The Impact Of Freezing of Gait on Activities of Daily Living Among Individuals With Parkinson's Disease and Mild Cognitive Impairment

AbstractObjectives:Parkinson’s disease (PD) patients with mild cognitive impairment (PD-MCI) have an increased risk of developing dementia (PDD). As activities of daily living (ADL) impairment is mandatory for the diagnosis of PDD, assessing early signs of instrumental ADL (iADL) dysfunction, especially in PD-MCI, is essential. In PD, self- and caregiver-reported iADL performance is often confounded by motor dysfunction and mood. Objective and time-efficient performance-based measurements are needed to screen for cognitive-related iADL dysfunction. We evaluated the Erlangen Test of Activities of Daily Living in Mild Dementia and Mild Cognitive Impairment (ETAM) in PD and determined its value for characterizing a subgroup of PD-MCI patients with mild performance-based iADL impairment.Methods:Twenty-one cognitively normal PD patients (PD-NC), 24 PD-MCI patients, and 18 healthy controls (HC) were analyzed. Assessments included the ETAM, a comprehensive neuropsychological test battery, iADL, mood, and motor measurements.Results:PD-MCI patients scored significantly lower on the ETAM total score compared to PD-NC patients (p = .002), whereas HC and PD-NC patients did not statistically differ. No HC scored lower than 27 points (diagnostic cutoff for mild iADL impairment); only PD-MCI patients scored below this cutoff (29.2%) suggesting the ETAM is able to characterize a PD-MCI subgroup with early iADL impairment. PD-MCI patients below the cutoff were more impaired in the attention domain (p = .04).Conclusions:The ETAM is a potentially valuable clinical assessment, able to detect first signs of iADL dysfunction in PD-MCI. Further studies in larger cohorts are needed to evaluate the prognostic ability for predicting PDD.

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Analysis of Functional and Cognitive Impairment in Institutionalized Individuals with Movement Disorders

Endocrine Metabolic & Immune Disorders - Drug Targets ◽

10.2174/1871530319666190311104247 ◽

2019 ◽

Vol 19 (7) ◽

pp. 1022-1031 ◽

Cited By ~ 2

Author(s):

Paula D. Cebrián ◽

Omar Cauli

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Cognitive Impairment ◽

Activities Of Daily Living ◽

Cognitive Performance ◽

Functional Impairment ◽

Movement Disorders ◽

Neurological Disorders ◽

Daily Living ◽

Severe Cognitive Impairment

Background: Many neurological disorders lead to institutionalization and can be accompanied in their advanced stages by functional impairment, and progressive loss of mobility, and cognitive alterations. Objective: We analyzed the relationship between functional impairment and cognitive performance and its related subdomains in individuals with Parkinson’s disease, Alzheimer’s disease accompanied by motor dysfunction, and with other neurological disorders characterized by both motor and cognitive problems. Methods: All participants lived in nursing homes (Valencia, Spain) and underwent cognitive evaluation with the Mini-Mental State Examination; functional assessment of independence in activities of daily living using the Barthel score and Katz index; and assessment of mobility with the elderly mobility scale. Results: The mean age of the subjects was 82.8 ± 0.6 years, 47% of the sample included individuals with Parkinson’s disease, and 48 % of the sample presented severe cognitive impairment. Direct significant relationships were found between the level of cognitive impairment and functional capacity (p < 0.01) and mobility (p < 0.05). Among the different domains, memory impairment was not associated with altered activities of daily living or mobility. The functional impairment and the risk of severe cognitive impairment were significantly (p<0.05) higher in female compared to male patients. Among comorbidities, overweight/obesity and diabetes were significantly (p < 0.05) associated with poor cognitive performance in those individuals with mild/moderate cognitive impairment. Conclusion: In institutionalized individuals with movement disorders there is an association between functional and cognitive impairment. Reduction of over-weight and proper control of diabetes may represent novel targets for improving cognitive function at such early stages.

