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Tröster AI. Developments in the prediction of cognitive changes following deep brain stimulation in persons with Parkinson's disease. Expert Rev Neurother 2024:1-17. [PMID: 38814926 DOI: 10.1080/14737175.2024.2360121] [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: 03/29/2024] [Accepted: 05/22/2024] [Indexed: 06/01/2024]
Abstract
INTRODUCTION Deep brain stimulation (DBS) is an effective treatment for Parkinson's disease (PD) motor symptoms that improves function and quality of life in appropriately selected patients. Because mild to moderate cognitive declines can follow DBS and impact quality of life in a minority of patients, an important consideration involves the cognitive deficit and its prediction. AREAS COVERED The author briefly summarizes cognitive outcomes from DBS and reviews in more detail the risks/predictors of post-DBS cognitive dysfunction by mainly focusing on work published between 2018 and 2024 and using comprehensive neuropsychological (NP) evaluations. Most publications concern bilateral subthalamic nucleus (STN) DBS. Comment is offered on challenges and potential avenues forward. EXPERT OPINION STN DBS is relatively safe cognitively but declines occur especially in verbal fluency and executive function/working memory. Numerous predictors and risk factors for cognitive outcomes have been identified (age and pre-operative neuropsychological status appear the most robust) but precise risk estimates cannot yet be confidently offered. Future studies should employ study center consortia, follow uniform reporting criteria (to be developed), capitalize on advances in stimulation, biomarkers, and artificial intelligence, and address DBS in diverse groups. Advances offer an avenue to investigate the amelioration of cognitive deficits in PD using neuromodulation.
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Affiliation(s)
- Alexander I Tröster
- Department of Clinical Neuropsychology and Center for Neuromodulation, Barrow Neurological Institute, Phoenix, Arizona, USA
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Garon M, Weis L, Siquier A, Fiorenzato E, Pistonesi F, Cianci V, Canesi M, Pesce F, Reali E, Pozzi B, Isaias IU, Siri C, Santangelo G, Cuoco S, Barone P, Kulisevsky J, Antonini A, Biundo R. Validation of the Italian version of the Parkinson's Disease- Cognitive Functional Rating Scale. J Neural Transm (Vienna) 2024; 131:305-314. [PMID: 38280057 PMCID: PMC11016123 DOI: 10.1007/s00702-024-02746-6] [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: 12/09/2023] [Accepted: 01/16/2024] [Indexed: 01/29/2024]
Abstract
A key distinguishing factor between mild cognitive impairment (MCI) and dementia in Parkinson's disease (PD) lies in the notable decrease in functioning due to cognitive impairment. The Parkinson's Disease-Cognitive Functional Rating Scale (PD-CRFS) was developed to assess functional limitations caused by cognitive impairment, while reducing the influence of motor impairment. The aim of this multicenter study was to (i) validate the Italian version of the PD-CFRS in PD, (ii) determine optimal cut-off scores for detecting MCI and dementia in PD, (iii) compare its performances with the most established functional assessment tool (IADL). Six hundred and sixty nine PD participants were recruited from 4 Italian Movement Disorders centers (Venice, Milan, Gravedona, and Salerno). They underwent Level-II cognitive evaluation, which resulted in 282 PD-NC, 310 PD-MCI, and 77 PDD. The PD-CFRS's psychometric and clinimetric properties, applicability, and responsiveness were analyzed. The PD-CFRS showed high acceptability. Floor and ceiling effects were acceptable. It also displayed strong internal consistency (Cronbach's α = 0.738), and test-retest reliability (ICC = .854). The PD-CFRS demonstrated higher coefficient of variation to detect dysfunction in PD-MCI patients in comparison to the IADL scale (PD-CFRS 96% vs IADL 22.5%). Convergent validity with the IADL was r = - 0.638 and - 0.527 in males and females, respectively. PD-CFRS total score negatively correlated with global cognition (MoCA corrected score r = - 0.61; p < 0.001). A cut-off score > 6.5 identified PDD with a sensitivity of 90% and specificity of 88% (AUC = .959). A cut-off value of > 1 detected PD-MCI with a sensitivity of 68% and specificity of 69% (AUC = .695). The Italian version of the PD-CFRS demonstrated to be an easy, valid and reliable tool that properly captures functional impairment due to cognitive decline in PD. It also proved to be particularly effective in the advanced stages of PD, and would be a useful support for the diagnosis of PD-MCI and PDD.
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Affiliation(s)
- Michela Garon
- Parkinson and Movement Disorders Unit, Study Center for Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Via Giustiniani 2, 35128, Padua, Italy.
- Padua Neuroscience Center (PNC), University of Padua, 35131, Padua, Italy.
- Parkinson's Disease and Movement Disorders Unit, Center for Rare Neurological Diseases (ERN-RND), Department of Neurosciences, University of Padova, Padua, Italy.
| | - Luca Weis
- IRCCS San Camillo Hospital, Via Alberoni 70, 30126, Venice, Italy
| | - Antònia Siquier
- Research Institute On Health Sciences (IUNICS), Balearic Islands Health Research Institute (IdISBa), University of the Balearic Islands, Balearic Islands, Spain
| | - Eleonora Fiorenzato
- Parkinson's Disease and Movement Disorders Unit, Center for Rare Neurological Diseases (ERN-RND), Department of Neurosciences, University of Padova, Padua, Italy
| | - Francesca Pistonesi
- Parkinson and Movement Disorders Unit, Study Center for Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
- Parkinson's Disease and Movement Disorders Unit, Center for Rare Neurological Diseases (ERN-RND), Department of Neurosciences, University of Padova, Padua, Italy
| | - Valeria Cianci
- Parkinson and Movement Disorders Unit, Study Center for Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
- Parkinson's Disease and Movement Disorders Unit, Center for Rare Neurological Diseases (ERN-RND), Department of Neurosciences, University of Padova, Padua, Italy
| | - Margherita Canesi
- Movement Disorders Rehabilitation Department, Moriggia-Pelascini Hospital, Via Pelascini 3, Gravedona Ed Uniti, Gravedona, Italy
| | - Francesca Pesce
- Movement Disorders Rehabilitation Department, Moriggia-Pelascini Hospital, Via Pelascini 3, Gravedona Ed Uniti, Gravedona, Italy
| | - Elisa Reali
- Parkinson Institute Milan, ASST G. Pini-CTO, Via Bignami 1, 20126, Milan, Italy
| | - Beatrice Pozzi
- Parkinson Institute Milan, ASST G. Pini-CTO, Via Bignami 1, 20126, Milan, Italy
| | - Ioannis Ugo Isaias
- Parkinson Institute Milan, ASST G. Pini-CTO, Via Bignami 1, 20126, Milan, Italy
- Department of Neurology, University Hospital of Würzburg, Julius Maximilian University of Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
| | - Chiara Siri
- Movement Disorders Rehabilitation Department, Moriggia-Pelascini Hospital, Via Pelascini 3, Gravedona Ed Uniti, Gravedona, Italy
- Parkinson Institute Milan, ASST G. Pini-CTO, Via Bignami 1, 20126, Milan, Italy
| | - Gabriella Santangelo
- Department of Psychology, University of Campania "Luigi Vanvitelli", Viale Ellittico, 31, Caserta, Italy
| | - Sofia Cuoco
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Neuroscience Section, University of Salerno, Baronissi, Salerno, Italy
| | - Paolo Barone
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Neuroscience Section, University of Salerno, Baronissi, Salerno, Italy
| | - Jaime Kulisevsky
- Movement Disorders Unit, Sant Pau Hospital, Hospital Sant Pau, C/ Mas Casanovas 90, 08041, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- CIBERNED (Network Centre for Neurodegenerative Diseases), Madrid, Spain
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Study Center for Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
- Padua Neuroscience Center (PNC), University of Padua, 35131, Padua, Italy
- Parkinson's Disease and Movement Disorders Unit, Center for Rare Neurological Diseases (ERN-RND), Department of Neurosciences, University of Padova, Padua, Italy
| | - Roberta Biundo
- Parkinson and Movement Disorders Unit, Study Center for Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
- Parkinson's Disease and Movement Disorders Unit, Center for Rare Neurological Diseases (ERN-RND), Department of Neurosciences, University of Padova, Padua, Italy
- Department of General Psychology, University of Padua, Padua, Italy
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Wang Z, Zheng Z, Huang J, Cai X, Liu X, Xue C, Yao L, Lu G. Neurocognitive changes at different follow-up times after bilateral subthalamic nucleus deep brain stimulation in patients with Parkinson's disease. Heliyon 2024; 10:e26303. [PMID: 38379975 PMCID: PMC10877422 DOI: 10.1016/j.heliyon.2024.e26303] [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: 06/13/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 02/22/2024] Open
Abstract
Background Bilateral deep thalamic nucleus brain stimulation (STN-DBS) surgery is often used to treat the motor symptoms of patients with Parkinson's disease. The change of neurocognitive symptoms in patients is, however, still unclear. Objective We aimed at analyzing the deterioration of neurocognitive symptoms in patients with Parkinson's disease after deep brain stimulation surgery under different follow-up times. Methods A comprehensive literature review was conducted using Pubmed, Cochrane Library, and Web of Science to screen eligible study records, the meta-analysis was performed using an inverse variance method and a random-effects model. Additionally, the areas of analysis include five: cognition, executive function, memory capacity, and verbal fluency (phonetic fluency and semantic fluency). They were analyzed for changes at six and twelve months postoperatively compared to baseline. The Meta-analysis has been registered with PROSPERO under the registration number: CRD42022308786. Results In terms of overall cognitive performance, executive function, and memory capacity, the original studies show a trend of improvement in these areas at 12 months postoperatively compared with 6 months, at variance, patients did not improve or deteriorated in phonetic fluency(d = -0.42 at both 6-month and 12-month follow-up) and semantic fluency from 6 to 12 months postoperatively. Conclusion In terms of most neurocognitive symptoms, including cognitive ability, executive function, and learning memory capacity, bilateral STN-DBS surgery appears to be safe at relatively long follow-up times. However, postoperative phonetic and semantic fluency changes should still not be underestimated, and clinicians should pay more attention to patients' changes in both.
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Affiliation(s)
- Zhuohang Wang
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Zijian Zheng
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Junwen Huang
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Xu Cai
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Xinjie Liu
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Cheng Xue
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Longping Yao
- Institute for Anatomy and Cell Biology, Medical Faculty, Heidelberg University, 69120, Heidelberg, Germany
| | - Guohui Lu
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China
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Pisani S, Gosse L, Wieretilo R, Ffytche D, Velayudhan L, Bhattacharyya S. Cognitive and executive impairments in Parkinson's disease psychosis: a Bayesian meta-analysis. J Neurol Neurosurg Psychiatry 2024; 95:277-287. [PMID: 37468306 DOI: 10.1136/jnnp-2022-331028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 05/31/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Cognitive and executive deficits lead to worsening of quality of life and are a risk factor for developing dementia in people with Parkinson's disease (PD) with psychosis (PDP). However, which key cognitive domains are differentially affected in PDP compared with those without (PDnP), remains unclear. Here, we examined this using a Bayesian meta-analytical approach. METHODS Searches were conducted on PubMed, Web of Science, SCOPUS, Medline and PsycINFO. Hedges' g effect-size estimates were extracted from eligible studies as a measure of standard mean differences between PDP and PDnP participants. Meta-analyses were conducted separately for each cognitive domain and subdomain, we examined the effect of age, PD medications, PD duration and severity, depression and psychosis severity for all major domains with meta-regressions. RESULTS Effect-size estimates suggest worse performance on all major domains (k=105 studies) in PDP compared with PDnP participants, with global cognition (k=103 studies, g=-0.57), processing speed (k=29 studies, g=-0.58), executive functions (k=33, g=-0.56), episodic memory (k=30 studies, g=-0.58) and perception (k=34 studies, g=-0.55) as the most likely affected domains. Age, depression and PD duration had moderating effects on task-related performance across most of the major nine domains. CONCLUSIONS We report extensive deficits across nine domains as well as subdomains in PD psychosis, with global cognition, processing speed and executive functions as the most likely impaired. The presence of depression may influence task-related performance in PDP, alongside age and PD duration, but not dose of dopamine replacement treatments.
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Affiliation(s)
- Sara Pisani
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Luca Gosse
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Faculty of Medicine, Dentistry and Health, Medical School, The University of Sheffield, Sheffield, UK
| | - Rita Wieretilo
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Dominic Ffytche
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Latha Velayudhan
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sagnik Bhattacharyya
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Galvez V, Romero-Rebollar C, Estudillo-Guerra MA, Fernandez-Ruiz J. Resting-state networks and their relationship with MoCA performance in PD patients. Brain Imaging Behav 2024:10.1007/s11682-024-00860-3. [PMID: 38332386 DOI: 10.1007/s11682-024-00860-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 02/10/2024]
Abstract
Although mild cognitive impairment is a common non-motor symptom experienced by individuals with Parkinson's Disease, the changes in intrinsic resting-state networks associated with its onset in Parkinson's remain underexamined. To address the issue, our study sought to examine resting-state network alterations and their association with total performance in the Montreal Cognitive Assessment and its cognitive domains in Parkinson's by means of functional magnetic resonance imaging of 29 Parkinson's patients with normal cognition, 25 Parkinson's patients with mild cognitive impairment, and 13 healthy controls. To contrast the Parkinson's groups with each other and the controls, the images were used to estimate the Z-score coefficient between the regions of interest from the default mode network, the salience network and the central executive network. Our first finding was that default mode and salience network connectivity decreased significantly in Parkinson's patients regardless of their cognitive status. Additionally, default mode network nodes had a negative and salience network nodes a positive correlation with the global assessment in Parkinson's with normal cognition; this inverse relationship of both networks to total score was not found in the group with cognitive impairment. Finally, a positive correlation was found between executive scores and anterior and posterior cortical network connectivity and, in the group with cognitive impairment, between language scores and salience network connectivity. Our results suggest that specific resting-state networks of Parkinson's patients with cognitive impairment differ from those of Parkinson's patients with normal cognition, supporting the evidence that cognitive impairment in Parkinson's Disease displays a differentiated neurodegenerative pattern.
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Affiliation(s)
- Victor Galvez
- Laboratorio de Neurociencias Cognitivas y Desarrollo, Escuela de Psicología, Universidad Panamericana, Ciudad de México, México.
| | - César Romero-Rebollar
- Escuela de Pedagogía, Universidad Panamericana, Ciudad de México, México
- Universidad Tecnológica de México-UNITEC MÉXICO-Campus en línea, Ciudad de México, México
| | - M Anayali Estudillo-Guerra
- Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Juan Fernandez-Ruiz
- Departamento de Fisiología, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
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Fernández-Fernández R, Lahera G, Fernández-Rodríguez B, Guida P, Trompeta C, Mata-Marín D, Gasca-Salas C. Social Cognition and Mild Cognitive Impairment in Mid-Stage Parkinson's Disease. Behav Sci (Basel) 2024; 14:101. [PMID: 38392454 PMCID: PMC10885927 DOI: 10.3390/bs14020101] [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: 11/17/2023] [Revised: 01/22/2024] [Accepted: 01/26/2024] [Indexed: 02/24/2024] Open
Abstract
Mild cognitive impairment (MCI) is a relevant non-motor feature in Parkinson's disease (PD). Social cognition (SC) is a cognitive domain that refers to the ability to decode others' intentions and to guide behavior in social contexts. We aimed to compare SC performance in mid-stage PD patients compared to a healthy population and according to their cognitive state. Fifty-two PD patients were classified as being cognitively normal (PD-CN) or having mild cognitive impairment (PD-MCI) following the Movement Disorder Society (MDS) Level II criteria. SC assessment included facial emotion recognition (FER), affective and cognitive theory of mind (ToM), and self-monitoring (RSMS test). Twenty-seven age-matched healthy controls (HC) were enrolled. PD-MCI patients scored worse than HC on affective and cognitive ToM task scores. Only cognitive ToM scores were significantly lower when compared with the PD-MCI and PD-CN groups. We found no differences in FER or self-monitoring performance. There were significant correlations between cognitive ToM and executive functions, memory, language, and attention, whereas FER and affective ToM correlated with memory. Our findings indicates that SC is normal in cognitively unimpaired and non-depressed mid-stage PD patients, whereas a decline in affective and cognitive ToM is linked to the presence of MCI.
