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Bălăeţ M, Alhajraf F, Zerenner T, Welch J, Razzaque J, Lo C, Giunchiglia V, Trender W, Lerede A, Hellyer PJ, Manohar SG, Malhotra P, Hu M, Hampshire A. Online cognitive monitoring technology for people with Parkinson's disease and REM sleep behavioural disorder. NPJ Digit Med 2024; 7:118. [PMID: 38714742 PMCID: PMC11076465 DOI: 10.1038/s41746-024-01124-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 04/23/2024] [Indexed: 05/10/2024] Open
Abstract
Automated online cognitive assessments are set to revolutionise clinical research and healthcare. However, their applicability for Parkinson's Disease (PD) and REM Sleep Behavioural Disorder (RBD), a strong PD precursor, is underexplored. Here, we developed an online battery to measure early cognitive changes in PD and RBD. Evaluating 19 candidate tasks showed significant global accuracy deficits in PD (0.65 SD, p = 0.003) and RBD (0.45 SD, p = 0.027), driven by memory, language, attention and executive underperformance, and global reaction time deficits in PD (0.61 SD, p = 0.001). We identified a brief 20-min battery that had sensitivity to deficits across these cognitive domains while being robust to the device used. This battery was more sensitive to early-stage and prodromal deficits than the supervised neuropsychological scales. It also diverged from those scales, capturing additional cognitive factors sensitive to PD and RBD. This technology offers an economical and scalable method for assessing these populations that can complement standard supervised practices.
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Affiliation(s)
- Maria Bălăeţ
- Department of Brain Sciences, Imperial College London, London, UK.
| | - Falah Alhajraf
- Oxford Parkinson's Disease Centre, Nuffield Department Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Tanja Zerenner
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Jessica Welch
- Oxford Parkinson's Disease Centre, Nuffield Department Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Jamil Razzaque
- Oxford Parkinson's Disease Centre, Nuffield Department Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Christine Lo
- Oxford Parkinson's Disease Centre, Nuffield Department Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | - William Trender
- Department of Brain Sciences, Imperial College London, London, UK
| | - Annalaura Lerede
- Department of Brain Sciences, Imperial College London, London, UK
| | - Peter J Hellyer
- Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sanjay G Manohar
- Oxford Parkinson's Disease Centre, Nuffield Department Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Paresh Malhotra
- Department of Brain Sciences, Imperial College London, London, UK
| | - Michele Hu
- Oxford Parkinson's Disease Centre, Nuffield Department Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Adam Hampshire
- Department of Brain Sciences, Imperial College London, London, UK
- Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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2
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Qamar MA, Rota S, Batzu L, Subramanian I, Falup-Pecurariu C, Titova N, Metta V, Murasan L, Odin P, Padmakumar C, Kukkle PL, Borgohain R, Kandadai RM, Goyal V, Chaudhuri KR. Chaudhuri's Dashboard of Vitals in Parkinson's syndrome: an unmet need underpinned by real life clinical tests. Front Neurol 2023; 14:1174698. [PMID: 37305739 PMCID: PMC10248458 DOI: 10.3389/fneur.2023.1174698] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/02/2023] [Indexed: 06/13/2023] Open
Abstract
We have recently published the notion of the "vitals" of Parkinson's, a conglomeration of signs and symptoms, largely nonmotor, that must not be missed and yet often not considered in neurological consultations, with considerable societal and personal detrimental consequences. This "dashboard," termed the Chaudhuri's vitals of Parkinson's, are summarized as 5 key vital symptoms or signs and comprise of (a) motor, (b) nonmotor, (c) visual, gut, and oral health, (d) bone health and falls, and finally (e) comorbidities, comedication, and dopamine agonist side effects, such as impulse control disorders. Additionally, not addressing the vitals also may reflect inadequate management strategies, leading to worsening quality of life and diminished wellness, a new concept for people with Parkinson's. In this paper, we discuss possible, simple to use, and clinically relevant tests that can be used to monitor the status of these vitals, so that these can be incorporated into clinical practice. We also use the term Parkinson's syndrome to describe Parkinson's disease, as the term "disease" is now abandoned in many countries, such as the U.K., reflecting the heterogeneity of Parkinson's, which is now considered by many as a syndrome.
