Clock drawing test: is it useful for dementia screening in patients having Parkinson disease with and without depression?

Fist-Edge-Palm (FEP) test has a high sensitivity in differentiating dementia from normal cognition in Parkinson's disease

BACKGROUND

The Fist-Edge-Palm (FEP) test takes 0.5-3 min to complete and is highly sensitive in differentiating Alzheimer's disease and frontotemporal dementia from normal cognition, but it has not yet been studied in Parkinson's disease (PD).

OBJECTIVE

To determine the sensitivity and specificity of the FEP test in screening patients with PD for cognitive impairment and dementia.

METHODS

PD patients were recruited and divided into three groups based on cognitive status: normal cognition, mild cognitive impairment (MCI) and dementia according to 2015 MDS clinical diagnostic criteria for PD and clinical dementia rating scale (CDR) assessment for cognitive status. MMSE, FEP and clock drawing test (CDT) were tested in all recruited PD patients. Chi-square test was used to compare the sensitivity of FEP and CDT in detecting PDD and PD-MCI.

RESULTS

A total of 108 PD patients were included: 52 normal cognition, 28 MCI, and 28 dementia. The sensitivity of FEP in differentiating PDD from PD-NC was 96.4% and the sensitivity for PD-MCI from PD-NC was 71.4%. The sensitivity of CDT in differentiating PDD from PD-NC was 71.4% and PD-MCI from PD-NC was 53.6%. The sensitivities of FEP and CDT were 83.9% and 62.5%, respectively, in identifying cognitive impairment (CDR ≥ 0.5) in PD patients.

CONCLUSION

FEP is a sensitive screening tool in differentiating PDD or PD-MCI from PD-NC, and it is much faster than MMSE and more sensitive than CDT. FEP may be a practical screening tool for daily clinical practice.

The Six-item Clock-Drawing Scoring System: a rapid screening for cognitive impairment in Parkinson's disease

BACKGROUND

Cognitive impairment, characterised by predominant executive dysfunction and visuospatial deficit, is frequently observed in Parkinson's disease (PD) and may lead to mild cognitive impairment (PD-MCI) and dementia (PD-D). The clock-drawing test (CDT) is a rapid cognitive evaluation that is appropriate for screening frontoparietal lobe dysfunction. This study aimed to evaluate the screening performance of the Six-item Clock-Drawing Scoring System (6-CDSS) in detecting cognitive impairment in PD patients.

METHODS

A retrospective analysis of free-drawn clocks from 136 PD patients was performed. The presence of cognitive impairment and dementia was documented by neurologists according to the standard diagnostic criteria. Diagnostic performance and the optimal screening cut-off scores for cognitive impairment and dementia using the 6-CDSS were determined.

RESULTS

One hundred and thirteen patients were documented as having PD with cognitive impairment (PD-CI). Of those, 39 were diagnosed as probable PD-D and 74 with PD-MCI. The optimal screening cut-off scores for PD-CI were 4/5 and 1/2 for probable PD-D. The area under the receiver operating characteristic curve was 0.88 and 0.91, respectively. Multiple regression analysis revealed that low education levels, poor activity of daily living, and older age were associated with low 6-CDSS scores.

CONCLUSIONS

CDT scoring using the 6-CDSS is a reliable system to screen cognitive impairment in PD and may serve as a simple screening tool for PD-D in clinical practice.

The effects of anxiety and external attentional focus on postural control in patients with Parkinson's disease

Background

Although anxiety is a common non-motor outcome of Parkinson's disease (PD) affecting 40% of patients, little attention has been paid so far to its effects on balance impairment and postural control. Improvement of postural control through focusing on the environment (i.e. external focus) has been reported, but the role of anxiety, as a confounding variable, remains unclear.

Objectives

This study aimed to investigate the influence of anxiety and attentional focus instruction on the standing postural control of PD patients.

Methods

Thirty-four patients with PD (17 with high anxiety (HA-PD) and 17 with low anxiety (LA-PD)), as well as 17 gender- and age-matched healthy control subjects (HC) participated in the study. Postural control was evaluated using a combination of two levels of postural difficulty (standing on a rigid force plate surface with open eyes (RO) and standing on a foam surface with open eyes (FO)), as well as three attentional focus instructions (internal, external and no focus).

Results

Only the HA-PD group demonstrated significant postural control impairment as compared to the control, as indicated by significantly greater postural sway measures. Moreover, external focus significantly reduced postural sway in all participants especially during the FO condition.

Conclusion

The results of the current study provide evidence that anxiety influences balance control and postural stability in patients with PD, particularly those with high levels of anxiety. The results also confirmed that external focus is a potential strategy that significantly improves the postural control of these patients. Further investigation of clinical applicability is warranted towards developing effective therapeutic and rehabilitative treatment plans.

Correlation of Visuospatial Ability and EEG Slowing in Patients with Parkinson's Disease

Background. Visuospatial dysfunction is among the first cognitive symptoms in Parkinson's disease (PD) and is often predictive for PD-dementia. Furthermore, cognitive status in PD-patients correlates with quantitative EEG. This cross-sectional study aimed to investigate the correlation between EEG slowing and visuospatial ability in nondemented PD-patients. Methods. Fifty-seven nondemented PD-patients (17 females/40 males) were evaluated with a comprehensive neuropsychological test battery and a high-resolution 256-channel EEG was recorded. A median split was performed for each cognitive test dividing the patients sample into either a normal or lower performance group. The electrodes were split into five areas: frontal, central, temporal, parietal, and occipital. A linear mixed effects model (LME) was used for correlational analyses and to control for confounding factors. Results. Subsequently, for the lower performance, LME analysis showed a significant positive correlation between ROCF score and parietal alpha/theta ratio (b = .59, p = .012) and occipital alpha/theta ratio (b = 0.50, p = .030). No correlations were found in the group of patients with normal visuospatial abilities. Conclusion. We conclude that a reduction of the parietal alpha/theta ratio is related to visuospatial impairments in PD-patients. These findings indicate that visuospatial impairment in PD-patients could be influenced by parietal dysfunction.