Nondemented Parkinson Disease Patients: Is Cognitive Performance Associated With Depressive Difficulties?

Cognitive impairment in patients with Parkinson's disease: A 30-month follow-up study

OBJECTIVE

A longitudinal (30-month) study of the cognitive changes in Parkinson's disease patients and analysis of influencing factors.

METHODS

The cognitive function and related symptoms of 102 patients with idiopathic Parkinson's disease were assessed using the Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE), and relevant scales, at baseline and 30-month follow-up. The t-test, nonparametric tests, and regression analyses were used to evaluate cognitive decline and investigate risk factors for cognitive impairment.

RESULTS

From baseline to follow-up, the MMSE and MoCA scores significantly decreased, respectively, from 28.16±2.29 to 26.18±3.64, and from 24.60±4.23 to 21.94±5.47 (both P<0.001). Impairment was observed in multiple cognitive areas, significantly in naming, delayed recall, and orientation (P<0.01). Patients at baseline with postural instability and gait disturbance (PIGD), lower MoCA scores, or depression had a higher risk of cognitive impairment at follow-up (P<0.01).

CONCLUSION

Cognitive impairment is highly prevalent in Parkinson's disease patients, especially for those with lower MoCA scores, PIGD, and depression.

Psychiatric Conditions in Parkinson Disease: A Comparison With Classical Psychiatric Disorders

Psychiatric conditions often complicate the outcome of patients affected by Parkinson disease (PD), but they differ from classical psychiatric disorders in terms of underlying biological mechanisms, clinical presentation, and treatment response. The purpose of the present review is to illustrate the biological and clinical aspects of psychiatric conditions associated with PD, with particular reference to the differences with respect to classical psychiatric disorders. A careful search of articles on main databases was performed in order to obtain a comprehensive review about the main psychiatric conditions associated with PD. A manual selection of the articles was then performed in order to consider only those articles that concerned with the topic of the review. Psychiatric conditions in patients with PD present substantial differences with respect to classical psychiatric disorders. Their clinical presentation does not align with the symptom profiles represented by Diagnostic and Statistical Manual for Mental Disorders and International Classification of Diseases. Furthermore, psychiatry treatment guidelines are of poor help in managing psychiatric symptoms of patients with PD. Specific diagnostic tools and treatment guidelines are needed to allow early diagnosis and adequate treatment of psychiatric conditions in comorbidity with PD.

Selective attention and facial expression recognition in patients with Parkinson's disease

Parkinson's disease (PD) has been associated with facial expression recognition difficulties. However, this impairment could be secondary to the one produced in other cognitive processes involved in recognition, such as selective attention. This study investigates the influence of two selective attention components (inhibition and visual search) on facial expression recognition in PD. We compared facial expression and non-emotional stimuli recognition abilities of 51 patients and 51 healthy controls, by means of an adapted Stroop task, and by "The Face in the Crowd" paradigm, which assess Inhibition and Visual Search abilities, respectively. Patients scored worse than controls in both tasks with facial expressions, but not with the other nonemotional stimuli, indicating specific emotional recognition impairment, not dependent on selective attention abilities. This should be taken into account in patients' neuropsychological assessment given the relevance of emotional facial expression for social communication in everyday settings.

Religious and spiritual beliefs in outpatients suffering from Parkinson Disease

OBJECTIVE

Personality changes are known to occur in idiopathic Parkinson's Disease (PD). The aim of the study was to evaluate whether religious and spiritual beliefs in PD patients are different from age-matched controls.

DESIGN

Eighty-three PD participants, 79 hypertensive individuals not affected by PD and 88 healthy subjects participated to a cross-sectional study. The Royal Free Interview (RFI) was used to evaluate participants' beliefs. The Hospital Anxiety and Depression Scale (HADS) was applied to monitor emotional distress.

RESULTS

There was no statistical evidence of a difference between PD participants and the two control groups, the only exception being observed between the left PD onset group and the controls, where the total RFI score was about 5 points higher (t-test: p = 0.0273). RFI total score was uncorrelated with age, severity of illness and depression, but was strongly dependent on the type of beliefs. The percentage of PD participants suffering from anxiety and depression was high (right onset: 54.8%; left onset: 68.6%), while only 15.2% of the hypertensive participants, and none of the healthy controls, had a HADS score above 10 points. Total RFI score was higher in women.

CONCLUSION

PD participants maintain their Faith in spite of the disease severity. Differences are found between right and left onset of PD. The possible beneficial effect of religious coping is discussed.

Cognitive performance in nondemented nonpsychotic Parkinson disease patients with or without a history of depression prior to the onset of motor symptoms

In Parkinson disease (PD), cognitive impairment is common, occurs mainly in the form of milder deficits (as opposed to dementia), and commonly coincides with depression. In this cross-sectional study, we evaluated whether depression that existed before the onset of typical motor symptoms (pre-PD depression) reflected on the actual cognitive performance. Nondemented nonpsychotic PD patients with (test, n = 27) and without (control, n = 112) a history of pre-PD depression, caliper-matched for age, education, and disease duration were assessed for motor and nonmotor disease characteristics and in a battery of cognitive tests. Test patients had higher actual depression/anxiety levels. Gradual multivariate and mediation analysis indicated unfavorable effects of pre-PD depression on cognition: a direct effect on mental set shifting/response inhibition (independent of actual depression/ anxiety or other factors); and indirect effects on other cognitive domains mediated through the increased depression/anxiety. Data suggest that pre-PD depression favors poorer cognitive abilities in nondemented patients at a given time after PD has been diagnosed.

Cognitive and personality features in Parkinson disease: 2 sides of the same coin?

OBJECTIVE

This study seeks to identify the possible relationship between certain executive functions and the main personality traits in 25 nondemented Parkinson disease (PD) patients.

BACKGROUND

Both the presence of cognitive changes-mainly concerning executive functions-and peculiar personality traits, such as low novelty seeking, moral rigidity, industriousness, or introversion, were fully documented in PD patients.

METHODS

Patients underwent the Tower of London test and Alternating Fluency tasks for planning abilities and cognitive flexibility to be assessed. Personality features were evaluated using the Big Five Adjectives checklist.

RESULTS

The study provided evidence of a significant correlation between the Tower of London and the Emotional Stability factor and between Alternating Fluencies and the Openness to Experience factor.

CONCLUSIONS

The Tower of London test and the Emotional Stability factor may require filtering of irrelevant information, activation of inhibition mechanisms, and use of negative feedback. The Alternating Fluency tasks and the Openness to Experience factor may require the ability to switch set and to express flexible thoughts or opinions in daily life. These results indicate that cognitive and personality changes in PD may be different expressions of a common psychologic mechanism related to the dysfunction of the frontostriatal system.

Predictors of health status in nondepressed and nondemented individuals with Parkinson's disease

Recent studies have shown that self-perceived health status (HS) in Parkinson's disease (PD) is associated with motor, cognitive, or mood symptoms, with the greatest association typically occurring with mood. The purpose of this study was to determine if these associations are present in nondepressed and nondemented individuals with PD by using sensitive neuropsychological measures and statistically derived factors from mood and motor scales. The best predictors of poor HS in PD participants (N = 32) without dementia or depression were mood symptoms, specific to self-reported cognitive impairment and anxiety. Bivariate correlations between HS and number of correct categories on the Wisconsin Card Sorting Test and the gait-balance factor from the Unified Parkinson's Disease Rating Scale Part III were also significant or approached significance. These findings suggest that specific mood and cognitive symptoms continue to be important factors in HS in those individuals who lack clinical levels of depression or dementia.