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Affiliation(s)
- Mubasher A. Qamar
- Institute of Psychiatry, Psychology and Neuroscience, Department of Basic and Clinical Neuroscience, Division of Neuroscience, King’s College London, London, United Kingdom
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Silvia Rota
- Institute of Psychiatry, Psychology and Neuroscience, Department of Basic and Clinical Neuroscience, Division of Neuroscience, King’s College London, London, United Kingdom
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Lucia Batzu
- Institute of Psychiatry, Psychology and Neuroscience, Department of Basic and Clinical Neuroscience, Division of Neuroscience, King’s College London, London, United Kingdom
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Indu Subramanian
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Parkinson’s Disease Research, Education and Clinical Centers, Greater Los Angeles Veterans Affairs Medical Center, Los Angeles, CA, United States
| | - Cristian Falup-Pecurariu
- Faculty of Medicine, Transilvania University of Braşov, Brașov, Romania
- Department of Neurology, County Clinic Hospital, Brașov, Romania
| | - Nataliya Titova
- Department of Neurology, Neurosurgery and Medical Genetics, Federal State Autonomous Educational Institution of Higher Education “N.I. Pirogov Russian National Research Medical University” of the Ministry of Health of the Russian Federation, Moscow, Russia
- Department of Neurodegenerative Diseases, Federal State Budgetary Institution “Federal Center of Brain Research and Neurotechnologies” of the Federal Medical Biological Agency, Moscow, Russia
| | - Vinod Metta
- Institute of Psychiatry, Psychology and Neuroscience, Department of Basic and Clinical Neuroscience, Division of Neuroscience, King’s College London, London, United Kingdom
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Lulia Murasan
- Faculty of Medicine, Transilvania University of Braşov, Brașov, Romania
- Department of Neurology, County Clinic Hospital, Brașov, Romania
| | - Per Odin
- Department of Neurology, University Hospital, Lund, Sweden
| | | | - Prashanth L. Kukkle
- Center for Parkinson’s Disease and Movement Disorders, Manipal Hospital, Karnataka, India, Bangalore
- Parkinson’s Disease and Movement Disorders Clinic, Bangalore, Karnataka, India
| | - Rupam Borgohain
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Rukmini Mridula Kandadai
- Department of Neurology, Nizam’s Institute of Medical Sciences, Autonomous University, Hyderabad, India
| | - Vinay Goyal
- Neurology Department, Medanta, Gurugram, India
| | - Kallo Ray Chaudhuri
- Institute of Psychiatry, Psychology and Neuroscience, Department of Basic and Clinical Neuroscience, Division of Neuroscience, King’s College London, London, United Kingdom
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
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A Comprehensive Assessment of Qualitative and Quantitative Prodromal Parkinsonian Features in Carriers of Gaucher Disease-Identifying Those at the Greatest Risk. Int J Mol Sci 2022; 23:ijms232012211. [PMID: 36293067 PMCID: PMC9603254 DOI: 10.3390/ijms232012211] [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: 08/01/2022] [Revised: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 11/17/2022] Open
Abstract
Carriers of GBA1 gene variants have a significant risk of developing Parkinson’s disease (PD). A cohort study of GBA carriers between 40−75 years of age was initiated to study the presence of prodromal PD features. Participants underwent non-invasive tests to assess different domains of PD. Ninety-eight unrelated GBA carriers were enrolled (43 males) at a median age (range) of 51 (40−74) years; 71 carried the N370S variant (c.1226A > G) and 25 had a positive family history of PD. The Montreal Cognitive Assessment (MoCA) was the most frequently abnormal (23.7%, 95% CI 15.7−33.4%), followed by the ultrasound hyperechogenicity (22%, 95% CI 14−32%), Unified Parkinson’s Disease Rating Scale part III (UPDRS-III) (17.2%, 95% CI 10.2−26.4%), smell assessment (12.4%, 95% CI 6.6−20.6%) and abnormalities in sleep questionnaires (11%, 95% CI 5.7−19.4%). Significant correlations were found between tests from different domains. To define the risk for PD, we assessed the bottom 10th percentile of each prodromal test, defining this level as “abnormal”. Then we calculated the percentage of “abnormal” tests for each subject; the median (range) was 4.55 (0−43.5%). Twenty-two subjects had more than 15% “abnormal” tests. The limitations of the study included ascertainment bias of individuals with GBA-related PD in relatives, some incomplete data due to technical issues, and a lack of well-characterized normal value ranges in some tests. We plan to enroll additional participants and conduct longitudinal follow-up assessments to build a model for identifying individuals at risk for PD and investigate interventions aiming to delay the onset or perhaps to prevent full-blown PD.