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Mild cognitive impairment in Parkinson's disease and vascular risk factors among Indian patients

International Psychogeriatrics ◽

10.1017/s1041610215001052 ◽

2015 ◽

Vol 27 (12) ◽

pp. 2098-2099

Author(s):

Vikas Dhikav ◽

Mansi Sethi ◽

Kuljeet Singh Anand

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Daily Living ◽

Activity Of Daily Living ◽

Vascular Risk ◽

Subjective Memory Complaints ◽

Subjective Memory ◽

Indian Patients

Mild cognitive impairment (MCI) is often defined as subjective memory complaints with intact activity of daily living without dementia. Its association as a precursor to Alzheimer's disease is well known. However, MCI in Parkinson's disease (PD) is poorly understood. The present small study aimed to measure the frequency of MCI and vascular factors in Indian patients with PD.

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Structural Neuroimaging Markers of Cognitive Decline in Parkinson’s Disease

Parkinson s Disease ◽

10.1155/2016/3217960 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 5

Author(s):

Alexandru Hanganu ◽

Oury Monchi

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Cognitive Impairment ◽

Clinical Practice ◽

Mild Cognitive Impairment ◽

Early Detection ◽

Cognitive Decline ◽

Cognitive Deficits ◽

Daily Living ◽

Near Future

Cognitive impairment in patients with Parkinson’s disease is a major challenge since it has been established that 25 to 40% of patients will develop cognitive impairment early in the disease. Furthermore, it has been reported that up to 80% of Parkinsonian patients will eventually develop dementia. Thus, it is important to improve the diagnosing procedures in order to detect cognitive impairment at early stages of development and to delay as much as possible the developing of dementia. One major challenge is that patients with mild cognitive impairment exhibit measurable cognitive deficits according to recently established criteria, yet those deficits are not severe enough to interfere with daily living, hence being avoided by patients, and might be overseen by clinicians. Recent advances in neuroimaging brain analysis allowed the establishment of several anatomical markers that have the potential to be considered for early detection of cognitive impairment in Parkinsonian patients. This review aims to outline the neuroimaging possibilities in diagnosing cognitive impairment in patients with Parkinson’s disease and to take into consideration the near-future possibilities of their implementation into clinical practice.

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Impact of impairment in instrumental activities of daily living and mild cognitive impairment on time to incident dementia: results of the Leipzig Longitudinal Study of the Aged

Psychological Medicine ◽

10.1017/s003329171000142x ◽

2010 ◽

Vol 41 (5) ◽

pp. 1087-1097 ◽

Cited By ~ 37

Author(s):

T. Luck ◽

M. Luppa ◽

M. C. Angermeyer ◽

A. Villringer ◽

H.-H. König ◽

...

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Longitudinal Study ◽

Activities Of Daily Living ◽

Daily Living ◽

High Risk Population ◽

Instrumental Activities ◽

Incident Dementia ◽

The Impact ◽

Mean Time

BackgroundEarly diagnosis of dementia requires knowledge about associated predictors. The aim of this study was to determine the impact of mild cognitive impairment (MCI) and impairment in instrumental activities of daily living (IADL) on the time to an incident dementia diagnosis.MethodData were derived from the Leipzig Longitudinal Study of the Aged (LEILA75+), a population-based study of individuals aged ⩾75 years. Kaplan-Meier survival analysis was used to determine time to incident dementia. Cox proportional hazards models were applied to determine the impact of MCI and IADL impairment on the time to incident dementia.ResultsIn total, 180 (22.0%) of 819 initially dementia-free subjects developed dementia by the end of the study. Mean time to incident dementia was 6.7 years [95% confidence interval (CI) 6.5–6.9]. MCI combined with IADL impairment was associated with a higher conversion rate to dementia, a shorter time to clinically manifest diagnosis and a lower chance of reversibility to cognitive normal. The highest risk for a shorter time to incident dementia was found for amnestic MCI combined with IADL impairment. The mean time to incident dementia was 3.7 years (95% CI 2.9–4.4) and thus half as long as in subjects without MCI and IADL impairment.ConclusionsSubjects with MCI and IADL impairment constitute a high-risk population for future dementia. The consideration of both – MCI and IADL impairment – might help to improve the prediction of dementia.

