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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Norling AM, Gerstenecker AT, Buford TW, Khan B, Oparil S, Lazar RM. The role of exercise in the reversal of IGF-1 deficiencies in microvascular rarefaction and hypertension. GeroScience 2019; 42:141-158. [PMID: 31808026 DOI: 10.1007/s11357-019-00139-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 11/19/2019] [Indexed: 12/18/2022] Open
Abstract
Hypertension has been linked with peripheral and central reductions in vascular density, and with devastating effects on brain function. However, the underlying mechanisms in the relationship between blood pressure and cognitive impairment have yet to be fully elucidated. Here, we review compelling evidence from two lines of inquiry: one that links microvascular rarefaction with insulin-like growth factor 1 (IGF-1) deficiencies, and another which posits that vascular dysfunction precedes hypertension. Based on the findings from experimental and clinical studies, we propose that these lines of evidence converge, and suggest that age-related declines in IGF-1 concentrations precede microvascular rarefaction, initiate an increase in vascular resistance, and therefore are causally linked to onset of hypertension. Physical exercise provides a relevant model for supporting our premise, given the well-established effects of exercise in attenuating vascular dysfunction, hypertension, IGF-1 deficiency, and cognitive decline. We highlight here the role of exercise-induced increases in blood flow in improving vascular integrity and enhancing angiogenesis via the actions of IGF-1, resulting in reversal of rarefaction and hypertension, and enhancement of cerebral blood flow and cognition.
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Affiliation(s)
- Amani M Norling
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, 35294, USA.,The UAB Evelyn F. McKnight Brain Institute, University of Alabama at Birmingham, Alabama, AL, 35294, USA
| | - Adam T Gerstenecker
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, 35294, USA.,The UAB Evelyn F. McKnight Brain Institute, University of Alabama at Birmingham, Alabama, AL, 35294, USA
| | - Thomas W Buford
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Bilal Khan
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Suzanne Oparil
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Ronald M Lazar
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, 35294, USA. .,The UAB Evelyn F. McKnight Brain Institute, University of Alabama at Birmingham, Alabama, AL, 35294, USA.
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Faust-Socher A, Duff-Canning S, Grabovsky A, Armstrong MJ, Rothberg B, Eslinger PJ, Meaney CA, Schneider RB, Tang-Wai DF, Fox SH, Zadikoff C, Kennedy N, Chou KL, Persad C, Litvan I, Mast BT, Gerstenecker AT, Weintraub S, Reginold W, Marras C. Responsiveness to Change of the Montreal Cognitive Assessment, Mini-Mental State Examination, and SCOPA-Cog in Non-Demented Patients with Parkinson's Disease. Dement Geriatr Cogn Disord 2019; 47:187-197. [PMID: 31315127 PMCID: PMC7186910 DOI: 10.1159/000496454] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 12/26/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Clinical monitoring of patients with Parkinson's disease (PD) for cognitive decline is an important element of care. The Montreal Cognitive Assessment (MoCA) has been proposed to be a sensitive tool for assessing cognitive impairment in PD. The aim of our study was to compare the responsiveness of the MoCA to decline in cognition to the responsiveness of the Mini Mental State Examination (MMSE) and the Scales for Outcomes of Parkinson's disease-cognition (SCOPA-Cog). METHODS PD patients without dementia were enrolled at 6 North American movement disorders centers between 2008 and 2011. Participants received annual evaluations including the MoCA, MMSE, and SCOPA-Cog followed by formal neuropsychological testing. The gold standard for change in cognition was defined as the change on the neuropsychological test scores over the annual assessments. The Reliable Change Method was used to provide an estimate of the probability that a given difference score would be obtained by chance. The sensitivity of the MoCA, MMSE, and SCOPA-Cog to change was quantified using receiver operating characteristics (ROC) curves. RESULTS One hundred seventeen patients were included in the analysis. Participants were followed at mean intervals of 11 ± 2 months for a median of 2 (maximum 5) visits. According to the reliable change index, 56 intervals of cognitive testing showed a decline in global cognition. ROC analysis of change in MoCA, MMSE, and SCOPA-Cog global scores compared to gold standard testing found an area under the curve (AUC) of 0.55 (95% CI 0.48-0.62), 0.56 (0.48-0.63), and 0.63 (0.55-0.70) respectively. There were no significant differences in the AUCs across the tests. The sensitivity of the MoCA, MMSE, and SCOPA-Cog to change at various thresholds for decline in scores reached a maximum of 71% for a cut-off of 1 point change on the SCOPA-Cog. CONCLUSION Using neuropsychological testing as a gold standard comparator, the performance of the MoCA, MMSE, and SCOPA-Cog for detecting decline in non-demented PD patients over a 1-year interval is poor. This has implications for clinical practice; stable scores may not be taken as reassurance of the absence of cognitive decline.