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Affiliation(s)
- Roberto Fernández-Fernández
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, 28938 Madrid, Spain
- Hospital Universitario Infanta Cristina, Parla, 28981 Madrid, Spain
- PhD Program in Health Sciences, University of Alcalá de Henares, 28054 Alcalá de Henares, Spain
| | - Guillermo Lahera
- Department of Medicine and Medical Specialities, University of Alcala, 28054 Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
- Psychiatry Service, Center for Biomedical Research in the Mental Health Network, University Hospital Príncipe de Asturias, 28805 Alcalá de Henares, Spain
| | - Beatriz Fernández-Rodríguez
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, 28938 Madrid, Spain
- PhD Program in Neuroscience, Cajal Institute, Autónoma de Madrid University, 28029 Madrid, Spain
| | - Pasqualina Guida
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, 28938 Madrid, Spain
- PhD Program in Neuroscience, Cajal Institute, Autónoma de Madrid University, 28029 Madrid, Spain
| | - Clara Trompeta
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, 28938 Madrid, Spain
- PhD Program in Health Sciences, University of Alcalá de Henares, 28054 Alcalá de Henares, Spain
| | - David Mata-Marín
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, 28938 Madrid, Spain
- PhD Program in Neuroscience, Cajal Institute, Autónoma de Madrid University, 28029 Madrid, Spain
| | - Carmen Gasca-Salas
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, 28938 Madrid, Spain
- Network Center for Biomedical Research on Neurodegenerative Diseases (CIBERNED), Instituto Carlos III, 28031 Madrid, Spain
- School of Medicine, University CEU-San Pablo, 28003 Madrid, Spain
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Gupta S, Khan J, Ghosh S. Molecular mechanism of cognitive impairment associated with Parkinson's disease: A stroke perspective. Life Sci 2024; 337:122358. [PMID: 38128756 DOI: 10.1016/j.lfs.2023.122358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 12/03/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023]
Abstract
Parkinson's disease (PD) is a common neurological illness that causes several motor and non-motor symptoms, most characteristically limb tremors and bradykinesia. PD is a slowly worsening disease that arises due to progressive neurodegeneration of specific areas of the brain, especially the substantia nigra of the midbrain. Even though PD has continuously been linked to a higher mortality risk in numerous epidemiologic studies, there have been significant discoveries regarding the connection between PD and stroke. The incidence of strokes such as cerebral infarction and hemorrhage is substantially associated with the development of PD. Moreover, cognitive impairments, primarily dementia, have been associated with stroke and PD. However, the underlying molecular mechanism of this phenomenon is still obscure. This concise review focuses on the relationship between stroke and PD, emphasizing the molecular mechanism of cognition deficit and memory loss evident in PD and stroke. Furthermore, we are also highlighting some potential drug molecules that can target both PD and stroke.
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Affiliation(s)
- Sanju Gupta
- Department of Bioscience & Bioengineering, Indian Institute of Technology Jodhpur (IIT-Jodhpur), Rajasthan 342037, India
| | - Juhee Khan
- Department of Bioscience & Bioengineering, Indian Institute of Technology Jodhpur (IIT-Jodhpur), Rajasthan 342037, India
| | - Surajit Ghosh
- Department of Bioscience & Bioengineering, Indian Institute of Technology Jodhpur (IIT-Jodhpur), Rajasthan 342037, India.
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Liang K, Li X, Guo Q, Ma J, Yang H, Fan Y, Yang D, Shi X, She Z, Qi X, Gu Q, Chen S, Zheng J, Li D. Structural changes in the retina and serum HMGB1 levels are associated with decreased cognitive function in patients with Parkinson's disease. Neurobiol Dis 2024; 190:106379. [PMID: 38104911 DOI: 10.1016/j.nbd.2023.106379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Cognitive impairment is a serious nonmotor symptom in patients with Parkinson's disease (PD). Currently, there are few studies investigating the relationship of serum markers and retinal structural changes with cognitive function in PD. OBJECTIVE To investigate the relationship between retinal structural changes, serum high mobility group box-1 (HMGB1) levels and cognitive function and motor symptoms in PD patients. METHODS Eighty-nine participants, including 47 PD patients and 42 healthy subjects, were enrolled. PD patients were divided into Parkinson's disease with normal cognitive (PD-NC), Parkinson's disease with mild cognitive impairment (PD-MCI), and Parkinson's disease with dementia (PDD) groups. The motor and nonmotor symptoms of PD patients were evaluated with clinical scale. Serum HMGB1 levels were detected by enzyme-linked immunosorbent assay (ELISA), and ganglion cell-inner plexiform layer complex (GCIPL) thickness changes in the macula were quantitatively analyzed by swept source optical coherence tomography (SS-OCT) in all patients. RESULTS Compared with the control group, the macular GCIPL (t = -2.308, P = 0.023) was thinner and serum HMGB1 (z = -2.285, P = 0.022) was increased in PD patients. Macular GCIPL thickness in patients with PD-MCI and PDD were significantly lower than that in PD-NC patients, but there were no significant difference between the PD-MCI and PDD groups. Serum HMGB1 levels in patients with PD-MCI and PDD were significantly higher than those in PD-NC patients, and serum HMGB1 levels in PDD patients were higher than those in PD-MCI patients. Correlation analysis showed that serum HMGB1 levels in PD patients were positively correlated with disease duration, HY stage, UPDRS-I score, UPDRS-III score, and UPDRS total score and negatively correlated with MOCA score. Macular GCIPL thickness was negatively correlated with HY stage and positively correlated with MOCA score, and macular GCIPL thickness was negatively correlated with serum HMGB1 level. Logistic regression analysis showed that elevated serum HMGB1 level, thinner macular GCIPL thickness, and higher HY stage were independent risk factors for Parkinson's disease with cognitive impairment (PD-CI). The areas under the receiver operating characteristic curve (AUC) for the serum HMGB1 level and macular GCIPL thickness-based diagnosis of PD-MCI, PDD and PD-CI based on in patients with PD were 0.786 and 0.825, 0.915 and 0.856, 0.852 and 0.841, respectively. The AUC for the diagnosis of PD-MCI, PDD and PD-CI with serum HMGB1 level and GCIPL thickness combined were 0.869, 0.967 and 0.916, respectively. CONCLUSION The macular GCIPL thickness and serum HMGB1 level are potential markers of cognitive impairment in PD patients, and their combination can significantly improve the accuracy of the diagnosis of cognitive impairment in PD.
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Affiliation(s)
- Keke Liang
- Department of Neurology, Henan University People's Hospital, Zhengzhou, China; Department of Neurology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Xiaohuan Li
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou, China; Department of Neurology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Qingge Guo
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou, China; Henan Eye Institute, Henan Eye Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Jianjun Ma
- Department of Neurology, Henan University People's Hospital, Zhengzhou, China; Department of Neurology, Henan Provincial People's Hospital, Zhengzhou, China; Department of Neurology, Zhengzhou University People's Hospital, Zhengzhou, China.
| | - Hongqi Yang
- Department of Neurology, Henan University People's Hospital, Zhengzhou, China; Department of Neurology, Henan Provincial People's Hospital, Zhengzhou, China; Department of Neurology, Zhengzhou University People's Hospital, Zhengzhou, China.
| | - Yongyan Fan
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou, China; Department of Neurology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Dawei Yang
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou, China; Department of Neurology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Xiaoxue Shi
- Department of Neurology, Henan University People's Hospital, Zhengzhou, China; Department of Neurology, Henan Provincial People's Hospital, Zhengzhou, China; Department of Neurology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Zonghan She
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou, China; Department of Neurology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Xuelin Qi
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou, China; Department of Neurology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Qi Gu
- Department of Neurology, Henan University People's Hospital, Zhengzhou, China; Department of Neurology, Henan Provincial People's Hospital, Zhengzhou, China; Department of Neurology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Siyuan Chen
- Department of Neurology, Henan University People's Hospital, Zhengzhou, China; Department of Neurology, Henan Provincial People's Hospital, Zhengzhou, China; Department of Neurology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Jinhua Zheng
- Department of Neurology, Henan University People's Hospital, Zhengzhou, China; Department of Neurology, Henan Provincial People's Hospital, Zhengzhou, China; Department of Neurology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Dongsheng Li
- Department of Neurology, Henan University People's Hospital, Zhengzhou, China; Department of Neurology, Henan Provincial People's Hospital, Zhengzhou, China; Department of Neurology, Zhengzhou University People's Hospital, Zhengzhou, China
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9
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Jellinger KA. Pathobiology of Cognitive Impairment in Parkinson Disease: Challenges and Outlooks. Int J Mol Sci 2023; 25:498. [PMID: 38203667 PMCID: PMC10778722 DOI: 10.3390/ijms25010498] [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: 11/23/2023] [Revised: 12/11/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
Cognitive impairment (CI) is a characteristic non-motor feature of Parkinson disease (PD) that poses a severe burden on the patients and caregivers, yet relatively little is known about its pathobiology. Cognitive deficits are evident throughout the course of PD, with around 25% of subtle cognitive decline and mild CI (MCI) at the time of diagnosis and up to 83% of patients developing dementia after 20 years. The heterogeneity of cognitive phenotypes suggests that a common neuropathological process, characterized by progressive degeneration of the dopaminergic striatonigral system and of many other neuronal systems, results not only in structural deficits but also extensive changes of functional neuronal network activities and neurotransmitter dysfunctions. Modern neuroimaging studies revealed multilocular cortical and subcortical atrophies and alterations in intrinsic neuronal connectivities. The decreased functional connectivity (FC) of the default mode network (DMN) in the bilateral prefrontal cortex is affected already before the development of clinical CI and in the absence of structural changes. Longitudinal cognitive decline is associated with frontostriatal and limbic affections, white matter microlesions and changes between multiple functional neuronal networks, including thalamo-insular, frontoparietal and attention networks, the cholinergic forebrain and the noradrenergic system. Superimposed Alzheimer-related (and other concomitant) pathologies due to interactions between α-synuclein, tau-protein and β-amyloid contribute to dementia pathogenesis in both PD and dementia with Lewy bodies (DLB). To further elucidate the interaction of the pathomechanisms responsible for CI in PD, well-designed longitudinal clinico-pathological studies are warranted that are supported by fluid and sophisticated imaging biomarkers as a basis for better early diagnosis and future disease-modifying therapies.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, A-1150 Vienna, Austria
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10
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Fink A, Dodel R, Georges D, Doblhammer G. The Impact of Sex-Specific Survival on the Incidence of Dementia in Parkinson's Disease. Mov Disord 2023; 38:2041-2052. [PMID: 37658585 DOI: 10.1002/mds.29596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 07/26/2023] [Accepted: 08/14/2023] [Indexed: 09/03/2023] Open
Abstract
OBJECTIVE The aim of our study is to analyze sex-specific patterns of Parkinson's disease dementia (PDD) incidence. We are investigating the extent to which sex differences in survival after initial Parkinson's disease (PD) diagnosis influence differences in PDD risk among PD patients. METHODS We used a random sample of German longitudinal health claims data of persons ages 50+ (2004-2019; n = 250,000) and identified new PD cases ages 65+ who were followed-up for a PDD diagnosis or death between 2006 and 2017. We performed Cox and competing-risk regression models, with death as competing event, to calculate PDD hazard ratios (HR) adjusted for age at PD onset, PD severity as measured by the modified Hoehn and Yahr (HY) scale, comorbidities, and medications. RESULTS Of 2195 new PD cases, 602 people died before PDD and 750 people developed PDD by the end of 2017. The adjusted risk of PDD differs by sex, with men having a higher PDD risk than women. When accounting for death, men and women do not differ in their PDD risk (HR = 1.02, P = 0.770). Sex-specific analyses showed significant age and severity effects in women (age: HR = 1.05, P < 0.001; HY 3-5 vs. 0-2.5: HR = 1.46, P = 0.011), but not in men. CONCLUSION Older age at first PD diagnosis and higher disease severity increase PDD risk, but this association is attenuated for PD men when controlling for death. This implies that the most frail PD men die rapidly before receiving a dementia diagnosis, whereas women with PD survive at higher rates, regardless of their age at onset and disease severity. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Anne Fink
- German Center for Neurodegenerative Diseases, Rostock, Germany
| | - Richard Dodel
- Chair of Geriatric Medicine and Center for Translational Neuro- and Behavioural Sciences, University Duisburg-Essen, Essen, Germany
| | - Daniela Georges
- Institute for Sociology and Demography, University of Rostock, Rostock, Germany
| | - Gabriele Doblhammer
- German Center for Neurodegenerative Diseases, Rostock, Germany
- Institute for Sociology and Demography, University of Rostock, Rostock, Germany
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11
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Quan Y, Xu J, Xu Q, Guo Z, Ou R, Shang H, Wei Q. Association between the risk and severity of Parkinson's disease and plasma homocysteine, vitamin B12 and folate levels: a systematic review and meta-analysis. Front Aging Neurosci 2023; 15:1254824. [PMID: 37941998 PMCID: PMC10628521 DOI: 10.3389/fnagi.2023.1254824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/25/2023] [Indexed: 11/10/2023] Open
Abstract
Background Parkinson's disease (PD) is recognized as the second most prevalent progressive neurodegenerative disease among the elderly. However, the relationship between PD and plasma homocysteine (Hcy), vitamin B12, and folate has yielded inconsistent results in previous studies. Hence, in order to address this ambiguity, we conducted a meta-analysis to summarize the existing evidence. Methods Suitable studies published prior to May 2023 were identified by searching PubMed, EMBASE, Medline, Ovid, and Web of Science. The methodological quality of eligible studies was assessed using the Newcastle-Ottawa Quality Assessment Scale (NOS). Meta-analysis and publication bias were then performed using R version 4.3.1. Results The results of our meta-analysis, consisting of case-control and cross-sectional studies, showed that PD patients had lower folate and vitamin B12 levels (SMD [95%CI]: -0.30[-0.39, -0.22], p < 0.001 for Vitamin B12; SMD [95%CI]: -0.20 [-0.28, -0.13], p < 0.001 for folate), but a significant higher Hcy level (SMD [95%CI]: 0.86 [0.59, 1.14], p < 0.001) than healthy people. Meanwhile, PD was significantly related to hyperhomocysteinemia (SMD [95%]: 2.02 [1.26, 2.78], p < 0.001) rather than plasma Hcy below 15 μmol/L (SMD [95%]: -0.31 [-0.62, 0.00], p = 0.05). Subgroup analysis revealed associations between the Hcy level of PD patients and region (p = 0.03), age (p = 0.03), levodopa therapy (p = 0.03), Hoehn and Yahr stage (p < 0.001), and cognitive impairment (p < 0.001). However, gender (p = 0.38) and sample size (p = 0.49) were not associated. Conclusion Hcy, vitamin B12, and folic acid potentially predict the onset and development of PD. Additionally, multiple factors were linked to Hcy levels in PD patients. Further studies are needed to comprehend their roles in PD.
