The Montreal Cognitive Assessment, but not the Mini-Mental State Examination, has adequate psychometric properties as a screening instrument for the detection of mild cognitive impairment or dementia in Parkinson disease. However, a positive screen using either instrument requires additional assessment due to suboptimal specificity at the recommended screening cutoff point.

Nightmares may be more than a marker of PTSD and hence may be important in the identification of suicidal ideation.

SETTING-Two movement disorders centers at the University of Pennsylvania and the Philadelphia Veterans Affairs Medical Center.PARTICIPANTS-A convenience sample of 131 patients with idiopathic PD who were screened for cognitive and psychiatric complications.MEASUREMENTS-Subjects were administered the MoCA and MMSE, and only subjects defined as having a normal age-and education-adjusted MMSE score were included in the analyses (N = 100). As previously recommended in patients without PD, a MoCA score less than 26 was used to indicate the presence of at least mild cognitive impairment (MCI). RESULTS-Mean MMSE andMoCA scores ± standard deviation were 28.8 ± 1.1 and 24.9 ± 3.1, respectively. More than half (52.0%) of subjects with normal MMSE scores had cognitive impairment according to their MoCA score. Impairments were seen in numerous cognitive domains, including memory, visuospatial and executive abilities, attention, and language. Predictors of cognitive impairment on the MoCA using univariate analyses were male sex, older age, lower © 2009, The American Geriatrics Society Address correspondence to Daniel Weintraub, 3615 Chestnut St., Room 330, Philadelphia, PA 19104. E-mail: weintrau@mail.med.upenn.edu. Author Contributions: S.N., A.D.S., J.E.D., A.C., S.S.H., P.J.M., J.W., M.B.S., D.W.: study concept and design, acquisition of subjects and data, analysis and interpretation of data, preparation of data, and preparation of manuscript. T.T.H.: analysis and interpretation of data, preparation of manuscript data, and preparation of manuscript. Impairments in executive function, attention, visuospatial skills, and memory characterize the "typical" cognitive profile in PD, whereas language and praxis are thought to be relatively spared. 3,4,9 The memory impairment associated with PD is classically considered a retrieval deficit (i.e., subcortical memory profile) as opposed to an encoding deficit (i.e., cortical memory profile). NIH Public AccessThere is substantial overlap in the pattern of observed cognitive deficits in PD without dementia and PDD. Studies enrolling both groups of patients have shown qualitatively similar, but quantitatively greater, impairments in patients with PDD in executive function, visuospatial abilities, attention, and psychomotor skills. 10 In longitudinal studies of patients without dementia at baseline, verbal memory deficits 11 and executive or visuospatial impairments 12 have been shown to predict development of PDD on long-term follow-up.Given the aforementioned high prevalence of MCI in PD and its association with future development of dementia, it is important that patients with PD, even those with mild disease, be screened regularly for cognitive impairment. 12 An ideal cognitive screening instrument in PD should be brief, assess a range of cognitive domains, simple to administer, sensitive to the initial stage of cognitive impairment, and unaffected by motor impairment.Few screening instruments have been validated or developed to assess global cognition in PD. The Scales for Outco...

This interventional study provides Class II evidence that atomoxetine (target dosage = 80 mg/day) is not efficacious in improving clinically significant depression in PD.

No abstract

The purpose of this study was to investigate whether duration of insomnia symptoms or nightmares was related to suicide risk independent of current insomnia symptoms, nightmares, anxiety symptoms, depressive symptoms and post traumatic symptoms. The cross-sectional study involved analyses of survey responses from undergraduate students who endorsed either insomnia symptoms (N = 660) or nightmares (N = 312). Both insomnia symptom and nightmare duration were significantly associated with suicide risk independent of current insomnia symptoms or nightmares, respectively. Relations were also significant after controlling for anxiety symptoms, depressive symptoms, and post-traumatic symptoms. Results suggest that duration of sleep disturbance is relevant when assessing suicide risk.

Parkinson's disease (PD) is a chronic, disabling illness affecting primarily the elderly and is associated with a high prevalence of depression. Although these are known risk factors for suicidal and death ideation, little is known about the prevalence and correlates of such ideation in PD. A convenience sample of 116 outpatients with idiopathic PD at two movement disorders centers were administered a modified Paykel Scale for suicidal and death ideation, as well as an extensive psychiatric, neuropsychological, and neurological battery. Univariate and multivariate logistic regression models were used to determine the correlates of suicidal or death ideation. Current death ideation (28%) or suicide ideation (11%) were present in 30% of the sample, and 4% had a lifetime suicide attempt. On univariate logistic regression analysis, increasing severity of depression (odds ratio = 2.92, 95% CI 2.01-4.24, P < 0.001), impulse control disorder (ICD) behaviors sometime during PD (odds ratio = 6.08, 95% CI 1.90-19.49, P = 0.002), and psychosis (odds ratio = 2.45, 95% CI 1.05-5.69, P = 0.04) were associated with either ideation. On multivariate logistic regression analysis, only increasing severity of depressive symptoms (odds ratio = 2.76, 95% CI 1.88-4.07, P < 0.001) predicted suicidal or death ideation. In conclusion, active suicidal or death ideation occurs in up to one-third of PD patients. Comorbid psychiatric disorders, more than PD-related disease variables, are associated with this ideation, highlighting the need for a comprehensive approach to the clinical care of PD patients. KeywordsParkinson's disease; suicide; depression Suicide is a major public health problem, ranking 11th among causes of death in the United States. 1 Modifiable risk factors for suicide include mood disorders (e.g., major depression), 2-8 substance abuse or alcoholism, 9,10 common chronic medical conditions (e.g., pain, congestive heart failure, and chronic obstructive pulmonary disease), 11,12 and lack of social ties, 5 while immutable risk factors include male sex and increasing age. in the United States are highest among elderly, white males, 4-6,15,16 a public health problem that will grow with the aging of the population.Suicide-related thoughts and behaviors may be categorized as suicide-related ideation, suicide attempts, and completed suicide. 17 Suicidal ideation is defined as thoughts about intentionally ending one's own life, whereas death ideation is the wish to die without intent to kill oneself.The reported prevalence of suicide ideation in the elderly varies widely, from less than 1% to 17%. 5,18 In a population-based study involving elderly people with no diagnosable mental disorders, 4% felt that life was not worth living, 28% had death wishes, 9% had thought about taking their lives, and 2% had seriously considered suicide within 1 month of interview. 19 Similar to completed suicide, suicidal ideation in the elderly is also associated with depression; 19 in a study of ∼1,000 elderly patients, it was reported that 50...

Understanding self-concealment, the tendency to actively conceal distressing personal information from others, may be important in developing effective ways to help individuals with suicidal ideation. Nevertheless, no published study has yet assessed the relation between self-concealment and suicidal behaviors. Additionally, most self-concealment research has been conducted solely with younger adults. The current study investigated the relation between self-concealment and depressive symptoms among older adults (age 65 and older), and between self-concealment and suicidal behaviors among both younger (college student) and older adults. As predicted, self-concealment was significantly related to suicidal behaviors in younger adults. Furthermore, self-concealment was significantly related to depressive symptoms in older adults. Interestingly, the association between self-concealment and suicidal behaviors in this age group was not significant.