Visuospatial cognitive tests for the evaluation of patients with Parkinson's disease

Pena, Marina Ceres Silva; Sobreira, Emmanuelle Silva Tavares; Souza, Carolina Pinto; Oliveira, Guiomar Nascimento; Tumas, Vitor; Vale, Francisco de Assis Carvalho do

doi:10.1590/S1980-57642009DN20300007

Abstract

Parkinson's disease (PD) is a neurological disorder characterized by motor disturbances, neuropsychological symptoms and cognitive changes, including cases of dementia. The most frequently described cognitive changes in these patients involve executive and visuospatial functions, which are very important for the execution of daily life activities.

Objective:

To compare different tests used to examine visuospatial functions in patients with PD.

Methods:

Thirty-five patients (21 women) with PD symptoms (medicated and "on") and mean schooling of 5.5±4.2 years were examined using the following tests: Mini-Mental State Examination (MMSE), Dementia Rating Scale (DRS), Scales of Outcomes of Parkinson's Disease (SCOPA-COG), Hooper Visual Organization Test (HVOT), Judgment of Line Orientation, Form V (JLO), and Clock drawing task - CLOX (1 and 2).

Results:

The mean MMSE score was 24.8±3.03 and 54.8% of the patients performed correctly in the copy of a pentagon drawing, with a medium-level performance in most tests. Good correlations were detected between JLO versus SCOPA Assembling patterns (0.67), JLO versus HVOT (0.56), JLO versus CLOX2 (0.64), SCOPA Figure Composition versus HVOT (0.54), CLOX1 versus CLOX2 (0.43), and DRS Construction versus CLOX2 (0.42).

Discussion:

Although correlations were detected, not all were strong, probably because the tests employed do not measure solely visuospatial functions, but also other skills such as attention, motor ability and executive functions. A limitation of the present study was the lack of a control group for the establishment of adequate standards for this population.

Key words:
Parkinson's disease; visuospatial functions; cognitive tests.

Resumo

A doença de Parkinson (PD) é um transtorno neurológico caracterizado por distúrbios motores, sintomas neuropsicológicos e por alterações cognitivas, inclusive casos de demência. As alterações cognitivas mais descritas nesses pacientes são as funções executivas e as visuais-espaciais, funções importantíssimas para a realização de atividades da vida diária.

Objetivo:

Comparar diferentes testes que examinam funções visuais-espaciais em pacientes com DP.

Métodos:

Foram avaliados 35 pacientes (21 mulheres) sintomáticos para DP (medicados e em "on") e escolaridade média de 5,5±4,2 com os seguintes testes: Mini-Exame do Estado Mental (MEEM), Escala de Avaliação de Demência de Mattis (EADM), Escala de Conseqüências da Doença de Parkinson (SCOPA-COG), Teste de Organização Visual de Hooper (TOVH), Julgamento de Orientação de Linhas - Forma V (JOL), e Teste do Desenho do Relógio - CLOX (1 e 2).

Resultados:

Os pacientes obtiveram média 24,8±3,03 no MMSE e 54,8% acertou o de cópia do desenho do pentágono e desempenho mediano na maioria dos testes. Foram encontradas boas correlações entre JOL versus SCOPA Composição de Figuras (0.67), JLO versus TOVH (0.56), JOL versus CLOX2 (0.64), SCOPA Composição de Figuras versus TOVH (0.54), CLOX1 versus CLOX2 (0.43) e EADM Construção versus CLOX2 (0.42).

Discussão:

Mesmo tendo sido verificadas correlações, nem todas foram "fortes", o que pode ser explicado pelo fato de que os testes não medem somente funções visuais-espaciais, mas outras habilidades como atenção, habilidade motora e funções executivas. Uma dificuldade do presente estudo diz respeito à falta de grupo controle para estabelecer padrões adequados à essa população.

Palavras-chave:
doença de Parkinson; funções visuais-espaciais; testes cognitivos.

