Cognitive impairment in Parkinson’s disease: Multidisciplinary Symposium Clinical Management of Parkinson’s disease

2017 ◽  
Vol 1 (3) ◽  
pp. 01-03
Author(s):  
Morgan Shabir
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Healthcare Professionals ◽  
Unmet Needs ◽  
Clinical Care ◽  
Pharmacological Interventions ◽  
Cognitive Health ◽  
Care Partners

People with Parkinson’s disease (PD) and their care partners frequently report cognitive decline as one of their greatest concerns. Mild cognitive impairment affects approximately 20–50% of people with PD, and longitudinal studies reveal dementia in up to 80% of PD. Through the Parkinson’s Disease Foundation Community Choice Research Award Program, the PD community identified maintaining cognitive function as one of their major unmet needs. In response, a working group of experts across multiple disciplines was organized to evaluate the unmet needs, current challenges, and future opportunities related to cognitive impairment in PD. Specific conference goals included defining the current state in the field and gaps regarding cognitive issues in PD from patient, care partner, and healthcare professional viewpoints; discussing non-pharmacological interventions to help maintain cognitive function; forming recommendations for what people with PD can do at all disease stages to maintain cognitive health; and proposing ideas for how healthcare professionals can approach cognitive changes in PD. This paper summarizes the discussions of the conference, first by addressing what is currently known about cognitive dysfunction in PD and discussing several non-pharmacological interventions that are often suggested to people with PD. Second, based on the conference discussions, we provide considerations for people with PD for maintaining cognitive health and for healthcare professionals and care partners when working with people with PD experiencing cognitive impairment. Furthermore, we highlight key issues and knowledge gaps that need to be addressed in order to advance research in cognition in PD and improve clinical care.

scholarly journals Corneal nerve fiber loss relates to cognitive impairment in patients with Parkinson’s disease

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Ning-Ning Che ◽  
Qiu-Huan Jiang ◽  
Guan-Xiao Ding ◽  
Si-Yuan Chen ◽  
Zhen-Xiang Zhao ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Nerve Fiber ◽  
Rating Scale ◽  
Motor Dysfunction ◽  
Control Group ◽  
Corneal Confocal Microscopy ◽  
Corneal Nerve

AbstractCognitive impairment in Parkinson’s disease (PD) adversely influences quality of life. There is currently no available biomarker to predict cognitive decline in PD. Corneal confocal microscopy (CCM) has been used as a non-invasive tool for quantifying small nerve damage in PD. The present study investigated whether corneal nerve measures were associated with cognitive function in PD. Patients with PD were classified into those with normal cognitive function (PD-CN), mild cognitive impairment (PD-MCI), and dementia (PDD). Corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD), and corneal nerve fiber length (CNFL) were quantified with CCM and compared with a control group. Sixty-five PD patients and thirty controls were studied. CNFD was decreased and CNBD was increased in PD patients compared to controls (P < 0.05). CNBD and CNBD/CNFD ratio was higher in PD-CN compared to controls. CNFD was positively correlated with the Montreal cognitive assessment (MoCA) score (r = 0.683, P < 0.001), but negatively associated with unified Parkinson disease rating scale (UPDRS)-part III (r = −0.481, P < 0.001) and total UPDRS scores (r = −0.401, P = 0.001) in PD patients. There was no correlation between CNFD and Levodopa equivalent daily dose (LEDD) (r = 0.176, P = 0.161). CNFD, CNBD, CNFL, and CNBD/CNFD ratio was lower with increasing Hoehn and Yahr stage. PD patients show evidence of corneal nerve loss compared with controls and corneal nerve parameters are associated with the severity of cognitive and motor dysfunction in PD. CCM could serve as an objective in vivo ophthalmic imaging technique to assess neurodegeneration in PD.

Directional Bias in Line Orientation Test Errors in Parkinson’s Disease

2020 ◽  
Vol 35 (6) ◽  
pp. 683-691 ◽  
Author(s):  
Patrick Riordan ◽  
Sandra L Kletzel ◽  
Genessa Lahr ◽  
Jamie Walter ◽  
Randi Wilson
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cognitive Impairment ◽  
Clinical Care ◽  
Error Rates ◽  
Line Orientation ◽  
Group Status ◽  
Directional Bias ◽  
Test Errors ◽  
Orientation Test

