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Bode M, Kalbe E, Liepelt-Scarfone I. Cognition and Activity of Daily Living Function in people with Parkinson's disease. J Neural Transm (Vienna) 2024:10.1007/s00702-024-02796-w. [PMID: 38976044 DOI: 10.1007/s00702-024-02796-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 06/08/2024] [Indexed: 07/09/2024]
Abstract
The ability to perform activities of daily living (ADL) function is a multifaceted construct that reflects functionality in different daily life situations. The loss of ADL function due to cognitive impairment is the core feature for the diagnosis of Parkinson's disease dementia (PDD). In contrast to Alzheimer's disease, ADL impairment in PD can be compromised by various factors, including motor and non-motor aspects. This narrative review summarizes the current state of knowledge on the association of cognition and ADL function in people with PD and introduces the concept of "cognitive ADL" impairment for those problems in everyday life that are associated with cognitive deterioration as their primary cause. Assessment of cognitive ADL impairment is challenging because self-ratings, informant-ratings, and performance-based assessments seldomly differentiate between "cognitive" and "motor" aspects of ADL. ADL function in PD is related to multiple cognitive domains, with attention, executive function, and memory being particularly relevant. Cognitive ADL impairment is characterized by behavioral anomalies such as trial-and-error behavior or task step omissions, and is associated with lower engagement in everyday behaviors, as suggested by physical activity levels and prolonged sedentary behavior. First evidence shows that physical and multi-domain interventions may improve ADL function, in general, but the evidence is confounded by motor aspects. Large multicenter randomized controlled trials with cognitive ADL function as primary outcome are needed to investigate which pharmacological and non-pharmacological interventions can effectively prevent or delay deterioration of cognitive ADL function, and ultimately the progression and conversion to PDD.
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Affiliation(s)
- Merle Bode
- Hertie Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, Eberhard Karls University Tübingen, Hoppe-Seyler Str. 3, 72076, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Elke Kalbe
- Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), University Hospital Cologne, Cologne, Germany
- Medical Faculty, University of Cologne, Cologne, Germany
| | - Inga Liepelt-Scarfone
- Hertie Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, Eberhard Karls University Tübingen, Hoppe-Seyler Str. 3, 72076, Tübingen, Germany.
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany.
- IB-Hochschule, Stuttgart, Germany.
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Weintraub D, Marras C, Amara A, Anderson KE, Chahine LM, Eberly S, Hosamath A, Kinel D, Mantri S, Mathur S, Oakes D, Purks JL, Standaert DG, Shoulson I, Arbatti L. Association between Subjective Cognitive Complaints and Incident Functional Impairment in Parkinson's Disease. Mov Disord 2024; 39:706-714. [PMID: 38318953 DOI: 10.1002/mds.29725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/05/2024] [Accepted: 01/09/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Early identification of subjective cognitive complaints (SCC) in Parkinson's disease (PD) may improve patient care if it predicts cognition-related functional impairment (CFI). OBJECTIVES The aim was to determine the cross-sectional and longitudinal association between SCC and CFI in PD. METHODS Data were obtained from Fox Insight, an online longitudinal study that collects PD patient-reported outcomes. Participants completed a PD Patient Report of Problems that asked participants for their five most bothersome disease problems. SCCs were placed into eight categories through human-in-the-loop curation and classification. CFI had a Penn Parkinson's Daily Activities Questionnaire (PDAQ-15) score ≤49. Cox proportional hazards models and Kaplan-Meier survival analyses determined if baseline SCC was associated with incident CFI. RESULTS The PD-PROP cohort (N = 21,160) was 55.8% male, mean age was 65.9 years, and PD duration was 4.8 years. At baseline, 31.9% (N = 6750) of participants reported one or more SCCs among their five most bothersome problems, including memory (13.2%), language/word finding (12.5%), and concentration/attention (9.6%). CFI occurred in 34.7% (N = 7332) of participants. At baseline, SCC was associated with CFI (P-value <0.001). SCC at baseline was associated with incident CFI (hazard ratio [HR] = 1.58 [95% confidence interval: 1.45, 1.72], P-value <0.001), as did cognitive impairment not otherwise specified (HR = 2.31), executive abilities (HR = 1.97), memory (HR = 1.85), and cognitive slowing (HR = 1.77) (P-values <0.001). Kaplan-Meier curves showed that by year 3 an estimated 45% of participants with any SCC at baseline developed new-onset CFI. CONCLUSIONS Self-reported bothersome cognitive complaints are associated with new-onset CFI in PD. Remote electronic assessment can facilitate widespread use of patient self-report at population scale. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Daniel Weintraub
- Departments of Psychiatry and Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Connie Marras
- Edmond J. Safra Program in Parkinson's Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Amy Amara
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Karen E Anderson
- Departments of Psychiatry and Neurology, Georgetown University, Washington, DC, USA
| | - Lana M Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shirley Eberly
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, USA
| | - Abhishek Hosamath
- Grey Matter Technologies, a Wholly Owned Subsidiary of modality.ai, San Francisco, California, USA
| | - Daniel Kinel
- Center for Health + Technology, University of Rochester Medical Center, Rochester, New York, USA
| | - Sneha Mantri
- Department of Neurology, Duke University, Durham, North Carolina, USA
| | | | - David Oakes
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, USA
| | - Jennifer L Purks
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - David G Standaert
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ira Shoulson
- Grey Matter Technologies, a Wholly Owned Subsidiary of modality.ai, San Francisco, California, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - Lakshmi Arbatti
- Grey Matter Technologies, a Wholly Owned Subsidiary of modality.ai, San Francisco, California, USA
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D’Ascanio S, Piras F, Banaj N, Assogna F, Pellicano C, Bassi A, Spalletta G, Piras F. Narrative discourse production in Parkinson's disease: Decoupling the role of cognitive-linguistic and motor speech changes. Heliyon 2023; 9:e18633. [PMID: 37576215 PMCID: PMC10415819 DOI: 10.1016/j.heliyon.2023.e18633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction the interplay between neuropsychological and communicative abilities in Parkinson's disease (PD) has been relatively overlooked, and it is not entirely understood which difficulties are consequent to impaired motor control, and which have a linguistic/cognitive basis. Here, we examined narrative discourse in PD using a multi-level analysis procedure considering sentence-level (productivity, lexical-grammatical processing) and discourse-level processes (narrative organization, informativeness), and partialling out patients' motor speech impairments. The interaction between cognitive (i.e. linguistic and executive) and communication abilities was also investigated. Methods Twenty-nine PD subjects in the mild stage of the disease were compared to 29 matched healthy comparators (HC) on quantitative measures of narrative discourse derived from two picture description tasks. Multivariate (considering articulation rate and educational attainment as covariates) and univariate (with group membership as independent variable) analyses of variance were conducted on separate linguistic domains. The contribution of executive/linguistic abilities to PD's narrative performance was explored by multiple regression analyses on narrative measures significantly differentiating patients from HC. Results significant reductions in patients were observed on measures of productivity (less well-formed words, shorter sentences) and informativeness (fewer conceptual units, less informative elements, lower number of details) and these alterations were explained by variations in linguistic abilities (action and object naming) rather than executive abilities. Articulation rate and educational attainment did not impact the observed reduced productivity and under-informativeness. Conclusion referential narrative discourse is altered in PD, regardless of motor impairments in speech production. The observed reductions in productivity/informativeness aspects of narratives were related to naming abilities and in particular to verbs processing, consistently with the neurocognitive model of motor language coupling. Since narratives are amenable to recurrent and automated analysis for the identification of linguistic patterns potentially anticipating the development of PD and the onset of cognitive deterioration, discourse abilities should be quantitatively and repeatedly profiled in the disorder.
