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Background:
The criteria for PD-MCI allow the use of global cognitive tests. Their predictive value for conversion from PD-MCI to PDD, especially compared to comprehensive neuropsychological assessment, is unknown.
Methods:
The MDS PD-MCI Study Group combined four datasets containing global cognitive tests as well as a comprehensive neuropsychol...
Contexts in source publication
Context 1
... Cox proportional hazards models indicated a significant contribution of PD-MCI as defined by MMSE and MoCA cutoff scores to the hazard of PDD (HRs respectively 2.57 and 4.14; see Supplementary Table 2). Age as well as UPDRS scores ...Context 2
... sensitivity and specificity were respectively: 67.7 and 68.1% for Level I-GCT based on the MMSE; 57.1 and 75.9% for Level I-CGT based on the MoCA; 32.8 and 94.7% for Level I-NPA; and 66.7 and 80.0% for level II (see Table 2). The Diagnostic Accuracy (DA) was sufficient for the MMSE (67.7), good for MoCA (73.3) and Level II (78.4) and very good for Level I-NPA (86.1). ...Similar publications
Today, in rural isolated areas or so-called ‘medical deserts’, access to diagnosis and care is very limited. With the current pandemic crisis, now even more than ever, telemedicine platforms are gradually more employed for remote medical assessment. Only a few are tailored to comprehensive teleneuropsychological assessment of older adults. Hence, o...
Citations
... For instance, an assessment with at least one test for each of the five cognitive domains independently contributed to the hazard of PDD [32]. Similarly, Boel et al. [33] found that MMSE and MoCA predicted the conversion to PDD and level I neuropsychological assessment showed good diagnostic accuracy (86%); (iii) we could not enroll a sufficient number of early-stage patients with PD due to the selection bias in our Parkinson Center (tertiary referral hospital for PD). However, meaningful information regarding distinct cognitive trajectories was provided by including patients with at least 3 years of consecutive neuropsychological assessments. ...
α-synuclein oligomers within synaptic terminals of autonomic fibers of the skin reliably discriminate Parkinson’s disease (PD) patients from healthy controls. Nonetheless, the prognostic role of oligomers for disease progression is unknown. We explored whether α-synuclein oligomers evaluated as proximity ligation assay (PLA) score may predict the worsening of cognitive functions in patients with Parkinson’s disease. Thirty-four patients with PD and thirty-four healthy controls (HC), matched 1:1 for age and sex, were enrolled. Patients with PD underwent baseline skin biopsy and an assessment of cognitive domains including Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Clock Drawing Test, and Frontal Assessment Battery. At the last follow-up visit available, patients were either cognitively stable (PD-CS) or cognitively deteriorated (PD-CD). α-synuclein oligomers were quantified as PLA scores. Differences between groups were assessed, controlling for potential confounders. The relationship between skin biopsy measures and cognitive changes was explored using correlation and multivariable regression analyses. The discrimination power of the PLA score was assessed via ROC curve. To elucidate the relationship between skin biopsy and longitudinal cognitive measures, we conducted multivariable regression analyses using delta scores of cognitive tests (Δ) as dependent variables. We found that PD-CD had higher baseline PLA scores than PD-CS (p = 0.0003), and they were correctly identified in the ROC curve analysis (AUC = 0.872, p = 0.0003). Furthermore, ANCOVA analysis with Bonferroni correction, considering all groups (PD-CS, PD-CD, and HC), showed significant differences between PD-CS and PD-CD (p = 0.003), PD-CS and HC (p = 0.002), and PD-CD and HC (p < 0.001). In the regression model using ΔMMSE as the dependent variable, the PLA score was found to be a significant predictor (β = −0.441, p = 0.016). Similar results were observed when evaluating the model with ΔMoCA (β = −0.378, p = 0.042). In conclusion, patients with Parkinson’s disease with higher α-synuclein burden in the peripheral nervous system may be more susceptible to cognitive decline.
