Neuropsychologic assessment in collaborative Parkinson's disease research: A proposal from the National Institute of Neurological Disorders and Stroke Morris K. Udall Centers of Excellence for Parkinson's Disease Research at the University of Pennsylvania and the University of Washington

Watson, G. Stennis; Cholerton, Brenna; Gross, Rachel G.; Weintraub, Daniel; Zabetian, Cyrus P.; Trojanowski, John Q.; Montine, Thomas J.; Siderowf, Andrew; Leverenz, James B.

doi:10.1016/j.jalz.2012.07.006

Cited by 27 publications

(22 citation statements)

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“…Second, the neuropsychological tests used to represent function within cognitive domains vary across studies, and the tests utilized here differ from some previous research. The measures chosen in this study and their assignment to specific cognitive domains were based on recently published consensus guidelines designed to harmonize neuropsychological assessment across the PANUC Clinical Consortium [12], but it should be recognized that a given test does not necessarily assess only the assigned cognitive domain. Third, medications were not included as a covariate in the adjusted models, though they may impact both cognition and PIGD symptoms.…”

Section: Discussionmentioning

confidence: 99%

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Association of cognitive domains with postural instability/gait disturbance in Parkinson's disease

Kelly

Johnson

McGough

et al. 2015

Parkinsonism & Related Disorders

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Introduction Research suggests an association between global cognition and postural instability/gait disturbance (PIGD) in Parkinson’s disease (PD), but the relationship between specific cognitive domains and PIGD symptoms is not clear. This study examined the association of cognition (global and specific cognitive domains) with PIGD symptoms in a large, well-characterized sample of individuals with PD. Methods Cognitive function was measured with a detailed neuropsychological assessment, including global cognition, executive function, memory, visuospatial function, and language. PIGD symptoms were measured using the Movement Disorder Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) Part III, Motor Examination subscale. Multiple linear regression analyses were performed to assess the relationship between cognition and PIGD symptoms with models adjusting for age, sex, education, enrollment site, disease duration, and motor symptom severity. Results The analysis included 783 participants, with mean (standard deviation) age of 67.3 (9.7) years and median (interquartile range) MDS-UPDRS Motor Subscale score of 26 (17, 35). Deficits in global cognition, executive function, memory, and phonemic fluency were associated with more severe PIGD symptoms. Deficits in executive function were associated with impairments in gait, freezing, and postural stability, while visuospatial impairments were associated only with more severe freezing, and poorer memory function was associated only with greater postural instability. Discussion While impairments in global cognition and aspects of executive functioning were associated with more severe PIGD symptoms, specific cognitive domains were differentially related to distinct PIGD components, suggesting the presence of multiple neural pathways contributing to associations between cognition and PIGD symptoms in persons with PD.

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Section: Discussionmentioning

confidence: 99%

“…Participants completed a comprehensive cognitive assessment based on published consensus guidelines [12]. We selected tests common to all study sites to assess global cognition as well as specific cognitive domains.…”

Section: Methodsmentioning

confidence: 99%

Association of cognitive domains with postural instability/gait disturbance in Parkinson's disease

Kelly

Johnson

McGough

et al. 2015

Parkinsonism & Related Disorders

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“…Following recently published consensus guidelines [8], GS participants underwent comprehensive cognitive examination at baseline and follow-up visits; MS participants were given additional tests to provide a more robust characterization of cognitive function, although these were not necessarily used for diagnostic purposes. Specific test details are provided in Table 1.…”

Section: Methodsmentioning

confidence: 99%

Pacific Northwest Udall Center of Excellence Clinical Consortium: Study Design and Baseline Cohort Characteristics

Cholerton

Zabetian

Quinn

et al. 2013

Journal of Parkinson's Disease

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Background The substantial proportion of individuals with Parkinson’s disease (PD) who have or are expected to develop concomitant cognitive impairment emphasizes the need for large, well-characterized participant cohorts to serve as a basis for research into the causes, manifestations, and potential treatments of cognitive decline in those with PD. Objective To establish a multi-site clinical core that cognitively and clinically characterizes patients with PD by obtaining quality longitudinal clinical, neuropsychological, and validated biomarker data. Methods Six hundred nineteen participants with idiopathic PD (68.0 ± 9.1 years, 7.1 ± 6.2 years since diagnosis, 70% males) were enrolled in the Pacific Northwest Udall Center (PANUC), one of the Morris K. Udall Centers of Excellence for Parkinson’s Research, Clinical Consortium and underwent comprehensive clinical and neuropsychological assessment. Participants were diagnosed with no cognitive impairment (PD-NCI), mild cognitive impairment (PD-MCI), or dementia (PDD) at a diagnostic consensus conference. Results A substantial proportion of the overall sample was diagnosed with cognitive impairment at baseline: 22% with PDD and 59% with PD-MCI. A higher rate of cognitive impairment was observed in men than women (87% vs. 68%, p<0.0001), despite a higher level of education. Most patients older than 50 years at the time of diagnosis and with disease duration greater than 10 years were cognitively impaired or demented. Conclusions The PANUC Clinical Consortium is a clinically and cognitively well-characterized cohort of patients with PD. Baseline cohort characteristics demonstrate a high rate of cognitive impairment in the sample, as well as potential sex differences with regard to cognitive diagnosis. The PANUC Clinical Consortium, with its access to biomarker, genetic, and autopsy data, provides an excellent foundation for detailed research related to cognitive impairment in PD.

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“…The neuropsychological assessment was previously described as part of the recommended standard battery of cognitive tests for patients with PD enrolled in cognitive research studies at Udall Centers. 19 Specific cognitive tests were as follows: global cognitive abilities, DRS-2; executive abilities/ working memory, Letter-Number Sequencing and phonemic verbal fluency (FAS); memory, Hopkins Verbal Learning Test-Revised (HVLT-R); visuospatial function, Judgment of Line Orientation; and language, the short Boston Naming Test (BNT) and semantic verbal fluency (animals). For all tests, published norms were used to generate standardized scores.…”

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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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Neuropsychologic assessment in collaborative Parkinson's disease research: A proposal from the National Institute of Neurological Disorders and Stroke Morris K. Udall Centers of Excellence for Parkinson's Disease Research at the University of Pennsylvania and the University of Washington

Cited by 27 publications

References 130 publications

Association of cognitive domains with postural instability/gait disturbance in Parkinson's disease

Association of cognitive domains with postural instability/gait disturbance in Parkinson's disease

Pacific Northwest Udall Center of Excellence Clinical Consortium: Study Design and Baseline Cohort Characteristics

Longitudinal study of normal cognition in Parkinson disease

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