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Patients’ Self-Report and Handwriting Performance Features as Indicators for Suspected Mild Cognitive Impairment in Parkinson’s Disease

Sensors ◽

10.3390/s22020569 ◽

2022 ◽

Vol 22 (2) ◽

pp. 569

Author(s):

Sara Rosenblum ◽

Sonya Meyer ◽

Ariella Richardson ◽

Sharon Hassin-Baer

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Performance Measures ◽

Early Identification ◽

Daily Living ◽

Functional Abilities ◽

Significant Group ◽

Stroke Width

Early identification of mild cognitive impairment (MCI) in Parkinson’s disease (PD) patients can lessen emotional and physical complications. In this study, a cognitive functional (CF) feature using cognitive and daily living items of the Unified Parkinson’s Disease Rating Scale served to define PD patients as suspected or not for MCI. The study aimed to compare objective handwriting performance measures with the perceived general functional abilities (PGF) of both groups, analyze correlations between handwriting performance measures and PGF for each group, and find out whether participants’ general functional abilities, depression levels, and digitized handwriting measures predicted this CF feature. Seventy-eight participants diagnosed with PD by a neurologist (25 suspected for MCI based on the CF feature) completed the PGF as part of the Daily Living Questionnaire and wrote on a digitizer-affixed paper in the Computerized Penmanship Handwriting Evaluation Test. Results indicated significant group differences in PGF scores and handwriting stroke width, and significant medium correlations between PGF score, pen-stroke width, and the CF feature. Regression analyses indicated that PGF scores and mean stroke width accounted for 28% of the CF feature variance above age. Nuances of perceived daily functional abilities validated by objective measures may contribute to the early identification of suspected PD-MCI.

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Memantine for the Patients with Mild Cognitive Impairment in Parkinson’s Disease: A Pharmacological fMRI Study

10.21203/rs.3.rs-967500/v1 ◽

2021 ◽

Author(s):

Shoji Kawashima ◽

Noriyuki Matsukawa ◽

RCIP-Nagoya Study Group

Keyword(s):

Parkinson’S Disease ◽

Working Memory ◽

Parkinson's Disease ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Spatial Working Memory ◽

Clinical Status ◽

Visuospatial Working Memory ◽

Increased Risk ◽

The Impact

Abstract Background:Mild cognitive impairment of Parkinson’s disease (PD-MCI) represents increased risk of future cognitive decline. The characteristics of PD-MCI are impairments in executive function and visuospatial recognition. The visuospatial n-back test has a merit that it can assess both cognitive domains. Concerning the treatment of PD-MCI and dementia in PD (PDD), many studies have reported efficacy of cholinesterase inhibitors. Similarly, some studies reported efficacy of memantine for PDD, showing that it improved clinical status or behavioral symptoms. However, therapeutic evidence of memantine for PD-MCI has not been unestablished. Methods: We aimed to investigate whether memantine can alter brain function of the patients with PD-MCI, using functional MRI. In comparison between memantine and placebo, we explored the difference in regions associated with visuospatial n-back test. The 0-back test reflects visuospatial recognition, and the 1-back and 2-back tests reflect visuospatial working memory. This study followed a randomized double-blind crossover design. Patients in the memantine group were given memantine at 5 mg/day in the first week, and the dose was increased by 5 mg/day per week, with the final dose of 20 mg/day. The patients in the placebo group were given a placebo following the same regimen. The population in this study constitutes 10 patients who completed follow-up. During maximum dose administration, fMRI scanning and neuropsychological tests were performed. Group comparisons between memantine and placebo were performed.Results: There were no significant regions enhanced by memantine comparing with placebo at any load of n-back tests. In contrast, exploring regions reduced by memantine, we found significant reduction of activations within right lingual gyrus and left superior frontal gyrus in comparison between 2-back and 0-back test. A number of correct answers of the 2-back test and time to complete Trail Making Test-A were worse at memantine intervention. Reduced brain activations were associated with worse visuo-spatial working memory caused by memantine.Conclusions:This study reports memantine did not improve visuospatial working memory of the patients with PD-MCI. Treatment of PD should be planned carefully considering the impact for cognitive function. Further study is needed to establish new therapeutic strategy of the patients with PD-MCI.

