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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

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.

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    • "Although as yet, not all aspects of this work have been fully replicated, there is nonetheless an emerging consensus from clinical [27] [28] and genetic studies [29] that the basic principles are true. Furthermore, studies using a range of imaging modalities including structural MRI [30], SPECT [31] and FDG-PET [32] to investigate PD patients with cognitive impairment support the hypothesis that pathological changes in posterior cortical regions are associated with progression to dementia in PD. "
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    • "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]. "
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    • "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). "
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