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Washington L. Dementia and the aging population: cognitive screening within correctional health. Int J Prison Health 2022; 19:10.1108/IJPH-08-2021-0070. [PMID: 35759397 PMCID: PMC10231416 DOI: 10.1108/ijph-08-2021-0070] [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] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to examine the literature surrounding dementia in the aging correctional population and assess the role of cognitive screening related to dementia detection within corrections. The literature regarding the role of dementia within the justice continuum is scant. Furthermore, correctional health researchers have not reached a consensus on the best age to administer cognitive screening in older persons or prioritizes a screening tool for the early detection of dementia. DESIGN/METHODOLOGY/APPROACH A key search term list including dementia screening and was developed to review the literature surrounding dementia and the aging correctional population. PubMed, Criminal Justice Abstracts (Ebsco) and the National Criminal Justice Reference Service were used within the academic search. A gray literature search using these same search terms was conducted reviewing criminal justice federal agencies and organizations for additional information on the dementia experience within correctional settings. Snowballing was used to capture relevant theoretical and empirical knowledge. FINDINGS Shortages in aging specialized health-care staffing presents a barrier for the clinical interpretation of Montreal Cognitive Assessment (MoCA) results. Correctional officers are also identified as useful candidates within the administration of cognitive screening with proper training. The MoCA may be the optimal cognitive screening tool for dementia, until an original cognitive screening tool is created specific to the correctional population. An age of 55 years or older may serve as the best cutoff score for classifying incarcerated individuals as older persons, and screening should be prioritized for these individuals. Finally, new specialized programs related to dementia within correctional settings are identified. RESEARCH LIMITATIONS/IMPLICATIONS A limitation of this research is the conflicting opinions among researchers regarding the use of general cognitive screening tools within the correctional setting. ORIGINALITY/VALUE This research can inform correctional organizational policy and practices regarding the screening of older persons suspected of dementia. Most notably, this research proposes that correctional settings should incorporate the MoCA within initial screening of all individuals 55 years of age or older, enriching the job design of correctional officer's job positions to include cognitive testing, and for correctional settings to provide dementia and age-associated training for correctional officers. Finally, this paper informs future research in the development of a cognitive assessment tool specific to the correctional population.
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Affiliation(s)
- Lance Washington
- Department of Research and Consulting, National Association of State Mental Health Program Directors Research Institute, Falls Church, Virginia, USA
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Cabeleira MEP, Pagnussat AS, Pinho AS, Asquidamini ACD, Freire AB, Pereira BT, Mello Rieder CR, Schifino GP, Fornari LHT, Junior NDS, Corrêa PS, Cechetti F. Impairments in gait kinematics and postural control may not correlate with dopamine transporter depletion in individuals with mild to moderate Parkinson's disease. Eur J Neurosci 2019; 49:1640-1648. [DOI: 10.1111/ejn.14328] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 10/29/2018] [Accepted: 12/21/2018] [Indexed: 01/08/2023]
Affiliation(s)
| | - Aline Souza Pagnussat
- Federal University of Health Sciences of Porto AlegrePost‐Graduation Program in Rehabilitation Sciences Porto Alegre Brazil
- Federal University of Health Sciences of Porto AlegrePost‐Graduation Program in Health Sciences Porto Alegre Brazil
| | - Alexandre Severo Pinho
- Federal University of Health Sciences of Porto AlegrePost‐Graduation Program in Health Sciences Porto Alegre Brazil
| | - Ane Caroline Dotta Asquidamini
- Federal University of Health Sciences of Porto AlegrePost‐Graduation Program in Rehabilitation Sciences Porto Alegre Brazil
| | - Ariane Bolla Freire
- Federal University of Health Sciences of Porto AlegrePost‐Graduation Program in Rehabilitation Sciences Porto Alegre Brazil
| | - Brenda Tubelo Pereira
- Federal University of Health Sciences of Porto AlegrePost‐Graduation Program in Rehabilitation Sciences Porto Alegre Brazil
| | - Carlos Roberto Mello Rieder
- Federal University of Health Sciences of Porto AlegrePost‐Graduation Program in Rehabilitation Sciences Porto Alegre Brazil
- Federal University of Health Sciences of Porto AlegrePost‐Graduation Program in Health Sciences Porto Alegre Brazil
| | - Giulia Palermo Schifino
- Federal University of Health Sciences of Porto AlegrePost‐Graduation Program in Rehabilitation Sciences Porto Alegre Brazil
| | - Luis Henrique Tieppo Fornari
- Federal University of Health Sciences of Porto AlegrePost‐Graduation Program in Rehabilitation Sciences Porto Alegre Brazil
| | | | - Philipe Souza Corrêa
- Federal University of Health Sciences of Porto AlegrePost‐Graduation Program in Rehabilitation Sciences Porto Alegre Brazil
| | - Fernanda Cechetti
- Federal University of Health Sciences of Porto AlegrePost‐Graduation Program in Rehabilitation Sciences Porto Alegre Brazil