Abstract Objective Value in evaluating error subtypes on visuospatial line orientation tests has been reported. Directional bias metrics for line orientation test errors represent easily quantifiable data that have not previously been studied. We evaluated whether patients with a clinical condition known to affect visuospatial functioning (Parkinson’s disease [PD]) exhibited unique directional error patterns on the RBANS Line Orientation test relative to other neuropsychology-referred patients. Method We compared overall directional bias in errors, directional bias by line location (left or right line and visual field), and absolute error rates (regardless of direction) by line location in a retrospective sample of patients with PD and a sample of neuropsychology-referred patients without PD. Groups were roughly matched on age, education, gender, and overall level of cognitive impairment. Results Patients with PD exhibited higher rates of leftward bias in errors, both overall and for the left stimulus line in each pair. Directional bias error scores better predicted PD versus non-PD group status than RBANS Line Orientation raw scores. Classification accuracy data for these variables were modest in the entire sample but stronger in a subsample of patients with mild levels of overall cognitive impairment. Conclusions Directional bias metrics for line orientation tests represent easily quantifiable data with potential theoretical and clinical value. In our sample, patients with PD made more left-biased line orientation errors than other neuropsychology-referred patients. By themselves, directional bias scores may have limited diagnostic potential, but they may be useful in diagnostic classification models and may have implications for clinical care.

scholarly journals Relationship of Serum Tau Levels with Cognitive Functions and Factors Affecting The Cognitive Function Decrease in Parkinson's Disease Patients

2021 ◽  
Vol 5 (3) ◽  
pp. 539-545
Author(s):  
Meldayeni Busra ◽  
Yuliarni Syafrita ◽  
Hendra Permana
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Tau Protein ◽  
Significant Relationship ◽  
Education Level ◽  
Motor Symptom ◽  
Categorical Variables ◽  
The Relationship

Introduction: Cognitive impairment is a non-motor symptom of Parkinson's disease (PD) which occurs as the disease progresses and affects quality of life. Many efforts have been developed in early detection of cognitive disorders, one of which is the examination of tau protein biomarkers, where the tau protein that undergoes pathological changes to form neurofibrillary tangles (NFTs) is found in Alzheimer's disease and PD and plays a role in cognitive impairment. However, the role of tau in PD is still controversial. This study aims to assess the relationship between serum tau levels and cognitive function and the factors that affect cognitive function in PD patients. Methods: This cross-sectional design was conducted at the RSUP DR. M Djamil Padang. During the period March to August 2020, 62 research subjects were obtained. Cognitive function examination was carried out by using the MoCA-Ina test and examination of serum tau levels using the Elisa method. The relationship between categorical variables was tested by Chi square and differences in serum tau levels in the group with and without cognitive impairment were tested with the Mann Whitney test, considered statistically significant if the p value <0.05. Results: With Moca Ina examination, it was found that 67.7% of patients had impaired cognitive function. The mean serum tau level was 198.004 ± 162.69 ng / L.There was a significant relationship between education level and degree of disease with cognitive function (p <0.05) and there was no difference in mean serum tau levels between groups with and without cognitive impairment. Conclusion: There is a significant relationship between education level and degree of disease with cognitive function and there is no difference in mean serum tau protein levels between the cognitive impaired group and the cognitive normal group.

scholarly journals Self-Management Education for Persons with Parkinson’s Disease and Their Care Partners: A Quasi-Experimental Case-Control Study in Clinical Practice

2020 ◽  
Vol 2020 ◽  
pp. 1-13 ◽  
Author(s):  
Carina Hellqvist ◽  
Carina Berterö ◽  
Nil Dizdar ◽  
Märta Sund-Levander ◽  
Peter Hagell
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Case Control Study ◽  
Clinical Care ◽  
Self Management ◽  
Group Differences ◽  
Care Partners ◽  
Before And After ◽  
Quasi Experimental ◽  
Control Study

Background. Parkinson’s disease is a neurodegenerative condition with both physical and mental consequences that affect many aspects of everyday life. Persons with Parkinson’s disease and their care partners want guidance from healthcare services in order to develop skills to adjust to life with a long-term condition. The Swedish National Parkinson School is a dyadic self-management programme to support both persons with Parkinson’s disease and care partners. Objective. To assess the outcomes of the Swedish National Parkinson School as reported by participants. Design. A quasi-experimental case-control study in clinical care using self-reported questionnaires. Participants. Swedish National Parkinson School was offered by health care professionals working in clinical care. Participants in the programme were also asked to participate in the study. A matched control group was recruited for a comparison of findings. In total, 92 persons with Parkinson’s disease and 55 care partners were included. Settings. Five Swedish geriatric and neurologic outpatient clinics. Method. Data were collected during 2015–2017, before and after participation in the National Parkinson School or before and after seven weeks of standard care. Outcomes were assessed using generic and Parkinson’s specific questionnaires. Descriptive statistics were used to describe baseline characteristics. Mann–Whitney U and Chi2 tests were used to test for between-group differences and within-group differences were tested by the Wilcoxon signed-ranks test. Results. Improvements regarding health status, constructive attitudes and approaches, and skill and technique acquisition were found after the intervention among persons with Parkinson’s disease. No changes were found among care partners. Conclusion. The findings indicate that the Swedish National Parkinson School may improve health status and self-management among persons with Parkinson’s disease, but further studies are needed to better understand the effects of the programme.