... Many versions of detailed cognitive batteries (e.g., recommended Level I or Level II PD-MCI batteries 9 ) are utilized, with some evidence that there is differential sensitivity among commonlyused neuropsychological tests to mild cognitive deficits in PD 15 . Recent research has suggested that in general Level I and Level II cognitive batteries are better able to predict conversion from PD-MCI to PD dementia than are global screening instruments 16 . However, it remains unclear how to best utilize and interpret results containing multiple individual (sub)scores from differently-scaled andnormed tests. ...
Background and Objectives: Cognitive impairment is common at all stages in Parkinson's disease (PD). However, the field is hampered by consensus over which neuropsychological tests to use and how to utilize the results generated by a cognitive battery. An option that combines the richness of a neuropsychological battery with the simplicity of a single test score is a cognitive summary score (CSS). The objective was to determine if a CSS created using robust norming is sensitive in detecting early cognitive deficits in de novo, untreated PD.
Methods: Using baseline cognitive data from PD participants and healthy controls (HCs) in the Parkinson's Progression Markers Initiative, these steps were taken: (1) creating a robust HC subgroup that did not demonstrate cognitive decline over time; (2) using the robust HC subgroup to create regression-based internally-derived standardized scores (z-scores) for six cognitive scores across five tests; and (3) creating a CSS by averaging all standardized test z-scores.
Results: PD participants scored worse than HCs on all cognitive tests, with a larger effect size (PD versus HCs) when the comparison group was the robust HC subgroup compared with all HCs. Applying internally-derived norms rather than published norms, the largest cognitive domain effect sizes (PD vs. robust HCs) were for processing speed/working memory (Cohen's d= -0.55) and verbal episodic memory (Cohen's d= -0.48 and -0.52). In addition, using robust norming shifted PD performance from the middle of the average range (CSS z-score= -0.01) closer to low average (CSS z-score= -0.40), with the CSS having a larger effect size (PD vs. robust HC subgroup; Cohen's d= -0.60) compared with all individual cognitive tests.
Discussion: PD patients perform worse cognitively than HC at disease diagnosis on multiple cognitive domains, particularly information processing speed and verbal memory. Using robust norming increases effect sizes and lowers the scores of PD patients to "expected" levels. The CSS performed better than all individual cognitive tests. A CSS developed using a robust norming process may be sensitive to cognitive changes in the earliest stages of PD and have utility as an outcome measure in clinical research, including clinical trials.
... Assess the full spectrum of PD-related CI (i.e., PD-SCD, PD-MCI, PD-D) using validated and sensitive methods (i.e., level-II neuropsychological assessment) [87] Include prodromal PD patients (e.g., RBD) to explore whether early multimodal cognitionbased approaches may slow the onset of cognitive decline Neuropsychiatric non-motor comorbidities Assess neuropsychiatric non-motor symptoms (e.g., apathy, depression, anxiety, ICD) given their potential impact on PD-related CI [82] Other individual patient variables potentially moderating treatment effects ...
Purpose of review. Cognitive impairment is one of the most challenging non-motor symptoms of Parkinson’s disease (PD) and may occur during all PD stages. There are no established pharmacological treatments for PD-related cognitive impairment, which may be improved by cognition-based interventions (i.e., cognitive stimulation, cognitive training, cognitive rehabilitation). Multimodal cognition-based interventions by adjunctive drugs, exercise, non-invasive brain stimulation and technologies may be effective in PD.
Recent findings. Exercise combined with cognitive training may enhance global, memory, visuospatial and executive functioning, transcranial direct current stimulation delivered alongside cognitive training may improve attention and executive functioning, and exergames, semi-immersive virtual reality (VR) and telerehabilitation plus non-immersive VR combined with cognitive training may ameliorate global and executive functioning in PD patients.
Summary. The evidence reviewed here, despite preliminary, is very encouraging and suggests strong rationale for combining pharmacological and non-pharmacological interventions with cognition-based treatments in PD. To overcome limitations of current studies, we propose some recommendations for future trials on drugs, exercise, non-invasive brain stimulation and technologies combined with cognition-based treatments for cognitive impairment in PD.
