dementia and mild cognitive impairment in patients

Arq Neuropsiquiatr 2009;67(2-B):423-427

DEMENTIA AND MILD COGNITIVE IMPAIRMENT IN PATIENTS WITH PARKINSON’S DISEASE Gloria Maria Almeida Souza Tedrus1, Lineu Corrêa Fonseca1, Grace Helena Letro1, Alexandre Souza Bossoni3, Adriana Bastos Samara4 Abstract – The objective of this research was to assess the occurrence of cognitive impairment in 32 individuals (average age: 67.2 years old) with Parkinson’s disease (PD). Procedures: clinical-neurological assessment; modified Hoehn and Yahr staging scale (HYS); standard neuropsychological battery of CERAD (Consortium to Establish a Registry for Alzheimer’s Disease); Pfeffer questionnaire; and Clinical Dementia Rating. A comparison was made with a control group (CG), consisting of 26 individuals with similar age and educational level but without cognitive impairment. The PD patients showed an inferior performance in the CERAD battery when compared to the CG. Three PD sub-groups were characterised according to cognition: no cognitive impairment – 15 cases; mild cognitive impairment – 10; dementia – 7 cases. There was a significant association between motor disability (HYS) and the occurrence of dementia. Dementia and mild cognitive impairment frequently occur in PD patients and should be investigated in a routine way. Key words: Parkinson disease, dementia, cognition.

Demência e transtorno cognitivo leve em pacientes com doença de Parkinson Resumo – O objetivo desta pesquisa foi avaliar a ocorrência de déficits cognitivos em 32 indivíduos (idade média: 67,2 anos) com doença de Parkinson (DP). Procedimentos: avaliação clínico-neurológica, escala de Hoehn and Yahr modificada (EHY), bateria neurospicológica do CERAD (Consortium to Establish a Registry for Alzheimer’s Disease), questionário de Pfeffer e escore clínico da demência (Clinical Dementia Rating). Foi feita comparação com grupo controle (GC) de 26 indivíduos sem declínio cognitivo, com idade e nível educacional similares. Os pacientes com DP tiveram desempenho inferior na bateria CERAD, quando comparados ao do GC. Foram caracterizados 3 subgrupos com PD segundo a cognição: sem déficits cognitivos - 15 casos; transtorno cognitivo leve – 10; demência – 7 casos. Houve associação entre comprometimento motor e ocorrência de demência. Demência e transtorno cognitivo leve são freqüentes em pacientes com DP e devem ser investigados de modo rotineiro. Palavras-chave: doença de Parkinson, cognição, demência.

Parkinson’s disease (PD) was initially characterised as a movement disorder with preservation of the intellectual abilities, but recently dementia has been shown in from 10 to 95% of PD patients, depending on the population studied and the diagnostic criteria and methods used1-3. In the various studies, the gravity of cognitive involvement varies from a discreet impairment restricted to specific domains4,5 to severe dementia1,2,3,6. Recent studies have referred to mild cognitive impairment (MCI) in PD, as in other clinical conditions, this being clinically characterised as intermediary between normal cognition and dementia5.

The relationship between motor aspects and compromised cognition in PD is controversial7. Some studies suggest that dementia occurs in cases with rapid progression of the motor impairment or in those with prolonged cases of the disease4,5. Other studies suggest the occurrence of dementia in patients in which the motor manifestation is predominantly rigidity or rigidity/tremor1 or in those with axial motor compromise8. The relationship between aspects of cognitive compromise, such as its occurrence and gravity, and the age of the patient at the start of the disease and type of evolution, are also not yet clear.

1

Professor of Neurology, Pontifícia Universidade Católica de Campinas, Campinas SP, Brazil (PUC-Campinas); 2Neurologist, Hospital e Maternidade Celso Pierro; 3Placement scholarship student PIBIC/CNPq, School of Medicine, PUC-Campinas; 4Neuropsychologist. Received 5 December 2008, received in final form 19 March 2009. Accepted 10 May 2009. Dra. Gloria Maria Almeida Souza Tedrus – Rua Sebastião de Souza 205 / 122 – 13020-020 Campinas SP - Brasil. 423

Parkinson’s disease: cognitive impairment Tedrus et al.

The objective of the present study was to evaluate cognitive performance of PD patients in the standard neuropsychological battery of the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD), the Pfeffer questionnaire and the Clinical Dementia Rating (CDR) and correlate the results with clinical aspects, such as assessing the occurrence of dementia and mild cognitive impairment (MCI) in this population. Method Participants Thirty-two consecutive patients (16 female), with an average age of 67.2 (sd: 10.0 years), and with a probable or definitive clinical diagnosis of PD according to the criteria of Calne et al.9, were included in this study. All were patients of the Neurology Clinic Outpatient’s Department of the Celso Pierro Hospital and Maternity Hospital (PUC-Campinas, Brazil). Information concerning the clinical data was obtained from an anamnesis with the patients and their relatives. All the patients included in the study took dopamine (mean dose – 292 mg; 150 to 500 mg), and were assessed in the on-phase. Patients using anti-psychotic or benzodiazepine medication were not included. The Ethics Commission for Research with Human Beings of PUC-Campinas, approved the project, and the subjects signed an informed consent form.

Arq Neuropsiquiatr 2009;67(2-B)

(1) Parkinson with normal cognition (PD-NLCog) – with no apparent cognitive impairment. (2) Parkinson with mild cognitive impairment (PD-MCI) – corresponding to cognitive complaints coming from the patients or their families; the reporting of a relative decline in cognitive functioning during the past year by a patient or informant; cognitive disorders as evidenced by a clinical evaluation; absence of major repercussions on daily life; and absence of dementia15. (3) Parkinson with dementia (PD-D) – dementia according to the Psychiatric Disease Diagnosis and Statistics Manual (DSMIV)16, starting at least one year after the installation of PD and without the characteristics of dementia with Lewy bodies. The cognitive aspects were compared with those of a control group (CG) consisting of 26 individuals with no history of cognitive impairment or neuropsychiatric disability, and with similar ages and educational levels. The relationship of the cognitive aspects with age, age when it started, duration, motor aspects of the PD and occurrence of depression were studied in the three sub-groups. Parametric and non-parametric statistical analyses were used according to the situation under study, with a significance level of p