Assessment of individual cognitive changes after deep brain stimulation surgery in Parkinson's disease using the Neuropsychological Test Battery Vienna short version

Long-term therapy of Parkinson’s disease with L‑DOPA is associated with a high risk of developing motor fluctuations and dyskinesia. Deep brain stimulation (DBS) of the subthalamic nucleus (STN) can improve these motor complications. Although the positive effect on motor symptoms has been proven, postoperative cognitive decline has been documented. To tackle the impact of DBS on cognition, 18 DBS patients were compared to 25 best medically treated Parkinson’s patients, 24 patients with mild cognitive impairment (MCI) and 12 healthy controls using the Neuropsychological Test Battery Vienna short version (NTBV-short) for cognitive outcome 12 months after the first examination. Reliable change index methodology was used. Roughly 10% of DBS patients showed cognitive decline mainly affecting the domains attention and executive functioning (phonemic fluency). Further research is needed to identify the mechanisms that lead to improvement or deterioration of cognitive functions in individual cases.

Facial emotion recognition and its relationship to cognition and depressive symptoms in patients with Parkinson's disease

BACKGROUND

Impairments in facial emotion recognition (FER) have been detected in patients with Parkinson disease (PD). Presently, we aim at assessing differences in emotion recognition performance in PD patient groups with and without mild forms of cognitive impairment (MCI) compared to healthy controls.

METHODS

Performance on a concise emotion recognition test battery (VERT-K) of three groups of 97 PD patients was compared with an age-equivalent sample of 168 healthy controls. Patients were categorized into groups according to two well-established classifications of MCI according to Petersen's (cognitively intact vs. amnestic MCI, aMCI, vs. non-amnestic MCI, non-aMCI) and Litvan's (cognitively intact vs. single-domain MCI, sMCI, vs. multi-domain MCI, mMCI) criteria. Patients and controls underwent individual assessments using a comprehensive neuropsychological test battery examining attention, executive functioning, language, and memory (Neuropsychological Test Battery Vienna, NTBV), the Beck Depression Inventory, and a measure of premorbid IQ (WST).

RESULTS

Cognitively intact PD patients and patients with MCI in PD (PD-MCI) showed significantly worse emotion recognition performance when compared to healthy controls. Between-groups effect sizes were substantial, showing non-trivial effects in all comparisons (Cohen's ds from 0.31 to 1.22). Moreover, emotion recognition performance was higher in women, positively associated with premorbid IQ and negatively associated with age. Depressive symptoms were not related to FER.

CONCLUSIONS

The present investigation yields further evidence for impaired FER in PD. Interestingly, our data suggest FER deficits even in cognitively intact PD patients indicating FER dysfunction prior to the development of overt cognitive dysfunction. Age showed a negative association whereas IQ showed a positive association with FER.

Visuo-constructional functions in patients with mild cognitive impairment, Alzheimer's disease, and Parkinson's disease

BACKGROUND

Several recently proposed criteria for assessing cognitive disorder require measuring the cognitive domain of visuo-constructional function. The aims of the present study were to develop a new test (Vienna Visuo-constructional Test-VVT) measuring visuo-constructional functions and to determine the reliability and validity of the VVT in patients with mild cognitive impairment (MCI), Parkinson's disease (PD), and Alzheimer's disease (AD). We further examined age and sex effects and the psychometric quality of the VVT.

METHODS

The study included 76 healthy controls and 103 patients who were referred to the Department of Neurology, Medical University of Vienna for neurocognitive assessment. An administering and scoring system for the VVT was developed.

RESULTS

Internal consistency (Cronbach's alpha) was found to range from 0.82 for the healthy control group to 0.93 for the total patient group. There was no sex effect, but age had a negative effect on VVT performance. The VVT successfully differentiated healthy controls from MCI patients, AD patients, and PD patients, respectively.

CONCLUSION

The VVT shows satisfactory validity and reliability and can be administered easily in clinical practice. It constitutes a new measure that can successfully be used to identify visuo-constructional problems in patients with cognitive dysfunction.

Subjective memory complaints, depressive symptoms and cognition in Parkinson's disease patients

BACKGROUND AND PURPOSE

The goal of this study was to establish the prevalence of subjective memory complaints (SMCs) and depressive symptoms (DS)s and their relation to cognitive functioning in patients with Parkinson's disease (PD).

METHODS

In all, 248 controls and 104 PD patients were included in the study. The PD group was subdivided into three PD subtypes with mild cognitive impairment (MCI) according to the Petersen criteria and three PD subtypes with MCI according to the Litvan criteria.

RESULTS

Substantial SMCs were reported by 7.7% of controls and 16.3% of the PD patients (P < 0.001). A clinically relevant degree of DSs was evident in 16.6% of controls compared with 40.4% in the PD group (P < 0.001). An analysis of variance revealed a statistically significant difference for SMCs across all Petersen groups as well across all Litvan groups. Two-factor analyses of variance with the factors cognitive status (MCI subtype) and depressive state (depressed versus not depressed) and SMCs as dependent variable revealed significant results.

CONCLUSIONS

Approximately 15% of PD patients seeking help in a movement disorder clinic report significant SMCs, with an increasing degree from cognitively healthy PD to PD-MCI. Significant DSs increase SMCs across all cognitive status groups.