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Affiliation(s)
- Sara D’Ascanio
- Neuropsychiatry Laboratory, Department of Clinical Neuroscience and Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Fabrizio Piras
- Neuropsychiatry Laboratory, Department of Clinical Neuroscience and Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Nerisa Banaj
- Neuropsychiatry Laboratory, Department of Clinical Neuroscience and Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Francesca Assogna
- Neuropsychiatry Laboratory, Department of Clinical Neuroscience and Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Clelia Pellicano
- Neuropsychiatry Laboratory, Department of Clinical Neuroscience and Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Andrea Bassi
- Neuropsychiatry Laboratory, Department of Clinical Neuroscience and Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Gianfranco Spalletta
- Neuropsychiatry Laboratory, Department of Clinical Neuroscience and Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Federica Piras
- Neuropsychiatry Laboratory, Department of Clinical Neuroscience and Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
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Nikbakht N, Rezaee M, Kalantari M, Tabatabaee SM, Shahidi GA. Psychometric Properties of the Persian Version of Penn Parkinson Daily Activities Questionnaire-15. Basic Clin Neurosci 2022; 13:685-694. [PMID: 37313019 PMCID: PMC10258598 DOI: 10.32598/bcn.2021.2410.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/16/2020] [Accepted: 06/28/2020] [Indexed: 11/02/2023] Open
Abstract
Introduction Appropriate information about the ability of patients with Parkinson disease (PD) to perform cognitive instrumental activities of daily living (IADL) is necessary. The present study aimed to assess the psychometric properties of the Persian version of the Penn Parkinson daily activities questionnaire-15 (PDAQ-15). Methods A total of 165 knowledgeable informants of PD patients completed the PDAQ-15. The clinical dementia rating scale, Hoehn and Yahr staging, hospital anxiety and depression scale (HADS), and Lawton IADL scale were used in the study. Internal consistency and test-retest reliability were evaluated by the Cronbach α coefficient and intraclass correlation coefficient (ICC), respectively. To examine the dimensionality of the questionnaire, exploratory factor analysis was used. The construct validity was assessed using the Spearman rank correlation test. To assess the discriminative validity, PDAQ-15 scores were compared across cognitive stages. Results The PDAQ-15 showed strong internal consistency (the Cronbach α=0.99) and test-retest reliability (ICC= 0.99). Only one dimension was identified for the PDAQ-15 in the factor analysis. There was a strong correlation between PDAQ-15 with the depression domain of the HADS scale and the Lawton IADL scale (rs=|0.71-0.95|). The correlation of PDAQ-15 with the anxiety domain of the HADS scale was moderate (rs=0.66). Discriminative validity analysis showed that the PDAQ-15 has significant power to discriminate between PD patients across cognitive stages. Conclusion These results suggest that the PDAQ-15 is a valid and reliable PD-specific instrument and can be useful in clinical and research settings.
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Affiliation(s)
- Negar Nikbakht
- Department of Occupational Therapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Rezaee
- Department of Occupational Therapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Minoo Kalantari
- Department of Occupational Therapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Mehdi Tabatabaee
- Department of Basic Sciences, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Gholam Ali Shahidi
- Department of Neurology, Iran University of Medical Sciences, Hazrat Rasool Hospital, Tehran, Iran
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Bezdicek O, Mana J, Růžička F, Havlik F, Fečíková A, Uhrová T, Růžička E, Urgošík D, Jech R. The Instrumental Activities of Daily Living in Parkinson’s Disease Patients Treated by Subthalamic Deep Brain Stimulation. Front Aging Neurosci 2022; 14:886491. [PMID: 35783142 PMCID: PMC9247575 DOI: 10.3389/fnagi.2022.886491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background Everyday functioning and instrumental activities of daily living (IADL) play a vital role in preserving the quality of life in patients with Parkinson’s disease (PD) after deep brain stimulation of the subthalamic nucleus (STN-DBS). Objective The main goal of the current study was to examine IADL change in pre-and post-surgery of the STN-DBS. We also analyzed the influence of the levodopa equivalent daily dose (LEDD) and global cognitive performance (Dementia Rating Scale; DRS-2) as covariates in relation to IADL. Methods Thirty-two non-demented PD patients were administered before and after STN-DBS neurosurgery the Penn Parkinson’s Daily Activities Questionnaire (PDAQ; self-report), the DRS-2 and Beck Depression Inventory (BDI-II) to assess IADL change, global cognition, and depression. Results We found a positive effect of STN-DBS on IADL in the post-surgery phase. Moreover, lower global cognition and lower LEDD are predictive of lower IADL in both pre-surgery and post-surgery examinations. Summary/Conclusion STN-DBS in PD is a safe method for improvement of everyday functioning and IADL. In the post-surgery phase, we show a relation of IADL to the severity of cognitive impairment in PD and to LEDD.