... Due to the relative scarcity of suitable subjects, further studies should encompass multi-site endeavours to collect datasets of sufficient size where more detailed hypotheses related to cognitive decline in STN DBS could be evaluated Secondly, the only outcome measure of cognitive function in the presented study was DRS-2. Although previously validated for use in PD patients in a Czech population and appropriately suitable for cognitive screening of global cognition, DRS-2 does not appear to have utility in evaluating single cognitive functions in PD (Lopez et al., 2023;Boel et al., 2022). Further studies using more complex assessment of cognition (e.g. level II diagnosis of PD-MCI) will be necessary to evaluate whether our results correspond to the type of cognitive deficit which may develop after DBS implantation. ...
Background and objectives
The intricate relationship between deep brain stimulation (DBS) in Parkinson’s disease (PD) and cognitive impairment has lately garnered substantial attention. The presented study evaluated pre-DBS structural and microstructural cerebral patterns as possible predictors of future cognitive decline in PD DBS patients.
Methods
Pre-DBS MRI data in 72 PD patients were combined with neuropsychological examinations and follow-up for an average of 2.3 years after DBS implantation procedure using a screening cognitive test validated for diagnosis of mild cognitive impairment in PD in a Czech population – Dementia Rating Scale 2.
Results
PD patients who would exhibit post-DBS cognitive decline were found to have, already at the pre-DBS stage, significantly lower cortical thickness and lower microstructural complexity than cognitively stable PD patients. Differences in the regions directly related to cognition as bilateral parietal, insular and cingulate cortices, but also occipital and sensorimotor cortex were detected. Furthermore, hippocampi, putamina, cerebellum and upper brainstem were implicated as well, all despite the absence of pre-DBS differences in cognitive performance and in the position of DBS leads or stimulation parameters between the two groups.
Conclusions
Our findings indicate that the cognitive decline in the presented PD cohort was not attributable primarily to DBS of the subthalamic nucleus but was associated with a clinically silent structural and microstructural predisposition to future cognitive deterioration present already before the DBS system implantation.
... The MoCA was used as a comparator because it is currently widely used and recommended by MDS as an abbreviated cognitive assessing instrument for PD-MCI [4]. The sensitivity and specificity of MoCA to diagnose PD-MCI based on MDS PD-MCI Level I diagnostic criteria were 57.1 % and 75.9 % [21], which is similar to the MemTrax in our study. However, there are some limitations of MoCA such as requiring trained evaluators, face-to-face administration, and the test is influenced by language, culture, education and motor symptoms. ...
... However, the MTx-%C and MTx-Cp were significantly higher in HC than in PD-N group, illustrating MemTrax maybe more sensitive in estimating subtle cognitive changes compared with MoCA. MoCA has a low sensitivity of 57.1 % and may miss many cases of PD-MCI [21]，while MTx-%C of MemTrax can identify more PD-MCI with the sensitivity of 70.3 %. Furthermore, by adjusting the cut-off of MTx-%C to 81 %, sensitivity of identifying cognitive impairment in PD could be improved to 88.9 %. ...
... In comparison with previous studies, disease duration was relatively homogeneous in our sample (mean disease duration of 5.56 ± 2.09 years) that allows the study of SC in a well-established population of late-onset mid-stage PD patients. Finally, in our study, we have applied the MDS Level II criteria for the diagnosis of PD-MCI [11], which seem to have the best balance of sensitivity, specificity, and diagnostic accuracy, as well as a better predictive value for the development of PDD for PD-MCI patients compared to patients with normal cognition [53]. ...
