Cognitive Impairment in Parkinson Disease

Leroi, Iracema; McDonald, Kathryn; Pantula, Hiranmayi; Harbishettar, Vijay

doi:10.1177/0891988712464823

Cited by 286 publications

(120 citation statements)

References 27 publications

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“…Recent assessments of well-being in PD-MCI caregivers has revealed mixed results, in that reduced quality of life measures were found in these caregivers [8] but explicit measures of burden using the Zarit Burden Interview (ZBI), did not show elevated levels of burden for PD-MCI caregivers as compared to PD-N caregivers [9, 10]. Such results contrast with reports of increased caregiver burden in carers of people with MCI who are at risk of Alzheimer’s dementia [11], although additional factors may contribute to PD caregiver difficulties [12].…”

Section: Introductionmentioning

confidence: 99%

Caregiver burden is increased in Parkinson’s disease with mild cognitive impairment (PD-MCI)

Jones

Kuijer

Livingston

et al. 2017

Transl Neurodegener

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BackgroundThere is limited evidence on caregiver outcomes associated with mild cognitive impairment in patients with Parkinson’s disease (PD-MCI) and the coping strategies used by these caregivers.MethodsTo investigate this relationship, we examined levels of burden, depression, anxiety, coping strategies and positive aspects of caregiving in the informal caregivers of 96 PD patients. The PD patients were classified using MDS-Task Force Level II criteria as showing either normal cognition (PD-N; n = 51), PD-MCI (n = 30) or with dementia (PDD; n = 15).ResultsMean Zarit Burden Interview (ZBI) score increased significantly between carers of PD-N (M = 13.39, SD = 12.22) compared to those of PD-MCI patients (M = 22.00, SD = 10.8), and between carers of PD-MCI and PDD patients (M = 29.33, SD = 9.59). Moreover, the proportion of carers showing clinically significant levels of burden (ZBI score ≥ 21) also increased as the patients’ cognitive status declined (18% for PD-N; 60% for PD-MCI; and 80% for PDD) and was mirrored by an increasing amount of time spent providing care by the caregivers. Caregiver ZBI score was independent of patient neuropsychiatric symptoms, motor function, disease duration and time that caregivers spent caregiving. Caregiver use of different coping strategies increased with worsening cognition. However, we found only equivocal evidence that the use of problem-focused, emotion-focused and dysfunctional coping mediated the association between patient cognitive status and caregiver burden, because the inverse models that used caregiver burden as the mediator were also significant.ConclusionsThe study highlights the impact of Parkinson’s disease on those providing care when the patient’s cognition is poor, including those with MCI. Caregiver well-being has important implications for caregiver support, nursing home placement and disease course.Electronic supplementary materialThe online version of this article (doi:10.1186/s40035-017-0085-5) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Caregiver burden is increased in Parkinson’s disease with mild cognitive impairment (PD-MCI)

Jones

Kuijer

Livingston

et al. 2017

Transl Neurodegener

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“…Cognitive impairment is observed in up to 24% of newly diagnosed PD patients [1], with up to 46% of patients developing dementia by 10 years of disease [2] and up to 80% of patients develop dementia after 20 years of PD [3]. Even in the absence of frank dementia, early, mild cognitive impairment is an independent contributor to poorer quality of life [4, 5] and disability even when motor symptoms are controlled with medications [6]. …”

Section: Introductionmentioning

confidence: 99%

Cognitive impairment in Parkinson's disease: Association between patient-reported and clinically measured outcomes

Mills

Mari

Pontone

et al. 2016

Parkinsonism & Related Disorders

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Background In Parkinson’s disease, the association between objective and patient-reported measures of cognitive dysfunction is unknown and highly relevant to research and clinical care. Objective To determine which cognitive domain-specific Montreal Cognitive Assessment (MoCA) subscores are most strongly associated with patient-reported cognitive impairment on question 1 (Q1) of the Movement Disorders Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS). Methods We analyzed data from 759 PD participants and 481 persons without PD with in a retrospective, cross sectional analysis using data from the NINDS Parkinson’s Disease Biomarkers Program (PDBP), a longitudinal, multicenter biomarker study. The relationship between a patient-reported cognitive rating (MDS- UPDRS q1.1) and objective cognitive assessments (MoCA) was assessed using multinomial logistic regression modeling and the outcomes reported as conditional odds ratios (cOR’s) representing the relative odds of a participant reporting cognitive impairment that is “slight” versus “normal” on MDS-UPDRSq1.1 for a one unit increase in a MoCA sub-score, adjusted for age and education. Results In PD participants, changes in visuospatial-executive performance and memory had the most significant impact on subjective cognitive impairment. A 1-point increase in visuospatial-executive function decreased the chance of reporting a MDS-UPDRS Q1 score of “slight” versus “normal” by a factor of 0.686 (p<0.001) and each 1 point improvement in delayed recall decreased the odds of reporting “slight” cognitive impairment by a factor of 0.836 (p<0.001). Conclusions Conversion from a PD patient’s report of “normal” to “slight” cognitive impairment may be associated with changes in visuospatial-executive dysfunction and memory more than other cognitive domains.

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“…[1] Their detrimental impact is not only evidenced by worsened quality of life[2], but also by increased nursing home admissions and health-related costs. [3] Sleep abnormalities also occur frequently in PD and contribute to worsened quality of life and patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

Relationships among cognitive impairment, sleep, and fatigue in Parkinson's disease using the MDS-UPDRS

Goldman¹,

Stebbins²,

Leung³

et al. 2014

Parkinsonism & Related Disorders

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Background Non-motor complications of Parkinson’s disease (PD), specifically cognitive impairment, sleep disturbances, and fatigue, are recognized as important contributors to poor patient outcomes and quality of life. How sleep problems and fatigue interrelate and impact cognitive function, however, has not systematically been investigated across the stages of PD. The aim of our study was to investigate the relationships among cognitive impairment, night-time sleep problems, daytime sleepiness, and fatigue across all severities of PD. Methods We examined these non-motor problems using the Movement Disorder Society-Sponsored Revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) in a study of 1319 PD patients drawn from three large cohort studies: the Parkinson’s Progressive Markers Initiative, the Rush University PD Cognitive-Behavioral-Imaging study, and the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale Clinimetric testing program study, which spanned the gamut of disease, from early to advanced PD. Generalized linear mixed models with logit linking functions and covariates including study cohort, age, PD duration, and presence/absence of PD medications were used to examine relationships between these three non-motor symptoms and cognitive impairment. Results Of these three frequent, and often inter-twined, non-motor complications, greater daytime sleepiness and fatigue were associated with worse cognitive impairment across the full spectrum of PD (F[16,1158]=2.40 and F[16,1158]=3.45 respectively, p’s<0.0005), but an association with night-time sleep was not detected (p=0.83). Conclusions Given this association of daytime sleepiness and fatigue with cognitive impairment, clinical monitoring for these problems should be considered across all points in the PD spectrum, from early to more advanced disease.

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Cognitive Impairment in Parkinson Disease

Abstract: The presence of dementia significantly increases caregiver burden and decreases quality of life. However, even mild levels of cognitive impairment increase disability and overall functional impairment progresses in tandem with cognitive decline.

Cited by 286 publications

References 27 publications

Caregiver burden is increased in Parkinson’s disease with mild cognitive impairment (PD-MCI)

Caregiver burden is increased in Parkinson’s disease with mild cognitive impairment (PD-MCI)

Cognitive impairment in Parkinson's disease: Association between patient-reported and clinically measured outcomes

Relationships among cognitive impairment, sleep, and fatigue in Parkinson's disease using the MDS-UPDRS

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