Mild cognitive impairment is common in Parkinson's disease patients with normal Mini-Mental State Examination (MMSE) scores

Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA.
Parkinsonism & Related Disorders (Impact Factor: 4.13). 07/2008; 15(3):226-31. DOI: 10.1016/j.parkreldis.2008.05.006
Source: PubMed

ABSTRACT Cognitive impairment occurs in the majority of Parkinson's disease (PD) patients, but little is known about detection of mild cognitive impairment (MCI) in this population. We report on the frequency and characteristics of cognitive deficits in PD patients with intact global cognition based on Mini-Mental State Examination (MMSE) performance.
One hundred and six PD patients with normal age- and education-adjusted MMSE scores (mean [SD] score=29.1 [1.1]) were administered standardized neuropsychological tests assessing memory, executive function, and attention. Impairment on a cognitive domain was a low score (i.e., >or=1.5 SD below the published normative mean) on at least two measures or tests (for memory and executive abilities) or a single measure (for attention).
Mild cognitive impairment was found in 29.2% of PD patients, with 17.9% demonstrating single domain and 11.3% multiple domain impairment. Memory and attention impairment were most common (15.1% and 17.0%, respectively), followed by executive impairment (8.5%). Depending on the measure of disease severity chosen, increasing age and disease severity, anti-anxiety medication use, and a suggestion for increasing severity of daytime sleepiness were independent predictors of cognitive impairment.
Cognitive deficits are common in PD patients with "normal" cognition based on MMSE performance, suggesting that MCI is under-recognized in clinical practice due to routine use of insensitive screening instruments. In contrast with some previous reports, early memory impairment may be as common as either executive or attentional deficits in PD. In addition, psychiatric medication use and daytime sleepiness may be reversible or treatable contributors to cognitive impairment.

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Available from: Paul J Moberg, Aug 28, 2015
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    • "For example, three participants who recalled falling at least monthly had no recent falls in their notes, and four had only a single fall recorded; five people without a MMSE in their notes had a MoCA suggesting moderate CI. Though using the MMSE and the MoCA to evaluate CI may have contributed to the differences in the rates and severity of CI noted in different parts of the current study, we agree with others [28] [29] who suspect MMSE underestimates the degree of cognitive dysfunction in PD. "
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