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Affiliation(s)
- Ondrej Bezdicek
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University, Prague, Czechia
- *Correspondence: Ondrej Bezdicek,
| | - Josef Mana
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University, Prague, Czechia
| | - Filip Růžička
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University, Prague, Czechia
| | - Filip Havlik
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University, Prague, Czechia
| | - Anna Fečíková
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University, Prague, Czechia
| | - Tereza Uhrová
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University, Prague, Czechia
| | - Evžen Růžička
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University, Prague, Czechia
| | - Dušan Urgošík
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czechia
| | - Robert Jech
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University, Prague, Czechia
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Goldman JG, Holden SK. Cognitive Syndromes Associated With Movement Disorders. Continuum (Minneap Minn) 2022; 28:726-749. [PMID: 35678400 DOI: 10.1212/con.0000000000001134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW This article reviews the recognition and management of cognitive syndromes in movement disorders, including those with parkinsonism, chorea, ataxia, dystonia, and tremor. RECENT FINDINGS Cognitive and motor syndromes are often intertwined in neurologic disorders, including neurodegenerative diseases such as Parkinson disease, atypical parkinsonian syndromes, Huntington disease, and other movement disorders. Cognitive symptoms often affect attention, working memory, and executive and visuospatial functions preferentially, rather than language and memory, but heterogeneity can be seen in the various movement disorders. A distinct cognitive syndrome has been recognized in patients with cerebellar syndromes. Appropriate recognition and screening for cognitive changes in movement disorders may play a role in achieving accurate diagnoses and guiding patients and their families regarding progression and management decisions. SUMMARY In the comprehensive care of patients with movement disorders, recognition of cognitive syndromes is important. Pharmacologic treatments for the cognitive syndromes, including mild cognitive impairment and dementia, in these movement disorders lag behind the therapeutics available for motor symptoms, and more research is needed. Patient evaluation and management require a comprehensive team approach, often linking neurologists as well as neuropsychologists, psychologists, psychiatrists, social workers, and other professionals.
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Custodio N, Montesinos R, Chambergo-Michilot D, Herrera-Perez E, Pintado-Caipa M, Seminario G W, Cuenca J, Mesía L, Failoc-Rojas VE, Diaz MM. A Functional Assessment Tool to Distinguish Controls From Alzheimer's Disease in Lima, Peru. Am J Alzheimers Dis Other Demen 2022; 37:15333175221104354. [PMID: 35656899 PMCID: PMC10581136 DOI: 10.1177/15333175221104354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The Alzheimer's Disease Cooperative Study-Activities of Daily Living (ADCS-ADL) scale is a versatile functional assessment tool for patients with Alzheimer's disease (ad). We evaluated its performance in controls, Peruvians with MCI or AD. METHODS A cross-sectional study of older adults attending a neurology institute in Lima (Peru) with mild cognitive impairment (MCI), ad or cognitively healthy. Test-retest reliability (intraclass correlation coefficient, ICC; internal consistency, Cronbach's alpha) and validity were assessed. RESULTS We enrolled 276 individuals (ad: 113, MCI: 68, controls: 95) with no age, sex, educational level, and depressive symptom differences. Reliability was ideal (ICC: .996), and Cronbach's alpha was adequate (.937). The ADCS-ADL could not differentiate MCI from controls but did differentiate ad severity. The ADCS-ADL correlated highly with nearly all tools. CONCLUSIONS The ADCS-ADL scale is reliable in a population with ad in Lima, Peru. Future work may validate a tool for Peruvians with lower educational levels.
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Affiliation(s)
- Nilton Custodio
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Perú
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú
- Escuela Profesional de Medicina Humana, Universidad Privada San Juan Bautista, Lima, Perú
| | - Rosa Montesinos
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú
- Servicio de Rehabilitación, Instituto Peruano de Neurociencias, Lima, Perú
| | | | - Eder Herrera-Perez
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú
- Grupo de Investigación Molident, Universidad San Ignacio de Loyola, Lima, Perú
| | - Maritza Pintado-Caipa
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Perú
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú
- Atlantic Fellow for Equity in Brain Health, Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Wendy Seminario G
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Perú
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú
| | - José Cuenca
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú
- Servicio de Neuropsicología, Instituto Peruano de Neurociencias, Lima, Peru
- Carrera de Psicología, Facultad de Ciencias de La Salud, Universidad Privada Del Norte, Lima, Perú
| | - Laura Mesía
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú
| | - Virgilio E Failoc-Rojas
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú
- Salud Mental, Universidad Privada Norbert Wiener, Lima, Perú
| | - Monica M Diaz
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Perú
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Weintraub D, Mamikonyan E. The Neuropsychiatry of Parkinson Disease: A Perfect Storm. Am J Geriatr Psychiatry 2019; 27:998-1018. [PMID: 31006550 PMCID: PMC7015280 DOI: 10.1016/j.jagp.2019.03.002] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/04/2019] [Accepted: 03/04/2019] [Indexed: 12/16/2022]
Abstract
Affective disorders, cognitive decline, and psychosis have long been recognized as common in Parkinson disease (PD), and other psychiatric disorders include impulse control disorders, anxiety symptoms, disorders of sleep and wakefulness, and apathy. Psychiatric aspects of PD are associated with numerous adverse outcomes, yet in spite of this and their frequent occurrence, there is incomplete understanding of epidemiology, presentation, risk factors, neural substrate, and management strategies. Psychiatric features are typically multimorbid, and there is great intra- and interindividual variability in presentation. The hallmark neuropathophysiological changes that occur in PD, plus the association between exposure to dopaminergic medications and certain psychiatric disorders, suggest a neurobiological basis for many psychiatric symptoms, although psychological factors are involved as well. There is evidence that psychiatric disorders in PD are still under-recognized and undertreated and although psychotropic medication use is common, controlled studies demonstrating efficacy and tolerability are largely lacking. Future research on neuropsychiatric complications in PD should be oriented toward determining modifiable correlates or risk factors and establishing efficacious and well-tolerated treatment strategies.