scholarly journals Features of GBA-associated Parkinson’s disease at presentation in the UK Tracking Parkinson’s study

2018 ◽  
Vol 89 (7) ◽  
pp. 702-709 ◽  
Author(s):  
Naveed Malek ◽  
Rimona S Weil ◽  
Catherine Bresner ◽  
Michael A Lawton ◽  
Katherine A Grosset ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Rating Scale ◽  
Disease Stage ◽  
Baseline Assessment ◽  
Mutation Carriers ◽  
Pathogenic Mutations ◽  
Motor Phenotype

ObjectivesTo examine the influence of the glucocerebrosidase (GBA) mutation carrier state on age at onset of Parkinson’s disease (PD), the motor phenotype and cognitive function at baseline assessment in a large cohort of UK patients. We also analysed the prevalence of mood and behavioural problems that may confound the assessment of cognitive function.MethodsWe prospectively recruited patients with PD in the Tracking Parkinson’s study. We fully sequenced the GBA gene in all recently diagnosed patients (≤3.5 years). We examined cognitive (Montreal Cognitive Assessment) and motor (Movement Disorder Society Unified Parkinson’s Disease Rating Scale part 3) function at a baseline assessment, at an average of 1.3 years after diagnosis. We used logistic regression to determine predictors of PD with mild cognitive impairment and PD with dementia.ResultsWe studied 1893 patients with PD: 48 (2.5%) were heterozygous carriers for known Gaucher’s disease (GD) causing pathogenic mutations; 117 (6.2%) had non-synonymous variants, previously associated with PD, and 28 (1.5%) patients carried variants of unknown significance in the GBA gene. L444P was the most common pathogenic GBA mutation. Patients with pathogenic GBA mutations were on average 5 years younger at disease onset compared with non-carriers (P=0.02). PD patients with GD-causing mutations did not have an increased family risk of PD. Patients with GBA mutations were more likely to present with the postural instability gait difficulty phenotype compared with non-carriers (P=0.02). Patients carrying pathogenic mutations in GBA had more advanced Hoehn and Yahr stage after adjustment for age and disease duration compared with non-carriers (P=0.005). There were no differences in cognitive function between GBA mutation carriers and non-carriers at this early disease stage.ConclusionsOur study confirms the influence of GBA mutations on the age of onset, disease severity and motor phenotype in patients with PD. Cognition did not differ between GBA mutation carriers and non-carriers at baseline, implying that cognitive impairment/dementia, reported in other studies at a later disease stage, is not present in recently diagnosed cases. This offers an important window of opportunity for potential disease-modifying therapy that may protect against the development of dementia in GBA-PD.Clinical trial registrationNCT02881099; Results.

scholarly journals Cognitive function in men with non-motor features of Parkinson’s disease

2021 ◽  
Vol 3 (1) ◽  
pp. e000112
Author(s):  
Mario H Flores-Torres ◽  
Katherine C Hughes ◽  
Samantha Molsberry ◽  
Xiang Gao ◽  
Jae H Kang ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Cognitive Decline ◽  
Smoking Status ◽  
Cognitive Interview ◽  
Coffee Consumption ◽  
Subjective Cognitive Decline ◽  
Prodromal Phase

ObjectiveSubtle cognitive deficits can occur during the prodromal phase of Parkinson’s disease (PD), commonly in conjunction with hyposmia. However, little is known about the association between cognitive function and other features suggestive of prodromal PD. We evaluated the association of non-motor prodromal PD features, including hyposmia, constipation and probable REM sleep behaviour disorder (pRBD), with objective measures of cognitive function and self-reported cognitive decline.MethodsThe study population comprised 804 men who responded to a telephone cognitive interview in 2016–2017. Participants included 680 individuals with hyposmia, of whom 45 had confirmed PD, and 124 men without hyposmia. Among these men, we evaluated objective cognitive function and subjective cognitive decline to determine whether the presence of non-motor features of prodromal PD was associated with cognitive functioning. Analyses were adjusted for age, physical activity, body mass index, smoking status and coffee consumption.ResultsIndividuals with non-motor features of prodromal PD had worse objective and subjective cognitive performance relative to men without non-motor features. Cognitive impairment was particularly prevalent among individuals with concurrent hyposmia, pRBD and constipation (multivariate-adjusted OR=3.80; 95% CI 1.52 to 9.47 for objective poor cognitive function; OR=8.71; 95% CI 3.18 to 23.83 for subjective cognitive decline). As expected, both objective (OR=7.91) and subjective (OR=17.42) cognitive impairment were also more common among men with confirmed PD.ConclusionsOur study suggests that cognition is commonly affected in individuals with non-motor prodromal PD features, particularly when multiple of these features are present.

