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Cognitive impairment in early-stage non-demented Parkinson's disease patients.
Acta Neurol Scand. 2014 May; 129(5):307-18.AN

Abstract

OBJECTIVES

In Parkinson's disease (PD), Parkinson's disease dementia (PDD) and Parkinson's disease-mild cognitive impairment (PD-MCI) are common. PD-MCI is a risk factor for developing PDD. Knowledge of cognition in early-stages PD is essential in understanding and predicting the dementia process.

MATERIALS AND METHODS

We describe the cognitive profile in early-stage PD patients with no prior clinical suspicion of cognitive impairment, depression or psychiatric disturbances, and investigate possible features distinguishing patients with cognitive deficits, defining a PD-MCI risk-profile. Single Photon Emission Computerized Tomography (SPECT) DaT-scan and neurological examination confirmed the diagnosis. Mini-mental state examination-, Addenbrooke's Cognitive Examination, Unified Parkinson's Disease Rating Scale scoring, Hoehn &Yahr/Activity of Daily Living staging and a neuropsychological test battery were applied. Mild cognitive impairment patients were identified according to modified criteria by Troster necessarily omitting subjective cognitive complaints. 80 patients, mean age 61.0 years (SD 6.6), mean duration of disease 3.4 years (SD 1.2) were included. 76 patients were neuropsychologically tested.

RESULTS

26 (34%) patients fulfilled modified PD-MCI criteria, 18 (69%) of these showed episodic memory deficits, 14 (54%) executive dysfunction, 13 (50%) language/praxis deficits, 12 (46%) visuospatial/constructional deficits and 9 (35%) attention/working memory deficits. Cognitive impairment was associated with higher Unified Parkinson's Disease Rating scale (UPDRS)-, bradykinesia- and rigidity scores and more symmetric distribution of symptoms, but not tremor scores. Patients with cognitive impairment were less educated. Other demographic and clinical variables were comparable.

CONCLUSIONS

34% of early-stage PD patients without prior clinical suspicion of cognitive impairment exhibit cognitive impairment, which is associated to disease severity, especially bradykinesia, rigidity, axial symptoms and less asymmetry of motor symptoms, even at early disease stages and when cognitive symptoms are mild.

Authors+Show Affiliations

Department of Neurology, Bispebjerg University Hospital, Copenhagen, Denmark; Department of Clinical Physiology and Nuclear Medicine, Bispebjerg University Hospital, Copenhagen, Denmark.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

24117192

Citation

Pfeiffer, H C V., et al. "Cognitive Impairment in Early-stage Non-demented Parkinson's Disease Patients." Acta Neurologica Scandinavica, vol. 129, no. 5, 2014, pp. 307-18.
Pfeiffer HC, Løkkegaard A, Zoetmulder M, et al. Cognitive impairment in early-stage non-demented Parkinson's disease patients. Acta Neurol Scand. 2014;129(5):307-18.
Pfeiffer, H. C., Løkkegaard, A., Zoetmulder, M., Friberg, L., & Werdelin, L. (2014). Cognitive impairment in early-stage non-demented Parkinson's disease patients. Acta Neurologica Scandinavica, 129(5), 307-18. https://doi.org/10.1111/ane.12189
Pfeiffer HC, et al. Cognitive Impairment in Early-stage Non-demented Parkinson's Disease Patients. Acta Neurol Scand. 2014;129(5):307-18. PubMed PMID: 24117192.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cognitive impairment in early-stage non-demented Parkinson's disease patients. AU - Pfeiffer,H C V, AU - Løkkegaard,A, AU - Zoetmulder,M, AU - Friberg,L, AU - Werdelin,L, Y1 - 2013/10/11/ PY - 2013/08/28/accepted PY - 2013/10/15/entrez PY - 2013/10/15/pubmed PY - 2014/12/15/medline KW - Parkinson's Disease KW - early-stage KW - mild cognitive impairment SP - 307 EP - 18 JF - Acta neurologica Scandinavica JO - Acta Neurol Scand VL - 129 IS - 5 N2 - OBJECTIVES: In Parkinson's disease (PD), Parkinson's disease dementia (PDD) and Parkinson's disease-mild cognitive impairment (PD-MCI) are common. PD-MCI is a risk factor for developing PDD. Knowledge of cognition in early-stages PD is essential in understanding and predicting the dementia process. MATERIALS AND METHODS: We describe the cognitive profile in early-stage PD patients with no prior clinical suspicion of cognitive impairment, depression or psychiatric disturbances, and investigate possible features distinguishing patients with cognitive deficits, defining a PD-MCI risk-profile. Single Photon Emission Computerized Tomography (SPECT) DaT-scan and neurological examination confirmed the diagnosis. Mini-mental state examination-, Addenbrooke's Cognitive Examination, Unified Parkinson's Disease Rating Scale scoring, Hoehn &Yahr/Activity of Daily Living staging and a neuropsychological test battery were applied. Mild cognitive impairment patients were identified according to modified criteria by Troster necessarily omitting subjective cognitive complaints. 80 patients, mean age 61.0 years (SD 6.6), mean duration of disease 3.4 years (SD 1.2) were included. 76 patients were neuropsychologically tested. RESULTS: 26 (34%) patients fulfilled modified PD-MCI criteria, 18 (69%) of these showed episodic memory deficits, 14 (54%) executive dysfunction, 13 (50%) language/praxis deficits, 12 (46%) visuospatial/constructional deficits and 9 (35%) attention/working memory deficits. Cognitive impairment was associated with higher Unified Parkinson's Disease Rating scale (UPDRS)-, bradykinesia- and rigidity scores and more symmetric distribution of symptoms, but not tremor scores. Patients with cognitive impairment were less educated. Other demographic and clinical variables were comparable. CONCLUSIONS: 34% of early-stage PD patients without prior clinical suspicion of cognitive impairment exhibit cognitive impairment, which is associated to disease severity, especially bradykinesia, rigidity, axial symptoms and less asymmetry of motor symptoms, even at early disease stages and when cognitive symptoms are mild. SN - 1600-0404 UR - https://www.unboundmedicine.com/medline/citation/24117192/Cognitive_impairment_in_early_stage_non_demented_Parkinson's_disease_patients_ L2 - https://doi.org/10.1111/ane.12189 DB - PRIME DP - Unbound Medicine ER -