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Sanou AS, Diallo AH, Holding P, Nankabirwa V, Engebretsen IMS, Ndeezi G, Tumwine JK, Meda N, Tylleskar T, Kashala-Abotnes E. Effects of schooling on aspects of attention in rural Burkina Faso, West Africa. PLoS One 2018; 13:e0203436. [PMID: 30183764 PMCID: PMC6124811 DOI: 10.1371/journal.pone.0203436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 08/21/2018] [Indexed: 11/25/2022] Open
Abstract
Background We aimed to study the effects of schooling on aspects of attention using the Test of Variables of Attention (TOVA) among children in rural Burkina Faso. Methods We re-enrolled children of a previously community-based cluster randomized exclusive breastfeeding trial in rural Burkina Faso. A total of 534 children (280 boys and 254 girls) aged 6 to 8 years were assessed using the TOVA. We examined the effect size difference using Cohen’s d, ANOVA and conducted regression analyses. Results Forty nine percent of the children were in school. Children not in school performed poorly with a small effect size difference for ‘Response Time’, ‘Errors of omission’, and ‘Errors of commission’ compared to children in school. The effect size difference was moderate for ‘Response Time Variability’, and ‘D prime score’. Conclusion Schooling affects different aspects of attention in rural Burkina Faso. In settings where literacy and schooling rate is low, public sensitizations of the benefits of schooling need to be reinforced and advice on sending children to school need to be provided continuously.
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Affiliation(s)
- Anselme Simeon Sanou
- Centre for International Health, Department of Global Public Health and Primary Health Care, Faculty of Medicine, University of Bergen, Bergen, Norway
- Department of Public Health, Centre MURAZ Research Institute, Bobo-Dioulasso, Burkina Faso
- * E-mail:
| | - Abdoulaye Hama Diallo
- Department of Public Health, Centre MURAZ Research Institute, Bobo-Dioulasso, Burkina Faso
- Department of Public Health, University of Ouagadougou, Ouagadougou, Burkina Faso
| | | | - Victoria Nankabirwa
- Centre for International Health, Department of Global Public Health and Primary Health Care, Faculty of Medicine, University of Bergen, Bergen, Norway
- Department of Epidemiology & Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
- Centre for Intervention Science in Maternal and Child Health, Department of Global Public Health and Primary Health Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Ingunn Marie S. Engebretsen
- Centre for International Health, Department of Global Public Health and Primary Health Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Grace Ndeezi
- Department of Paediatrics and Child Health, Makerere University, Kampala, Uganda
| | - James K. Tumwine
- Department of Paediatrics and Child Health, Makerere University, Kampala, Uganda
| | - Nicolas Meda
- Department of Public Health, Centre MURAZ Research Institute, Bobo-Dioulasso, Burkina Faso
- Department of Public Health, University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Thorkild Tylleskar
- Centre for International Health, Department of Global Public Health and Primary Health Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Esperance Kashala-Abotnes
- Centre for International Health, Department of Global Public Health and Primary Health Care, Faculty of Medicine, University of Bergen, Bergen, Norway
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Flannery SL, Jowett T, Garvey A, Cutfield NJ, Machado L. Computerized testing in Parkinson's disease: Performance deficits in relation to standard clinical measures. J Clin Exp Neuropsychol 2018; 40:1062-1073. [PMID: 29978753 DOI: 10.1080/13803395.2018.1485880] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE This study assessed deficits associated with Parkinson's disease (PD) at two time points separated by 1 year using a computerized neuropsychological battery, and determined interrelationships with conventional clinical measures of cognitive functioning (Montreal Cognitive Assessment; MoCA) and motor impairment (Part III of the Unified PD Rating Scale; UPDRS), as well as other factors known to influence cognitive dysfunction in PD. METHOD Participants included 37 with PD and 47 controls. Linear mixed-effects models were developed for each computerized task. RESULTS Results showed that the PD group performed worse than controls on all of the computerized tasks at both time points. In contrast, MoCA scores differed between PD and controls only at follow-up. However, the MoCA detected decline over the year in the PD group, whereas only one of the computerized tasks did. In both groups, higher MoCA scores predicted better performance on some but not all of the computerized tasks. Surprisingly, UPDRS-rated motor impairment did not predict performance on any of the computerized tasks, and aside from older age, which predicted poorer performance on all but one task, the other factors-education, affective and impulsivecompulsive symptoms, sleep quality, dopaminergic medication-generally had no relationship with performance on the computerized tasks. CONCLUSIONS The presence of performance deficits for all of the computerized tasks in the PD group compared to controls, but not for the MoCA at initial testing, indicates that the computerized battery was better able to detect deficits. However, in contrast to the MoCA, the current results call into question the suitability of the computerized battery as measured here for tracking decline.
