbic structures. Based on the characteristic features associated with this condition, clinical diagnostic criteria for probable and possible PD-D are proposed.
Cognitive Impairment and Dementia in Parkinson’s Disease
European Journal of Neurology, 2010
Over the last decade, the importance of cognitive impairment and dementia in Parkinson's disease (PDD) has been increasingly recognized. Investigators have proposed criteria for PD dementia, and mild cognitive impairment. Risk profiles associated with the development of dementia based on demographic, neurological, neuropsychological, imaging, and genetic investigations have been delineated. The FDA has approved a treatment for PDD, and efforts now are directed toward intervention at earlier stages of cognitive impairment.
Parkinson’s disease and dementia
Neurological Sciences, 2006
Parkinson's disease (PD) is one of the most common neurodegenerative disorders, affecting about 1% of the population over the age of 60. In addition to motor abnormalities, there are several non-motor signs and symptoms that may create a considerable burden for patients and caregivers. Dementia is common and affects approximately 40% of PD patients during the course of the disease, the risk for the development of dementia being 6 times higher than in non-PD age-matched controls. In most cases, PD patients with dementia (PDD) display a dysexecutive syndrome and visuospatial deficits, while memory is relatively unaffected. The overlap between PDD and dementia with Lewy bodies suggests that they likely share similar underlying neuropathological processes.
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.
Frontiers in Neurology, 2012
Parkinson's disease (PD) is a common, disabling, neurodegenerative disorder. In addition to classical motor symptoms, non-motor features are now widely accepted as part of the clinical picture, and cognitive decline is a very important aspect of the disease, as it brings an additional significant burden for the patient and caregivers. The diagnosis of cognitive decline in PD, namely mild cognitive impairment (MCI) and dementia, can be extremely challenging, remaining largely based on clinical and cognitive assessments. Diagnostic criteria and methods for PD dementia and MCI have been recently issued by expert work groups. This manuscript has synthesized relevant data in order to obtain a pragmatic and updated review regarding cognitive decline in PD, from milder stages to dementia. This text will summarize clinical features, diagnostic methodology, and therapeutic issues of clinical decline in PD. Relevant clinical genetic issues, including recent advances, will also be approached.
The Epidemiology of Dementia Associated with Parkinson's Disease
Brain Pathology, 2010
Parkinson's disease (PD) is the second most common neurodegenerative illness after Alzheimer's disease (AD). Cognitive impairment and dementia are common features in PD and characterized by a wide range of cognitive deficits distinct from those seen in AD. Mild cognitive impairment occurs even early in PD and is associated with shorter time to dementia. The purpose of this review is to present recent findings on clinical aspects of dementia in PD and to elucidate underlying clinical and neurobiological risk factors.
Cognitive impairment in nondemented Parkinson's disease
Movement Disorders, 2011
A substantial percentage of patients with newly diagnosed Parkinson's disease without dementia are reported to be affected by cognitive impairment (CI). In practice, however, CI is underrecognized, as the signs may not be apparent in early-stage disease and many routine assessment tools lack the sensitivity to detect subtle cognitive dysfunction. Patients with PD and mild CI (MCI) may have a higher risk of developing dementia than cognitively intact PD patients; however, it is not currently known which patients with CI are at increased risk of developing dementia. This review summarizes current knowledge about CI in nondemented PD; it discusses the structural and functional changes associated with CI and addresses areas of unmet needs. We focus on questions that should be addressed in future studies to achieve consensus on its characteristics and definition, pathophysiology, epidemiology, diagnosis and assessment, and treatment and management.
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.