Cognitive Impairment in Parkinson Disease: Impact on Quality of Life, Disability, and Caregiver Burden

Journal of Geriatric Psychiatry and Neurology (Impact Factor: 2.24). 11/2012; 25(4). DOI: 10.1177/0891988712464823
Source: PubMed


Aim: To compare quality of life, level of disability, and caregiver burden in 3 groups of people with Parkinson disease (PD): those with mild cognitive impairment (PD-MCI), those with dementia (PDD), and those with no cognitive impairment (PD-NC). Background: Although the cognitive profile of those with PD-MCI and PDD has been well described, little is known about the personal and clinical impact of cognitive impairment and its impact on caregivers. Method: Quality of life and disability were measured in 3 groups of participants with PD (PD-NC, n = 54; PD-MCI, n = 48; and PDD, n = 25). The PD-MCI group was classified using Movement Disorder Society Task Force consensus criteria. Caregivers (n = 102) in the 3 groups were assessed using the Zarit Burden Inventory. Results: Both quality of life and caregiver burden were similar in the 2 groups without dementia but were significantly different in those with PDD. In contrast, global disability was progressively greater as cognition declined across the 3 PD groups: PD-NC < PD-MCI < PDD and on the Activities of Daily Living scale a step up in impairment was seen with the presence of any cognitive impairment. Conclusions: The presence of dementia significantly increases caregiver burden and decreases quality of life. However, even mild levels of cognitive impairment increase disability and overall functional impairment progresses in tandem with cognitive decline.

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Available from: Kathryn R. Mcdonald
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    • "Patients with PD are therefore a " population at risk " for cognitive impairment and require cognitive screening . Moreover, PD patients with cognitive impairment (CI) suffer from a reduced quality of life and increased caregiver burden and require long-term management [4]. Rapid screening for CI is an important step in achieving optimal long-term care for PD patients. "
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    ABSTRACT: Aim . This study sought to establish the discriminant validity of a rapid cognitive screen, that is, the National Institute of Neurological Disease and Stroke-Canadian Stroke Network (NINDS-CSN) 5-minute protocol, and compare its discriminant validity to the Montreal Cognitive Assessment (MoCA) and Mini Mental State Examination (MMSE) in detecting cognitive impairment (CI) in PD patients. Methods . One hundred and one PD patients were recruited from a movement disorders clinic in Singapore and they received the NINDS-CSN 5-minute protocol, MoCA, and MMSE. No cognitive impairment (NCI) was defined as Clinical Dementia Rating (CDR) = 0 and CI was defined as CDR ≥ 0.5. Results . Area under the receiver operating characteristic curve of NINDS-CSN 5-minute protocol was statistically equivalent to MoCA and larger than MMSE (0.86 versus 0.90, P = 0.07 ; 0.86 versus 0.76, P = 0.03 ). The sensitivity of NINDS-CSN 5-minute protocol (
    Full-text · Article · Dec 2015 · Parkinson's Disease
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    • "In spite of the significant differences in GAS and caregiver burden noted earlier, we did not observe a significant difference in health-related QoL between the two groups. Cognitive impairment is an important factor in predicting health-related QoL, and it has been shown that health-related QoL is significantly lower in PDD than in PD without dementia or PD with mild cognitive impairment (Leroi et al., 2012). This finding is consistent with another study of memantine in PDD, which did not find a statistically significant difference in patient-rated QoL between treatment and placebo groups. "
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    ABSTRACT: Memantine, an uncompetitive antagonist of N-methyl-d-aspartate receptors, may have a role in managing symptoms associated with dementia in Parkinson's disease (PDD), although its role in improving patient-reported outcomes (PROs) has not been extensively investigated. PROs may be more sensitive than standard psychometric measures for detecting change in complex conditions such as PDD. The aim of this study was to examine the effect of memantine on PROs: individually determined goals and health-related quality of life. We also examined memantine's effect on caregiver burden. This 22-week double-blind randomised controlled trial evaluated participants with PDD on 20 mg of memantine or placebo. Outcome measures were Goal Attainment Scaling (GAS), the Parkinson's Disease Questionnaire-8 and the Zarit Burden Inventory. A significantly greater proportion of participants on memantine (64%) had better than expected GAS outcomes compared with those on placebo (7%) (p = 0.007). Furthermore, the improvement in mean GAS score, as well as mean caregiver burden score, from baseline to drug discontinuation was significantly greater in those on memantine compared with those on placebo (p = 0.03 and 0.04, respectively). Significant differences in quality of life were not seen. In this study, memantine improved individually set goals and caregiver burden in PDD. This suggests that clinimetric measures such as GAS may be more sensitive than conventional psychometric measures in detecting improvements in people with PDD. Copyright © 2014 John Wiley & Sons, Ltd.
    Full-text · Article · Sep 2014 · International Journal of Geriatric Psychiatry
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    • "to investigate QoL in PD-MCI [1] [8]. It is vital to understand the contribution MCI and cognitive decline has on PD patients, in addition to the motor and non-motor symptoms, and the extent to which it influences QoL. "
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    ABSTRACT: Background Poor quality of life (QoL) is a feature of people with Parkinson’s disease (PD) who develop dementia. The relationship between mild cognitive impairment in PD (PD-MCI) and QoL is less clear. To address this, we studied the impact of varying severities of cognitive impairment on QoL in a cohort of non-demented patients with early PD. Method Patients with newly diagnosed PD (n=219) and age and sex matched healthy controls (n=99) completed a schedule of neuropsychological tests, in addition to scales assessing QoL (PDQ-39), depression, sleep, neuropsychiatric symptoms and a clinical examination. The Movement Disorder Society criteria were used to define and classify PD-MCI. Results Participants with PD-MCI were significantly older than those with normal cognition, had more severe motor symptoms, scored higher for depression and had poorer quality of life. Logistic regression showed that mild cognitive impairment, independent of other factors, was an indicator of poorer QoL. Using cognitive performance 2.0 standard deviations (SD) below normative data as a cut-off to define PD-MCI, there was a significant difference in QoL scores between patients with PD-MCI and those classified as having normal cognition. Subjects with less severe mild cognitive impairment did not exhibit significant differences in QoL. Conclusions PD-MCI is a significant, independent factor contributing to poorer QoL in patients with newly diagnosed PD. Those classified with greatest impairment (2.0 SD below normal values) have lower QoL. This has implications for clinical practice and future interventions targeting cognitive impairments.
    Full-text · Article · Jul 2014 · Parkinsonism & Related Disorders
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