Cognitive impairment in early-stage non-demented Parkinson's disease patients

Pfeiffer, Helle Cecilie Viekilde; Løkkegaard, Annemette; Zoetmulder, Marielle; Friberg, Lars; Werdelin, L.

doi:10.1111/ane.12189

Cited by 139 publications

(102 citation statements)

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“…Demographic and clinical factors such as age, 10 motor subtypes, 11 and early visuospatial, language, and fluency deficits 12,13 have also been shown to predict future cognitive decline. However, to our knowledge, no research has focused on those patients defined as having normal cognition (NC) at baseline, which allows for examination of the course of cognitive decline from its clinical onset.…”

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confidence: 99%

Longitudinal study of normal cognition in Parkinson disease

et al. 2015

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Objective: To report the rates and predictors of progression from normal cognition to either mild cognitive impairment (MCI) or dementia using standardized neuropsychological methods.Methods: A prospective cohort of patients diagnosed with Parkinson disease (PD) and baseline normal cognition was assessed for cognitive decline, performance, and function for a minimum of 2 years, and up to 6. A panel of movement disorders experts classified patients as having normal cognition, MCI, or dementia, with 55/68 (80.9%) of eligible patients seen at year 6. Kaplan-Meier curves and Cox proportional hazard models were used to examine cognitive decline and its predictors. Results:We enrolled 141 patients, who averaged 68.8 years of age, 63% men, who had PD on average for 5 years. The cumulative incidence of cognitive impairment was 8.5% at year 1, increasing to 47.4% by year 6. All incident MCI cases had progressed to dementia by year 5. In a multivariate analysis, predictors of future decline were male sex (p 5 0.02), higher Unified Parkinson's Disease Rating Scale motor score (p # 0.001), and worse global cognitive score (p , 0.001).Conclusions: Approximately half of patients with PD with normal cognition at baseline develop cognitive impairment within 6 years and all new MCI cases progress to dementia within 5 years. Our results show that the transition from normal cognition to cognitive impairment, including dementia, occurs frequently and quickly. Certain clinical and cognitive variables may be useful in predicting progression to cognitive impairment in PD. Nonmotor symptoms are common in Parkinson disease (PD), 1 including mild cognitive impairment (MCI) and dementia (PDD).2 Up to 80% of patients with PD develop dementia long-term, 3 and 20%-30% of patients with PD without dementia meet criteria for MCI. 4 Both PD-MCI and PDD impact negatively on patient quality of life, cost of care, and caregiver burden. 5,6 Longitudinal reports on patients with early PD-MCI show that more than 25% will develop dementia within 3 years, 7 and MCI at disease onset increases risk for development of dementia. 8Another study reported that up to 50% of patients with early PD developed cognitive decline within 5 years, 9 although the sample size was relatively small and lack of cognitive impairment at baseline was defined by Mini-Mental State Examination score only.Structural MRI, and plasma and CSF biomarkers, are associated with cognitive functioning and predict future cognitive decline in PD.1 However, many biomarkers are invasive, costly, and done mainly at academic centers conducting research. Demographic and clinical factors such as age, 10 motor subtypes, 11 and early visuospatial, language, and fluency deficits 12,13 have also been shown to predict future cognitive decline. However, to our knowledge, no research has focused on those patients defined as having normal cognition (NC) at baseline, which allows for examination of the course of cognitive decline from its clinical onset.

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Longitudinal study of normal cognition in Parkinson disease

et al. 2015

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“…Azonban bizonyos kognitív területek már a betegség kezdeti fázisában is érintettek lehetnek, ugyanis kezdeti stádiumban akár a betegek egyharmadánál is megfi gyelhető bizonyos káro-sodások jelenléte [3,4].…”

Section: Parkinson-kórban éSzlelhető Neurokognitív Eltérésekunclassified

“…A kognitív funkcióromlás leggyakrabban a végrehajtó funkciókhoz köthető teljesítményben fi gyelhető meg, amely viselkedésgátlási, fi gyelemfenntartási és -váltási nehézségben nyilvánulnak meg [3,4]. A kognitív teljesít-mény romlása, a motiváció csökkenése, a mozgásterve-zési, az összehangolási és a végrehajtási nehézségek a praefrontalis kéreg sérülésére utalhatnak, ám az ilyen tünetek jelenléte Parkinson-kórban kevésbé kérgi káro-sodással, mintsem a praefrontalis körök működészavará-val magyarázhatók [5].…”