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Affiliation(s)
- Yuxin Quan
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jisen Xu
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qing Xu
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhiqing Guo
- State Key Laboratory of Biotherapy, Sichuan University, Chengdu, Sichuan, China
| | - Ruwei Ou
- Department of Neurology, Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Huifang Shang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qianqian Wei
- Department of Neurology, Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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12
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Gasca-Salas C, Duff-Canning S, McArthur E, Armstrong MJ, Fox S, Meaney CA, Tang-Wai DF, Gill D, Eslinger PJ, Zadikoff C, Marshall FJ, Mapstone M, Chou KL, Persad C, Litvan I, Mast BT, Gerstenecker AT, Weintraub S, Marras C. Predictors of Cognitive Change in Parkinson Disease: A 2-year Follow-up Study. Alzheimer Dis Assoc Disord 2023; 37:335-342. [PMID: 37615480 DOI: 10.1097/wad.0000000000000576] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 06/19/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Mild cognitive impairment is common in Parkinson disease (PD-MCI). However, instability in this clinical diagnosis and variability in rates of progression to dementia raises questions regarding its utility for longitudinal tracking and prediction of cognitive change in PD. We examined baseline neuropsychological test and cognitive diagnosis predictors of cognitive change in PD. METHODS Persons with PD, without dementia PD (N=138) underwent comprehensive neuropsychological assessment at baseline and were followed up to 2 years. Level II Movement Disorder Society criteria for PD-MCI and PD dementia (PDD) were applied annually. Composite global and domain cognitive z -scores were calculated based on a 10-test neuropsychological battery. RESULTS Baseline diagnosis of PD-MCI was not associated with a change in global cognitive z -scores. Lower baseline attention and higher executive domain z -scores were associated with greater global cognitive z -score worsening regardless of cognitive diagnosis. Worse baseline domain z -scores in the attention and language domains were associated with progression to MCI or PDD, whereas higher baseline scores in all cognitive domains except executive function were associated with clinical and psychometric reversion to "normal" cognition. CONCLUSIONS Lower scores on cognitive tests of attention were predictive of worse global cognition over 2 years of follow-up in PD, and lower baseline attention and language scores were associated with progression to MCI or PDD. However, PD-MCI diagnosis per se was not predictive of cognitive decline over 2 years. The association between higher executive domain z -scores and greater global cognitive worsening is probably a spurious result.
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Affiliation(s)
- Carmen Gasca-Salas
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales
- Network Center for Biomedical Research on Neurodegenerative Diseases (CIBERNED), Instituto Carlos III
- University CEU-San Pablo, Madrid, Spain
| | - Sarah Duff-Canning
- The Edmond J Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, University of Toronto
| | | | - Melissa J Armstrong
- Department of Neurology, University of Florida College of Medicine; Gainesville, FL
| | - Susan Fox
- The Edmond J Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, University of Toronto
| | | | - David F Tang-Wai
- Department of Medicine (Neurology), University of Toronto, University Health Network Memory Clinic
| | - David Gill
- Department of Neurology, Rochester Regional Health
| | - Paul J Eslinger
- Department of Neurology, Penn State Hershey Medical Center, Hershey, PA
| | - Cindy Zadikoff
- Department of Neurology, Northwestern University
- AbbVie Inc., North Chicago
| | - Fred J Marshall
- Department of Neurology, University of Rochester, Rochester, NY
| | - Mark Mapstone
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Carol Persad
- Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Irene Litvan
- Department of Neurosciences, Parkinson and Other Movement Disorders Center UC San Diego, La Jolla, CA
| | - Benjamin T Mast
- Psychological & Brain Sciences, University of Louisville, Louisville, KY
| | - Adam T Gerstenecker
- Department of Neurology, Division of Neuropsychology, University of Alabama at Birmingham, Birmingham, AL
| | - Sandra Weintraub
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Connie Marras
- The Edmond J Safra Program in Parkinson's disease, University Health Network, University of Toronto, Toronto
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13
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Yang J, Pourzinal D, Byrne GJ, McMahon KL, Copland DA, O'Sullivan JD, Mitchell L, Dissanayaka NN. Global assessment, cognitive profile, and characteristics of mild cognitive impairment in Parkinson's disease. Int J Geriatr Psychiatry 2023; 38:e5955. [PMID: 37318156 DOI: 10.1002/gps.5955] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 06/07/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Cognitive deficits are evident throughout the course of Parkinson's disease (PD), with 24% of patients experiencing subtle cognitive disturbances at the time of diagnosis, and with up to 80% of patients developing PD dementia (PDD) at advanced stages of the disease PD patients with mild cognitive impairment (MCI), an at-risk phenotype of PDD, present with heterogeneous clinical characteristics that complicate the management of PD. OBJECTIVES This study aims to examine the characteristics of PD-MCI by using the Movement Disorder Society (MDS) diagnostic criteria and evaluate the validity of global cognitive scales in identifying PD-MCI. METHODS Seventy-nine (79) PD patients completed neuropsychological assessments and a comprehensive cognitive battery. PD-MCI was classified according to the level 2 MDS task force criteria. Mini-Mental State Examination (sMMSE), Montreal Cognitive Assessment (MoCA) and Parkinson's Disease Cognitive Rating Scale (PDCRS) were examined against a level 2 dichotomised PD-MCI diagnosis. Characteristics of PD-MCI were evaluated using logistic regression analysis. RESULTS Twenty-seven patients met criteria for PD-MCI (34%). The MoCA and PDCRS demonstrated high validity to screen for PD-MCI. Impairments in multiple cognitive domains were observed in 77.8% of PD-MCI patients. There were significantly more males in the PD-MCI group compared to PD patients without MCI (p < 0.01). CONCLUSIONS PD patients with MCI exhibited impairments in the attention/working memory, executive function and memory domains. Heterogeneous cognitive characteristics in PD warrant further investigation into specific cognitive subtypes to advance understanding and effective evaluation of PD-MCI.
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Affiliation(s)
- Jihyun Yang
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Dana Pourzinal
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Gerard J Byrne
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- Mental Health Service, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Katie L McMahon
- School of Clinical Sciences, Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Queensland, Australia
| | - David A Copland
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- School of Health & Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - John D O'Sullivan
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- Department of Neurology, Royal Brisbane & Women's Hospital, Herston, Queensland, Australia
| | - Leander Mitchell
- School of Psychology, The University of Queensland, St Lucia, Queensland, Australia
| | - Nadeeka N Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- Department of Neurology, Royal Brisbane & Women's Hospital, Herston, Queensland, Australia
- School of Psychology, The University of Queensland, St Lucia, Queensland, Australia
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14
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Fama R, Müller-Oehring EM, Levine TF, Sullivan EV, Sassoon SA, Asok P, Brontë-Stewart HM, Poston KL, Pohl KM, Pfefferbaum A, Schulte T. Episodic memory deficit in HIV infection: common phenotype with Parkinson's disease, different neural substrates. Brain Struct Funct 2023; 228:845-858. [PMID: 37069296 PMCID: PMC10147801 DOI: 10.1007/s00429-023-02626-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/03/2023] [Indexed: 04/19/2023]
Abstract
Episodic memory deficits occur in people living with HIV (PLWH) and individuals with Parkinson's disease (PD). Given known effects of HIV and PD on frontolimbic systems, episodic memory deficits are often attributed to executive dysfunction. Although executive dysfunction, evidenced as retrieval deficits, is relevant to mnemonic deficits, learning deficits may also contribute. Here, the California Verbal Learning Test-II, administered to 42 PLWH, 41 PD participants, and 37 controls, assessed learning and retrieval using measures of free recall, cued recall, and recognition. Executive function was assessed with a composite score comprising Stroop Color-Word Reading and Backward Digit Spans. Neurostructural correlates were examined with MRI of frontal (precentral, superior, orbital, middle, inferior, supplemental motor, medial) and limbic (hippocampus, thalamus) volumes. HIV and PD groups were impaired relative to controls on learning and free and cued recall trials but did not differ on recognition or retention of learned material. In no case did executive functioning solely account for the observed mnemonic deficits or brain-performance relations. Critically, the shared learning and retrieval deficits in HIV and PD were related to different substrates of frontolimbic mnemonic neurocircuitry. Specifically, diminished learning and poorer free and cued recall were related to smaller orbitofrontal volume in PLWH but not PD, whereas diminished learning in PD but not PLWH was related to smaller frontal superior volume. In PD, poorer recognition correlated with smaller thalamic volume and poorer retention to hippocampal volume. Although memory deficits were similar, the neural correlates in HIV and PD suggest different pathogenic mechanisms.
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Affiliation(s)
- Rosemary Fama
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd, Stanford, CA, 94305, USA
- Neuroscience Program, Center for Health Sciences, Bioscience Division, SRI International, 333 Ravenswood Ave, Menlo Park, CA, 94025, USA
| | - Eva M Müller-Oehring
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd, Stanford, CA, 94305, USA.
- Neuroscience Program, Center for Health Sciences, Bioscience Division, SRI International, 333 Ravenswood Ave, Menlo Park, CA, 94025, USA.
| | - Taylor F Levine
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Edith V Sullivan
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd, Stanford, CA, 94305, USA
| | - Stephanie A Sassoon
- Neuroscience Program, Center for Health Sciences, Bioscience Division, SRI International, 333 Ravenswood Ave, Menlo Park, CA, 94025, USA
| | - Priya Asok
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd, Stanford, CA, 94305, USA
- Neuroscience Program, Center for Health Sciences, Bioscience Division, SRI International, 333 Ravenswood Ave, Menlo Park, CA, 94025, USA
| | - Helen M Brontë-Stewart
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, 94305, USA
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Kathleen L Poston
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, 94305, USA
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Kilian M Pohl
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd, Stanford, CA, 94305, USA
- Neuroscience Program, Center for Health Sciences, Bioscience Division, SRI International, 333 Ravenswood Ave, Menlo Park, CA, 94025, USA
| | - Adolf Pfefferbaum
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd, Stanford, CA, 94305, USA
- Neuroscience Program, Center for Health Sciences, Bioscience Division, SRI International, 333 Ravenswood Ave, Menlo Park, CA, 94025, USA
| | - Tilman Schulte
- Neuroscience Program, Center for Health Sciences, Bioscience Division, SRI International, 333 Ravenswood Ave, Menlo Park, CA, 94025, USA
- Clinical Psychology, Palo Alto University, 1791 Arastradero Rd, Palo Alto, CA, 94304, USA
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15
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The Increase of Theta Power and Decrease of Alpha/Theta Ratio as a Manifestation of Cognitive Impairment in Parkinson's Disease. J Clin Med 2023; 12:jcm12041569. [PMID: 36836103 PMCID: PMC9965386 DOI: 10.3390/jcm12041569] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/06/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
In this study, we aim to assess and examine cognitive functions in Parkinson's Disease patients using EEG recordings, with a central focus on characteristics associated with a cognitive decline. Based on neuropsychological evaluation using Mini-Mental State Examination, Montreal Cognitive Assessment, and Addenbrooke's Cognitive Examination-III, 98 participants were divided into three cognitive groups. All the particpants of the study underwent EEG recordings with spectral analysis. The results revealed an increase in the absolute theta power in patients with Parkinson's disease dementia (PD-D) compared to cognitively normal status (PD-CogN, p=0.00997) and a decrease in global relative beta power in PD-D compared to PD-CogN (p=0.0413). An increase in theta relative power in the left temporal region (p=0.0262), left occipital region (p=0.0109), and right occipital region (p=0.0221) were observed in PD-D compared to PD-N. The global alpha/theta ratio and global power spectral ratio significantly decreased in PD-D compared to PD-N (p = 0.001). In conclusion, the increase in relative theta power and the decrease in relative beta power are characteristic changes in EEG recordings in PD patients with cognitive impairment. Identifying these changes can be a useful biomarker and a complementary tool in the neuropsychological diagnosis of cognitive impairment in Parkinson's Disease.
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16
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Guan J, Li F, Kang D, Anderson T, Pitcher T, Dalrymple-Alford J, Shorten P, Singh-Mallah G. Cyclic Glycine-Proline (cGP) Normalises Insulin-Like Growth Factor-1 (IGF-1) Function: Clinical Significance in the Ageing Brain and in Age-Related Neurological Conditions. Molecules 2023; 28:molecules28031021. [PMID: 36770687 PMCID: PMC9919809 DOI: 10.3390/molecules28031021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
Insulin-like growth factor-1 (IGF-1) function declines with age and is associated with brain ageing and the progression of age-related neurological conditions. The reversible binding of IGF-1 to IGF binding protein (IGFBP)-3 regulates the amount of bioavailable, functional IGF-1 in circulation. Cyclic glycine-proline (cGP), a metabolite from the binding site of IGF-1, retains its affinity for IGFBP-3 and competes against IGF-1 for IGFBP-3 binding. Thus, cGP and IGFBP-3 collectively regulate the bioavailability of IGF-1. The molar ratio of cGP/IGF-1 represents the amount of bioavailable and functional IGF-1 in circulation. The cGP/IGF-1 molar ratio is low in patients with age-related conditions, including hypertension, stroke, and neurological disorders with cognitive impairment. Stroke patients with a higher cGP/IGF-1 molar ratio have more favourable clinical outcomes. The elderly with more cGP have better memory retention. An increase in the cGP/IGF-1 molar ratio with age is associated with normal cognition, whereas a decrease in this ratio with age is associated with dementia in Parkinson disease. In addition, cGP administration reduces systolic blood pressure, improves memory, and aids in stroke recovery. These clinical and experimental observations demonstrate the role of cGP in regulating IGF-1 function and its potential clinical applications in age-related brain diseases as a plasma biomarker for-and an intervention to improve-IGF-1 function.
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Affiliation(s)
- Jian Guan
- Department of Pharmacology and Clinical Pharmacology, Faculty of Medicine and Health Sciences, School of Biomedical Sciences, The University of Auckland, Auckland 1142, New Zealand
- Centre for Brain Research, Faculty of Medicine and Health Sciences, School of Biomedical Sciences, The University of Auckland, Auckland 1142, New Zealand
- Brain Research New Zealand, The Centre for Research Excellent, Dunedin 9016, New Zealand
- The cGP Lab Limited New Zealand, Auckland 1021, New Zealand
- Correspondence: ; Tel.: +64-9-923-6134
| | - Fengxia Li
- Department of Pharmacology and Clinical Pharmacology, Faculty of Medicine and Health Sciences, School of Biomedical Sciences, The University of Auckland, Auckland 1142, New Zealand
- Centre for Brain Research, Faculty of Medicine and Health Sciences, School of Biomedical Sciences, The University of Auckland, Auckland 1142, New Zealand
- Guangdong Pharmaceutical University, Guangzhou Higher Education Mega Center, Guangzhou 510075, China
- The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, China
| | - Dali Kang
- Department of Pharmacology and Clinical Pharmacology, Faculty of Medicine and Health Sciences, School of Biomedical Sciences, The University of Auckland, Auckland 1142, New Zealand
- Centre for Brain Research, Faculty of Medicine and Health Sciences, School of Biomedical Sciences, The University of Auckland, Auckland 1142, New Zealand
- Brain Research New Zealand, The Centre for Research Excellent, Dunedin 9016, New Zealand
- Shenyang Medical College, Shenyang 110034, China
| | - Tim Anderson
- New Zealand Brain Research Institute, Christchurch 4710, New Zealand
- Department of Medicine, University of Otago, Dunedin 9016, New Zealand
- Department of Neurology, Canterbury District Health Board, Christchurch 4710, New Zealand
| | - Toni Pitcher
- New Zealand Brain Research Institute, Christchurch 4710, New Zealand
- Department of Medicine, University of Otago, Dunedin 9016, New Zealand
- Department of Neurology, Canterbury District Health Board, Christchurch 4710, New Zealand
| | - John Dalrymple-Alford
- Department of Neurology, Canterbury District Health Board, Christchurch 4710, New Zealand
- Department of Psychology, University of Canterbury, Christchurch 4710, New Zealand
| | - Paul Shorten
- AgResearch Ltd., Ruakura Research Centre, Hamilton 3214, New Zealand
- Riddet Institute, Massey University, Palmerston North 4474, New Zealand
| | - Gagandeep Singh-Mallah
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden
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17
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Hong JY, Lee PH. Subjective Cognitive Complaints in Cognitively Normal Patients With Parkinson's Disease: A Systematic Review. J Mov Disord 2023; 16:1-12. [PMID: 36353806 PMCID: PMC9978265 DOI: 10.14802/jmd.22059] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 08/15/2022] [Indexed: 11/11/2022] Open
Abstract
Subjective cognitive complaints (SCCs) refer to self-perceived cognitive decline and are related to objective cognitive decline. SCCs in cognitively normal individuals are considered a preclinical sign of subsequent cognitive impairment due to Alzheimer's disease, and SCCs in cognitively normal patients with Parkinson's disease (PD) are also gaining attention. The aim of this review was to provide an overview of the current research on SCCs in cognitively normal patients with PD. A systematic search found a lack of consistency in the methodologies used to define and measure SCCs. Although the association between SCCs and objective cognitive performance in cognitively normal patients with PD is controversial, SCCs appear to be predictive of subsequent cognitive decline. These findings support the clinical value of SCCs in cognitively normal status in PD; however, further convincing evidence from biomarker studies is needed to provide a pathophysiological basis for these findings. Additionally, a consensus on the definition and assessment of SCCs is needed for further investigations.
