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Bayram E, Banks SJ. Risk of impairment in cognitive instrumental activities of daily living for sexual and gender minority adults with reported Parkinson's disease. Clin Neuropsychol 2024:1-22. [PMID: 38741341 DOI: 10.1080/13854046.2024.2350096] [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: 06/20/2023] [Accepted: 04/26/2024] [Indexed: 05/16/2024]
Abstract
Objective: To investigate the risk of impairment in cognitive instrumental activities of daily living (IADL) for people with Parkinson's (PwP) identifying as sexual and/or gender minorities (SGM). Method: Data were obtained from Fox Insight, an online, longitudinal study with self/informant-report questionnaires from PwP and people without Parkinson's. Groups consisted of PwP without cognitive IADL impairment at baseline, identifying as (1) SGM with female sex assigned at birth (SGM-F, n = 75); (2) cisgender, heterosexual with female sex assigned at birth (CH-F, n = 2046); (3) SGM with male sex assigned at birth (SGM-M, n = 84); (4) cisgender, heterosexual with male sex assigned at birth (CH-M, n = 2056). Impairment in cognitive IADL was based on Penn Parkinson's Daily Activities Questionnaire-15 (PDAQ-15). Group differences for PDAQ-15 and impairment likelihood during follow-up were assessed with unadjusted models and adjusting for variables that differed between the groups. Results: SGM-F were the youngest at Parkinson's diagnosis; SGM-M had the lowest PDAQ-15 at baseline (p ≤ .014 for all). Scores declined more for males than females in unadjusted and adjusted models (p < .001 for both). In unadjusted models, SGM-M had a higher impairment risk than PwP identifying as cisgender and heterosexual (p ≤ .018). In adjusted models, females had a lower impairment risk than males (p < .001). Age, education, and discrimination level were significant moderators (p < .001 for all). Conclusions: SGM-M can be at a higher risk for impairment in cognitive IADL, associated with social determinants. Female sex assigned at birth may be associated with a lower level of impairment risk, although this advantage can disappear with social determinants.
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Affiliation(s)
- Ece Bayram
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Sarah J Banks
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
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Siciliano M, Tessitore A, Morgante F, Goldman JG, Ricciardi L. Subjective Cognitive Complaints in Parkinson's Disease: A Systematic Review and Meta-Analysis. Mov Disord 2024; 39:17-28. [PMID: 38173220 DOI: 10.1002/mds.29649] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 10/15/2023] [Accepted: 10/17/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Subjective cognitive complaints (SCCs) in Parkinson's disease (PD) are reported frequently, but their prevalence and association with changes on objective testing are not fully known. OBJECTIVE We aimed to determine the prevalence, clinical correlates, and predictive value of SCCs in PD. METHODS We conducted a systematic review and meta-analysis. From 204 abstracts, we selected 31 studies (n = 3441 patients), and from these, identified the prevalence, clinical features, associations with neuropsychiatric symptoms, and predictive values of SCCs in PD. RESULTS The meta-analysis showed an SCC prevalence of 36%. This prevalence, however, was significantly moderated by study heterogeneity regarding female sex, disease severity, levodopa equivalent daily dosage, exclusion from the overall sample of patients with objective cognitive impairment, and measurement instrument. SCC prevalence did not differ between de novo and treated PD patients. SCCs were weakly and negligibly associated with cognitive changes on objective testing in cross-sectional studies. However, in cognitively healthy patients, SCCs had a risk ratio of 2.71 for later cognitive decline over a mean follow-up of 3.16 years. Moreover, SCCs were moderately related to co-occurring symptoms of depression, anxiety, or apathy and were more strongly related to these neuropsychiatric symptoms than objective cognitive functioning. CONCLUSION Our analyses suggest that SCCs in patients with and without objective cognitive impairment are frequent, occurring in more than one third of PD patients. Establishing uniform measurement instruments for identifying PD-related SCCs is critical to understand their implications. Even in cases lacking evidence of objective cognitive impairment and where SCCs might reflect underlying neuropsychiatric symptoms, the possibility of later cognitive deterioration should not be excluded. Therefore, SCCs in PD patients warrant close monitoring for opportunities for targeted and effective interventions. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Mattia Siciliano
- Department of Advanced Medical and Surgical Sciences-MRI Research Center Vanvitelli-FISM, University of Campania "Luigi Vanvitelli", Naples, Italy
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom
| | - Alessandro Tessitore
- Department of Advanced Medical and Surgical Sciences-MRI Research Center Vanvitelli-FISM, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesca Morgante
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom
| | | | - Lucia Ricciardi
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom
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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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Degirmenci Y, Angelopoulou E, Georgakopoulou VE, Bougea A. Cognitive Impairment in Parkinson's Disease: An Updated Overview Focusing on Emerging Pharmaceutical Treatment Approaches. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1756. [PMID: 37893474 PMCID: PMC10608778 DOI: 10.3390/medicina59101756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/17/2023] [Accepted: 09/29/2023] [Indexed: 10/29/2023]
Abstract
Cognitive impairment in patients with Parkinson's disease (PD) is one of the commonest and most disabling non-motor manifestations during the course of the disease. The clinical spectrum of PD-related cognitive impairment includes subjective cognitive decline (SCD), mild cognitive impairment (MCI) and PD dementia (PDD). As the disease progresses, cognitive decline creates a significant burden for the family members and/or caregivers of patients with PD, and has a great impact on quality of life. Current pharmacological treatments have demonstrated partial efficacy and failed to halt disease progression, and novel, effective, and safe therapeutic strategies are required. Accumulating preclinical and clinical evidence shows that several agents may provide beneficial effects on patients with PD and cognitive impairment, including ceftriaxone, ambroxol, intranasal insulin, nilotinib, atomoxetine, mevidalen, blarcamesine, prasinezumab, SYN120, ENT-01, NYX-458, GRF6021, fosgonimeton, INT-777, Neuropeptide S, silibinin, osmotin, cordycepin, huperzine A, fibroblast growth factor 21, Poloxamer 188, ginsenoside Rb1, thioredoxin-1, tangeretin, istradefylline and Eugenia uniflora. Potential underlying mechanisms include the inhibition of a-synuclein aggregation, the improvement of mitochondrial function, the regulation of synaptic plasticity, an impact on the gut-brain axis, the modulation of neuroinflammation and the upregulation of neurotrophic factors, as well as cholinergic, dopaminergic, serotoninergic and norepinephrine neurotransmission. In this updated overview, we aim to cover the clinical aspects of the spectrum of PD-related cognitive impairment and discuss recent evidence on emerging treatment approaches that are under investigation at a preclinical and clinical level. Finally, we aim to provide additional insights and propose new ideas for investigation that may be feasible and effective for the spectrum of PD-related cognitive impairment.
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Affiliation(s)
- Yildiz Degirmenci
- Department of Neurology, School of Medicine, Istanbul Health and Technology University, 34093 Istanbul, Turkey;
- Parkinson’s Disease and Movement Disorders Unit, Neurology Clinic, Sisli Kolan International Hospital, 34384 Istanbul, Turkey
| | - Efthalia Angelopoulou
- 1st Department of Neurology, Medical School, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece;
| | | | - Anastasia Bougea
- 1st Department of Neurology, Medical School, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece;
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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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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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Rosenblum S, Meyer S, Richardson A, Hassin-Baer S. Early identification of subjective cognitive functional decline among patients with Parkinson's disease: a longitudinal pilot study. Sci Rep 2022; 12:22242. [PMID: 36564494 PMCID: PMC9789081 DOI: 10.1038/s41598-022-26280-1] [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: 07/20/2022] [Accepted: 12/13/2022] [Indexed: 12/25/2022] Open
Abstract
Practical methods for early identification of Parkinson's disease (PD) mild cognitive impairment (PD-MCI) through changes in real-life daily functioning are scarce. The aim of the study was to examine whether the cognitive functional (CF) feature, comprising of seven self-reported Movement Disorder Society's (MDS) Unified Parkinson's Disease Rating Scale (UPDRS) items, predicts PD patients' cognitive functional status after a year. We conducted a 1-year follow-up of 34 PD patients (50-78 year; 70.6% men) suspected of MCI using the following measures: the MDS-UPDRS, UPDRS-CF feature, Beck Depression Inventory (BDI), Montreal Cognitive Assessment (MoCA), Trail Making Test (TMT), Parkinson's Disease Cognitive Functional Rating Scale (PD-CFRS), and Daily Living Questionnaire (DLQ). The first and second UPDRS-CF feature scores, and additional measures at the 1-year follow-up significantly correlated. Hierarchical regression revealed that the initial MoCA, TMT, and BDI scores predicted the second UPDRS-CF, and the first UPDRS-CF predicted 31% of the second PD-CFRS score variance. Depression moderated the relationship between the first UPDRS-CF score and the DLQ Part A. These results suggest practical, self-reported, daily functional markers for identifying gradual decline in PD patients. They consider the patients' heterogeneity, underlying cognitive pathology, and implications on daily functioning, health, and well-being.