Section: Parkinson-kórban éSzlelhető Neurokognitív Eltérésekunclassified

“…A betegségtartam, a rigid-akinetikus altípus, a motoros tünetek súlyossága, a korán megjelenő hallucinációk lehetséges rizikófakto-roknak tekinthetők a PD-demencia megjelenéséhez [4]. Longitudinális vizsgálatok alapján felmerül annak a lehetősége is, hogy a kognitív érintettség és a demencia a betegség progressziójával párhuzamosan minden hosszú kórtörténettel rendelkező betegnél megjelenhet [9,10,11].…”

Section: Parkinson-kórban éSzlelhető Neurokognitív Eltérésekunclassified

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Neurokognitív zavarok diagnosztizálási és kezelési lehetőségei Parkinson-kórban

et al. 2015

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A jelen tudományos közleményt a szerzők a Pécsi Tudományegyetem alapításának 650. évfordulójának szentelik.Az összefoglaló közleményben a szerzők részletesen bemutatják a Parkinson-kórhoz társuló neurokognitív zavarok jellegzetességeit, felmérésük lehetséges módjait és kezelési lehetőségeit. A neurokognitív zavarok meghatározását sokáig nehezítette a diagnosztikai kritériumrendszerek sokszínűsége. Az Amerikai Pszichiátriai Társaság által a Mentális Rendellenességek Kórmeghatározó és Statisztikai Kézikönyvének ötödik átdolgozása (Diagnostic and Statistical Manual of Mental Disorders, DSM-5) magával hozta a major és az enyhe neurokognitív zavar megnevezéseket a demencia és az enyhe kognitív zavar fogalmát helyettesítendően. A DSM-5 neurokognitív zavarra vonatkozó defi ní-ciói a klinikumban jól alkalmazhatóak, ám szükségessé vált a leggyakrabban használt szűrőtesztek, úgymint a Mini

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“…A lack of dopamine can cause dysfunction in physical and mental mechanisms including motor symptoms such as bradykinesia, rigidity, postural instability, and resting tremor but also cognitive loss, even in the early stages of the disease [Aarsland et al 2009]. Patients with PD often show mild cognitive impairment in at least one cognitive domain such as episodic memory (69%), executive functions (54%), visuospatial/ construction (46%), and working memory/attention (35%) [Pfeiffer et al 2014], which is most obviously associated with a faster thinning of the gray matter [Hanganu et al 2014]. There also seems to be a positive correlation between bradykinesia, working memory, and mental flexibility on the one hand, and postural instability, gait disturbances, and changes in visuospatial memory on the other [Moustafa et al 2013].…”

Section: Introductionmentioning

confidence: 99%

A pilot study on the benefit of cognitive rehabilitation in Parkinson’s disease

Natalia

Adler

Opwis

et al. 2016

Ther Adv Neurol Disord

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Purpose: Patients with Parkinson's disease (PD) show inefficiencies in cognitive performance including working memory functions. Since these problems impact on quality of life and overall well-being, the current study was aimed at improving patients' situations by evaluating the computerized cognitive training tool, BrainStim. Method: A total of 19 healthy controls (HCs) and six patients with PD were included in the study. While all PD patients received cognitive training, the HC sample was subdivided into 12 subjects with training (HC-T) and 10 subjects without (HC-NT). Participants underwent a double baseline assessment, a post-training assessment, and a 3-month follow up on neuropsychological tests and self-report measures on fatigue and depression. Training was administered between the second baseline and postassessment. It comprised 16 supervised sessions according to a standardized training protocol over 4 weeks. Results: Significant improvements in verbal and visuospatial short-term and long-term memory were found in both training groups. In addition, the HC-T improved on mental speed, and verbal and visuospatial working memory. Both training groups showed stable results for all short-term visuospatial measures after 3 months. Further, the HC-T showed stable results for working memory, verbal, and visuospatial short-term and long-term memory. Conclusions:The efficacy of the applied computerized cognitive training tool BrainStim could be verified in patients with PD and healthy age-matched controls. The preliminary findings highlighted the suitability of a specific cognitive intervention to improve cognitive inefficiencies in patients with PD as well as in healthy older people. Further research on cognitive training in combination with PD drug therapy is needed to better understand the mutual interaction and to offer optimal therapeutic approaches to patients.

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Cognitive impairment in early-stage non-demented Parkinson's disease patients

Cited by 139 publications

References 46 publications

Longitudinal study of normal cognition in Parkinson disease

Longitudinal study of normal cognition in Parkinson disease

Neurokognitív zavarok diagnosztizálási és kezelési lehetőségei Parkinson-kórban

A pilot study on the benefit of cognitive rehabilitation in Parkinson’s disease

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