The aims of this project were to determine the risk factors for and clinical characteristics of mild cognitive impairment (MCI) in Parkinson’s disease (PD). We performed a retrospective record review of 72 non-demented PD patients (age: 57.79 ± 10.57, duration of PD: 7.32 ± 4.97) who completed a standardized neurological assessment, including a full neuropsychological battery, as part of their diagnostic work-up. Of these participants, 47.2% were cognitively normal and 52.8% met criteria for MCI. The majority of MCI patients had single domain MCI (23/38), the affected domains being memory (n = 9), executive function (n = 6), visuospatial skills (n = 6), and language (n = 2). The MCI group had longer duration of disease and higher postural instability and gait disorder subscale scores than the cognitively normal group. This report provides further support for use of the concept of MCI in PD research. There may be certain disease characteristics that could alert practitioners to the emergence of cognitive changes in patients. Future studies should focus on additional risk factors for MCI subtypes and their possible progression to frank dementia.

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Objectives To empirically expand the existing subtypes of mild cognitive impairment (MCI) by incorporating information on neuropsychiatric and functional features, and to assess whether cerebrovascular disease (CVD) risk factors are associated with any of these subgroups. Design Latent class analysis using 1,655 patients with MCI. Setting Participants in the Uniform Data Set (UDS) from 29 NIH Alzheimer’s Disease Centers. Participants Patients with a consensus diagnosis of MCI from each center and with a Mini-Mental State Examination (MMSE) score of 22 or greater. Measurements UDS cognitive battery, Neuropsychiatric Inventory Questionnaire (NPI-Q), and Functional Assessment Questionnaire (FAQ) administered at initial visit. Results Seven empirically-based subgroups of MCI were identified: (1) minimally impaired (relative frequency, 12%); (2) amnestic only (16%); (3) amnestic with functional and neuropsychiatric features (16%); (4) amnestic multi-domain (12%); (5) amnestic multi-domain with functional and neuropsychiatric features (12%); (6) functional and neuropsychiatric features (15%); and (7) executive function and language impairments (18%). Two of these subgroups with functional and neuropsychiatric features were at least 3.8 times more likely than the minimally impaired subgroup to have a Rosen-Hachinski score ≥ 4, an indicator of probable CVD. Conclusions Findings suggest there are several distinct phenotypes of MCI characterized by either prominent cognitive features, prominent functional and neuropsychiatric features, or a combination of all three. Subgroups with functional and neuropsychiatric features are significantly more likely to have CVD, which suggests there might be distinct differences in disease etiology from the other phenotypes.

This study investigated the assets of the daily prospective National Institute of Mental Health Life-Chart Method (NIMH-LCM-p or LCM-p) for use in clinical trials in bipolar disorder. Fifty-two outpatients, who met DSM-III-R criteria for bipolar disorder, were randomly assigned in a double-blind design to an intended 1 year of treatment with lithium or carbamazepine, a crossover to the opposite drug in the second year, and then to a combination of both agents in the third year. For each patient, the LCM-p was initiated upon admission and was continued on a daily basis. Overall therapeutic effect for each phase (intended year) was assessed by using the Clinical Global Impressions-Bipolar Version (CGI-BP) scale. Kruskal-Wallis analysis of variance was used to examine the detailed course-of-illness variables derived from the LCM-p (e.g., percentage of time ill, average severity of illness, episodes per year, and mood switches per year) in relation to the global assessments of treatment response (CGI-BP). Most of the individual LCM-p-derived illness variables varied significantly (P <.05) as a function of global treatment response. Since global ratings of the degree of improvement can represent very different proportions of improvement in percentage of time ill, average severity of mania or depression, or frequency of manic and depressive episodes, the LCM-p provides the basis for a comprehensive description of both the illness course and the response to treatment. The LCM-p appears to have considerable utility in clinical trials of pharmacological and other interventions of bipolar disorder. It provides a detailed characterization of the severity, frequency, and duration of manic and depressive episodes, which facilitates the assessment of global improvement and allows for the quantification of separate components of the illness, which are or are not responsive to a given treatment.