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Affiliation(s)
- Sara Rosenblum
- grid.18098.380000 0004 1937 0562Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, 3498838 Israel
| | - Sonya Meyer
- grid.411434.70000 0000 9824 6981Department of Occupational Therapy, Ariel University, Ariel, 4077603 Israel
| | - Ariella Richardson
- grid.419646.80000 0001 0040 8485Department of Industrial Engineering, Jerusalem College of Technology, Jerusalem, 9372115 Israel
| | - Sharon Hassin-Baer
- grid.413795.d0000 0001 2107 2845Movement Disorders Institute, Sheba Medical Centre, Ramat-Gan, 5262000 Israel ,grid.413795.d0000 0001 2107 2845Department of Neurology, Sheba Medical Centre, Ramat-Gan, 5262000 Israel ,grid.12136.370000 0004 1937 0546Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801 Israel
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Yang N, Ju Y, Ren J, Wang H, Li P, Ning H, Tao J, Liu W. Prevalence and affective correlates of subjective cognitive decline in patients with de novo Parkinson's disease. Acta Neurol Scand 2022; 146:276-282. [PMID: 35722712 PMCID: PMC9545461 DOI: 10.1111/ane.13662] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/11/2022] [Accepted: 05/26/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The novel concept of subjective cognitive decline (SCD) in Parkinson's disease (PD) refers to subjective cognitive impairment without concurrent objective cognitive deficits. This study aimed to determine the prevalence and affective correlates of SCD in de novo PD patients. MATERIALS AND METHODS A total of 139 de novo PD patients underwent comprehensive neuropsychological evaluation. PD patients with SCD (PD-SCD) did not meet the diagnostic criteria for mild cognitive impairment in PD (PD-MCI) based on the Movement Disorder Society Level II Criteria and were defined by a Domain-5 Score ≥1 on the Non-Motor Symptoms Questionnaire. Affective symptoms were measured using the Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA). RESULTS In de novo PD cohort, the prevalence of SCD was 28.1%. PD-SCD patients performed significantly better than PD-MCI patients on tests of five cognitive domains. The more commonly affected domains in PD-SCD patients were memory (28.2%) and attention/working memory (25.6%). Multivariable linear regression analysis revealed that PD-SCD was significantly associated with both HAMD (β = 4.518, 95% CI = 0.754-8.281, p = .019) and HAMA scores (β = 4.259, 95% CI = 1.054-7.464, p = .010). Furthermore, binary logistic regression analysis revealed that higher HAMD (OR = 1.128, 95% CI = 1.019-1.249, p = .020) and HAMA scores (OR = 1.176, 95% CI = 1.030-1.343, p = .017) increased the risk of PD-SCD. CONCLUSIONS Our findings suggest that SCD is highly prevalent in de novo PD patients. The presence of PD-SCD is suggestive of an underlying affective disorder.
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Affiliation(s)
- Ning Yang
- Department of Traditional Chinese Medicine, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yuanyuan Ju
- Cerebrovascular Disease Center, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Jingru Ren
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Haidong Wang
- Department of Traditional Chinese Medicine, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Peishan Li
- Department of Traditional Chinese Medicine, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Houxu Ning
- Department of Traditional Chinese Medicine, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Jiaping Tao
- Department of Traditional Chinese Medicine, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Weiguo Liu
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
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