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Affiliation(s)
- Samuel L Flannery
- a Department of Psychology and Brain Health Research Centre , University of Otago , Dunedin , New Zealand.,b Brain Research New Zealand , Dunedin , New Zealand
| | - Tim Jowett
- c Department of Mathematics and Statistics , University of Otago , Dunedin , New Zealand
| | - Anthony Garvey
- b Brain Research New Zealand , Dunedin , New Zealand.,d Dunedin School of Medicine and Brain Health Research Centre , University of Otago , Dunedin , New Zealand
| | - Nicholas J Cutfield
- b Brain Research New Zealand , Dunedin , New Zealand.,d Dunedin School of Medicine and Brain Health Research Centre , University of Otago , Dunedin , New Zealand
| | - Liana Machado
- a Department of Psychology and Brain Health Research Centre , University of Otago , Dunedin , New Zealand.,b Brain Research New Zealand , Dunedin , New Zealand
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Tröster AI. Some Clinically Useful Information that Neuropsychology Provides Patients, Carepartners, Neurologists, and Neurosurgeons About Deep Brain Stimulation for Parkinson's Disease. Arch Clin Neuropsychol 2018; 32:810-828. [PMID: 29077802 PMCID: PMC5860398 DOI: 10.1093/arclin/acx090] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 09/06/2017] [Indexed: 12/02/2022] Open
Abstract
Deep brain stimulation (DBS) is an effective (but non-curative) treatment for some of the motor symptoms and treatment complications associated with dopaminergic agents in Parkinson's disease (PD). DBS can be done relatively safely and is associated with quality of life gains. In most DBS centers, neuropsychological evaluations are performed routinely before surgery, and sometimes after surgery. The purpose of such evaluation is not to decide solely on its results whether or not to offer DBS to a given candidate, but to provide the patient and treatment team with the best available information to make reasonable risk-benefit assessments. This review provides information relevant to the questions often asked by patients and their carepartners, neurologists, and neurosurgeons about neuropsychological outcomes of DBS, including neuropsychological adverse event rates, magnitude of cognitive changes, outcomes after unilateral versus bilateral surgery directed at various targets, impact of mild cognitive impairment (MCI) on outcome, factors implicated in neurobehavioral outcomes, and safety of newer interventions or techniques such as asleep surgery and current steering.
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Affiliation(s)
- Alexander I Tröster
- Department of Clinical Neuropsychology and Center for Neuromodulation, Barrow Neurological Institute, Phoenix, AZ, USA
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9
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Weintraub D, Tröster AI, Marras C, Stebbins G. Initial cognitive changes in Parkinson's disease. Mov Disord 2018; 33:511-519. [PMID: 29543342 PMCID: PMC5920539 DOI: 10.1002/mds.27330] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/02/2018] [Accepted: 01/04/2018] [Indexed: 01/05/2023] Open
Abstract
The focus on cognitive impairment in neurodegenerative diseases, including PD, is shifting from the dementia stage to earlier stages of impairment, including mild cognitive impairment. This shift is driven primarily by the desire to improve long-term outcomes by delivering therapeutic interventions earlier in the clinical course, even presymptomatically in those at highest risk, and at the initial stage in the pathophysiological cascade that underpins common dementia syndromes. This article focuses on key findings and challenges in studying earliest stages of cognitive decline in PD, including a detailed examination of neuropsychological testing, cognitive performance in early and prodromal PD, epidemiological research for PD mild cognitive impairment to date, and expert recommendations for assessment. © 2018 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Daniel Weintraub
- Departments of Psychiatry and Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Alexander I. Tröster
- Barrow Neurological Institute, Department of Clinical Neuropsychology and Barrow Center for Neuromodulation, Phoenix, AZ, USA
| | - Connie Marras
- Department of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Glenn Stebbins
- Rush University Medical Center, Department of Neurological Sciences, Chicago, IL, USA
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10
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Rosenberg-Katz K, Maidan I, Jacob Y, Giladi N, Mirelman A, Hausdorff JM. Alterations in conflict monitoring are related to functional connectivity in Parkinson's disease. Cortex 2016; 82:277-286. [DOI: 10.1016/j.cortex.2016.06.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 06/02/2016] [Accepted: 06/16/2016] [Indexed: 02/03/2023]