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Affiliation(s)
- Daniel Weintraub
- Perelman School of Medicine (DW, EM), University of Pennsylvania, Philadelphia; Parkinson's Disease Research, Education and Clinical Center (PADRECC) (DW), Philadelphia Veterans Affairs Medical Center, Philadelphia.
| | - Eugenia Mamikonyan
- Perelman School of Medicine (DW, EM), University of Pennsylvania, Philadelphia
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Deck BL, Xie SX, Choi G, Rick J, Siderowf A, Rudovsky S, Chen‐Plotkin A, Duda JE, Morley JF, Dahodwala N, Trojanowski JQ, Weintraub D. Cognitive Functional Abilities in Parkinson's Disease: Agreement Between Patients and Informants. Mov Disord Clin Pract 2019; 6:440-445. [PMID: 31392244 PMCID: PMC6660222 DOI: 10.1002/mdc3.12781] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/19/2019] [Accepted: 04/22/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The Penn Parkinson's Daily Activities Questionnaire-15 (PDAQ-15) assesses cognition-related instrumental activities of daily living (IADL) in Parkinson's disease (PD). OBJECTIVES To assess the degree and predictors of disagreement between patients (PT) and knowledgeable informants (KI) on the PDAQ-15. METHODS We recruited 254 PT and KI pairs (PT-KI), determined predictors of agreement, and compared scores to a performance-based functional measure (Direct Assessment of Functional Status [DAFS]; N = 61). RESULTS PT and KI total score (intraclass correlation = 0.57) and individual item (Cohen's kappa = 0.46-0.62) agreement were moderate. Patient depression, global cognition, and caregiver burden (all P < 0.05), predicted PT-KI discrepancy. PT-KI discrepancy was highest in patients with a dementia diagnosis, followed by mild cognitive impairment and then normal cognition (all P < 0.01), with PT rating themselves relatively more functionally intact as cognition worsened. DAFS performance was more highly correlated with KI (r = 0.82; P < 0.001) than PT (r = 0.62; P < 0.001) PDAQ-15 score. CONCLUSIONS Our results support using KI as proxies when assessing cognitive IADLs in PD PTs, particularly in cases of more advanced cognitive decline.
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Affiliation(s)
- Benjamin L. Deck
- Departments of Neurology, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of PsychologyDrexel UniversityPhiladelphiaPennsylvaniaUSA
| | - Sharon X. Xie
- Departments of Biostatistics, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Gyujae Choi
- Department of Radiation Oncology Baylor College of MedicineHoustonTexasUSA
| | - Jacqueline Rick
- Departments of Neurology, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Andrew Siderowf
- Departments of Neurology, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Samuel Rudovsky
- Departments of Neurology, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Alice Chen‐Plotkin
- Departments of Neurology, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - John E. Duda
- Departments of Neurology, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Michael J. Crescenz Veterans Affairs Medical Center, Parkinson's Disease ResearchEducation and Clinical Center (PADRECC)PhiladelphiaPennsylvaniaUSA
| | - James F. Morley
- Departments of Neurology, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Michael J. Crescenz Veterans Affairs Medical Center, Parkinson's Disease ResearchEducation and Clinical Center (PADRECC)PhiladelphiaPennsylvaniaUSA
| | - Nabila Dahodwala
- Departments of Neurology, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - John Q. Trojanowski
- Departments of Pathology and Laboratory Medicine, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Daniel Weintraub
- Departments of Neurology, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Departments of Psychiatry, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Michael J. Crescenz Veterans Affairs Medical Center, Parkinson's Disease ResearchEducation and Clinical Center (PADRECC)PhiladelphiaPennsylvaniaUSA
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Martinez-Horta S, Horta-Barba A, Kulisevsky J. Cognitive and behavioral assessment in Parkinson's disease. Expert Rev Neurother 2019; 19:613-622. [PMID: 31180250 DOI: 10.1080/14737175.2019.1629290] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction: Cognitive impairment and behavioral disturbances are common findings in Parkinson's disease (PD). Despite initially being considered late complications of the disease, it is currently accepted that almost all PD patients will exhibit cognitive and behavioral abnormalities from the early and even the premotor stages of the disease. Areas covered: The present review focuses on the cognitive profile of PD, the clinical picture of PD-MCI and dementia in PD (PDD) and the recommended methods for cognitive assessment in this population. The authors also describe the more representative neuropsychiatric alterations and provide an overview of the recommended methods of assessment. Expert opinion: Cognitive and behavioral symptoms are inherent to PD, appear in a vast majority of patients at some point during disease progression and have an enormous impact on health-related quality of life of patients and caregivers. Validated methods of cognitive and behavioral assessment are currently developed and must be used in research and clinical settings.
