Fluctuating cognition and different cognitive and behavioural profiles in Parkinson’s disease with dementia: comparison of dementia with Lewy bodies and Alzheimer’s disease

Abstract

To examine the occurrence of fluctuating cognition (FC) in a group of patients with Parkinson's disease with dementia (PDD), and to determine whether the presence of FC in PDD is associated with a pattern of cognitive and behavioural disturbances similar to the one shown by patients affected by dementia with Lewy bodies (DLB), a cluster analysis was carried out on the scores obtained by 27 PDD patients on the Clinician Assessment of Fluctuation Scale (CAF). The analysis separated the PDD patients into two subgroups, called PDD non-fluctuators (PDDNF; CAF <or= 2) and PDD fluctuators (PDDF; CAF > 2). The two groups underwent a cognitive and behavioural evaluation. Their scores were compared with those obtained by DLB and Alzheimer's disease (AD) patients. When exploring the cognitive performance of the patients with the Dementia Rating Scale-2 (DRS-2), PDDF had a similar pattern of impairments compared to DLB, which involved prevalently the attention and initiation/perseveration domains, and which was significantly more pronounced compared to that shown by PDDNF. The main behavioural finding of the study was the similar incidence of visual hallucinations in the PDDF and DLB groups, which was significantly higher compared to PDDNF and AD. Our results confirmed the hypothesis that subgroups with different cognitive profiles exist within PDD and that the occurrence of FC is the clinical variable associated with a DLB pattern of impairment in PDD. In conclusion, our study suggests that when FC occurs in PDD this syndrome becomes clinically undistinguishable from DLB.

Dementia with Lewy Bodies versus Alzheimer's Disease and Parkinson's Disease Dementia: A Comparison of Cognitive Profiles

“…Demonstration of a significant amyloid pathology in [11C] Pittsburgh compound B positron-emission tomography might explain why the level of deterioration in memory and executive functions is higher in DLB than in PDD. A very recent study found that a subgroup of PDD patients not experiencing cognitive fluctuations showed significantly less attentional, executive, and memory deficits compared to those with DLB and PDD experiencing cognitive fluctuations 31. The differences in cognitive profiles between DLB and PDD in our data may be influenced by the discrepancy of distribution in the two subgroups of PDD.…”

The association between cognitive fluctuations and activities of daily living and quality of life among institutionalized patients with dementia

“…Given the impact of CFs on a range of cognitive functions and relationship between cognition and ADLs, it is not surprising that CFs were significantly associated with ADLs. However, both CFs and SIB total score contributed independently to the level of impairment in ADLs in our study, indicating there is an independent relationship between CFs and ADLs.…”

Cognitive effects of dopamine depletion in the context of diminished acetylcholine signaling capacity in mice

“…Studies have demonstrated memory deficits in PDD (Higginson et al, 2005; Kuzis et al, 1999; Noe et al, 2004; Owen et al, 1993b; Varanese et al, 2010). The impairment is most evident for visual-spatial memory tasks (Noe et al, 2004; Owen et al, 1993b).…”