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Cognitive status correlates with neuropathologic stage in Parkinson disease.

Abstract

OBJECTIVE

To study the association of cognitive status with the stages of a published neuropathologic staging procedure for sporadic Parkinson disease (PD) in a cohort of 88 patients with PD from a single neurologic unit. None had received the clinical diagnosis of dementia with Lewy bodies (DLB).

METHODS

The authors assessed Lewy neurites/bodies (LNs/LBs) immunoreactive for alpha-synuclein semiquantitatively in sections from 18 brain regions. In silver-stained sections and sections immunostained for tau and beta-amyloid protein, the authors semiquantitatively evaluated comorbidities potentially contributing to cognitive decline, e.g., Alzheimer disease (AD), argyrophilic grain disease (AGD), and cerebral vascular disease. The authors analyzed four Mini-Mental State Examination (MMSE) subgroups ranging from marginally impaired cognition to severe dementia using nonparametric tests.

RESULTS

It was possible to assign all patients to one of the PD stages. MMSE scores correlated with neuropathologic stages (p < 0.005) and this association showed a linear trend (p < 0.025). Median MMSE test scores for women were lower than those for men. Cognitively impaired individuals displayed higher stages of AD-related neurofibrillary pathology (p < 0.05) and beta-amyloid deposition (p < 0.05) than cognitively unimpaired persons. MMSE scores did not correlate significantly with AGD, disease duration, age at disease onset, or age at death. Hoehn and Yahr scores, however, correlated with PD stages (p < 0.0005) and MMSE scores (p < 0.0005).

CONCLUSIONS

The decrease in median Mini-Mental State Examination scores between PD stages 3 to 6 indicates that the risk of developing dementia increases with disease progression. In some individuals, however, cognitive decline can develop in the presence of mild Parkinson disease-related cortical pathology and, conversely, widespread cortical lesions do not necessarily lead to cognitive decline.

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  • Authors+Show Affiliations

    ,

    Institute for Clinical Neuroanatomy, J.W. Goethe University, Frankfurt/Main, Germany. Braak@em.uni-frankfurt.de

    , , ,

    Source

    Neurology 64:8 2005 Apr 26 pg 1404-10

    MeSH

    Aged
    Aged, 80 and over
    Alzheimer Disease
    Brain
    Cerebral Cortex
    Cerebrovascular Disorders
    Cognition Disorders
    Cohort Studies
    Disease Progression
    Female
    Humans
    Lewy Bodies
    Male
    Neurofibrillary Tangles
    Neuropsychological Tests
    Parkinson Disease
    Plaque, Amyloid
    Predictive Value of Tests
    Prognosis
    Prospective Studies
    Risk Factors
    Severity of Illness Index
    Sex Factors

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    15851731

    Citation

    Braak, H, et al. "Cognitive Status Correlates With Neuropathologic Stage in Parkinson Disease." Neurology, vol. 64, no. 8, 2005, pp. 1404-10.
    Braak H, Rüb U, Jansen Steur EN, et al. Cognitive status correlates with neuropathologic stage in Parkinson disease. Neurology. 2005;64(8):1404-10.
    Braak, H., Rüb, U., Jansen Steur, E. N., Del Tredici, K., & de Vos, R. A. (2005). Cognitive status correlates with neuropathologic stage in Parkinson disease. Neurology, 64(8), pp. 1404-10.
    Braak H, et al. Cognitive Status Correlates With Neuropathologic Stage in Parkinson Disease. Neurology. 2005 Apr 26;64(8):1404-10. PubMed PMID: 15851731.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Cognitive status correlates with neuropathologic stage in Parkinson disease. AU - Braak,H, AU - Rüb,U, AU - Jansen Steur,E N H, AU - Del Tredici,K, AU - de Vos,R A I, PY - 2005/4/27/pubmed PY - 2006/1/21/medline PY - 2005/4/27/entrez SP - 1404 EP - 10 JF - Neurology JO - Neurology VL - 64 IS - 8 N2 - OBJECTIVE: To study the association of cognitive status with the stages of a published neuropathologic staging procedure for sporadic Parkinson disease (PD) in a cohort of 88 patients with PD from a single neurologic unit. None had received the clinical diagnosis of dementia with Lewy bodies (DLB). METHODS: The authors assessed Lewy neurites/bodies (LNs/LBs) immunoreactive for alpha-synuclein semiquantitatively in sections from 18 brain regions. In silver-stained sections and sections immunostained for tau and beta-amyloid protein, the authors semiquantitatively evaluated comorbidities potentially contributing to cognitive decline, e.g., Alzheimer disease (AD), argyrophilic grain disease (AGD), and cerebral vascular disease. The authors analyzed four Mini-Mental State Examination (MMSE) subgroups ranging from marginally impaired cognition to severe dementia using nonparametric tests. RESULTS: It was possible to assign all patients to one of the PD stages. MMSE scores correlated with neuropathologic stages (p < 0.005) and this association showed a linear trend (p < 0.025). Median MMSE test scores for women were lower than those for men. Cognitively impaired individuals displayed higher stages of AD-related neurofibrillary pathology (p < 0.05) and beta-amyloid deposition (p < 0.05) than cognitively unimpaired persons. MMSE scores did not correlate significantly with AGD, disease duration, age at disease onset, or age at death. Hoehn and Yahr scores, however, correlated with PD stages (p < 0.0005) and MMSE scores (p < 0.0005). CONCLUSIONS: The decrease in median Mini-Mental State Examination scores between PD stages 3 to 6 indicates that the risk of developing dementia increases with disease progression. In some individuals, however, cognitive decline can develop in the presence of mild Parkinson disease-related cortical pathology and, conversely, widespread cortical lesions do not necessarily lead to cognitive decline. SN - 1526-632X UR - https://www.unboundmedicine.com/medline/citation/15851731/Cognitive_status_correlates_with_neuropathologic_stage_in_Parkinson_disease_ L2 - http://www.neurology.org/cgi/pmidlookup?view=long&amp;pmid=15851731 DB - PRIME DP - Unbound Medicine ER -