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Affiliation(s)
- Saul Martinez-Horta
- a Movement Disorders Unit, Neurology Department , Hospital de la Santa Creu i Sant Pau , Barcelona , Spain.,b Biomedical Research Institute (IIB-Sant Pau) , Barcelona , Spain.,c Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED) , Madrid , Spain.,d Autonomous University of Barcelona , Barcelona , Spain
| | - Andrea Horta-Barba
- a Movement Disorders Unit, Neurology Department , Hospital de la Santa Creu i Sant Pau , Barcelona , Spain.,b Biomedical Research Institute (IIB-Sant Pau) , Barcelona , Spain.,c Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED) , Madrid , Spain
| | - Jaime Kulisevsky
- a Movement Disorders Unit, Neurology Department , Hospital de la Santa Creu i Sant Pau , Barcelona , Spain.,b Biomedical Research Institute (IIB-Sant Pau) , Barcelona , Spain.,c Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED) , Madrid , Spain.,d Autonomous University of Barcelona , Barcelona , Spain
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11
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Holden SK, Medina LD, Hoyt B, Sillau SH, Berman BD, Goldman JG, Weintraub D, Kluger BM. Validation of a performance-based assessment of cognitive functional ability in Parkinson's disease. Mov Disord 2018; 33:1760-1768. [PMID: 30306618 PMCID: PMC6261681 DOI: 10.1002/mds.27487] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/13/2018] [Accepted: 08/08/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Outcome measures that capture functional abilities related to cognition offer the potential to demonstrate real-world effectiveness of cognitive-enhancing treatments. However, distinguishing functional disability related to cognition from that attributed to motor symptoms can be difficult in PD. A performance-based functional assessment allows for direct observation of activity of daily living skills and separation of cognitive from motoric disabilities. OBJECTIVES Validate the University of California San Diego Performance-Based Skills Assessment in PD. METHODS One hundred PD participants, ranging from normal cognition to dementia, completed the University of California San Diego Performance-Based Skills Assessment, a performance-based measure of cognitively demanding activities of daily living, as well as a neuropsychological battery and motor examination. Cognitive classification was determined by consensus conference, blinded to University of California San Diego Performance-Based Skills Assessment scores. Psychometric properties of the University of California San Diego Performance-Based Skills Assessment, including internal consistency, test-retest and inter-rater reliability, and discriminant validity for dementia, were examined. RESULTS The University of California San Diego Performance-Based Skills Assessment demonstrated strong internal consistency (Cronbach's α = 0.82) and test-retest reliability (r = 0.89) and correlated strongly with global cognition (Mattis Dementia Rating Scale: r = 0.80; P < 0.001). University of California San Diego Performance-Based Skills Assessment regression models indicated greater contribution from cognitive explanatory variables (marginal partial: R2 = 0.33) than motor variables (marginal partial: R2 = 0.05), controlling for age, education, disease duration, and l-dopa equivalent dose. Additionally, the University of California San Diego Performance-Based Skills Assessment exhibited strong discriminant validity for dementia (area under the curve = 0.91). CONCLUSIONS The University of California San Diego Performance-Based Skills Assessment is a valid measure of functional abilities related to cognition rather than motor symptoms in PD. Furthermore, it reliably distinguishes demented from nondemented participants. The University of California San Diego Performance-Based Skills Assessment may be considered as an outcome measure that combines cognitive and functional abilities in treatment trials for cognitive impairment in PD. © 2018 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Samantha K. Holden
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Luis D. Medina
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Brian Hoyt
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Stefan H. Sillau
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Brian D. Berman
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA
- Neurology Section, Denver VA Medical Center, Denver, Colorado, USA
| | - Jennifer G. Goldman
- Department of Neurological Sciences, Section of Parkinson’s Disease and Movement Disorders, Rush University Medical Center, Chicago, Illinois, USA
| | - Daniel Weintraub
- Parkinson’s Disease and Mental Illness Research Education, Clinical and Education Centers, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
- Departments of Psychiatry and Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Benzi M. Kluger
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA
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12
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Becker S, Bäumer A, Maetzler W, Nussbaum S, Timmers M, Van Nueten L, Salvadore G, Zaunbrecher D, Roeben B, Brockmann K, Streffer J, Berg D, Liepelt-Scarfone I. Assessment of cognitive-driven activity of daily living impairment in non-demented Parkinson's patients. J Neuropsychol 2018; 14:69-84. [PMID: 30320954 DOI: 10.1111/jnp.12173] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 09/10/2018] [Indexed: 01/15/2023]
Abstract
The core criterion for Parkinson's disease dementia (PDD) is the impairment in activities of daily living (ADL) function primarily caused by cognitive, not motor symptoms. There is evidence to assume that mild ADL impairments in mild cognitive impairment (PD-MCI) characterize those patients at high risk for dementia. Data of 216 Parkinson's disease (PD) patients assessed with comprehensive motor and neuropsychological assessments were analysed. Based on linear regression models, subscores of the Functional Activities Questionnaire (FAQ) primarily reflecting patients' global cognitive status (FAQC ) or PD-related motor severity (FAQM ) were developed. A quotient (FAQQ ) of both scores was calculated, with values >1 indicating more cognitive- compared to motor-driven ADL impairment. Both FAQC and FAQM scores were higher in PD-MCI than cognitively normal (PD-CN) patients, indicating more severe cognitive- and motor-driven ADL impairments in this group. One third (31.6%) of the PD-MCI group had a FAQQ score >1, which was significantly different from patients with PD-CN (p = .02). PD-MCI patients with an FAQQ score >1 were more impaired on tests assessing attention (p = .019) and language (p = .033) compared to PD-MCI patients with lower FAQQ values. The differentiation between cognitive- and motor-driven ADL is important, as the loss of functional capacity is the defining factor for a diagnosis of PDD. We were able to differentiate the cognitive-driven from the motor-driven ADL impairments for the FAQ. PD-MCI patients with more cognitive- compared to motor-driven ADL impairments may pose a risk group for conversion to PDD and can be targeted for early treatments.