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Affiliation(s)
- Jin Yong Hong
- Department of Neurology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea,Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea,Corresponding author: Phil Hyu Lee, MD, PhD Department of Neurology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea / Tel: +82-2-2228-1608 / Fax: +82-2-393-0705 / E-mail:
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Wang Z, Zheng Y, Cai H, Yang C, Li S, Lv H, Feng T, Yu Z. Aβ1-42-containing platelet-derived extracellular vesicle is associated with cognitive decline in Parkinson's disease. Front Aging Neurosci 2023; 15:1170663. [PMID: 37122378 PMCID: PMC10140302 DOI: 10.3389/fnagi.2023.1170663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 03/27/2023] [Indexed: 05/02/2023] Open
Abstract
Background Cortical amyloid deposition is a common observation in Parkinson's disease dementia (PDD) patients. Aβ1-42 is linked to a more rapid progression of dementia. Platelets, which degranulate upon activation, are a primary source of Aβ. It has been repeatedly reported that peripheral extracellular vesicles (EVs) can partially reach the central nervous system. Thus, we speculate that activated platelet-derived Aβ1-42-containing EVs (PEV-Aβ1-42) play a crucial role in the cognitive decline of PD patients. Methods The study included 189 participants: 66 with non-dementia PD, 73 with PDD, and 50 healthy controls. All participants underwent blood collection and clinical assessments. Twenty PD patients underwent re-examination and repeated blood collection 14 months later. A nano-scale flow cytometry assay was used to detect PEVs and PEV-Aβ1-42 using fluorescence-labeled CD62P and Aβ1-42 antibodies. Results Parkinson's disease dementia patients had higher PEV-Aβ1-42 concentrations than healthy controls (p = 0.028). The ratio of PEV-Aβ1-42 to PEV was significantly higher in PDD patients compared to those in non-dementia PD and healthy controls (p PD-ND < 0.001, p HC = 0.041). The PEV-Aβ1-42/PEV ratio appears to influence the odds of developing dementia (OR = 1.76, p < 0.001). The change in the PEV-Aβ1-42/PEV ratio was also correlated with cognitive decline over 14 months (r = -0.447, p < 0.05). Conclusion The plasma PEV-Aβ1-42/PEV ratio may serve as a diagnostic and prognostic biomarker for PDD patients.
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Affiliation(s)
- Ziyu Wang
- Center for Movement Disorders, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuanchu Zheng
- Center for Movement Disorders, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Huihui Cai
- Center for Movement Disorders, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chen Yang
- Center for Movement Disorders, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Siming Li
- Center for Movement Disorders, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hong Lv
- Clinical Diagnosis Department of Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- *Correspondence: Zhenwei Yu, ; Tao Feng, , ; Hong Lv,
| | - Tao Feng
- Center for Movement Disorders, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- *Correspondence: Zhenwei Yu, ; Tao Feng, , ; Hong Lv,
| | - Zhenwei Yu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- *Correspondence: Zhenwei Yu, ; Tao Feng, , ; Hong Lv,
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Mantovani E, Zucchella C, Argyriou AA, Tamburin S. Treatment for cognitive and neuropsychiatric non-motor symptoms in Parkinson's disease: current evidence and future perspectives. Expert Rev Neurother 2023; 23:25-43. [PMID: 36701529 DOI: 10.1080/14737175.2023.2173576] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Non-motor symptoms (NMS) affect patients with Parkinson's disease (PD) from the prodromal to the advanced stages. NMS phenotypes greatly vary and have a huge impact on patients' and caregivers' quality of life (QoL). The management of cognitive and neuropsychiatric NMS remains an unmet need. AREAS COVERED The authors, herein, review the dopaminergic and non-dopaminergic pathogenesis, clinical features, assessment, and pharmacological and non-pharmacological treatments of cognitive and neuropsychiatric NMS in PD. They discuss the current evidence and report the findings of an overview of ongoing trials on pharmacological and selected non-pharmacological strategies. EXPERT OPINION The treatment of cognitive and neuropsychiatric NMS in PD is poorly explored, and therapeutic options are unsatisfactory. Pharmacological treatment of cognitive NMS is based on symptomatic active principles used in Alzheimer's disease. Dopamine agonists, selective serotonin, and serotonin-norepinephrine reuptake inhibitors have some evidence on PD-related depression. Clozapine, quetiapine, and pimavanserin may be considered for psychosis in PD. Evidence on the treatment of other neuropsychiatric NMS is limited or lacking. Addressing pathophysiological and clinical issues, which hamper solid evidence on the treatment of cognitive and neuropsychiatric NMS, may reduce the impact on QoL for PD patients and their caregivers.
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Affiliation(s)
- Elisa Mantovani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Chiara Zucchella
- Section of Neurology, Department of Neurosciences, Verona University Hospital, Verona, Italy
| | - Andreas A Argyriou
- Department of Neurology, "Agios Andreas" State General Hospital of Patras, Patras, Greece
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Pagonabarraga J, Pérez-González R, Bejr-Kasem H, Marín-Lahoz J, Horta-Barba A, Martinez-Horta S, Aracil-Bolaños I, Sampedro F, Campolongo A, Rivas E, Puig-Davi A, Ruiz-Barrios I, Pérez-Pérez J, Pascual-Sedano B, Kulisevsky J. Dissociable contribution of plasma NfL and p-tau181 to cognitive impairment in Parkinson's disease. Parkinsonism Relat Disord 2022; 105:132-138. [PMID: 35752549 DOI: 10.1016/j.parkreldis.2022.05.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 04/13/2022] [Accepted: 05/24/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Cognitive dysfunction is a disabling complication in Parkinson's disease (PD). Accuracy of diagnosis of mild cognitive impairment in PD (PD-MCI) depends on the tests performed, which limits results generalization. Blood-based biomarkers could provide additional objective information for PD-MCI diagnosis and progression. Blood neurofilament light chain (NfL), a marker of neuronal injury, has shown good performance for PD disease stratification and progression. While NfL is not disease-specific, phosphorylated-tau at threonine-181 (p-tau181) in blood is a highly specific marker of concomitant brain amyloid-β and tau pathology. METHODS We investigated the potential of plasma NfL and p-tau181 levels as markers of cognitive impairment in a prospective cohort of 109 PD patients with and without PD-MCI (age 68.1 ± 7 years, education 12.2± 5 years), and 40 comparable healthy controls. After a follow-up of 4 years, we evaluated their predictive value for progression to dementia. RESULTS Although NfL and p-tau181 levels were significantly increased in PD compared with healthy controls, only NfL levels were significantly higher in PD-MCI compared with PD with normal cognition (PD-NC) at baseline. After a follow-up of 4 years, only NfL predicted progression to dementia (HR 1.23, 95% CI 1.02-1.53; p = 0.038). Significant correlations between fluid biomarkers and neuropsychological examination were only found with NfL levels. CONCLUSIONS Plasma NfL levels objectively differentiates PD-MCI from PD-NC patients, and may serve as a plasma biomarker for predicting progression to dementia in PD. Plasma levels of p-tau181 does not seem to help in differentiating PD-MCI or to predict future cognitive deterioration.
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Affiliation(s)
- Javier Pagonabarraga
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Department of Medicine, Barcelona, Spain; Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación en Red - Enfermedades Neurodegenerativas (CIBERNED), Spain.
| | - Rocío Pérez-González
- Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación en Red - Enfermedades Neurodegenerativas (CIBERNED), Spain.
| | - Helena Bejr-Kasem
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Department of Medicine, Barcelona, Spain; Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación en Red - Enfermedades Neurodegenerativas (CIBERNED), Spain
| | - Juan Marín-Lahoz
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Department of Medicine, Barcelona, Spain; Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación en Red - Enfermedades Neurodegenerativas (CIBERNED), Spain
| | - Andrea Horta-Barba
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Department of Medicine, Barcelona, Spain; Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
| | - Saul Martinez-Horta
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Department of Medicine, Barcelona, Spain; Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación en Red - Enfermedades Neurodegenerativas (CIBERNED), Spain
| | - Ignacio Aracil-Bolaños
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Department of Medicine, Barcelona, Spain; Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
| | - Frederic Sampedro
- Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación en Red - Enfermedades Neurodegenerativas (CIBERNED), Spain
| | - Antonia Campolongo
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Department of Medicine, Barcelona, Spain; Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación en Red - Enfermedades Neurodegenerativas (CIBERNED), Spain
| | - Elisa Rivas
- Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación en Red - Enfermedades Neurodegenerativas (CIBERNED), Spain
| | - Arnau Puig-Davi
- Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
| | - I Ruiz-Barrios
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Department of Medicine, Barcelona, Spain
| | - Jesús Pérez-Pérez
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Department of Medicine, Barcelona, Spain; Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
| | - Berta Pascual-Sedano
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Department of Medicine, Barcelona, Spain; Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación en Red - Enfermedades Neurodegenerativas (CIBERNED), Spain
| | - Jaime Kulisevsky
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Department of Medicine, Barcelona, Spain; Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación en Red - Enfermedades Neurodegenerativas (CIBERNED), Spain
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Amboni M, Ricciardi C, Adamo S, Nicolai E, Volzone A, Erro R, Cuoco S, Cesarelli G, Basso L, D'Addio G, Salvatore M, Pace L, Barone P. Machine learning can predict mild cognitive impairment in Parkinson's disease. Front Neurol 2022; 13:1010147. [PMID: 36468069 PMCID: PMC9714435 DOI: 10.3389/fneur.2022.1010147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/12/2022] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Clinical markers of cognitive decline in Parkinson's disease (PD) encompass several mental non-motor symptoms such as hallucinations, apathy, anxiety, and depression. Furthermore, freezing of gait (FOG) and specific gait alterations have been associated with cognitive dysfunction in PD. Finally, although low cerebrospinal fluid levels of amyloid-β42 have been found to predict cognitive decline in PD, hitherto PET imaging of amyloid-β (Aβ) failed to consistently demonstrate the association between Aβ plaques deposition and mild cognitive impairment in PD (PD-MCI). AIM Finding significant features associated with PD-MCI through a machine learning approach. PATIENTS AND METHODS Patients were assessed with an extensive clinical and neuropsychological examination. Clinical evaluation included the assessment of mental non-motor symptoms and FOG using the specific items of the MDS-UPDRS I and II. Based on the neuropsychological examination, patients were classified as subjects without and with MCI (noPD-MCI, PD-MCI). All patients were evaluated using a motion analysis system. A subgroup of PD patients also underwent amyloid PET imaging. PD-MCI and noPD-MCI subjects were compared with a univariate statistical analysis on demographic data, clinical features, gait analysis variables, and amyloid PET data. Then, machine learning analysis was performed two times: Model 1 was implemented with age, clinical variables (hallucinations/psychosis, depression, anxiety, apathy, sleep problems, FOG), and gait features, while Model 2, including only the subgroup performing PET, was implemented with PET variables combined with the top five features of the former model. RESULTS Seventy-five PD patients were enrolled (33 PD-MCI and 42 noPD-MCI). PD-MCI vs. noPD-MCI resulted in older and showed worse gait patterns, mainly characterized by increased dynamic instability and reduced step length; when comparing amyloid PET data, the two groups did not differ. Regarding the machine learning analyses, evaluation metrics were satisfactory for Model 1 overcoming 80% for accuracy and specificity, whereas they were disappointing for Model 2. CONCLUSIONS This study demonstrates that machine learning implemented with specific clinical features and gait variables exhibits high accuracy in predicting PD-MCI, whereas amyloid PET imaging is not able to increase prediction. Additionally, our results prompt that a data mining approach on certain gait parameters might represent a reliable surrogate biomarker of PD-MCI.
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Affiliation(s)
- Marianna Amboni
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, Italy
- IDC Hermitage-Capodimonte, Naples, Italy
| | - Carlo Ricciardi
- Department of Electrical Engineering and Information Technologies, University of Naples “Federico II”, Naples, Italy
- Bioengineering Unit, Institute of Care and Scientific Research Maugeri, Telese Terme, Italy
| | - Sarah Adamo
- Department of Electrical Engineering and Information Technologies, University of Naples “Federico II”, Naples, Italy
- Bioengineering Unit, Institute of Care and Scientific Research Maugeri, Telese Terme, Italy
| | | | - Antonio Volzone
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, Italy
| | - Roberto Erro
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, Italy
| | - Sofia Cuoco
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, Italy
| | - Giuseppe Cesarelli
- Bioengineering Unit, Institute of Care and Scientific Research Maugeri, Telese Terme, Italy
- Department of Chemical, Materials and Production Engineering, University of Naples “Federico II”, Naples, Italy
| | | | - Giovanni D'Addio
- Bioengineering Unit, Institute of Care and Scientific Research Maugeri, Telese Terme, Italy
| | | | - Leonardo Pace
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, Italy
| | - Paolo Barone
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, Italy
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22
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Specific pattern of linguistic impairment in Parkinson's disease patients with subjective cognitive decline and mild cognitive impairment predicts dementia. J Int Neuropsychol Soc 2022:1-9. [PMID: 36226685 DOI: 10.1017/s1355617722000571] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Parkinson's disease patients with subjective cognitive decline (PD-SCD) and mild cognitive impairment (PD-MCI) have an increased risk of dementia (PDD). Thus, the identification of early cognitive changes that can be useful predictors of PDD is a highly relevant challenge. Posterior cortically based functions, including linguistic processes, have been associated with PDD. However, investigations that have focused on linguistic functions in PD-MCI are scarce and none of them include PD-SCD patients. Our aim was to study language performance in PD-SCD and PD-MCI. Moreover, language subcomponents were considered as predictors of PDD. METHOD Forty-six PD patients and twenty controls were evaluated with a neuropsychological protocol. Patients were classified as PD-SCD and PD-MCI. Language production and comprehension was assessed. Follow-up assessment was conducted to a mean of 7.5 years after the baseline. RESULTS PD-MCI patients showed a poor performance in naming (actions and nouns), action generation, anaphora resolution and sentence comprehension (with and without center-embedded relative clause). PD-SCD showed a poor performance in action naming and action generation. Deficit in action naming was an independent risk factor for PDD during the follow-up. Moreover, the combination of deficit in action words and sentence comprehension without a center-embedded relative clause was associated with a greater risk. CONCLUSIONS The results are of relevance because they suggest that a specific pattern of linguistic dysfunctions, that can be present even in the early stages of the disease, can predict future dementia, reinforcing the importance of advancing in the knowledge of linguistic dysfunctions in predementia stages of PD.