Mild cognitive impairment (MCI) is a relevant non-motor feature in Parkinson’s disease (PD). Social cognition (SC) is a cognitive domain that refers to the ability to decode others’ intentions and to guide behavior in social contexts. We aimed to compare SC performance in mid-stage PD patients compared to a healthy population and according to their cognitive state. Fifty-two PD patients were classified as being cognitively normal (PD-CN) or having mild cognitive impairment (PD-MCI) following the Movement Disorder Society (MDS) Level II criteria. SC assessment included facial emotion recognition (FER), affective and cognitive theory of mind (ToM), and self-monitoring (RSMS test). Twenty-seven age-matched healthy controls (HC) were enrolled. PD-MCI patients scored worse than HC on affective and cognitive ToM task scores. Only cognitive ToM scores were significantly lower when compared with the PD-MCI and PD-CN groups. We found no differences in FER or self-monitoring performance. There were significant correlations between cognitive ToM and executive functions, memory, language, and attention, whereas FER and affective ToM correlated with memory. Our findings indicates that SC is normal in cognitively unimpaired and non-depressed mid-stage PD patients, whereas a decline in affective and cognitive ToM is linked to the presence of MCI.
... Furthermore, since PDD was associated with a higher age in our study (Tables 2 and 4), the number of older HC and PDND individuals should be increased to rule out the aging effect. Although a level II neuropsychological assessment has been suggested to achieve a better sensitivity and accuracy when diagnosing PD-MCI, the global cognitive test MoCA may provide the benefit of prediction for the conversion of PD-MCI to PDD [54]. Moreover, this study only measured plasma miRNA, so exosomederived miRNA may not be detected via our extraction method. ...
The early detection of cognitive decline and timely non-pharmacological management or drug therapy are extremely important in providing care for Parkinson’s disease with dementia (PDD). In this study, we first conducted a discovery study to identify six plasma microRNAs that may allow for the differentiation of PD with or without mild cognitive impairment via NGS. A total of 120 participants were further recruited in a validation cohort and divided into four subgroups, namely, normal controls (HC), PD with no dementia (PDND), PD with mild cognitive impairment (PD-MCI) and PDD. Among the six candidates, miR-203a-3p was successfully detected in the plasma of the validation cohort using droplet digital PCR (ddPCR). Our results show that the ratio of miR-203a-3p/miR-16-5p observed in PDD was significantly increased compared to in PD-MCI (p < 0.001) and PDND (p = 0.041). Moreover, the ratio of miR-203a-3p/miR-16-5p showed a significant correlation with MoCA scores (r = -0.237, p = 0.024) in patients with PD (PwP). The ROC curve of the logistic regression model, consisting of the variables of age, the ratio of miR-203a-3p/miR-16-5p and the UPDRS III score, also demonstrated an average AUC of 0.883 via 5-fold cross-validation. In conclusion, the ratio of miR-203a-3p/miR-16-5p may serve as a potential biomarker for distinguishing cognitive dysfunction from PwP.
... Individual long-term cohort studies have shown that patients with more pronounced memory complaints show a more drastic decline in episodic memory testing over time [44; 45] and a decrease in the total according to cognitive screening tests [46,47]. ...
Subclinical stage of the disease precedes the clinical stage of moderate cognitive decline in Alzheimer's disease (AD). Subjective cognitive decline (SCD) — a condition in which the level of cognitive function habitual for the subject gradually begins to decrease. In 2021, researchers from the National Institute on Aging and the Alzheimer's Association (NIA-AA) clinical criteria for the diagnosis of SCD have been proposed, as well as features that increase the probability of preclinical stage AD in patients with moderate cognitive impairment have been identified. Patients should be offered a complex of examinations — questionnaires regarding the impact of memory impairment on current cognitive activity (forgetfulness, searching for things, difficulty finding words, etc.), testable self-report of cognitive dynamics, neuropsychological testing and diagnosis of pathopsychological changes such as depression and anxiety. It would appear that counselling in the form of interviews and/or testing of persons able to provide relevant information about the patient should be included in the examination of patients with complaints of memory disorders, regardless of their degree of severity. It may be necessary to conduct a survey on the patient’s daily activity, ability to self-service (score, orientation, planning, control and so on), as well as to obtain information about any memory-related changes that have become visible to others, because it is the data from the partner/relative that increase the predictive value of the diagnostic. The modern approach to the study of cognitive functions in elderly people without dementia in the long-term is certainly able to help identify people with a high risk of developing AD.
