Parkinson's disease-cognitive cognitive scale specific for rating scale: A new Parkinson's disease

Centro de Investigación Biomédica en Red, Enfermedades Neurodegenerativas, Madrid, Madrid, Spain
Movement Disorders (Impact Factor: 5.63). 05/2008; 23(7):998-1005. DOI: 10.1002/mds.22007
Source: PubMed

ABSTRACT Cognitive defects associated with cortical pathology may be a marker of dementia in Parkinson's disease (PD). There is a need to improve the diagnostic criteria of PD dementia (PDD) and to clarify the cognitive impairment patterns associated with PD. Current neuropsychological batteries designed for PD are focused on fronto-subcortical deficits but are not sensitive for cortical dysfunction. We developed a new scale, the Parkinson's Disease-Cognitive Rating Scale (PD-CRS), that was designed to cover the full spectrum of cognitive defects associated with PD. We prospectively studied 92 PD patients [30 cognitively intact (CogInt), 30 mild cognitive impairment (MCI), 32 PDD] and 61 matched controls who completed the PD-CRS and neuropsychological tests assessing the cognitive domains included in the PD-CRS. Acceptability, construct validity, reliability, and the discriminative properties of the PD-CRS were examined. The PD-CRS included items assessing fronto-subcortical defects and items assessing cortical dysfunction. Construct validity, test-retest and inter-rater reliability of PD-CRS total scores showed an intraclass correlation coefficient >0.70. The PD-CRS showed an excellent test accuracy to diagnose PDD (sensitivity 94%, specificity 94%). The PD-CRS total scores and confrontation naming item scores-assessing "cortical" dysfunction-independently differentiated PDD from non-demented PD. Alternating verbal fluency and delayed verbal memory independently differentiated the MCI group from both controls and CogInt. The PD-CRS appeared to be a reliable and valid PD-specific battery that accurately diagnosed PDD and detected subtle fronto-subcortical deficits. Performance on the PD-CRS showed that PDD is characterized by the addition of cortical dysfunction upon a predominant and progressive fronto-subcortical impairment.