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Brown DS, Bernstein IH, McClintock SM, Munro Cullum C, Dewey RB, Husain M, Lacritz LH. Use of the Montreal Cognitive Assessment and Alzheimer's Disease-8 as cognitive screening measures in Parkinson's disease. Int J Geriatr Psychiatry 2016; 31:264-72. [PMID: 26177715 PMCID: PMC5524653 DOI: 10.1002/gps.4320] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 05/21/2015] [Accepted: 05/21/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine the sensitivity and specificity of the Montreal Cognitive Assessment (MoCA), a brief cognitive screening measure previously validated for use in Parkinson's disease (PD), and Alzheimer's Disease-8 (AD8), an eight-item informant report used to screen for dementia, but not yet validated for use in PD, to identify cognitive impairment in a sample of 111 patients with PD. METHODS Cognitive impairment was determined based on a battery of neuropsychological measures, excluding the MoCA and AD8. Classification rates of both the MoCA and AD8 in identifying cognitive impairment were examined using logistic regression and receiver operator characteristic (ROC) analysis. Optimal cutoff scores were determined to maximize sensitivity and specificity. RESULTS The MoCA correctly classified 78.4% of participants (p < 0.001), and ROC analysis yielded an area under the curve (AUC) of 0.82. A MoCA cutoff score of <25 yielded optimal sensitivity (0.77) and specificity (0.79) for identifying PD patients with cognitive impairment. Similar analyses for the AD8 were statistically nonsignificant, although the classification rate was 70.5%, with an AUC of 0.50. CONCLUSIONS These results provide additional support for the MoCA, but not the AD8, in identifying cognitive impairment in patients with PD.
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Affiliation(s)
- Daniel S. Brown
- Division of Psychology, Department of Psychiatry; University of Texas Southwestern Medical Center; Dallas TX USA
| | - Ira H. Bernstein
- Department of Clinical Science; University of Texas Southwestern Medical Center; Dallas TX USA
| | - Shawn M. McClintock
- Division of Psychology, Department of Psychiatry; University of Texas Southwestern Medical Center; Dallas TX USA
- Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences; Duke University School of Medicine; Durham NC USA
| | - C. Munro Cullum
- Division of Psychology, Department of Psychiatry; University of Texas Southwestern Medical Center; Dallas TX USA
- Department of Neurology & Neurotherapeutics; University of Texas Southwestern Medical Center; Dallas TX USA
| | - Richard B. Dewey
- Department of Neurology & Neurotherapeutics; University of Texas Southwestern Medical Center; Dallas TX USA
| | - Mustafa Husain
- Department of Neurology & Neurotherapeutics; University of Texas Southwestern Medical Center; Dallas TX USA
- Department of Psychiatry and Behavioral Sciences; Duke University School of Medicine; Durham NC USA
- Department of Psychiatry; University of Texas Southwestern Medical Center; Dallas TX USA
| | - Laura H. Lacritz
- Division of Psychology, Department of Psychiatry; University of Texas Southwestern Medical Center; Dallas TX USA
- Department of Neurology & Neurotherapeutics; University of Texas Southwestern Medical Center; Dallas TX USA
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12
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Association between Community Ambulation Walking Patterns and Cognitive Function in Patients with Parkinson's Disease: Further Insights into Motor-Cognitive Links. PARKINSONS DISEASE 2015; 2015:547065. [PMID: 26605103 PMCID: PMC4641932 DOI: 10.1155/2015/547065] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 09/10/2015] [Accepted: 10/04/2015] [Indexed: 11/30/2022]
Abstract
Background. Cognitive function is generally evaluated based on testing in the clinic, but this may not always reflect real-life function. We tested whether parameters derived from long-term, continuous monitoring of gait are associated with cognitive function in patients with Parkinson's disease (PD). Methods. 107 patients with PD (age: 64.9 ± 9.3 yrs; UPDRS motor sum “off”: 40.4 ± 13.2; 25.23% women) wore a 3D accelerometer on their lower back for 3 days. Computerized measures of global cognitive function, executive function, attention, and nonverbal memory were assessed. Three-day acceleration derived measures included cadence, variability, bilateral coordination, and dynamic postural control. Associations between the acceleration derived measures and cognitive function were determined. Results. Linear regression showed associations between vertical gait variability and cadence and between global cognitive score, attention, and executive function (p ≤ 0.048). Dynamic postural control was associated with global cognitive score and attention (p ≤ 0.027). Nonverbal memory was not associated with the acceleration-derived measures. Conclusions. These findings suggest that metrics derived from a 3-day worn body-fixed sensor reflect cognitive function, further supporting the idea that the gait pattern may be altered as cognition declines and that gait provides a window into cognitive function in patients with PD.