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Weintraub D, Irwin D. Diagnosis and Treatment of Cognitive and Neuropsychiatric Symptoms in Parkinson Disease and Dementia With Lewy Bodies. Continuum (Minneap Minn) 2022; 28:1314-1332. [DOI: 10.1212/con.0000000000001151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Xie H, Zhang Q, Jiang Y, Bai Y, Zhang J. Parkinson’s disease with mild cognitive impairment may has a lower risk of cognitive decline after subthalamic nucleus deep brain stimulation: A retrospective cohort study. Front Hum Neurosci 2022; 16:943472. [PMID: 36147298 PMCID: PMC9486063 DOI: 10.3389/fnhum.2022.943472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/10/2022] [Indexed: 11/22/2022] Open
Abstract
Background The cognitive outcomes induced by subthalamic nucleus deep brain stimulation (STN-DBS) remain unclear, especially in PD patients with mild cognitive impairment (MCI). This study explored the cognitive effects of STN-DBS in PD patients with MCI. Methods This was a retrospective cohort study that included 126 PD patients who underwent STN-DBS; all patients completed cognitive and motor assessments before and at least 6 months after surgery. Cognitive changes were mainly evaluated by the Montreal cognitive assessment (MoCA) scale and the seven specific MoCA domains, including visuospatial/executive function, naming, attention, language, abstract, delayed recall, and orientation. Motor improvement was evaluated by the UPDRS-III. Cognitive changes and motor improvements were compared between PD-MCI and normal cognitive (NC) patients. Logistic regression analyses were performed to explore predictors of post-operative cognitive change. Results At the time of surgery, 61.90% of the included PD patients had MCI. Compared with the PD-MCI group, the PD-NC group had a significantly higher proportion of cases with post-operative cognitive decline during follow-up of up to 36 months (mean 17.34 ± 10.61 months), mainly including in global cognitive function, visuospatial/executive function and attention. Covariate-adjusted binary logistic regression analyses showed that pre-operative global cognitive status was an independent variable for post-operative cognitive decline. We also found that pre-operative cognitive specific function could predict its own decline after STN-DBS, except for the naming and orientation domains. Conclusion PD-MCI patients are at a lower risk of cognitive decline after STN-DBS compared with PD-NC patients.
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Affiliation(s)
- Hutao Xie
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Quan Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yin Jiang
- Beijing Key Laboratory of Neurostimulation, Beijing, China
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- *Correspondence: Yin Jiang,
| | - Yutong Bai
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Yutong Bai,
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Neurostimulation, Beijing, China
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Jianguo Zhang,
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25
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Yu RL, Wu RM. Mild cognitive impairment in patients with Parkinson’s disease: An updated mini-review and future outlook. Front Aging Neurosci 2022; 14:943438. [PMID: 36147702 PMCID: PMC9485585 DOI: 10.3389/fnagi.2022.943438] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/15/2022] [Indexed: 12/04/2022] Open
Abstract
Mild cognitive impairment (MCI) is one of the common non-motor symptoms in patients with Parkinson’s disease (PD). MCI is the transition stage between normal aging and full-blown dementia and is also a powerful predictor of dementia. Although the concept of MCI has been used to describe some of the PD symptoms for many years, there is a lack of consistent diagnostic criteria. Moreover, because of the diverse patterns of the cognitive functions, each cognitive impairment will have a different progression. In this review, we overviewed the diagnostic criteria for PD-MCI, primarily focused on the heterogeneity of PD-MCI patients’ cognitive function, including various types of cognitive functions and their progression rates. A review of this topic is expected to be beneficial for clinical diagnosis, early intervention, and treatment. In addition, we also discussed the unmet needs and future vision in this field.
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Affiliation(s)
- Rwei-Ling Yu
- College of Medicine, Institute of Behavioral Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ruey-Meei Wu
- Department of Neurology, College of Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
- *Correspondence: Ruey-Meei Wu,
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Kuroha Y, Takahashi T, Arai Y, Yoshino M, Kasuga K, Hasegawa A, Matsubara N, Koike R, Ikeuchi T. [Neuropsychological and regional cerebral blood flow of posterior parietal area features in patients with Parkinson's disease with mild cognitive impairment]. Rinsho Shinkeigaku 2022; 62:532-540. [PMID: 35753785 DOI: 10.5692/clinicalneurol.cn-001709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This study aimed to clarify associations between neuropsychological scales and regional cerebral blood flow (rCBF) of on 123I-IMP-SPECT in patients with Parkinson's disease with mild cognitive impairment (PD-MCI). Forty-two participants (mean age, 65.5 ± 8.9 years; mean disease duration, 11.1 ±5.7 years) were evaluated using the Wechsler Adult Intelligence Scale, third edition (WAIS-III), Wechsler Memory Scale, revised (WMS-R), Stroop test, Category word fluency, Auditory verbal learning test, Raven colored progressive matrices, Trail Making Test-B, and Clock drawing test. Participants were classified into PD-MCI and PD non-demented (PD-ND) using ten of these scales or its subtests. The rCBF of the posterior cingulate gyrus, precuneus, and parietal lobes was evaluated by 123I-IMP-SPECT using the easy Z-score imaging system (eZIS analysis). Extent was the extent index of voxels showing z-score > 2, and Severity was mean z-score in those regions on eZIS analysis. Cingulate island sign score (CIScore) was the ratio of integrated z-scores of the posterior cingulate gyrus to those of the posterior cortex.Twenty-three participants were diagnosed with PD-MCI (55%). The rCBF indices were significantly increased in the PD-MCI group compared to the PD-ND group (Extent: P = 0.047; CIScore: P = 0.006). These indices were significantly correlated with WAIS-III Processing Speed (Extent: P = 0.041, R = -0.317; Severity: P = 0.047, R = -0.309), Stroop effect (Extent: P = 0.003, R = 0.443; Severity: P = 0.004, R = 0.437), WMS-R Visual memory (Extent: P = 0.019, R = -0.361; Severity: P = 0.014, R = -0.375), and Delayed memory score (Extent: P = 0.005, R = -0.423; Severity: P = 0.044, R = -0.312). The rCBF indices showed no correlations with the number of impaired cognitive domains. Collectively, decreased posterior parietal area rCBF and lower scores on selective neuropsychological scales might be helpful to detect a transition period from PD-MCI to PD-D.
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Affiliation(s)
- Yasuko Kuroha
- Department of Neurology, National Hospital Organization Nishiniigata Chuo Hospital
| | - Tetsuya Takahashi
- Department of Neurology, National Hospital Organization Nishiniigata Chuo Hospital
| | - Yuki Arai
- Certified Clinical Psychologist, National Hospital Organization Nishiniigata Chuo Hospital
| | - Mihoko Yoshino
- Certified Clinical Psychologist, National Hospital Organization Nishiniigata Chuo Hospital
| | - Kensaku Kasuga
- Department of Molecular Genetics, Brain Research Institute, Niigata University
| | - Arika Hasegawa
- Department of Neurology, National Hospital Organization Nishiniigata Chuo Hospital
| | - Nae Matsubara
- Department of Neurology, National Hospital Organization Nishiniigata Chuo Hospital
| | - Ryoko Koike
- Department of Neurology, National Hospital Organization Nishiniigata Chuo Hospital
| | - Takeshi Ikeuchi
- Department of Molecular Genetics, Brain Research Institute, Niigata University
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Li D, Ren T, Li H, Liao G, Zhang X. Porphyromonas gingivalis: A key role in Parkinson's disease with cognitive impairment? Front Neurol 2022; 13:945523. [PMID: 35959396 PMCID: PMC9363011 DOI: 10.3389/fneur.2022.945523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/04/2022] [Indexed: 11/15/2022] Open
Abstract
Cognitive impairment (CI) is a common complication of Parkinson's disease (PD). The major features of Parkinson's disease with cognitive impairment (PD-CI) include convergence of α-Synuclein (α-Syn) and Alzheimer's disease (AD)-like pathologies, neuroinflammation, and dysbiosis of gut microbiota. Porphyromonas gingivalis (P. gingivalis) is an important pathogen in periodontitis. Recent research has suggested a role of P. gingivalis and its virulence factor in the pathogenesis of PD and AD, in particular concerning neuroinflammation and deposition of α-Synuclein (α-Syn) and amyloid-β (Aβ). Furthermore, in animal models, oral P. gingivalis could cause neurodegeneration through regulating the gut-brain axis, suggesting an oral-gut-brain axis might exist. In this article, we discussed the pathological characteristics of PD-CI and the role of P. gingivalis in them.
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Affiliation(s)
- Dongcheng Li
- Department of Neurology, Affiliated Maoming People's Hospital, Southern Medical University, Maoming, China
| | - Tengzhu Ren
- Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Hao Li
- Department of Neurology, Affiliated Maoming People's Hospital, Southern Medical University, Maoming, China
| | - Geng Liao
- Department of Neurology, Affiliated Maoming People's Hospital, Southern Medical University, Maoming, China
| | - Xiong Zhang
- Department of Neurology, Affiliated Maoming People's Hospital, Southern Medical University, Maoming, China
- *Correspondence: Xiong Zhang
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Morphological basis of Parkinson disease-associated cognitive impairment: an update. J Neural Transm (Vienna) 2022; 129:977-999. [PMID: 35726096 DOI: 10.1007/s00702-022-02522-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/25/2022] [Indexed: 12/15/2022]
Abstract
Cognitive impairment is one of the most salient non-motor symptoms of Parkinson disease (PD) that poses a significant burden on the patients and carers as well as being a risk factor for early mortality. People with PD show a wide spectrum of cognitive dysfunctions ranging from subjective cognitive decline and mild cognitive impairment (MCI) to frank dementia. The mean frequency of PD with MCI (PD-MCI) is 25.8% and the pooled dementia frequency is 26.3% increasing up to 83% 20 years after diagnosis. A better understanding of the underlying pathological processes will aid in directing disease-specific treatment. Modern neuroimaging studies revealed considerable changes in gray and white matter in PD patients with cognitive impairment, cortical atrophy, hypometabolism, dopamine/cholinergic or other neurotransmitter dysfunction and increased amyloid burden, but multiple mechanism are likely involved. Combined analysis of imaging and fluid markers is the most promising method for identifying PD-MCI and Parkinson disease dementia (PDD). Morphological substrates are a combination of Lewy- and Alzheimer-associated and other concomitant pathologies with aggregation of α-synuclein, amyloid, tau and other pathological proteins in cortical and subcortical regions causing destruction of essential neuronal networks. Significant pathological heterogeneity within PD-MCI reflects deficits in various cognitive domains. This review highlights the essential neuroimaging data and neuropathological changes in PD with cognitive impairment, the amount and topographical distribution of pathological protein aggregates and their pathophysiological relevance. Large-scale clinicopathological correlative studies are warranted to further elucidate the exact neuropathological correlates of cognitive impairment in PD and related synucleinopathies as a basis for early diagnosis and future disease-modifying therapies.
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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: 0] [Impact Index Per Article: 0] [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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Capturing Subjective Mild Cognitive Decline in Parkinson’s Disease. Brain Sci 2022; 12:brainsci12060741. [PMID: 35741626 PMCID: PMC9221413 DOI: 10.3390/brainsci12060741] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/29/2022] [Accepted: 06/01/2022] [Indexed: 12/10/2022] Open
Abstract
This study aimed to capture subjective daily functional cognitive decline among patients with Parkinson’s disease. Participants (40–79 y; 78 with Parkinson’s disease and 41 healthy matched controls) completed the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS), Parkinson’s Disease Cognitive Functional Rating Scale (CFRS), Daily Living Questionnaire (DLQ), and Time Organisation and Participation Scale (TOPS) questionnaires. Patients with Parkinson’s disease were divided into groups with or without suspected mild cognitive decline according to their scores on the Cognitive Functional (CF) feature, which is based on certain items of the MDS-UPDRS. Significant between-group differences were found in the DLQ and TOPS scores. Significant correlations were found among the questionnaire results, with specific DLQ and TOPS items accounting for 35% of the variance in the CF feature, which correlated with daily cognitive functional states. This study’s results are relevant for detecting subtle deficits in Parkinson’s disease patients suspected of mild cognitive decline, which can affect health and quality of life and relates to risk for later dementia.
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Dodich A, Funghi G, Meli C, Pennacchio M, Longo C, Malaguti MC, Di Giacopo R, Zappini F, Turella L, Papagno C. Deficits in Emotion Recognition and Theory of Mind in Parkinson's Disease Patients With and Without Cognitive Impairments. Front Psychol 2022; 13:866809. [PMID: 35645902 PMCID: PMC9138611 DOI: 10.3389/fpsyg.2022.866809] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/14/2022] [Indexed: 11/24/2022] Open
Abstract
Background Emotion recognition and social deficits have been previously reported in Parkinson's disease (PD). However, the extent of these impairments is still unclear and social cognition is excluded from the cognitive domains considered in the current criteria for PD mild cognitive impairment (MCI). This study aims to analyze emotion recognition, affective and cognitive theory of mind in early PD patients classified according to Level II MCI criteria, and to evaluate the prevalence of socio-cognitive deficits in this sample. Methods We enrolled 45 participants with PD, classified as cognitively unimpaired (CU; n = 32) or MCI (n = 13) based on a standard neuropsychological assessment. Social cognitive skills were evaluated through validated tests for emotion recognition (i.e., Ekman 60-faces test, Ek60 Test) and mental states attribution (Story-based Empathy Task, SET) and compared to a group of 45 healthy controls (HC). Between-group differences in social tasks were performed, as well as correlation analyses to assess the relationship between social, cognitive, and clinical variables. Finally, the number of patients with social cognitive impairments in both MCI and CU subgroups was computed based on Italian normative data. Results Statistical comparison revealed significant differences among groups in the Ek60 test, with MCI obtaining significantly lower scores than HC and CU, especially for negative emotions. Significant differences were detected also in the SET, with lower performance in emotion and intention attribution for both PD groups compared to HC. A significant correlation emerged between the Ek60 test and emotion attribution. Nine patients showed poor performance at social tasks, five of them being classified as PD-CU. Discussion Parkinson's disease cognitive profile was characterized by emotion recognition and attribution deficits. These results, as well as the detection of CU patients with isolated socio-cognitive impairments, underline the importance of assessing social cognition in PD as a possible early marker of cognitive decline.