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Affiliation(s)
- Achinoam Faust-Socher
- The Edmond J Safra Program in Parkinson’s disease and the Morton and Gloria Shulman Movement Disorders Centre, University Health Network, Toronto, ON, Canada,Movement Disorders Unit, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Sarah Duff-Canning
- The Edmond J Safra Program in Parkinson’s disease and the Morton and Gloria Shulman Movement Disorders Centre, University Health Network, Toronto, ON, Canada
| | - Arthur Grabovsky
- Department of Statistical Sciences, University of Toronto, Toronto, ON, Canada
| | - Melissa J. Armstrong
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Brandon Rothberg
- The Edmond J Safra Program in Parkinson’s disease and the Morton and Gloria Shulman Movement Disorders Centre, University Health Network, Toronto, ON, Canada
| | - Paul J. Eslinger
- Departments of Neurology, Neural and Behavioral Sciences, and Radiology, Penn State Hershey Medical Center, Hershey, PA, USA
| | - Christopher A. Meaney
- Division of Biostatistics, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Ruth B. Schneider
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - David F. Tang-Wai
- Division of Neurology, University Health Network Memory Clinic, University of Toronto, Toronto, ON
| | - Susan H. Fox
- The Edmond J Safra Program in Parkinson’s disease and the Morton and Gloria Shulman Movement Disorders Centre, University Health Network, Toronto, ON, Canada
| | - Cindy Zadikoff
- Department of Neurology, Northwestern University, Chicago, IL, USA
| | - Nancy Kennedy
- Department of Psychiatry and Behavioral Science, Northwestern University, Chicago, IL, USA
| | - Kelvin L. Chou
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Carol Persad
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Irene Litvan
- Parkinson and Other Movement Disorders Center, Department of Neuroscience, UC San Diego, San Diego, CA, USA
| | - Benjamin T. Mast
- Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Adam T. Gerstenecker
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sandra Weintraub
- Department of Psychiatry and Behavioural Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - William Reginold
- The Edmond J Safra Program in Parkinson’s disease and the Morton and Gloria Shulman Movement Disorders Centre, University Health Network, Toronto, ON, Canada
| | - Connie Marras
- The Edmond J Safra Program in Parkinson's disease and the Morton and Gloria Shulman Movement Disorders Centre, University Health Network, Toronto, Ontario, Canada,
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Marras C, Armstrong MJ, Meaney CA, Fox S, Rothberg B, Reginold W, Tang-Wai DF, Gill D, Eslinger PJ, Zadikoff C, Kennedy N, Marshall FJ, Mapstone M, Chou KL, Persad C, Litvan I, Mast BT, Gerstenecker AT, Weintraub S, Duff-Canning S. Measuring mild cognitive impairment in patients with Parkinson's disease. Mov Disord 2013; 28:626-33. [PMID: 23520128 PMCID: PMC4524474 DOI: 10.1002/mds.25426] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 01/15/2013] [Accepted: 02/07/2013] [Indexed: 11/10/2022] Open
Abstract
We examined the frequency of Parkinson disease with mild cognitive impairment (PD-MCI) and its subtypes and the accuracy of 3 cognitive scales for detecting PD-MCI using the new criteria for PD-MCI proposed by the Movement Disorders Society. Nondemented patients with Parkinson's disease completed a clinical visit with the 3 screening tests followed 1 to 3 weeks later by neuropsychological testing. Of 139 patients, 46 met Level 2 Task Force criteria for PD-MCI when impaired performance was based on comparisons with normative scores. Forty-two patients (93%) had multi-domain MCI. At the lowest cutoff levels that provided at least 80% sensitivity, specificity was 44% for the Montreal Cognitive Assessment and 33% for the Scales for Outcomes in Parkinson's Disease-Cognition. The Mini-Mental State Examination could not achieve 80% sensitivity at any cutoff score. At the highest cutoff levels that provided specificity of at least 80%, sensitivities were low (≤44%) for all tests. When decline from estimated premorbid levels was considered evidence of cognitive impairment, 110 of 139 patients were classified with PD-MCI, and 103 (94%) had multi-domain MCI. We observed dramatic differences in the proportion of patients who had PD-MCI using the new Level 2 criteria, depending on whether or not decline from premorbid level of intellectual function was considered. Recommendations for methods of operationalizing decline from premorbid levels constitute an unmet need. Among the 3 screening tests examined, none of the instruments provided good combined sensitivity and specificity for PD-MCI. Other tests recommended by the Task Force Level 1 criteria may represent better choices, and these should be the subject of future research.
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Affiliation(s)
- Connie Marras
- Toronto Western Hospital Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Research, Toronto, Ontario, Canada.
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