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Shen YJ, Wang WA, Huang FD, Chen J, Liu HY, Xia YL, Han M, Zhang L. The use of MMSE and MoCA in patients with acute ischemic stroke in clinical. Int J Neurosci 2015; 126:442-7. [DOI: 10.3109/00207454.2015.1031749] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Parsey CM, Schmitter-Edgecombe M. Applications of technology in neuropsychological assessment. Clin Neuropsychol 2013; 27:1328-61. [PMID: 24041037 DOI: 10.1080/13854046.2013.834971] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Most neuropsychological assessments include at least one measure that is administered, scored, or interpreted by computers or other technologies. Despite supportive findings for these technology-based assessments, there is resistance in the field of neuropsychology to adopt additional measures that incorporate technology components. This literature review addresses the research findings of technology-based neuropsychological assessments, including computer- and virtual reality-based measures of cognitive and functional abilities. We evaluate the strengths and limitations of each approach, and examine the utility of technology-based assessments to obtain supplemental cognitive and behavioral information that may be otherwise undetected by traditional paper-and-pencil measures. We argue that the potential of technology use in neuropsychological assessment has not yet been realized, and continued adoption of new technologies could result in more comprehensive assessment of cognitive dysfunction and in turn, better informed diagnosis and treatments. Recommendations for future research are also provided.
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Affiliation(s)
- Carolyn M Parsey
- a Department of Psychology , Washington State University , Pullman , WA , USA
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Thaler A, Mirelman A, Gurevich T, Simon E, Orr-Urtreger A, Marder K, Bressman S, Giladi N. Lower cognitive performance in healthy G2019S LRRK2 mutation carriers. Neurology 2012; 79:1027-32. [PMID: 22914834 DOI: 10.1212/wnl.0b013e3182684646] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess cognitive abilities of healthy first-degree relatives of Ashkenazi patients with Parkinson disease (PD), carriers of the G2019S mutation in the LRRK2 gene. METHODS In this observational study, 60 consecutive healthy first-degree relatives (aged 50.9 ± 6.2 years; 48% male; 30 G2019S carriers) were assessed using a computerized cognitive program, the Montreal Cognitive Assessment questionnaire, the Unified Parkinson's Disease Rating Scale Part III, and the Geriatric Depression Scale. RESULTS G2019S carriers scored significantly lower on the computerized executive function index (p = 0.04) and on specific executive function tasks (Stroop test, p = 0.007). CONCLUSION Carrying the LRRK2 G2019S mutation was associated with lower executive performance in a population at risk for PD.
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Affiliation(s)
- Avner Thaler
- Movement Disorders Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Israel
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Lessig S, Nie D, Xu R, Corey-Bloom J. Changes on brief cognitive instruments over time in Parkinson's disease. Mov Disord 2012; 27:1125-8. [PMID: 22692724 DOI: 10.1002/mds.25070] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 04/30/2012] [Accepted: 05/08/2012] [Indexed: 11/11/2022] Open
Abstract
Two hundred and twenty-one subjects with Parkinson's disease (PD) were examined using the Mini-Mental Status Examination (MMSE) and Montreal Cognitive Assessment (MoCA), with a subset of these (n = 98) examined on repeat testing up to 3 years. The MoCA was more sensitive in identifying cognitive deficit, specifically in the domains of visuospatial abilities, language, and memory. In longitudinal study, the MMSE changed significantly over time, particularly in patients with disease duration of >10 years. The MoCA, however, did not change significantly, even when subjects were stratified by age, MMSE score, and disease duration. This suggests that the MoCA may be more sensitive for detecting early cognitive change in PD, but that the MMSE, and not the MoCA, may be better for tracking cognitive decline.
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Affiliation(s)
- Stephanie Lessig
- Department of Neurosciences, University of California San Diego, San Diego, California, USA.
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Romann AJ, Dornelles S, Maineri NDL, Rieder CRDM, Olchik MR. Cognitive assessment instruments in Parkinson's disease patients undergoing deep brain stimulation. Dement Neuropsychol 2012; 6:2-11. [PMID: 29213766 PMCID: PMC5619101 DOI: 10.1590/s1980-57642012dn06010002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Deep Brain Stimulation (DBS) is a widely used surgical technique in individuals
with Parkinson's disease (PD) that can lead to significant reductions in motor
symptoms.