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Affiliation(s)
- Alessandra Dodich
- Center for Mind/Brain Sciences CIMeC, University of Trento, Rovereto, Italy
| | - Giulia Funghi
- Center for Mind/Brain Sciences CIMeC, University of Trento, Rovereto, Italy
| | - Claudia Meli
- Center for Mind/Brain Sciences CIMeC, University of Trento, Rovereto, Italy
| | - Maria Pennacchio
- Center for Mind/Brain Sciences CIMeC, University of Trento, Rovereto, Italy
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Chiara Longo
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
- Dipartimento di Scienze Neurologiche, Ospedale Santa Chiara, Trento, Italy
| | | | | | - Francesca Zappini
- Center for Mind/Brain Sciences CIMeC, University of Trento, Rovereto, Italy
| | - Luca Turella
- Center for Mind/Brain Sciences CIMeC, University of Trento, Rovereto, Italy
| | - Costanza Papagno
- Center for Mind/Brain Sciences CIMeC, University of Trento, Rovereto, Italy
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Boel JA, Bie RM, Schmand BA, Dalrymple‐Alford JC, Marras C, Adler CH, Goldman JG, Tröster AI, Burn DJ, Litvan I, Geurtsen GJ, Bernard B, Stebbins G, Filoteo JV, Weintraub D, Caviness JN, Belden C, Zabetian CP, Cholerton BA, Huang X, Eslinger PJ, Leverenz JB, Duff‐Canning S, Farrer M, Anderson TJ, Myall DJ, Naismith SL, Lewis SJ, Halliday GM, Wu R, Williams‐Gray CH, Breen DP, Barker RA, Yarnall AJ, Klein M, Mollenhauer B, Trenkwalder C, Kulisevsky J, Pagonabarraga J, Gasca‐Salas C, Rodriguez‐Oroz MC, Junque C, Segura B, Barone P, Santangelo G, Cammisuli DM, Biundo R, Antonini A, Weis L, Pedersen KF, Alves G. Level I
PD‐MCI
using global cognitive tests and the risk for Parkinson's disease dementia. Mov Disord Clin Pract 2022; 9:479-483. [PMID: 35582313 PMCID: PMC9092740 DOI: 10.1002/mdc3.13451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/07/2022] [Accepted: 03/24/2022] [Indexed: 11/21/2022] Open
Abstract
Background The criteria for PD‐MCI allow the use of global cognitive tests. Their predictive value for conversion from PD‐MCI to PDD, especially compared to comprehensive neuropsychological assessment, is unknown. Methods The MDS PD‐MCI Study Group combined four datasets containing global cognitive tests as well as a comprehensive neuropsychological assessment to define PD‐MCI (n = 467). Risk for developing PDD was examined using a Cox model. Global cognitive tests were compared to neuropsychological test batteries (Level I&II) in determining risk for PDD. Results PD‐MCI based on a global cognitive test (MMSE or MoCA) increases the hazard for developing PDD (respectively HR = 2.57, P = 0.001; HR = 4.14, P = <0.001). The C‐statistics for MMSE (0.72) and MoCA (0.70) were lower than those based on neuropsychological tests (Level I = 0.82; Level II = 0.81). Sensitivity, specificity and diagnostic accuracy balance was best in Level II. Conclusion MMSE and MoCA predict conversion to PDD. However, Level II neuropsychological assessment seems the preferred assessment for PD‐MCI.
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Affiliation(s)
- Judith A. Boel
- Amsterdam UMC location University of Amsterdam Department of Neurology The Netherlands
- Department of Psychology University of Amsterdam The Netherlands
| | - Rob M.A. Bie
- Amsterdam UMC location University of Amsterdam Department of Neurology The Netherlands
- Amsterdam Neuroscience The Netherlands
| | - Ben A. Schmand
- Department of Psychology University of Amsterdam The Netherlands
- Amsterdam UMC location University of Amsterdam Department of Medical Psychology The Netherlands
| | - John C. Dalrymple‐Alford
- New Zealand Brain Research Institute and School of Psychology, Speech and Hearing University of Canterbury Christchurch New Zealand
| | - Connie Marras
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J Safra Program in Parkinson's disease, Toronto Western Hospital University of Toronto Canada
| | - Charles H. Adler
- Arizona Study of Aging and Neurodegenerative Disorders, Mayo Clinic Arizona, Scottsdale, Arizona, USA and Banner Sun Health Research Institute Sun City Arizona USA
| | - Jennifer G. Goldman
- Shirley Ryan AbilityLab and Northwestern University Departments of Physical Medicine and Rehabilitation and Neurology Chicago Illinois USA
| | - Alexander I. Tröster
- Department of Clinical Neuropsychology and Center for Neuromodulation Barrow Neurological Institute Phoenix Arizona USA
| | - David J. Burn
- Institute of Neuroscience Newcastle University Newcastle upon Tyne UK
| | - Irene Litvan
- Parkinson and Other Movement Disorder Center, Department of Neurosciences University of California San Diego California
| | - Gert J. Geurtsen
- Amsterdam UMC location University of Amsterdam Department of Medical Psychology The Netherlands
- Amsterdam Neuroscience The Netherlands
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Neuropsychology of Parkinson's disease. PROGRESS IN BRAIN RESEARCH 2022; 269:39-58. [PMID: 35248203 DOI: 10.1016/bs.pbr.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Bock MA, Tanner CM. The epidemiology of cognitive function in Parkinson's disease. PROGRESS IN BRAIN RESEARCH 2022; 269:3-37. [PMID: 35248199 DOI: 10.1016/bs.pbr.2022.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Epidemiology is the study of the distribution of disease in human populations, which is important in evaluating burden of illness, identifying modifiable risk factors, and planning for current and projected needs of the health care system. Parkinson's disease (PD) is the second most common serious neurodegenerative illness and is expected to further increase in prevalence. Cognitive changes are increasingly viewed as an integral non-motor feature in PD, emerging even in the prodromal phase of the disease. The prevalence of PD-MCI ranges from 20% to 40% depending on the population studied. The incidence of PD-dementia increases with duration of disease, with estimates growing from 3% to 30% of individuals followed for 5 years or less to over 80% after 20 years. There are several challenges in estimating the frequency of cognitive change, including only recently standardized diagnostic criteria, variation depending on exact neuropsychological evaluations performed, and differences in population sampling. Clinical features associated with cognitive decline include older age, increased disease duration and severity, early gait dysfunction, dysautonomia, hallucinations and other neuropsychiatric features, the presence of REM behavior disorder, and posterior predominant dysfunction on neuropsychological testing. There is increasing evidence that genetic risk factors, in particular GBA and MAPT mutations, contribute to cognitive change. Possible protective factors include higher cognitive reserve and regular exercise. Important sequelae of cognitive decline in PD include higher caregiver burden, decreased functional status, and increased risk of institutionalization and mortality. Many remaining uncertainties regarding the epidemiology of cognitive change in PD require future research, with improved biomarkers and more sensitive and convenient outcome measures.
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Affiliation(s)
- Meredith A Bock
- Movement Disorders and Neuromodulation Center, Department of Neurology, Weill Institute for Neuroscience, University of California, San Francisco, CA, United States; Mental Illness Research, Education, and Clinical Center, San Francisco Veteran's Affairs Health Care System, San Francisco, CA, United States; Parkinson's Disease Research Education and Clinical Center, San Francisco Veteran's Affairs Health Care System, San Francisco, CA, United States
| | - Caroline M Tanner
- Movement Disorders and Neuromodulation Center, Department of Neurology, Weill Institute for Neuroscience, University of California, San Francisco, CA, United States; Parkinson's Disease Research Education and Clinical Center, San Francisco Veteran's Affairs Health Care System, San Francisco, CA, United States.
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Amboni M, Ricciardi C, Cuoco S, Donisi L, Volzone A, Ricciardelli G, Pellecchia MT, Santangelo G, Cesarelli M, Barone P. Mild Cognitive Impairment Subtypes Are Associated With Peculiar Gait Patterns in Parkinson's Disease. Front Aging Neurosci 2022; 14:781480. [PMID: 35299943 PMCID: PMC8923162 DOI: 10.3389/fnagi.2022.781480] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 01/31/2022] [Indexed: 12/02/2022] Open
Abstract
Background Mild cognitive impairment (MCI) is frequent in Parkinson's disease (PD) and represents a risk factor for the development of dementia associated with PD (PDD). Since PDD has been associated with disability, caregiver burden, and an increase in health-related costs, early detection of MCI associated with PD (PD-MCI) and its biomarkers is crucial. Objective Given that gait is considered a surrogate marker for cognitive decline in PD, the aim of this study was to compare gait patterns in PD-MCI subtypes in order to verify the existence of an association between specific gait features and particular MCI subtypes. Methods A total of 67 patients with PD were consecutively enrolled and assessed by an extensive clinical and cognitive examination. Based on the neuropsychological examination, patients were diagnosed as patients with MCI (PD-MCI) and without MCI (no-PD-MCI) and categorized in MCI subtypes. All patients were evaluated using a motion capture system of a BTS Bioengineering equipped with six IR digital cameras. Gait of the patients was assessed in the ON-state under three different tasks (a single task and two dual tasks). Statistical analysis included the t-test, the Kruskal-Wallis test with post hoc analysis, and the exploratory correlation analysis. Results Gait pattern was poorer in PD-MCI vs. no-PD-MCI in all tasks. Among PD-MCI subtypes, multiple-domain PD-MCI and amnestic PD-MCI were coupled with worse gait patterns, notably in the dual task. Conclusion Both the magnitude of cognitive impairment and the presence of memory dysfunction are associated with increased measures of dynamic unbalance, especially in dual-task conditions, likely mirroring the progressive involvement of posterior cortical networks.
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Affiliation(s)
- Marianna Amboni
- Department of Medicine, Surgery and Dentistry, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Fisciano, Italy
- Istituto di Diagnosi e Cura (IDC) Hermitage-Capodimonte, Naples, Italy
| | - Carlo Ricciardi
- Department of Electrical Engineering and Information Technology, University of Naples Federico II, Naples, Italy
- Istituti Clinici Scientifici Maugeri Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Telese Terme, Italy
| | - Sofia Cuoco
- Department of Medicine, Surgery and Dentistry, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Fisciano, Italy
| | - Leandro Donisi
- Istituti Clinici Scientifici Maugeri Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Telese Terme, Italy
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Antonio Volzone
- Department of Medicine, Surgery and Dentistry, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Fisciano, Italy
| | - Gianluca Ricciardelli
- Department of Medicine, Azienda Ospedaliera Universitaria OO. RR. San Giovanni di Dio e Ruggi D’Aragona, Salerno, Italy
| | - Maria Teresa Pellecchia
- Department of Medicine, Surgery and Dentistry, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Fisciano, Italy
| | - Gabriella Santangelo
- Department of Psychology, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Mario Cesarelli
- Department of Electrical Engineering and Information Technology, University of Naples Federico II, Naples, Italy
- Istituti Clinici Scientifici Maugeri Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Telese Terme, Italy
| | - Paolo Barone
- Department of Medicine, Surgery and Dentistry, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Fisciano, Italy
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Chiu SY, Bowers D, Armstrong MJ. Lewy Body Dementias: Controversies and Drug Development. Neurotherapeutics 2022; 19:55-67. [PMID: 34859379 PMCID: PMC9130410 DOI: 10.1007/s13311-021-01161-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2021] [Indexed: 01/03/2023] Open
Abstract
Lewy body dementia (LBD) is one of the most common neurodegenerative dementias. Clinical trials for symptomatic and disease-modifying therapies in LBD remain a national research priority, but there are many challenges in both past and active drug developments in LBD. This review highlights the controversies in picking the appropriate populations, interventions, target selections, and outcome measures, which are all critical components of clinical trial implementation in LBD. The heterogeneity of LBD neuropathology and clinical presentations, limited understanding of core features such as cognitive fluctuations, and lack of validated LBD-specific outcome measures and biomarkers represent some of the major challenges in LBD trials.
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Affiliation(s)
- Shannon Y Chiu
- Department of Neurology, University of Florida, PO Box 100268, Gainesville, FL, 32611, USA.
| | - Dawn Bowers
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, 32603, USA
| | - Melissa J Armstrong
- Department of Neurology, University of Florida, PO Box 100268, Gainesville, FL, 32611, USA
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Liebermann-Jordanidis H, Roheger M, Boosfeld L, Franklin J, Kalbe E. Which Test Is the Best to Assess Visuo-Cognitive Impairment in Patients with Parkinson's Disease with Mild Cognitive Impairment and Dementia? A Systematic Review and Meta-Analysis. JOURNAL OF PARKINSON'S DISEASE 2022; 12:1749-1782. [PMID: 35599499 DOI: 10.3233/jpd-223238] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Visuo-cognitive impairment is common in patients with Parkinson's disease with mild cognitive impairment (PD-MCI) and constitutes a prognostic factor for the conversion to Parkinson's disease dementia (PDD). However, systematic analyses on which neuropsychological tests are most suitable to assess visuo-cognition in PD-MCI and PDD and to differentiate these cognitive stages are lacking. OBJECTIVE To review neuropsychological tests used to assess visuo-cognition including visuo-perceptual and visuo-spatial processing, visuo-constructive copying and drawing on command abilities; and to identify the visuo-cognitive subdomain as well as tests most suitable to discriminate between PD-MCI and PDD. METHODS MEDLINE, PsycINFO, Web of Science Core Collection, and CENTRAL were systematically searched for relevant studies assessing visuo-cognitive outcomes in patients with PD-MCI and PDD. Risk of bias was assessed using a customized form based on well-established tools. Random-effect meta-analyses were conducted. RESULTS 33 studies were included in the systematic review. Data of 19 studies were entered in meta-analyses. Considerable heterogeneity regarding applied tests, test versions, and scoring systems exists. Data indicate that visuo-constructive command tasks are the subdomain best suited to discriminate between PD-MCI and PDD. Furthermore, they indicate that the Rey-Osterrieth-Complex-Figure Test (ROCF), Corsi Block-Tapping Test, Judgment of Line Orientation (JLO), and Clock Drawing Test (CDT) are tests able to differentiate between the two stages. CONCLUSION We provide suggestions for suitable visuo-cognitive tests (Corsi Block-Tapping Test, or JLO, ROCF, CDT) to improve diagnostic accuracy. Methodological challenges (e.g., heterogeneity of definitions, tests) are discussed and suggestions for future research are provided. REGISTRATION https://www.crd.york.ac.uk/prospero/, ID: CRD42018088244.
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Affiliation(s)
- Hannah Liebermann-Jordanidis
- Department of Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Mandy Roheger
- Department of Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Lukas Boosfeld
- Department of Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Jeremy Franklin
- Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, Cologne, Germany
| | - Elke Kalbe
- Department of Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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Mapping Actuarial Criteria for Parkinson’s Disease-Mild Cognitive Impairment onto Data-Driven Cognitive Phenotypes. Brain Sci 2021; 12:brainsci12010054. [PMID: 35053799 PMCID: PMC8773733 DOI: 10.3390/brainsci12010054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/05/2021] [Accepted: 12/22/2021] [Indexed: 11/17/2022] Open
Abstract
Prevalence rates for mild cognitive impairment in Parkinson’s disease (PD-MCI) remain variable, obscuring the diagnosis’ predictive utility of greater dementia risk. A primary factor of this variability is inconsistent operationalization of normative cutoffs for cognitive impairment. We aimed to determine which cutoff was optimal for classifying individuals as PD-MCI by comparing classifications against data-driven PD cognitive phenotypes. Participants with idiopathic PD (n = 494; mean age 64.7 ± 9) completed comprehensive neuropsychological testing. Cluster analyses (K-means, Hierarchical) identified cognitive phenotypes using domain-specific composites. PD-MCI criteria were assessed using separate cutoffs (−1, −1.5, −2 SD) on ≥2 tests in a domain. Cutoffs were compared using PD-MCI prevalence rates, MCI subtype frequencies (single/multi-domain, executive function (EF)/non-EF impairment), and validity against the cluster-derived cognitive phenotypes (using chi-square tests/binary logistic regressions). Cluster analyses resulted in similar three-cluster solutions: Cognitively Average (n = 154), Low EF (n = 227), and Prominent EF/Memory Impairment (n = 113). The −1.5 SD cutoff produced the best model of cluster membership (PD-MCI classification accuracy = 87.9%) and resulted in the best alignment between PD-MCI classification and the empirical cognitive profile containing impairments associated with greater dementia risk. Similar to previous Alzheimer’s work, these findings highlight the utility of comparing empirical and actuarial approaches to establish concurrent validity of cognitive impairment in PD.
