The aim of this study was to establish the rate of progression from mild cognitive impairment (MCI) to dementia in patients with Parkinson's disease (PD). PD patients without dementia were recruited in 1997 from an ongoing prospective epidemiological study. The assessment included neurological and psychiatric examinations, a clinical interview based on the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R) criteria for dementia, and a battery of neuropsychological tests. PD was diagnosed according to established criteria, dementia was diagnosed according to the DSM-III-R criteria, and subtypes of MCI were classified according to modified Petersen's criteria. Seventy-two nondemented PD patients were included. A total of 34 were cognitively intact, whereas 38 were diagnosed with MCI (amnestic, n = 6; single nonmemory domain, n = 17; multiple domains slightly impaired, n = 15). Fifty-nine patients (82%) completed follow-up examination 4 years later, and 18 (62%) of the patients with MCI and 6 (20%) of the cognitively intact PD patients were demented (P = 0.001). Single domain nonmemory MCI and multiple domains slightly impaired MCI were associated with later development of dementia (P = 0.003; P = 0.04), whereas amnestic MCI subtype was not (P = 0.76). We conclude that patients with PD and MCI had a higher risk of developing dementia than cognitively intact PD patients, suggesting that MCI in PD is an early manifestation of dementia. However, these findings should be interpreted with caution due to the relatively small number of subjects included in this study.
"Mild cognitive impairment (MCI) and PD dementia (PDD) are frequent and incidence increases with age, disease duration, and disease severity . Even though there is still some debate regarding the definition, MCI is considered a cognitive decline that is not normal for age but with basically normal functional activities, and that appears to place patients at risk of progressing to dementia   . ISSN 1877-7171/15/$35.00 "
[Show abstract][Hide abstract] ABSTRACT: Background: There is increasing evidence to suggest a tight relationship between cognitive impairment and falls in Parkinson's disease (PD). Here, we draw attention to a potentially significant flaw in the existent falls-related research, namely the apparent exclusion of patients with cognitive impairment or dementia. Objective: Our objective was to review all published, ongoing or scheduled fall-related intervention studies, in order to investigate the extent to which cognitively impaired individuals with PD were included in these studies. Methods: We analyzed published controlled trials regarding falls and PD in commonly used databases, as well as relevant ongoing clinical trials registered within the World Health Organization database, clinicaltrials.gov and the European Clinical Trials Database. Results: Fourteen of the fifteen published studies included had explicit cognitive exclusion criteria as part of their study protocol. Most of the 54 ongoing PD fall-related studies excluded patients with cognitive impairment. Conclusions: This suggests that individuals with cognitive impairment or dementia are excluded from fall-related research studies. We strongly recommend that future work in this area should include a representative sample of patients with PD, including subjects with cognitive decline.
"Az átlagpopulációhoz mérve, amelyben az amnesztikus MCI-forma előfordulása a leggyakoribb, az újonnan diagnosztizált Parkinson-kóros betegek esetében a nonamnesztikus variánsok megléte a jellemzőbb . A kognitív hanyatlás a betegség időtartamának előrehaladtával egyre gyakoribbá válik, azonban a progresszió sebességének mértékében nagy egyéni különbségek fi gyelhetők meg . Az enyhe kognitív zavar azonosítása alapján előre jelezhető a későbbiekben kialakuló Parkinson-kórhoz "
[Show abstract][Hide abstract] ABSTRACT: In the present review the recent developments in the definitions of neurocognitive disorders associated with Parkinson's disease are summarized including the possibilities for screening and treating. For a long time, the recognition of neurocognitive disorders associated in patients with Parkinson's disease was unsatisfactory due to the heterogeneity of definitions. The recently developed Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) introduced the definitions of mild and major neurocognitive disorders instead of mild cognitive impairment and dementia. The new DSM-5 definitions are clinically well applicable; therefore, the validation of the most frequent screening tests (Mini-Mental State Examination; Addenbrooke's Cognitive Examination; Montreal Cognitive Assessment; Mattis Dementia Rating Scale) is warranted. Based on a Hungarian sample of 295 patients with Parkinson's disease, the cut-off scores having the best discriminative values are highly dependent on education years (Addenbrooke's Cognitive Examination: 0-8 years of education: 82.5 points, 9-12 years of education: 83.5 points, and ≥13 years of education: 84.5 points; Mini-Mental State Examination: 26.5-27.5-28.5 points, Montreal Cognitive Assessment: 23.5-24.5-24.5 points, Mattis Dementia Rating Scale: 138.5-139.5-139.5 points, respectively). Orv. Hetil., 2015, 156(23), 915-926.
Orvosi Hetilap 06/2015; 156(23):915-26. DOI:10.1556/650.2015.30159
"The accurate identification of MCI in ndPD patients is critical, as cholinesterase inhibitors have been associated with improved attention  and increased frontal brain activity in cognitively impaired PD . In addition, studies have shown that cognitive dysfunction is a risk factor for the subsequent development of Parkinson's disease dementia , and cognitive impairment in ndPD predicts disability, impaired driving, and increased risk for falls, which results in increased medical care costs . "
[Show abstract][Hide abstract] ABSTRACT: Background: We examined the sensitivity of different executive function measures for detecting deficits in Parkinson’s disease patients without dementia.
Methods: Twenty-one non-demented PD subjects and 21 neurologically healthy controls were administered widely used clinical executive functioning measures as well as the NIH EXAMINER battery, which produces Cognitive Control, Working Memory, and Verbal Fluency scores, along with an overall Executive Composite score, using psychometrically matched scales.
Results: No significant differences between groups were observed on widely used clinical measures. The PD patients scored lower than controls on the EXAMINER Executive Composite, Cognitive Control, and Working Memory Scores.
Conclusions: The NIH EXAMINER Executive Composite and Cognitive Control Scores are sensitive measures of executive dysfunction in non-demented PD, and may be more sensitive than several widely used measures. Results highlight the importance of careful test selection when evaluating for mild cognitive impairment in PD.
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