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Affiliation(s)
- Sara Becker
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Germany
| | - Alena Bäumer
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Germany
| | - Walter Maetzler
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany.,Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Susanne Nussbaum
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Germany
| | - Maarten Timmers
- Janssen Research and Development, Janssen - Pharmaceutical Companies of Johnson & Johnson, Beerse, Belgium.,Reference Center for Biological Markers of Dementia (BIODEM), Institute Born-Bunge, University of Antwerp, Belgium
| | - Luc Van Nueten
- Janssen Research and Development, Janssen - Pharmaceutical Companies of Johnson & Johnson, Beerse, Belgium
| | - Giacomo Salvadore
- Janssen Research and Development LLC, Janssen - Pharmaceutical Companies of Johnson & Johnson, Raritan, New Jersey, USA
| | - Detlev Zaunbrecher
- Private Practice for Neurology, Psychiatry, and Psychotherapy, Mössingen, Germany
| | - Benjamin Roeben
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Germany
| | - Kathrin Brockmann
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Germany
| | - Johannes Streffer
- Janssen Research and Development, Janssen - Pharmaceutical Companies of Johnson & Johnson, Beerse, Belgium.,Reference Center for Biological Markers of Dementia (BIODEM), Institute Born-Bunge, University of Antwerp, Belgium
| | - Daniela Berg
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany.,Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Inga Liepelt-Scarfone
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Germany
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13
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Smith KM, Caplan DN. Communication impairment in Parkinson's disease: Impact of motor and cognitive symptoms on speech and language. BRAIN AND LANGUAGE 2018; 185:38-46. [PMID: 30092448 DOI: 10.1016/j.bandl.2018.08.002] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 07/21/2018] [Accepted: 08/02/2018] [Indexed: 06/08/2023]
Abstract
Communication impairment is common in Parkinson's disease (PD) and may have both motor speech control and cognitive-linguistic underpinnings. The neurobiology of communication impairment in PD is poorly understood, and work is needed to disentangle the relative contributions of motor and cognitive dysfunction. In clinical practice, cognitive-linguistic impairments are often overlooked despite the large body of research on this topic in neurocognitive and linguistics literature. In this review, we will discuss the roles of motor speech changes, cognitive and linguistic impairment, and other related functions in the communication disabilities of individuals with PD. We will describe the various types of communication difficulties in PD and tools for measuring these symptoms. We will discuss specific deficits that may further understanding of the neurobiology of communication impairment in PD, including voice and speech acoustic changes, linguistic processing and production difficulties, and pausing. We will emphasize the importance of an interdisciplinary approach and the patient perspective on daily communication in guiding future research.
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Affiliation(s)
- Kara M Smith
- University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA.
| | - David N Caplan
- Massachusetts General Hospital, 175 Cambridge Street, Boston, MA 02114, USA.
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14
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Beyle A, Glonnegger H, Cerff B, Gräber S, Berg D, Liepelt-Scarfone I. The Multiple Object Test as a performance-based tool to assess the decline of ADL function in Parkinson's disease. PLoS One 2018; 13:e0200990. [PMID: 30067788 PMCID: PMC6070239 DOI: 10.1371/journal.pone.0200990] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 07/08/2018] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION As cognitive-driven worsening of activities of the daily living (ADL) in Parkinson's disease (PD) is the core feature of PD dementia (PDD), there is great need for sensitive quantitative assessment. Aim of our study was the evaluation of cognitive-driven worsening of ADL by the performance-based Multiple Object Test (MOT), offering an essential clinical advantage as it is quick and easy to apply in a clinical context even on severely impaired patients. METHODS 73 PD patients were assessed longitudinally over a period of 37 (6-49) months. According to their neuropsychological profile the sample was divided into two groups: PD patients with (n = 34, PD-CI) and without cognitive impairment (n = 39, PD-noCI). The MOT comprises five routine tasks (e.g. to make coffee) quick and easy to apply. Quantitative (total error number, processing time) and qualitative parameters (error type) were analyzed using non-parametric test statistic (e.g.Wilcoxon signed-rank test, binary logistic regression). RESULTS Median number of total errors (p = 0.001), processing time (p<0.001), perplexity (p = 0.035), and omission errors (p<0.001) increased significantly from baseline to follow-up in the total sample. Worsening of MOT performance was correlated to cognitive decline in the attention/ executive function and visuo-constructive domain. PD-CI showed an increase in omission errors (p = 0.027) compared to PD-noCI over time. This increase in omission errors between visits was further identified as a risk marker for PDD conversion. CONCLUSION The MOT, especially frequency of omission errors, is a promising tool to rate PD patients objectively and might help to identify patients with a high risk for having mild cognitive impairment or dementia.
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Affiliation(s)
- Aline Beyle
- German Center of Neurodegenerative Diseases (DZNE), Tübingen, Germany
- Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tuebingen, Tübingen, Germany
- Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Hannah Glonnegger
- German Center of Neurodegenerative Diseases (DZNE), Tübingen, Germany
- Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tuebingen, Tübingen, Germany
| | - Bernhard Cerff
- German Center of Neurodegenerative Diseases (DZNE), Tübingen, Germany
- Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tuebingen, Tübingen, Germany
| | - Susanne Gräber
- German Center of Neurodegenerative Diseases (DZNE), Tübingen, Germany
- Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tuebingen, Tübingen, Germany
| | - Daniela Berg
- German Center of Neurodegenerative Diseases (DZNE), Tübingen, Germany
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Inga Liepelt-Scarfone
- German Center of Neurodegenerative Diseases (DZNE), Tübingen, Germany
- Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tuebingen, Tübingen, Germany
- * E-mail:
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15
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Smith KM, Ash S, Xie SX, Grossman M. Evaluation of Linguistic Markers of Word-Finding Difficulty and Cognition in Parkinson's Disease. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2018; 61:1691-1699. [PMID: 29955824 PMCID: PMC6195062 DOI: 10.1044/2018_jslhr-l-17-0304] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 03/05/2018] [Indexed: 05/10/2023]
Abstract
PURPOSE Early cognitive symptoms such as word-finding difficulty (WFD) in daily conversation are common in Parkinson's disease (PD), but studies have been limited by a lack of feasible, quantitative measures. Linguistic analysis, focused on pauses in speech, may yield markers of impairment of cognition and communication in PD. The objective of this study was to evaluate the relationship of linguistic markers in semistructured speech to WFD symptoms and cognitive function in PD. METHOD Speech recordings of description of the Cookie Theft picture in 53 patients with PD without dementia and 23 elderly controls were analyzed with Praat software. Montreal Cognitive Assessment (MoCA; Nasreddine et al., 2005), category naming fluency, and confrontation naming tests were administered. Questionnaires rating WFD symptoms and cognitive instrumental activities of daily living were completed. We determined the relationships between (a) pause length and location, (b) MoCA score, and (c) WFD symptoms, using Pearson's correlations and multivariate regression models. RESULTS Compared with controls, patients with PD had more pauses within utterances as well as fewer words per minute and a lower percentage of well-formed sentences. Pauses within utterances differed significantly between PD-mild cognitive impairment and normal cognition (p < .001). Words per minute and percentage of well-formed sentences were predictive of MoCA in multivariate regression models. Pauses before verbs were associated with patient-reported severity of WFD symptoms (p = .006). CONCLUSIONS Linguistic markers including pauses within utterances distinguish patients with PD with mild cognitive symptoms from elderly controls. These markers are associated with global cognitive function before the onset of dementia. Pauses before verbs and grammatical markers may index early cognitive symptoms such as WFD that may interfere with functional communication. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.6615401.