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Martínez-Horta S, Bejr-Kasem H, Horta-Barba A, Pascual-Sedano B, Santos-García D, de Deus-Fonticoba T, Jesús S, Aguilar M, Planellas L, García-Caldentey J, Caballol N, Vives-Pastor B, Hernández-Vara J, Cabo-Lopez I, López-Manzanares L, González-Aramburu I, Ávila-Rivera MA, Catalán MJ, López-Díaz LM, Puente V, García-Moreno JM, Borrué C, Solano-Vila B, Álvarez-Sauco M, Vela L, Escalante S, Cubo E, Carrillo-Padilla F, Martínez-Castrillo JC, Sánchez-Alonso P, Alonso-Losada MG, López-Ariztegui N, Gastón I, Blázquez-Estrada M, Seijo-Martínez M, Rúiz-Martínez J, Valero-Merino C, Kurtis M, de Fábregues-Boixar O, González-Ardura J, Prieto-Jurczynska C, Martinez-Martin P, Mir P, Kulisevsky J. Identifying comorbidities and lifestyle factors contributing to the cognitive profile of early Parkinson's disease. BMC Neurol 2021; 21:477. [PMID: 34879838 PMCID: PMC8653592 DOI: 10.1186/s12883-021-02485-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 11/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Identifying modifiable risk factors for cognitive impairment in the early stages of Parkinson's disease (PD) and estimating their impact on cognitive status may help prevent dementia (PDD) and the design of cognitive trials. METHODS Using a standard approach for the assessment of global cognition in PD and controlling for the effects of age, education and disease duration, we explored the associations between cognitive status, comorbidities, metabolic variables and lifestyle variables in 533 PD participants from the COPPADIS study. RESULTS Among the overall sample, 21% of participants were classified as PD-MCI (n = 114) and 4% as PDD (n = 26). The prevalence of hypertension, diabetes and dyslipidemia was significantly higher in cognitively impaired patients while no between-group differences were found for smoking, alcohol intake or use of supplementary vitamins. Better cognitive scores were significantly associated with regular physical exercise (p < 0.05) and cognitive stimulation (< 0.01). Cognitive performance was negatively associated with interleukin 2 (Il2) (p < 0.05), Il6 (p < 0.05), iron (p < 0.05), and homocysteine (p < 0.005) levels, and positively associated with vitamin B12 levels (p < 0.005). CONCLUSIONS We extend previous findings regarding the positive and negative influence of various comorbidities and lifestyle factors on cognitive status in early PD patients, and reinforce the need to identify and treat potentially modifiable variables with the intention of exploring the possible improvement of the global cognitive status of patients with PD.
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Affiliation(s)
- Saul Martínez-Horta
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Mas Casanovas 90, 08041, Barcelona, Spain.,Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Helena Bejr-Kasem
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Mas Casanovas 90, 08041, Barcelona, Spain.,Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Andrea Horta-Barba
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Mas Casanovas 90, 08041, Barcelona, Spain.,Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Berta Pascual-Sedano
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Mas Casanovas 90, 08041, Barcelona, Spain.,Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | | | | | - Silvia Jesús
- Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Miquel Aguilar
- Hospital Universitari Mutua de Terrassa, Terrassa, Barcelona, Spain
| | | | - Juan García-Caldentey
- Hospital Quiron Palmaplanas, Clínica Rotger y Centro Neurológico Oms 42, Palma de Mallorca, Spain
| | - Nuria Caballol
- Consorci Sanitari Integral, Hospital Moisés Broggi, Sant Joan Despí, Barcelona, Spain
| | | | - Jorge Hernández-Vara
- Neurology Department and Neurodegenerative Diseases Research Group, Vall D'Hebron Universitari Campus, Barcelona, Spain
| | - Iria Cabo-Lopez
- Complejo Hospitalario Universitario de Pontevedra (CHOP), Pontevedra, Spain
| | | | | | | | | | | | | | | | - Carmen Borrué
- Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - Berta Solano-Vila
- Hospital Universitari Josep Trueta y Hospital Santa Caterina, Girona, Spain
| | | | - Lydia Vela
- Fundación Hospital de Alcorcón, Madrid, Spain
| | - Sonia Escalante
- Hospital de Tortosa Verge de la Cinta (HTVC), Tortosa, Tarragona, Spain
| | - Esther Cubo
- Complejo Asistencial Universitario de Burgos, Burgos, Spain
| | - Francisco Carrillo-Padilla
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica. Hospital Universitario de Canarias, Tenerife, Spain
| | | | | | | | - Nuria López-Ariztegui
- Servicio de Neurología, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | | | | | | | | | | | | | - Oriol de Fábregues-Boixar
- Neurology Department and Neurodegenerative Diseases Research Group, Vall D'Hebron Universitari Campus, Barcelona, Spain
| | | | | | - Pablo Martinez-Martin
- Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Centro Nacional de Epidemiología y CIBERNED, Instituto de Salud Carlos III, Madrid, Spain
| | - Pablo Mir
- Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain.,Departamento de Medicina, Facultad de Medicina, Universidad de Sevilla, Sevilla, Spain
| | - Jaime Kulisevsky
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Mas Casanovas 90, 08041, Barcelona, Spain. .,Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain. .,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.
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40
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Xue B, Xiao A, Luo X, Li R. The effect of a game training intervention on cognitive functioning and depression symptoms in the elderly with mild cognitive impairment: A randomized controlled trial. Int J Methods Psychiatr Res 2021; 30:e1887. [PMID: 34291527 PMCID: PMC8633942 DOI: 10.1002/mpr.1887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/10/2021] [Accepted: 07/08/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES This study aimed to explore whether game training could improve cognitive functioning and depression symptoms in the elderly affected by mild cognitive impairment (MCI). METHODS A non-blinded randomized controlled trial was conducted. Participants were 72 patients with MCI and depression from a nursing home in Wuhan. Participants were randomized to either the intervention group or the control group (n = 36 each). The intervention group received regular nursing care plus game training for 50 min, three times per week for 8 weeks, whereas the control group received only regular nursing care during the same research period. Cognitive functioning and depression symptoms were tested in both groups at baseline and at the end of the 8-week intervention. We used the Montreal Cognitive Assessment and the 15-item Geriatric Depression Scale to assess cognitive functioning and depression symptoms, respectively. RESULTS The 8-week game training intervention significantly improved the cognitive and depression scores when compared with the control group and baseline scores (p < 0.05). No significant difference was observed in the control group (p > 0.05). CONCLUSIONS Our results suggest that the implementation of game training can improve the cognitive functioning and depression symptoms of the elderly with MCI, indicated that can be widely used.
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Affiliation(s)
- Bing Xue
- Department of Nursing, School of Health Sciences, Wuhan University, Wuhan, China
| | - Ao Xiao
- Department of Nursing, School of Health Sciences, Wuhan University, Wuhan, China
| | - Xianwu Luo
- Department of Nursing, School of Health Sciences, Wuhan University, Wuhan, China.,Department of Healthcare Management, School of Health Sciences, Wuhan University, Wuhan, China
| | - Rui Li
- Department of Healthcare Management, School of Health Sciences, Wuhan University, Wuhan, China
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Che NN, Jiang QH, Ding GX, Chen SY, Zhao ZX, Li X, Malik RA, Ma JJ, Yang HQ. Corneal nerve fiber loss relates to cognitive impairment in patients with Parkinson’s disease. NPJ Parkinsons Dis 2021; 7:80. [PMID: 34504084 PMCID: PMC8429586 DOI: 10.1038/s41531-021-00225-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 08/10/2021] [Indexed: 11/27/2022] Open
Abstract
Cognitive impairment in Parkinson’s disease (PD) adversely influences quality of life. There is currently no available biomarker to predict cognitive decline in PD. Corneal confocal microscopy (CCM) has been used as a non-invasive tool for quantifying small nerve damage in PD. The present study investigated whether corneal nerve measures were associated with cognitive function in PD. Patients with PD were classified into those with normal cognitive function (PD-CN), mild cognitive impairment (PD-MCI), and dementia (PDD). Corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD), and corneal nerve fiber length (CNFL) were quantified with CCM and compared with a control group. Sixty-five PD patients and thirty controls were studied. CNFD was decreased and CNBD was increased in PD patients compared to controls (P < 0.05). CNBD and CNBD/CNFD ratio was higher in PD-CN compared to controls. CNFD was positively correlated with the Montreal cognitive assessment (MoCA) score (r = 0.683, P < 0.001), but negatively associated with unified Parkinson disease rating scale (UPDRS)-part III (r = −0.481, P < 0.001) and total UPDRS scores (r = −0.401, P = 0.001) in PD patients. There was no correlation between CNFD and Levodopa equivalent daily dose (LEDD) (r = 0.176, P = 0.161). CNFD, CNBD, CNFL, and CNBD/CNFD ratio was lower with increasing Hoehn and Yahr stage. PD patients show evidence of corneal nerve loss compared with controls and corneal nerve parameters are associated with the severity of cognitive and motor dysfunction in PD. CCM could serve as an objective in vivo ophthalmic imaging technique to assess neurodegeneration in PD.
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Iarkov A, Mendoza C, Echeverria V. Cholinergic Receptor Modulation as a Target for Preventing Dementia in Parkinson's Disease. Front Neurosci 2021; 15:665820. [PMID: 34616271 PMCID: PMC8488354 DOI: 10.3389/fnins.2021.665820] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 08/26/2021] [Indexed: 12/20/2022] Open
Abstract
Parkinson’s disease (PD) is a neurodegenerative condition characterized by the loss of dopaminergic neurons in the substantia nigra pars compacta (SNpc) in the midbrain resulting in progressive impairment in cognitive and motor abilities. The physiological and molecular mechanisms triggering dopaminergic neuronal loss are not entirely defined. PD occurrence is associated with various genetic and environmental factors causing inflammation and mitochondrial dysfunction in the brain, leading to oxidative stress, proteinopathy, and reduced viability of dopaminergic neurons. Oxidative stress affects the conformation and function of ions, proteins, and lipids, provoking mitochondrial DNA (mtDNA) mutation and dysfunction. The disruption of protein homeostasis induces the aggregation of alpha-synuclein (α-SYN) and parkin and a deficit in proteasome degradation. Also, oxidative stress affects dopamine release by activating ATP-sensitive potassium channels. The cholinergic system is essential in modulating the striatal cells regulating cognitive and motor functions. Several muscarinic acetylcholine receptors (mAChR) and nicotinic acetylcholine receptors (nAChRs) are expressed in the striatum. The nAChRs signaling reduces neuroinflammation and facilitates neuronal survival, neurotransmitter release, and synaptic plasticity. Since there is a deficit in the nAChRs in PD, inhibiting nAChRs loss in the striatum may help prevent dopaminergic neurons loss in the striatum and its pathological consequences. The nAChRs can also stimulate other brain cells supporting cognitive and motor functions. This review discusses the cholinergic system as a therapeutic target of cotinine to prevent cognitive symptoms and transition to dementia in PD.
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Affiliation(s)
- Alexandre Iarkov
- Laboratorio de Neurobiología, Facultad de Ciencias de la Salud, Universidad San Sebastián, Concepción, Chile
| | - Cristhian Mendoza
- Laboratorio de Neurobiología, Facultad de Ciencias de la Salud, Universidad San Sebastián, Concepción, Chile
| | - Valentina Echeverria
- Laboratorio de Neurobiología, Facultad de Ciencias de la Salud, Universidad San Sebastián, Concepción, Chile.,Research & Development Service, Bay Pines VA Healthcare System, Bay Pines, FL, United States
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43
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What Do We Know about Theory of Mind Impairment in Parkinson's Disease? Behav Sci (Basel) 2021; 11:bs11100130. [PMID: 34677223 PMCID: PMC8533307 DOI: 10.3390/bs11100130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/17/2021] [Accepted: 09/20/2021] [Indexed: 12/15/2022] Open
Abstract
Theory of mind (ToM) is a social cognitive skill that involves the ability to attribute mental states to self and others (what they think (cognitive ToM) and feel (affective ToM)). We aim to provide an overview of previous knowledge of ToM in Parkinson's disease (PD). In the last few years more attention has been paid to the study of this construct as a non-motor manifestation of PD. In advanced stages, both components of ToM (cognitive and affective) are commonly impaired, although in early PD results remain controversial. Executive dysfunction correlates with ToM deficits and other cognitive domains such as language and visuospatial function have also been related to ToM. Recent studies have demonstrated that PD patients with mild cognitive impairment show ToM deficits more frequently in comparison with cognitively normal PD patients. In addition to the heterogeneity of ToM tests administered in different studies, depression and dopaminergic medication may also be acting as confounding factors, but there are still insufficient data to support this. Neuroimaging studies conducted to understand the underlying networks of cognitive and affective ToM deficits in PD are lacking. The study of ToM deficit in PD continues to be important, as this may worsen quality of life and favor social stigma. Future studies should be considered, including assessment of the patients' cognitive state, associated mood disorders, and the role of dopaminergic deficit.
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Aracil-Bolaños I, Sampedro F, Marín-Lahoz J, Horta-Barba A, Martínez-Horta S, Gónzalez-de-Echávarri JM, Pérez-Pérez J, Bejr-Kasem H, Pascual-Sedano B, Botí M, Campolongo A, Izquierdo C, Gironell A, Gómez-Ansón B, Kulisevsky J, Pagonabarraga J. Tipping the scales: how clinical assessment shapes the neural correlates of Parkinson's disease mild cognitive impairment. Brain Imaging Behav 2021; 16:761-772. [PMID: 34553331 DOI: 10.1007/s11682-021-00543-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2021] [Indexed: 11/30/2022]
Abstract
Mild cognitive impairment in Parkinson's disease (PD-MCI) is associated with consistent structural and functional brain changes. Whether different approaches for diagnosing PD-MCI are equivalent in their neural correlates is presently unknown. We aimed to profile the neuroimaging changes associated with the two endorsed methods of diagnosing PD-MCI. We recruited 53 consecutive non-demented PD patients and classified them as PD-MCI according to comprehensive neuropsychological examination as operationalized by the Movement Disorders Task Force. Voxel-based morphometry, cortical thickness, functional connectivity and graph theoretical measures were obtained on a 3-Tesla MRI scanner. 18 patients (32%) were classified as PD-MCI with Level-II criteria, 19 (33%) with the Parkinson's disease Cognitive Rating Scale (PD-CRS) and 32 (60%) with the Montreal Cognitive Assessment (MoCA) scale. Though regions of atrophy differed across classifications, reduced gray matter in the precuneus was found using both Level-II and PD-CRS classifications in PD-MCI patients. Patients diagnosed with the PD-CRS also showed extensive changes in cortical thickness, concurring with the MoCA in regions of the cingulate cortex, and again with Level-II regarding cortical thinning in the precuneus. Functional connectivity analysis found higher coherence within salience network regions of interest, and decreased anticorrelations between salience/central executive and default-mode networks in the PD-CRS classification for PD-MCI patients. Graph theoretical metrics showed a widespread decrease in node degree for the three classifications in PD-MCI, whereas betweenness centrality was increased in select nodes of the default mode network (DMN). Clinical and neuroimaging commonalities between the endorsed methods of cognitive assessment suggest a corresponding set of neural correlates in PD-MCI: loss of structural integrity in DMN structures, mainly the precuneus, and a loss of weighted connections in the salience network that might be counterbalanced by increased centrality in the DMN. Furthermore, the similarity of the results between exhaustive Level-II and screening Level-I tools might have practical implications in the search for neuroimaging biomarkers of cognitive impairment in Parkinson's disease.
