Diagnosing mild cognitive impairment in Parkinson’s disease: which tests perform best in the Italian population?

Abstract

Mild cognitive impairment (MCI) is common in patients with Parkinson's disease (PD) and should be recognized early because it represents a predictor of PD-related dementia and worse disease course. Diagnostic criteria for PD-related MCI (PD-MCI) have recently been defined by a Movement Disorders Society (MDS) task force. The present study explored which neuropsychological tests perform best for a level II (i.e., comprehensive neuropsychological assessment) diagnosis of PD-MCI according to the MDS task force criteria in Italian-speaking PD patients. To this aim, we assessed a comprehensive 23-item neuropsychological battery, derived the best-performing 10-test battery (i.e., two tests per domain for each of the five cognitive domains), and explored its accuracy for diagnosing PD-MCI in comparison to the full battery in a group of PD patients. A secondary aim was to explore the role of this battery for subtyping PD-MCI according to single-domain vs. multiple-domain involvement. The 10-test battery showed 73% sensitivity and 100% specificity for diagnosing PD-MCI, and 69% sensitivity and 100% specificity for PD-MCI subtyping. In patients older than 70 years, we derived a slightly different 10-test battery with 84% sensitivity and 100% specificity for PD-MCI diagnosis, and 86% sensitivity and 100% specificity for PD-MCI subtyping. These 10-item neuropsychological batteries might represent a good trade-off between diagnostic accuracy and time of application, and their role in PD-MCI diagnosis and subtyping should be further explored in future prospective studies.

Olfaction in patients with Parkinson’s disease: a new threshold test analysis through turning points trajectories

“…We evaluated 135 consecutive PD patients at the Department of Neuroscience, Verona University Hospital, Italy. Inclusion criteria were: (a) diagnosis of idiopathic PD; (b) no PD-associated dementia (Jellinger 2018 ); (c) no coexisting reasons (e.g., delirium, cerebrovascular disease, head trauma, metabolic abnormalities, medication adverse effects) that could have influenced olfaction and/or cognition (Litvan et al 2012 ; Drareni et al 2020 ); (d) no other PD-related conditions (e.g., severe motor impairment, psychosis, severe motor fluctuations or dyskinesia, excessive daytime sleepiness) that could have influenced assessment of cognition (Litvan et al 2012 ; Federico et al 2017 ) and olfaction; (e) no history of ear nose and throat disorders, middle ear surgery, head or face trauma, Bell’s palsy, systemic diseases or any other clinical condition that could have interfered with olfaction and taste evaluation, and (f) no current smoking (Ajmani et al 2017 ).…”

“…Executive function was explored with the frontal assessment battery (Appollonio et al 2005 ), phonemic fluency test (Mondini et al 2011 ) and the Stroop task (Brugnolo et al 2016 ). Visuospatial function was assessed with the Benton judgement of line orientation test (Benton et al 1978 ), the intersecting pentagons derived from the MMSE (Federico et al 2017 ) and the clock copying test (Goldman et al 2015 ). Language was evaluated with the short form of the Boston naming test (Fastenau et al 1998 ), object naming test and verb naming test (Capasso and Miceli 2001 ).…”

“…All patients were in a stable ON condition and underwent the mini mental state examination (MMSE), MoCA and a comprehensive 15-test neuropsychological battery that were performed by an expert neuropsychologist (AF) in a quiet room (Goldman et al 2015;Federico et al 2015Federico et al , 2017. The diagnosis of MCI-PD was based on the Movement Disorder Society level II criteria, which stipulate a cognitive battery including at least two tests for each of the five cognitive domains (i.e., memory, attention, executive function, visuospatial function and language) and the abnormality of at least two tests (Litvan et al 2012).…”

Psychometric Properties of the Persian Version of Penn Parkinson Daily Activities Questionnaire-15

“…There is one classification for cognitive deficits in PD, ranging from mild cognitive impairment (PD-MCI) to PD Dementia (PDD). Patients with PD-MCI are at great risk of developing PDD ( Federico et al, 2017 ). Reports from the Movement Disorder Society indicate that 26.7% of PD patients are PD-MCI type and 30% to 40% PDD ( Dancis & Cotter, 2015 ).…”