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Cognitive status correlates with neuropathologic stage in Parkinson disease.
Neurology. 2005 Apr 26; 64(8):1404-10.Neur

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.

Authors+Show Affiliations

Braak H
Institute for Clinical Neuroanatomy, J.W. Goethe University, Frankfurt/Main, Germany. Braak@em.uni-frankfurt.de
Rüb U
No affiliation info available
Jansen Steur EN
No affiliation info available
Del Tredici K
No affiliation info available
de Vos RA
No affiliation info available

MeSH

AgedAged, 80 and overAlzheimer DiseaseBrainCerebral CortexCerebrovascular DisordersCognition DisordersCohort StudiesDisease ProgressionFemaleHumansLewy BodiesMaleNeurofibrillary TanglesNeuropsychological TestsParkinson DiseasePlaque, AmyloidPredictive Value of TestsPrognosisProspective StudiesRisk FactorsSeverity of Illness IndexSex 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), 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_ DB - PRIME DP - Unbound Medicine ER -