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Affiliation(s)
- Kara M. Smith
- Parkinson Disease and Movement Disorders Center, Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Department of Neurology, University of Massachusetts Memorial Medical Center/UMass Medical School, Worcester
| | - Sharon Ash
- Department of Neurology and the Penn Frontotemporal Degenerative Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Sharon X. Xie
- Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Murray Grossman
- Department of Neurology and the Penn Frontotemporal Degenerative Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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16
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Goldman JG, Holden SK, Litvan I, McKeith I, Stebbins GT, Taylor JP. Evolution of diagnostic criteria and assessments for Parkinson's disease mild cognitive impairment. Mov Disord 2018; 33:503-510. [DOI: 10.1002/mds.27323] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 01/01/2018] [Accepted: 01/04/2018] [Indexed: 12/16/2022] Open
Affiliation(s)
- Jennifer G. Goldman
- Department of Neurological Sciences, Section of Parkinson Disease and Movement Disorders; Rush University Medical Center; Chicago Illinois USA
| | - Samantha K. Holden
- Department of Neurology; University of Colorado, Department of Neurology; Aurora Colorado USA
| | - Irene Litvan
- Department of Neurosciences; University of California San Diego, Department of Neurosciences; San Diego California USA
| | - Ian McKeith
- Institute of Neuroscience; Newcastle University; Newcastle upon Tyne United Kingdom
| | - Glenn T. Stebbins
- Department of Neurological Sciences, Section of Parkinson Disease and Movement Disorders; Rush University Medical Center; Chicago Illinois USA
| | - John-Paul Taylor
- Institute of Neuroscience; Newcastle University; Newcastle upon Tyne United Kingdom
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17
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Rocha RSB, De Oliveira Rocha LS, Pena ESM, Caldas LCP, Moreno MA. Analysis of autonomic modulation of heart rate in patients with Parkinson's disease and elderly individuals submitted to game therapy training. Geriatr Gerontol Int 2017; 18:20-25. [DOI: 10.1111/ggi.13130] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 05/10/2017] [Accepted: 06/13/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Rodrigo Santiago Barbosa Rocha
- Physiotherapy Course; University of Amazon - UNAMA; Belém Brazil
- Physiotherapy Course; Pará State University - UEPA; Belém Brazil
- Postgraduate Program in Sciences of Human Movement; Methodist University of Piracicaba - UNIMEP; Piracicaba Brazil
| | - Larissa Salgado De Oliveira Rocha
- Physiotherapy Course; University of Amazon - UNAMA; Belém Brazil
- Postgraduate Program in Sciences of Human Movement; Methodist University of Piracicaba - UNIMEP; Piracicaba Brazil
| | | | | | - Marlene Aparecida Moreno
- Postgraduate Program in Sciences of Human Movement; Methodist University of Piracicaba - UNIMEP; Piracicaba Brazil
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18
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Deck BL, Rick J, Xie SX, Chen-Plotkin A, Duda JE, Morley JF, Chahine LM, Dahodwala N, Trojanowski JQ, Weintraub D. Statins and Cognition in Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2017; 7:661-667. [PMID: 28922167 PMCID: PMC5675567 DOI: 10.3233/jpd-171113] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The relationship between statins and cognition in Parkinson's disease (PD) is poorly understood. OBJECTIVES Analyses were performed to determine associations between statin use and cross-sectional and longitudinal cognitive performance in PD. METHODS Neuropsychological tests, medication logs, and ratings of functional abilities were collected from 313 PD participants longitudinally. RESULTS At baseline, statin users (SU; N = 129) were older, more likely male, and had shorter PD duration than non-statin users (NSU; N = 184). In Cross-sectional analysis, SU performed better on global cognition, Trails B, semantic fluency, and phonemic fluency tasks. Rate of long-term global cognitive (Dementia Rating Scale-2 and MoCA) decline was significantly less in SU.
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Affiliation(s)
- Benjamin L. Deck
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jacqueline Rick
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sharon X. Xie
- Department of Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Alice Chen-Plotkin
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - John E. Duda
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Parkinson’s Disease Research, Education and Clinical Center (PADRECC), Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - James F. Morley
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Parkinson’s Disease Research, Education and Clinical Center (PADRECC), Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Lana M. Chahine
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nabila Dahodwala
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - John Q. Trojanowski
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel Weintraub
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Parkinson’s Disease Research, Education and Clinical Center (PADRECC), Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
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19
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Brennan L, Siderowf A, Rubright JD, Rick J, Dahodwala N, Duda JE, Hurtig H, Stern M, Xie SX, Rennert L, Karlawish J, Shea JA, Trojanowski JQ, Weintraub D. The Penn Parkinson's Daily Activities Questionnaire-15: Psychometric properties of a brief assessment of cognitive instrumental activities of daily living in Parkinson's disease. Parkinsonism Relat Disord 2016; 25:21-6. [PMID: 26923524 PMCID: PMC4818172 DOI: 10.1016/j.parkreldis.2016.02.020] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 02/04/2016] [Accepted: 02/18/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION To describe the psychometric properties of the Penn Parkinson's Daily Activities Questionnaire-15 (PDAQ-15), a 15-item measure of cognitive instrumental activities of daily living for Parkinson's disease (PD) patients derived from the original 50-item PDAQ. METHODS PDAQ-15 items were chosen by expert consensus. Knowledgeable informants of PD participants (n = 161) completed the PDAQ-15. Knowledgeable informants were defined as an individual having regular contact with the PD participant. PD participants were assigned a diagnosis of normal cognition, mild cognitive impairment, or dementia based on expert consensus. RESULTS PDAQ-15 scores correlated strongly with global cognition (Dementia Rating Scale-2, r = 0.71, p < 0.001) and a performance-based functional measure (Direct Assessment of Functional Status, r = 0.83; p < 0.001). PDAQ-15 scores accurately discriminated between non-demented PD participants (normal cognition/mild cognitive impairment) and PD with dementia (ROC curve area = 0.91), participants with and without any cognitive impairment (normal cognition versus mild cognitive impairment/dementia, ROC curve area = 0.85) and between participants with mild cognitive impairment and dementia (ROC curve area = 0.84). CONCLUSIONS The PDAQ-15 shows good discriminant validity across cognitive stages, correlates highly with global cognitive performance, and appears suitable to assess daily cognitive functioning in PD.