    • "For some time it has been recognized that frequently used global cognitive instruments, such as the Mini-Mental State Examination (MMSE) [9] and the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog), [10] do not map well onto the mild cognitive deficits reported to occur in many PD patients due to their focus on " cortical " deficits and their development for non-PD populations. As a result, several global cognitive assessment instruments have been developed or undergone validation for use in PD, including the Parkinson's Disease- Cognitive Rating Scale (PD-CRS), [11] the Parkinson Neuropsychometric Dementia Assessment (PANDA), [12] the Scales for Outcomes of Parkinson's Disease- Cognition (SCOPA-COG), [13] the Dementia Rating Scale-2 (DRS-2), [14] and the Montreal Cognitive Assessment (MoCA) [15] [16]. In addition, a plethora of individual neuropsychological tests have been used in PD to specifically assess executive, memory, attention, visuospatial and language domain abilities, often in different combinations to create a battery of tests. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Cognitive impairment is a common occurrence in Parkinson's disease (PD), although the severity and specific presentation varies across patients. Initial deficits, including mild cognitive impairment (PD-MCI), may remain stable or in many cases, may progress over variable lengths of time to Parkinson's disease dementia (PDD). As there are currently no marketed treatments for milder forms of cognitive impairment, an opportunity exists to define the path for therapeutic development in this area. In the absence of a well-defined path for the approval of therapies that target PD-MCI, pharmaceutical companies are unlikely to pursue this indication. In order to move forward and improve the quality of life for PD patients, it is imperative for the field to have consensus on the definition of PD-MCI, the best instruments to measure cognitive decline, and a strategy for future clinical trials.
  • Source
    • "In the case of PD, an assessment tool specifically designed for PD may be more appropriate for capturing the wide spectrum of cognitive changes associated with this neurodegenerative disease. The PD- Cognitive Rating Scale (PD-CRS), for example, provides the best combination of acceptability, internal consistency, and test-retest and inter-rater reliability and includes assessments of both frontal-subcortical and instrumental-cortical function [Pagonabarraga et al., 2008]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The spectrum of cognitive symptoms in Parkinson's disease (PD) can span various domains, including executive function, language, attention, memory, and visuospatial skills. These symptoms may be attributable to the degradation of projection fibers associated with the underlying neurodegenerative process. The primary purpose of this study is to find microstructural correlates of impairments across these cognitive domains in PD using diffusion tensor imaging (DTI). Sixteen patients with PD with comprehensive neuropsychological evaluation and DTI data were retrospectively studied. Fractional anisotropy (FA) and mean diffusivity (MD) were assessed using regions-of-interest (ROI) analysis and confirmed with a voxel-based approach. Executive function directly correlated with FA and inversely correlated with MD in mostly frontal white matter tracts, especially the anterior limb of the internal capsule and genu of the corpus callosum. Likewise, language and attentional performance demonstrated correlations with DTI parameters in the frontal regions, but the attention domain additionally recruited regions widespread throughout the brain, with the most significant correlation identified in cingulate gyrus (cingulum). Lastly, memory impairment mainly involved MD alterations within the fornix. No significant correlations were found between visuospatial skills and DTI measures. Despite some overlap, unique patterns of white matter diffusivity underlie impairments in distinct cognitive domains in patients with PD. DTI combined with neurocognitive tests may be a valuable biomarker for identifying cognitive impairments in PD. Hum Brain Mapp, 2013. © 2013 Wiley Periodicals, Inc.
    Human Brain Mapping 04/2014; 35(4). DOI:10.1002/hbm.22256 · 6.92 Impact Factor
  • Source
    • "We categorized as minor hallucinators to those patients with presence and/or passage hallucinations who scored 1 in the Hallucinations and Psychosis item of the MDS-UPDRS, and that had experienced minor hallucinations at least weekly during the last month. Cognition was assessed by the Parkinson's Disease- Cognitive Rating Scale (PD-CRS) [16] and the Mattis Dementia Rating Scale (MDRS) [17]. Exclusion criteria included history of major psychiatric disorders , cerebrovascular disease, other conditions known to impair mental status other than PD, or the presence of factors that prevented MRI scanning (e.g., claustrophobia, MRI non-compatible prosthesis). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Hallucinations are a frequent and severe complication in Parkinson's disease (PD). Minor hallucinations are generally not disturbing, but likely progress to well-structured hallucinations with loss of insight and a great impact on quality of life. Knowledge on the neural bases of minor hallucinations may help to describe those systems associated with the early development of psychotic phenomena in PD. In this study, we aimed to identify the pattern of structural brain alterations associated with minor hallucinations in PD by using voxel-based morphometry (VBM). We prospectively collected a sample of 46 non-demented PD patients, with (N = 17) and without (n = 29) minor hallucinations (passage and/or presence hallucinations), and 15 healthy controls. Groups were matched for age, education and global cognitive function. Presence and type of minor psychotic phenomena was assessed by the new MDS-UPDRS. Three dimensional T1-weighted MRI images were acquired with a 1.5 T magnet, and analyzed using optimized VBM. Compared to controls, PD with minor hallucinations (PD-mH) showed reduced gray matter volume bilaterally in different areas of the dorsal visual stream, and in functionally related midbrain and cerebellar structures. Additionally, bilateral gray matter volume increases were observed in the PD-mH group in limbic and paralimbic regions. Our data support a major role of the dorsal visual stream in the genesis of minor hallucinations in PD, reinforcing the importance of posterior cortical regions for the development of cognitive and psychiatric complications in PD.
    Parkinsonism & Related Disorders 12/2013; 20(3). DOI:10.1016/j.parkreldis.2013.11.017 · 4.13 Impact Factor
Show more