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Motor and non-motor wearing-off and its impact in the quality of life of patients with Parkinson's disease

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20180074 ◽

2018 ◽

Vol 76 (8) ◽

pp. 517-521 ◽

Cited By ~ 9

Author(s):

Mayela Rodríguez-Violante ◽

Natalia Ospina-García ◽

Ned Merari Dávila-Avila ◽

Diego Cruz-Fino ◽

Alejandra de la Cruz-Landero ◽

...

Keyword(s):

Quality Of Life ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Activities Of Daily Living ◽

Daily Living ◽

Rating Scale ◽

Motor Fluctuations ◽

Wearing Off ◽

The Impact

ABSTRACT The wearing-off phenomenon is common in patients with Parkinson's disease. Motor and non-motor symptoms can fluctuate in relation to the “on/off” periods. Objective: To assess the impact of motor and non-motor wearing-off on activities of daily living and quality of life of patients with PD. Methods: A cross-sectional study was carried out. All patients were evaluated using the Movement Disorders Society Unified Parkinson's Disease Rating Scale. Wearing-off was assessed using the Wearing-Off Questionnaire-19, and quality of life was assessed using the Parkinson's Disease Questionnaire-8. Results: A total of 271 patients were included; 73.4% had wearing-off; 46.8% had both motor and non-motor fluctuations. Patients with both motor and non-motor wearing-off had a worst quality of life compared with those with only motor fluctuations (p = 0.047). Conclusions: Motor and non-motor fluctuations have an impact on activities of daily living and quality of life. Non-motor wearing-off may have a higher impact.

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Impact of social and mobility restrictions in Parkinson’s disease during COVID-19 lockdown

BMC Neurology ◽

10.1186/s12883-021-02364-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Raquel Luis-Martínez ◽

Roberto Di Marco ◽

Luca Weis ◽

Valeria Cianci ◽

Francesca Pistonesi ◽

...

Keyword(s):

Quality Of Life ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Activities Of Daily Living ◽

Daily Living ◽

Functional Independence ◽

The Body ◽

Before And After ◽

The Impact

Abstract Background The consequences of strict COVID-19 mobility restrictions on motor/non-motor features in Parkinson’s disease (PD) have not been systematically studied but worse mobility and quality of life have been reported. To elucidate this question, 12 mild to moderate PD patients were assessed in March 2020 before and after two months of isolation as part of a clinical study that had to be interrupted due to the pandemic and the implementation of COVID19 mobility restrictions. Methods Twelve patients were systematically evaluated before and after the lockdown period as part of a larger cohort that previously underwent thermal water rehabilitation. Clinical outcomes were the Body Mass index, the Mini-Balance Evaluation Systems Test, the MDS-Unified Parkinson’s Disease Rating Scale part III, the 6 Minute Walking Test and the New Freezing of Gait Questionnaire. Global cognition was evaluated with the Montreal Cognitive Assessment scale. The impact of COVID-19 restrictions on quality of life and functional independence was evaluated with The Parkinson’s disease Quality of life (PDQ-39), the Activities of Daily Living (ADL) and Instrumental Activities of Daily Living questionnaires (IADL) and the Parkinson’s disease cognitive functional rating scales (PD-CFRS). Results After two months of isolation the Mini-BESTest score worsened (p=0.005), and four patients reported one or more falls during the lockdown. BMI increased (p=0.031) while the remaining clinical variables including quality of life did not change. Conclusion We observed moderate worsening at Mini-BESTest, greater risk of falls and increased body weight as consequence of prolonged immobility. We believe negative effects were partially softened since patients were in contact with our multidisciplinary team during the lockdown and had previously received training to respond to the needs of this emergency isolation. These findings highligh the importnace of patient-centered interventions in PD management.

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