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Affiliation(s)
- Laura Brennan
- Drexel Neurosciences Institute, Drexel University College of Medicine, 245 N. 15th St., 7102 NCB, Philadelphia, PA 19102, USA; Department of Psychiatry, University of Pennsylvania School of Medicine, 3615 Chestnut St., #330, Philadelphia, PA 19104, USA
| | - Andrew Siderowf
- Avid Radiopharmaceuticals, 3711 Market St # 7, Philadelphia, PA 19104, USA
| | - Jonathan D Rubright
- National Board of Medical Examiners, 3750 Market Street, Philadelphia, PA 19104, USA
| | - Jacqueline Rick
- Department of Neurology, University of Pennsylvania School of Medicine, 330 S. 9th St., Philadelphia, PA 19107, USA
| | - Nabila Dahodwala
- Department of Neurology, University of Pennsylvania School of Medicine, 330 S. 9th St., Philadelphia, PA 19107, USA
| | - John E Duda
- Department of Neurology, University of Pennsylvania School of Medicine, 330 S. 9th St., Philadelphia, PA 19107, USA; Philadelphia Veterans Affairs Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104, USA
| | - Howard Hurtig
- Department of Neurology, University of Pennsylvania School of Medicine, 330 S. 9th St., Philadelphia, PA 19107, USA
| | - Matthew Stern
- Department of Neurology, University of Pennsylvania School of Medicine, 330 S. 9th St., Philadelphia, PA 19107, USA
| | - Sharon X Xie
- Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, 8th Floor Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104, USA
| | - Lior Rennert
- Philadelphia Veterans Affairs Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104, USA
| | - Jason Karlawish
- Departments of Medical Ethics and Medicine, PENN-CMU Roybal Center on Behavioral Economics and Health, The LDI Center for Health Incentives, and Alzheimer's Disease Center, 3401 Market Street, Suite 320, Philadelphia, PA 19104, USA
| | - Judy A Shea
- Department of Medicine, University of Pennsylvania School of Medicine, 3400 Civic Center Boulevard, Building 421, Philadelphia, PA 19104, USA
| | - John Q Trojanowski
- Department of Neurology, University of Pennsylvania School of Medicine, 330 S. 9th St., Philadelphia, PA 19107, USA
| | - Daniel Weintraub
- Department of Psychiatry, University of Pennsylvania School of Medicine, 3615 Chestnut St., #330, Philadelphia, PA 19104, USA; Department of Neurology, University of Pennsylvania School of Medicine, 330 S. 9th St., Philadelphia, PA 19107, USA; Philadelphia Veterans Affairs Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104, USA.
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20
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Weintraub D, Hauser RA, Elm JJ, Pagan F, Davis MD, Choudhry A. Rasagiline for mild cognitive impairment in Parkinson's disease: A placebo-controlled trial. Mov Disord 2016; 31:709-14. [PMID: 27030249 DOI: 10.1002/mds.26617] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 02/12/2016] [Accepted: 02/19/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND This study's aims were to determine the efficacy and tolerability of rasagiline, a selective monoamine oxidase inhibitor B, for PD patients with mild cognitive impairment. METHODS Patients on stable dopaminergic therapy were randomized to adjunct rasagiline 1 mg/day or placebo in this 24-week, double-blind, placebo-controlled, multisite study. The primary endpoint was mean change from baseline to week 24 on the Scales for Outcomes of Parkinson's Disease-Cognition total score. Key secondary measures included changes in cognition, activities of daily living, motor scores, and Clinical Global Impression of Change, as well as safety and tolerability measures. RESULTS Of the 170 patients randomized, 151 (88.2%) completed the study. Change in Scales for Outcomes of Parkinson's Disease-Cognition scores were not significantly different in the rasagiline and placebo groups (adjusted mean: 1.6 [standard error {SE} = 0.5] vs. 0.8 [SE = 0.5] points; LS means difference = 0.8; 95% confidence interval: -0.48, 2.05; P = 0.22). There were no between-group differences in change in the MoCA (p=0.84) or Penn Daily Activities Questionnaire (P = 0.48) scores or in the distribution of Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change modified for mild cognitive impairment (P = 0.1). Changes in motor (UPDRS part III; P = 0.02) and activities of daily living (UPDRS part II; P < 0.001) scores favored rasagiline. Rasagiline was well tolerated; the most common adverse events in both groups were falls and dizziness. CONCLUSIONS Rasagiline treatment in PD patients with mild cognitive impairment was not associated with cognitive improvement. Rasagiline did not worsen cognition, improved motor symptoms and activities of daily living, and was well tolerated in elderly cognitively impaired patients. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Daniel Weintraub
- Departments of Psychiatry and Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Jordan J Elm
- Department of Public Health Science, Medical University of South Carolina, Charleston, South Carolina, USA
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