To determine the incidence and possible risk factors for dementia in patients with clinically probable Parkinson's disease (PD), a cohort (n = 86) of nondemented patients over 65 years of age with PD fulfilling the PD Brain Bank clinical diagnostic criteria were determined from community records. A similarly aged group of control subjects (n = 102) were recruited from the same area. Both groups were assessed at baseline and approximately 4 years later for cognition, mood, and motor function (PD patients only). The presence and severity of cognitive impairments was based on subject and informant interview, neuropsychological assessment based on the Cambridge Cognitive Examination (CAMCOG) and the application of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). At 4 years, 51 (59%) of the PD and 72 (71%) of the control cohort were available for reassessment. Of the PD cohort, 18 (35.3%) had developed dementia and 5 (9.4%) had evidence of mild cognitive impairments. In the control group, 5 (7%) had developed dementia. The incidence of dementia per 1,000 person-years in the PD cohort was 107.1 (95% confidence interval [CI], 59.9-159.8) and in the control group was 17.9 (95% CI, 5.8-31.9). The relative risk of patients developing dementia was 5.1 times that of the controls (95% CI, 2.1-12.5). Increasing age, later age of onset of PD, longer duration of PD symptoms, the presence of hallucinations, and impairment of memory and language function were all predictive factors for the development of dementia (P < 0.05). Dementia was also found to be a significant predictor for institutional placement in the PD group. Compared with similarly aged controls, patients with clinically probable PD have a fivefold-increased risk of developing dementia. This finding has significant implications for successful clinical management of this condition.

there is difficulty in diagnosing parkinsonism and Parkinson's disease in elderly subjects and we suggest early referral of those suspected of having parkinsonism for specialist assessment.

Objectives: to assess the level of depressive symptomatology in a community based group of patients with Parkinson's disease (PD) and their carers and to investigate the patient characteristics that might predict carer distress. Methods: the GDS-15 geriatric depression scale was used to measure self-rated depressive symptoms in a group of 132 subjects with clinically probable PD randomly selected from a community-based disease register. Disease severity was assessed by the Webster scale and cognitive function by the CAMCOG test. Carers of the patients, who in this study were all spouses, were also asked to complete the GDS-15. Results: a total of 64% of our group of patients and 34% of carers scored within the 'depressed' range on the GDS-15. Patients with high levels of depressive symptoms tended to have more severe disease, disease of longer duration and more impaired cognitive function. The GDS score of the carer was best predicted by the GDS score of the patient being cared for. Less than 10% of patients and carers were being treated with antidepressant medication. Conclusions: this community-based study confirms the high level of depressive symptoms in PD suggested by hospital-and clinic-based studies. Depression in patients appears to be related to disease severity and cognitive impairment. An important determinant of carer distress and mood disorder, as reflected by the GDS score, appears to be the level of depression expressed by the patient being cared for. Despite high levels of depressive symptoms in both patients and carers, very few subjects were in receipt of antidepressant drug therapy.

Mild cognitive impairment in Parkinson's disease is an important predictor for the progression to PDD. This investigation also confirmed that if PD patients live long enough, they will develop cognitive impairment or dementia. Early detection of cognitive impairment in these individuals is possible with existing standardised global cognitive assessments, which include semantic language assessment.

The results of this study are indicative of the validity of the PDQL as an important additional measurement which reflects the impact of PD from the patient perspective. It shows poorer quality of life to be associated with increasing age, disease severity more severe depressive symptomatology and impaired cognitive functioning. However, the responsiveness of this instrument in the evaluation of care in PD remains to be determined.

Aim: to assess cognitive function in elderly subjects with clinically probable Parkinson's disease (PD). Methods: a community sample of 126 patients with probable PD completed the CAMCOG, which is the cognitive section of the Cambridge Examination for Mental Disorders, and the Mini-Mental State Examination (MMSE). The performance of the CAMCOG and the MMSE in detecting dementia in this subject group was compared with the results of applying the DSM-IV criteria for dementia to this population. Results: A total of 44% of the group met DSM-IV criteria for dementia, which is higher than most previous prevalence figures for dementia in PD. The CAMCOG was more sensitive than the MMSE in detecting cognitive impairment and more specific than the MMSE in detecting dementia as defined by DSM-IV criteria. Poorer performance on the CAMCOG was related to gender, social class and age (P < 0.05). Among subjects with PD, those with dementia, as defined by DSM-IV criteria, were significantly older, had greater depressive symptomatology and had greater motor deficits. A greater proportion of the group with dementia were living in residential care (P < 0.05). Conclusion:The CAMCOG appears to be a useful screening instrument for dementia and cognitive impairment in PD. Furthermore, it may prove helpful in detecting those with PD who may be at risk of developing dementia and in longitudinal studies of cognitive function in PD.

Magnetic resonance imaging has good specificity and negative predictive value for predicting an uninvolved CRM post downstaging CRT in locally advanced rectal cancer although sensitivity and positive predictive value for an involved CRM were unsatisfactory. The shortcomings of MRI stem from poor differentiation of viable tumour from posttreatment changes and inability to identify small nodal and tumour deposits. Clinical correlates in this group of patients have confirmed the importance of achieving a clear CRM at surgery.

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