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Affiliation(s)
- Ignacio Aracil-Bolaños
- Movement Disorders Unit, Neurology Department, Sant Pau Hospital, Mas Casanovas 90-08041, Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona (U.A.B.), Barcelona, Spain.,Institut d'Investigacions Biomèdiques- Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Frederic Sampedro
- Institut d'Investigacions Biomèdiques- Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Juan Marín-Lahoz
- Movement Disorders Unit, Neurology Department, Sant Pau Hospital, Mas Casanovas 90-08041, Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona (U.A.B.), Barcelona, Spain.,Institut d'Investigacions Biomèdiques- Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Andrea Horta-Barba
- Movement Disorders Unit, Neurology Department, Sant Pau Hospital, Mas Casanovas 90-08041, Barcelona, Spain.,Institut d'Investigacions Biomèdiques- Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Saül Martínez-Horta
- Movement Disorders Unit, Neurology Department, Sant Pau Hospital, Mas Casanovas 90-08041, Barcelona, Spain.,Institut d'Investigacions Biomèdiques- Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | | | - Jesús Pérez-Pérez
- Movement Disorders Unit, Neurology Department, Sant Pau Hospital, Mas Casanovas 90-08041, Barcelona, Spain.,Institut d'Investigacions Biomèdiques- Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Helena Bejr-Kasem
- Movement Disorders Unit, Neurology Department, Sant Pau Hospital, Mas Casanovas 90-08041, Barcelona, Spain.,Institut d'Investigacions Biomèdiques- Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Berta Pascual-Sedano
- Movement Disorders Unit, Neurology Department, Sant Pau Hospital, Mas Casanovas 90-08041, Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona (U.A.B.), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Mariángeles Botí
- Movement Disorders Unit, Neurology Department, Sant Pau Hospital, Mas Casanovas 90-08041, Barcelona, Spain.,Institut d'Investigacions Biomèdiques- Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Antonia Campolongo
- Movement Disorders Unit, Neurology Department, Sant Pau Hospital, Mas Casanovas 90-08041, Barcelona, Spain.,Institut d'Investigacions Biomèdiques- Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Cristina Izquierdo
- Movement Disorders Unit, Neurology Department, Sant Pau Hospital, Mas Casanovas 90-08041, Barcelona, Spain.,Institut d'Investigacions Biomèdiques- Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Alexandre Gironell
- Movement Disorders Unit, Neurology Department, Sant Pau Hospital, Mas Casanovas 90-08041, Barcelona, Spain.,Institut d'Investigacions Biomèdiques- Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Beatriz Gómez-Ansón
- Departament de Medicina, Universitat Autònoma de Barcelona (U.A.B.), Barcelona, Spain.,Institut d'Investigacions Biomèdiques- Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Neuroradiology Unit, Sant Pau Hospital, Barcelona, Spain
| | - Jaime Kulisevsky
- Movement Disorders Unit, Neurology Department, Sant Pau Hospital, Mas Casanovas 90-08041, Barcelona, Spain. .,Departament de Medicina, Universitat Autònoma de Barcelona (U.A.B.), Barcelona, Spain. .,Institut d'Investigacions Biomèdiques- Sant Pau (IIB-Sant Pau), Barcelona, Spain. .,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.
| | - Javier Pagonabarraga
- Movement Disorders Unit, Neurology Department, Sant Pau Hospital, Mas Casanovas 90-08041, Barcelona, Spain. .,Departament de Medicina, Universitat Autònoma de Barcelona (U.A.B.), Barcelona, Spain. .,Institut d'Investigacions Biomèdiques- Sant Pau (IIB-Sant Pau), Barcelona, Spain. .,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.
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De Roy J, Postuma RB, Brillon-Corbeil M, Montplaisir J, Génier Marchand D, Escudier F, Panisset M, Chouinard S, Gagnon JF. Detecting the Cognitive Prodrome of Dementia in Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2021; 10:1033-1046. [PMID: 32310188 DOI: 10.3233/jpd-191857] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND More than 75% of Parkinson's disease (PD) patients will develop dementia. Previous studies on the cognitive predictors of dementia in PD had some methodological limitations and the cognitive tests identified as good predictors vary greatly. OBJECTIVE This prospective cohort study aims to identify the optimal cognitive predictors of dementia in PD using complementary statistical methods. METHODS Eighty PD patients without dementia underwent polysomnographic recording, a neurological examination, and a complete neuropsychological assessment at baseline. They were then followed for a mean of 4.3 years. Baseline group comparisons and survival analyses were used to identify optimal cognitive predictors. Moreover, patients who developed dementia were pair-matched at baseline according to age, sex, and education to healthy controls (2 : 1), and receiver operating characteristic curves were calculated for cognitive tests. RESULTS At follow-up, 23 patients (29%) developed dementia. PD patients who developed dementia had poorer baseline performance and a higher proportion of clinically impaired performance on several cognitive tests. Impaired baseline performance on the Block Design subtest was the best independent predictor of dementia (HR = 8). Moreover, the Trail Making Test part B (time) and Verbal Fluency (semantic) had the best psychometric properties (area under the curve >0.90) for identifying PD patients at risk of dementia. CONCLUSION The present study identified three cognitive tests as the most accurate to detect individuals with PD at high risk of developing dementia.
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Affiliation(s)
- Jessie De Roy
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada.,Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada
| | - Ronald B Postuma
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada.,Department of Neurology, Montreal General Hospital, Montreal, QC, Canada
| | - Marina Brillon-Corbeil
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada.,Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada
| | - Jacques Montplaisir
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada.,Department of Psychiatry, Université de Montréal, Montréal, QC, Canada
| | - Daphné Génier Marchand
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada.,Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada
| | - Frédérique Escudier
- Research Centre, Institut Universitaire de gériatrie de Montréal, Montreal, QC, Canada
| | - Michel Panisset
- Unité des troubles du mouvement André Barbeau, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Sylvain Chouinard
- Unité des troubles du mouvement André Barbeau, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Jean-François Gagnon
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada.,Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada.,Research Centre, Institut Universitaire de gériatrie de Montréal, Montreal, QC, Canada
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Analyses of Visuospatial and Visuoperceptual Errors as Predictors of Dementia in Parkinson's Disease Patients with Subjective Cognitive Decline and Mild Cognitive Impairment. J Int Neuropsychol Soc 2021; 27:722-732. [PMID: 33303048 DOI: 10.1017/s1355617720001216] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Subjective cognitive decline (SCD) and mild cognitive impairment (MCI) in Parkinson's disease (PD) are considered as the risk factors for dementia (PDD). Posterior cortically based functions, such as visuospatial and visuoperceptual (VS-VP) processing, have been described as predictors of PDD. However, no investigations have focused on the qualitative analysis of the Judgment of Line Orientation Test (JLOT) and the Facial Recognition Test (FRT) in PD-SCD and PD-MCI. The aim of this work was to study the VS-VP errors in JLOT and FRT. Moreover, these variables are considered as predictors of PDD. METHOD Forty-two PD patients and 19 controls were evaluated with a neuropsychological protocol. Patients were classified as PD-SCD and PD-MCI. Analyses of errors were conducted following the procedure described by Ska, Poissant, and Joanette (1990). Follow-up assessment was conducted to a mean of 7.5 years after the baseline. RESULTS PD-MCI patients showed a poor performance in JLOT and FRT total score and made a greater proportion of severe intraquadrant (QO2) and interquadrant errors (IQO). PD-SCD showed a poor performance in FRT and made mild errors in JLOT. PD-MCI and QO2/IQO errors were independent risk factors for PDD during the follow-up. Moreover, the combination of both PD-MCI diagnosis and QO2/IQO errors was associated with a greater risk. CONCLUSIONS PD-MCI patients presented a greater alteration in VS-VP processing observable by the presence of severe misjudgments. PD-SCD patients also showed mild difficulties in VS-SP functions. Finally, QO2/IQO errors in PD-MCI are a useful predictor of PDD, more than PD-MCI diagnosis alone.
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Liu H, Deng B, Xie F, Yang X, Xie Z, Chen Y, Yang Z, Huang X, Zhu S, Wang Q. The influence of white matter hyperintensity on cognitive impairment in Parkinson's disease. Ann Clin Transl Neurol 2021; 8:1917-1934. [PMID: 34310081 PMCID: PMC8419402 DOI: 10.1002/acn3.51429] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/05/2021] [Accepted: 07/02/2021] [Indexed: 01/11/2023] Open
Abstract
The aim of this meta‐analysis was to review systematically and to identify the relationship between the severity and location of white matter hyperintensities (WMHs) and the degree of cognitive decline in patients with Parkinson’s disease (PD). We searched the PubMed, EMBASE, Web of Science, Ovid, and Cochrane Library databases for clinical trials of the severity and location of WMHs on the degree of cognitive impairment in PD through October 2020. We conducted the survey to compare the association of WMH burden in patients with PD with mild cognitive impairment (PD‐MCI) versus those with normal cognition (PD‐NC) and in patients with PD with dementia (PDD) versus those with PD without dementia (PD‐ND). Nine studies with PD‐MCI versus PD‐NC and 10 studies with PDD versus PD‐ND comparisons were included. The WMH burden in PD‐MCI patients was significantly different compared to that in PD‐NC patients (standard mean difference, SMD = 0.39, 95% CI: 0.12 to 0.66, p = 0.005), while there was no correlation shown in the age‐matched subgroup of the comparison. In addition, PDD patients had a significantly higher burden of WMHs (SMD = 0.8, 95% CI: 0.44 to 1.71, p < 0.0001), especially deep white matter hyperintensities (SMD = 0.54, 95% CI: 0.36 to 0.73, p < 0.00001) and periventricular hyperintensities (SMD = 0.70, 95% CI: 0.36 to 1.04, p < 0.0001), than PD‐NC patients, regardless of the adjustment of age. WMHs might be imaging markers for cognitive impairment in PDD but not in PD‐MCI, regardless of age, vascular risk factors, or race. Further prospective studies are needed to validate the conclusions.
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Affiliation(s)
- Hailing Liu
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, 510282, P.R. China.,Department of Neurology, Maoming People's Hospital, Maoming, Guangdong, China
| | - Bin Deng
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, 510282, P.R. China
| | - Fen Xie
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, 510282, P.R. China
| | - Xiaohua Yang
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, 510282, P.R. China
| | - Zhenchao Xie
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, 510282, P.R. China
| | - Yonghua Chen
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, 510282, P.R. China
| | - Zhi Yang
- Department of Neurology, Maoming People's Hospital, Maoming, Guangdong, China
| | - Xiyan Huang
- Department of Rehabilitation, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, 510282, P.R. China
| | - Shuzhen Zhu
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, 510282, P.R. China
| | - Qing Wang
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, 510282, P.R. China
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Aarsland D, Batzu L, Halliday GM, Geurtsen GJ, Ballard C, Ray Chaudhuri K, Weintraub D. Parkinson disease-associated cognitive impairment. Nat Rev Dis Primers 2021; 7:47. [PMID: 34210995 DOI: 10.1038/s41572-021-00280-3] [Citation(s) in RCA: 341] [Impact Index Per Article: 113.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 02/08/2023]
Abstract
Parkinson disease (PD) is the second most common neurodegenerative disorder, affecting >1% of the population ≥65 years of age and with a prevalence set to double by 2030. In addition to the defining motor symptoms of PD, multiple non-motor symptoms occur; among them, cognitive impairment is common and can potentially occur at any disease stage. Cognitive decline is usually slow and insidious, but rapid in some cases. Recently, the focus has been on the early cognitive changes, where executive and visuospatial impairments are typical and can be accompanied by memory impairment, increasing the risk for early progression to dementia. Other risk factors for early progression to dementia include visual hallucinations, older age and biomarker changes such as cortical atrophy, as well as Alzheimer-type changes on functional imaging and in cerebrospinal fluid, and slowing and frequency variation on EEG. However, the mechanisms underlying cognitive decline in PD remain largely unclear. Cortical involvement of Lewy body and Alzheimer-type pathologies are key features, but multiple mechanisms are likely involved. Cholinesterase inhibition is the only high-level evidence-based treatment available, but other pharmacological and non-pharmacological strategies are being tested. Challenges include the identification of disease-modifying therapies as well as finding biomarkers to better predict cognitive decline and identify patients at high risk for early and rapid cognitive impairment.
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Affiliation(s)
- Dag Aarsland
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. .,Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway.
| | - Lucia Batzu
- Parkinson's Foundation Centre of Excellence, King's College Hospital and Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Glenda M Halliday
- Brain and Mind Centre and Faculty of Medicine and Health School of Medical Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Gert J Geurtsen
- Amsterdam UMC, University of Amsterdam, Department of Medical Psychology, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | | | - K Ray Chaudhuri
- Parkinson's Foundation Centre of Excellence, King's College Hospital and Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Daniel Weintraub
- Departments of Psychiatry and Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Parkinson's Disease Research, Education and Clinical Center (PADRECC), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
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Geurts HM, McQuaid GA, Begeer S, Wallace GL. Self-reported parkinsonism features in older autistic adults: A descriptive study. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:217-229. [PMID: 34154378 PMCID: PMC8750133 DOI: 10.1177/13623613211020183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
LAY ABSTRACT Autistic adults without a suspected intellectual disability reported several motor features such as having tremors, and stiffness in one's legs which are considered to be part of a complex of motor features called parkinsonism. This so-called parkinsonism was remarkably prevalent in middle-aged and older autistic adults in two independent studies (Dutch study: 50-81 years, 183 males, 113 females, all adulthood diagnoses; the USA study: 50-83 years, 110 females, 109 males, majority adulthood diagnosis). Parkinsonism can be part of the progressive motor disease-Parkinson's disease. Therefore, it is important that future studies, including in-person neurological assessment, determine if (and if so, why) autistic adults who report these motor features are at increased risk for developing Parkinson's disease.
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Affiliation(s)
- Hilde M Geurts
- University of Amsterdam, The Netherlands.,Leo Kannerhuis (Youz/Parnassiagroup), The Netherlands
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Gonzalez-Latapi P, Bayram E, Litvan I, Marras C. Cognitive Impairment in Parkinson's Disease: Epidemiology, Clinical Profile, Protective and Risk Factors. Behav Sci (Basel) 2021; 11:bs11050074. [PMID: 34068064 PMCID: PMC8152515 DOI: 10.3390/bs11050074] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/07/2021] [Accepted: 05/08/2021] [Indexed: 02/07/2023] Open
Abstract
Cognitive impairment is a common non-motor symptom in Parkinson's Disease (PD) and an important source of patient disability and caregiver burden. The timing, profile and rate of cognitive decline varies widely among individuals with PD and can range from normal cognition to mild cognitive impairment (PD-MCI) and dementia (PDD). Beta-amyloid and tau brain accumulation, oxidative stress and neuroinflammation are reported risk factors for cognitive impairment. Traumatic brain injury and pesticide and tobacco exposure have also been described. Genetic risk factors including genes such as COMT, APOE, MAPT and BDNF may also play a role. Less is known about protective factors, although the Mediterranean diet and exercise may fall in this category. Nonetheless, there is conflicting evidence for most of the factors that have been studied. The use of inconsistent criteria and lack of comprehensive assessment in many studies are important methodological issues. Timing of exposure also plays a crucial role, although identification of the correct time window has been historically difficult in PD. Our understanding of the mechanism behind these factors, as well as the interactions between gene and environment as determinants of disease phenotype and the identification of modifiable risk factors will be paramount, as this will allow for potential interventions even in established PD.
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Affiliation(s)
- Paulina Gonzalez-Latapi
- Edmond J. Safra Program in Parkinson’s Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, ON M5T2S8, Canada;
| | - Ece Bayram
- Parkinson and Other Movement Disorders Center, Department of Neurosciences, University of California San Diego, La Jolla, CA 92093, USA; (E.B.); (I.L.)
| | - Irene Litvan
- Parkinson and Other Movement Disorders Center, Department of Neurosciences, University of California San Diego, La Jolla, CA 92093, USA; (E.B.); (I.L.)
| | - Connie Marras
- Edmond J. Safra Program in Parkinson’s Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, ON M5T2S8, Canada;
- Correspondence:
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