scholarly journals Corneal Nerve Fiber Loss Relates to Cognitive Impairment in Patients with Parkinson’s Disease

2020 ◽  
Author(s):  
Ning-Ning Che ◽  
Qiu-Huan Jiang ◽  
Guan-Xiao Ding ◽  
Si-Yuan Chen ◽  
Zhen-Xiang Zhao ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Nerve Fiber ◽  
Rating Scale ◽  
Motor Dysfunction ◽  
Control Group ◽  
Corneal Confocal Microscopy ◽  
Corneal Nerve

Abstract Background Cognitive impairment in Parkinson’s disease (PD) adversely influences quality of life. There is currently no available biomarker to predict cognitive decline in PD. PD involves both the central and peripheral nervous system and especially small fiber damage occurs in PD. Corneal confocal microscopy (CCM) has been used as a non-invasive tool for quantifying small nerve fibre damage in PD. The present study investigated whether corneal nerve measures were associated with cognitive function in PD. Methods Patients with PD were classified into those with normal cognitive function (PD-CN), mild cognitive impairment (PD-MCI), and dementia (PDD). Corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD) and corneal nerve fiber length (CNFL) were quantified with CCM and compared with a control group.Results Sixty-five PD patients (44.62% male; mean age 64.60±6.95 years; mean disease duration 4.63±2.53 years) and 30 controls (53.33% male; mean age 62.43±6.16 years) were studied. CNFD was decreased and CNBD was increased in PD patients compared to controls ( P <0.05). CNFD decreased progressively with decline in cognitive function in PD patients. CNBD and CNBD/CNFD ratio was higher in PD-CN compared to controls but decreased with worsening cognitive function in PD-MCI and PDD patients. CNFD correlated with the Montreal cognitive assessment (MoCA) score ( r =0.683, P <0.0001), unified Parkinson disease rating scale (UPDRS)-part III ( r =-0.481, P <0.0001) and total UPDRS scores ( r =-0.401, P <0.0001) in PD patients. CNFD, CNBD, CNFL were lower and CNBD/CNFD ratio was higher with increasing Hoehn and Yahr stage. There was no correlation between CNFD and Levodopa equivalent daily dose (LEDD) ( r =0.176, P =0.161). CNFD, CNBD and CNFL could discriminate between PD-MCI and PD-CN with an area under the curve (AUC) of 82.85%, 67.47%, and 78.74%, respectively. CNFD, CNBD and CNFL could discriminate between PDD and PD-CN with an AUC of 96.67%, 90.12% and 84.44%. A combination of all three CCM parameters further increased the AUC value. Conclusions PD patients show evidence of corneal nerve loss compared with controls and corneal nerve parameters are associated with the severity of cognitive and motor dysfunction in PD. CCM could serve as an objective in vivo ophthalmic imaging technique to assess neurodegeneration in PD.

scholarly journals Cognitive Impairment in Genetic Parkinson’s Disease

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
A. Planas-Ballvé ◽  
D. Vilas
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Cognitive Decline ◽  
Autosomal Recessive ◽  
Autosomal Dominant ◽  
Cognitive Profiles ◽  
And Biological Markers ◽  
Gba Mutations

Cognitive impairment is common in idiopathic Parkinson’s disease (PD). Knowledge of the contribution of genetics to cognition in PD is increasing in the last decades. Monogenic forms of genetic PD show distinct cognitive profiles and rate of cognitive decline progression. Cognitive impairment is higher in GBA- and SNCA-associated PD, lower in Parkin- and PINK1-PD, and possibly milder in LRRK2-PD. In this review, we summarize data regarding cognitive function on clinical studies, neuroimaging, and biological markers of cognitive decline in autosomal dominant PD linked to mutations in LRRK2 and SNCA, autosomal recessive PD linked to Parkin and PINK1, and also PD linked to GBA mutations.

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