... Specifically, the SBRs were calculated with the formula: (target region/reference region)-1, in which occipital lobe was the reference region. To examine the effects of CI on clinical assessments and local network topology, PD patients (n = 145) were classified into CI+ group (MoCA score < 26) and CI-group (MoCA score ≥ 26) according to the MDS PD-MCI criteria [50,51], which entailed MoCA scores < 26. The clinical features of participants in each group were shown in Table 1 and Figure 1. ...
Cognitive impairment (CI) is one of the most prominent non-motor symptoms in Parkinson's disease (PD). How brain network abnormalities contribute to CI in PD patients remain largely unclear. The goal of this study is to explore whether aberrations of brain network topology were causally associated with cognitive decline in PD patients. PD patients receiving magnetic resonance imaging from Parkinson's Progression Markers Initiative (PPMI) database were specifically selected. According to the scores of Montreal Cognitive Assessment (MoCA), PD patients were classified into CI+ group (MoCA score ≤ 25) and CI- group (MoCA score > 25) to investigate whether clinical features and brain networks were significantly different between two groups. Mediation analysis was utilized to evaluate whether brain network alterations contributed to CI in PD patients. We revealed CI + group exhibited more severe non-motor symptoms compared to CI- group. In addition, age, excessive daytime sleepiness, and depressive symptoms were found to be significantly associated with CI of PD patients. Moreover, CI+ group exhibited statistically different local topological properties in structural network compared to CI- group. Furthermore, differential local topological metrics in structural network meditated the effects of age, excessive daytime sleepiness, and depression on cognitive decline of PD patients. Taken together, out study suggested that PD patients with CI exhibited notable disturbances of structural network topology, which mediated negative associations between of age, excessive daytime sleepiness, depression and cognitive decline of PD patients.
... This study has the following limitations. First, the evaluation of nonmotor symptoms may have been affected by subjective factors; cognitive impairment of PD patients was evaluated according to MoCA, which was able to define cognitive impairment in PD at the first level of accuracy only [34]; in future studies, we can adopt more objective evaluation methods. Second, we assessed patients only at baseline while using VBM in the crosssectional study. ...
Objective
This study was designed to investigate the diagnostic value of plasma SIRT1 levels and whole-brain gray matter (GM) volume in Parkinson’s disease (PD) patients with cognitive impairment.
Methods
Automated enzymatic analysis was performed to measure plasma SIRT1 levels in 80 healthy controls and 77 PD patients. Motor symptoms and nonmotor symptoms in PD patients were assessed using the corresponding scales. A Siemens MAGNETOM Prisma 3 T MRI scanner was used to acquire images in 35 of 77 PD patients.
Results
Plasma SIRT1 levels in PD patients were lower than those in healthy controls. Plasma SIRT1 levels were negatively correlated with the age, Unified Parkinson’s Disease Rating Scale Part III (UPDRS-III) scores, anxiety, depression, excessive daytime sleepiness (EDS), quality of life, and especially cognitive impairment. Thus, it showed that plasma SIRT1 levels were relevant to visuospatial/executive function, memory, and language. Receiver-operating characteristic (ROC) analysis confirmed that plasma SIRT1 levels had good diagnostic accuracy for PD with anxiety and EDS. Furthermore, plasma SIRT1 levels had a significant positive correlation with GM volume in the whole brain, and ROC analysis confirmed that plasma SIRT1 levels and the total GM volume had good diagnostic accuracy for PD with cognitive impairment.
Conclusions
This study showed that plasma SIRT1 levels were correlated with the nonmotor symptoms of anxiety, depression, EDS, and especially cognitive impairment as well as the total GM volume. Furthermore, the combination of plasma SIRT1 levels and the total GM volume had good diagnostic accuracy for PD with cognitive impairment.
