Parkinson's disease—cognitive rating scale (PD-CRS): A new cognitive scale specific for Parkinson's disease

Centro de Investigación Biomédica en Red, Enfermedades Neurodegenerativas, Madrid, Madrid, Spain
Movement Disorders (Impact Factor: 5.68). 05/2008; 23(7):998-1005. DOI: 10.1002/mds.22007
Source: PubMed


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.

Download full-text


Available from: Alexandre Gironell,
781 Reads
  • 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 · 5.97 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 · 3.97 Impact Factor
  • Source
    • "The alternating fluency task employed in this study required switching between two semantic categories. The fact that the PD patients performed worse than controls on this theoretically most demanding ''frontal'' task supports previous evidence of larger deficits in alternating semantic fluency than on standard semantic fluency tasks in PD (Zec 1999; Henry and Crawford 2004a; Pagonabarraga et al. 2008). As the alternating fluency task was not related to brain GM volume in the present study, it could be proposed that alternating fluency deficits in early stage, non-demented PD are related to functional, rather than structural, disruptions of the fronto-striatal circuitry, and may best be captured using functional imaging approaches. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Verbal fluency impairments are frequent in Parkinson's disease (PD) and they may be present already at early stages. Semantic fluency impairment is associated with Parkinson's disease dementia and temporal, frontal and cerebellar cortical changes. Few studies have addres-sed cerebral structural correlates of different verbal fluency tasks in early stage PD. We therefore studied gray matter volumes of T1-weighted MRI images using voxel-based morphometry in relation to semantic, phonemic, and alternating verbal fluency in younger (mean age \65 years), early stage (mean disease duration \3 years), non-demented PD patients (n = 28) and healthy controls (n = 27). We found a significant association between worse phonemic fluency and smaller striatal, namely right caudate gray matter volume in the PD group only (family-wise error corrected p = 0.007). Reduced semantic fluency was associated with smaller gray matter volumes in left parietal cortex (p = 0.037) and at trend level with smaller bilateral cerebellum gray matter volume across groups (p = 0.062), but not in the separate PD or control groups. There were no significant relationships between alternating fluency and gray matter volumes in the whole sample or in the groups separately. The fact that phonemic fluency, but not semantic or alternating fluency, was associated with caudate gray matter volume at early stage PD suggests that different fluency tasks rely on different neural substrates, and that language networks supporting semantic search and verbal-semantic switching are unrelated to brain gray matter volume at early disease stages in PD.
    Journal of Neural Transmission - Parkinson s Disease and Dementia Section 08/2013; DOI:10.1007/s00702-013-1073-2
Show more