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Affiliation(s)
- Aline Juliane Romann
- Mestranda em Medicina, Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre RS, Brazil (UFRGS). Fonoaudióloga Clínica
| | - Silvia Dornelles
- Doutora em Ciências da Criança e do Adolescente, UFRGS. Professora Adjunto da UFRGS, Departamento de Psicologia do Desenvolvimento e da Personalidade
| | - Nicole de Liz Maineri
- Mestre em Medicina e Ciências da Saúde, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre RS, Brazil (PUCRS). Neuropsicóloga do Laboratório de Estudos Cognitivos, MemoLab (Hospital Moinhos de Vento)
| | - Carlos Roberto de Mello Rieder
- Doutor em Clinical Neuroscience (University of Birmingham). Professor Adjunto de Neurologia da Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) e do Programa de Pós Graduação em Medicina, Ciências Médicas, UFRGS
| | - Maira Rozenfeld Olchik
- Doutora em Educação, UFRGS. Professora Adjunto do Curso de Fonoaudiologia da UFRGS, Departamento de Cirurgia e Ortopedia
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Improving precision in the quantification of cognition using the Montreal Cognitive Assessment and the Mini-Mental State Examination. Int Psychogeriatr 2011; 23:1107-15. [PMID: 21281555 DOI: 10.1017/s1041610210002450] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The Montreal Cognitive Assessment (MoCA) can be used to quantify cognitive ability in older persons undergoing screening for cognitive impairment. Although highly sensitive in detecting mild cognitive impairment, its measurement precision is weakest among persons with milder forms of impairment. We sought to overcome this limitation by integrating information from the Mini-Mental State Examination (MMSE) into the calculation of cognitive ability. METHODS Data from 185 geriatric outpatients screened for cognitive impairment with the MoCA and the MMSE were Rasch analyzed to evaluate the extent to which the MMSE items improved measurement precision in the upper ability ranges of the population. RESULTS Adding information from the MMSE resulted in a 13.8% (13.3-14.3%) reduction in measurement error, with significant improvements in all quartiles of patient ability. The addition of three-word repetition and recall, copy pentagons, repeat sentence, and write sentence improved measurement of cognition in the upper levels of ability. CONCLUSIONS The algorithm presented here maximizes the yield of available clinical data while improving measurement of cognitive ability, which is particularly important for tracking changes over time in patients with milder levels of impairment.
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Factor SA, Steenland NK, Higgins DS, Molho ES, Kay DM, Montimurro J, Rosen AR, Zabetian CP, Payami H. Disease-related and genetic correlates of psychotic symptoms in Parkinson's disease. Mov Disord 2011; 26:2190-5. [PMID: 21714002 DOI: 10.1002/mds.23806] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 04/18/2011] [Accepted: 04/28/2011] [Indexed: 12/20/2022] Open
Abstract
Our aim was to examine disease-related and genetic correlates of the development of psychotic symptoms in a large population of patients with Parkinson's disease. We studied 500 patients with Parkinson's disease from the NeuroGenetics Research Consortium using logistic regression models. Predictors were demographic, clinical (motor/nonmotor features), and genetic, measured as continuous or dichotomous variables. Continuous measures were divided into population-based tertiles. Results are given as odds ratios (95% confidence intervals) for dichotomous variables and by ascending tertile for continuous variables. Psychotic symptoms were associated with increasing age: 4.86 (1.62-14.30) and 6.25 (2.09-18.74) (test for trend: P = 0.01); and duration of disease: 3.81 (1.23-11.76) and 5.33 (1.68-16.89) (test for trend: P = 0.03). For nonmotor features, we demonstrated positive trends with depression: 1.31 (0.47-3.61) and 5.01 (2.04-12.33) (test for trend: P < 0.0001); cognitive dysfunction: 0.69 (0.26-1.84) and 2.51 (1.00-6.29) (test for trend: P = 0.03); and an excess for those with sleep disorders: 2.00 (1.03-3.89) (P = 0.04). Psychotic symptoms were not associated with tremor or postural instability scores, but there was an association with freezing of gait: 3.83 (1.67-8.75) (P < 0.002). Psychotic symptoms were not associated with the presence of any examined polymorphisms in the apolipoprotein, alpha-synuclein, or microtubule associated protein tau genes. This is the largest study to examine correlates of psychotic symptoms in Parkinson's disease. We discovered a novel association with freezing of gait. We demonstrated an association with depression and duration of disease, both of which were inconsistently related in previous studies, and confirmed the association with age, cognitive dysfunction, and sleep disorders.
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Affiliation(s)
- Stewart A Factor
- Department of Neurology, Emory University School of Medicine, 1841 Clifton Road NE, Atlanta, GA 30329, USA.
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