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References

¹
Barbosa MT, Caramelli P, Maia DP, et al. Parkinsonism and Parkinson's disease in the elderly: a community based survey in Brazil (the Bambuí study). Mov Disord 2006;21:800-808.
²
Melo LMB, Reis E, Caramelli P. Declínio cognitivo e demência associados à doença de Parkinson: características clínicas e tratamento. Rev Psiq Clín 2007;34:176-183.
³
Galvin JE, Pollack J, Morris JC. Clinical phenotype of Parkinson disease dementia. Neurology 2006;67:1605-1611.
⁴
Bosboom JLW, Stoffers D, Wolters EC. Cognitive dysfunction and dementia in Parkinson's disease. J Neural Transm 2004;111:1303-1315.
⁵
Janvin CC, Aarsland D, Larsen JP. Cognitive Predictors of Dementia in Parkinson's Disease: A Community-Based, 4-Year Longitudinal Study. J Geriatr Psychiatry Neurol 2005;18: 149-154.
⁶
Hely MA, Reid WG, Adena MA, Halliday GM, Morris JG. The Sydney multicenter study of Parkinson's disease: the inevitability of dementia at 20 years. Mov Disord 2008;23:837-844.
⁷
Silva-Filho, J.H., Validade e normas do Wisconsin Card Sorting Test em adultos da região de Ribeirão Preto, in Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto. Tese. Departamento de Psicologia e Educação; Universidade de São Paulo: Ribeirão Preto, SP. 2007.
⁸
Greene JDW. Apraxia, agnosias, and higher visual function abnormalities. J Neurol Neurosurg Psychiatry 2005;76(suppl 5):25-34.
⁹
Gelb DJ, Oliver E, Gilman S. Diagnostic criteria for Parkinson's disease. Arch Neurol 1999;56: 33.
¹⁰
Tumas V, Rodrigues GGR, Farias TLA, Crippa JAS. A precisão do diagnóstico de depressão na doença de Parkinson: um estudo comparativo entre a UPDRS, a escala geriátrica de depressão e o inventário de depressão de Beck. Arq Neuropsiquiatr 2008;66:152-156.
¹¹
Rabey JM, Bass H, Bonuccelli U, et al. Evaluation of the Short Parkinson´s Evaluation Scale: a new friendly scale for the evaluation of Parkinson's disease in clinical drug trials. Clin Neuropharmacol 1997;20:322-337.
¹²
Tumas V, Ujikawa LT, Ferreira, GM. Utility and reliability of a simplified clinical scale for Parkinson's disease. Arq Neuropsiquiatr 2004;62(suppl 2):220-221.
¹³
Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. Sugestões para o uso do mini-Exame do Estado Mental no Brasil. Arq Neuropsiquiatr 2003; 61:777-781.
¹⁴
Porto CSF, Fichman HC, Caramelli P, Bahia VS, Nitrini R. Brazilian version of the Mattis Dementia Rating Scale: Diagnosis of mild dementia in Alzheimer's Disease. Arq Neuropsiquiatr 2003; 61:339-345.
¹⁵
Marinus J, Visser M, Verwey NA, et al. Assessment of cognition in Parkinson's disease. Neurology 2003;61:1222-1228.
¹⁶
WPS, ed. Hooper Visual Organization Test (VOT) Manual. Ed. W.P.S.E.r.o.o.e.o. 1958. Los Angesles, California; 1975.
¹⁷
Benton ALV, Varney NR, Hamsher KS. Judgment of line orientation, form V., Iowa city, Iowa: Department of Neurology, University Hospitals; 1975.
¹⁸
Royall DR, Mahurin RK, Gray KF. Bedside assessment of executive cognitive impairment: the executive interview. J Am Geriatr Soc 1992;40:1221-1226.
¹⁹
Royall DR, Codes JA, Polk M. CLOX: an executive clock drawing task. J Neurol Neurosurg Psychiatry 1998;64:558-594.
²⁰
Foss MP, Vale FAC, Specialli JG. Influência da escolaridade na avaliação neuropsicológica de idosos. Arq Neuropsiquiatr 2003;63:119-126.
²¹
Piovezan MR, Teive HAG, Piovesan EJ, Mader MJ, Werneck LC. Cognitive function assessment in idiopathic Parkinsons's disease. Arq Neuropsiquiatr 2007; 65: 942-946.

Publication Dates

Publication in this collection
Jul-Sep 2008

History

Received
11 July 2008
Accepted
24 Aug 2008

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Barbosa MT, Caramelli P, Maia DP, et al. Parkinsonism and Parkinson's disease in the elderly: a community based survey in Brazil (the Bambuí study). Mov Disord 2006;21:800-808.

[2] ²
Melo LMB, Reis E, Caramelli P. Declínio cognitivo e demência associados à doença de Parkinson: características clínicas e tratamento. Rev Psiq Clín 2007;34:176-183.

[3] ³
Galvin JE, Pollack J, Morris JC. Clinical phenotype of Parkinson disease dementia. Neurology 2006;67:1605-1611.

[4] ⁴
Bosboom JLW, Stoffers D, Wolters EC. Cognitive dysfunction and dementia in Parkinson's disease. J Neural Transm 2004;111:1303-1315.

[5] ⁵
Janvin CC, Aarsland D, Larsen JP. Cognitive Predictors of Dementia in Parkinson's Disease: A Community-Based, 4-Year Longitudinal Study. J Geriatr Psychiatry Neurol 2005;18: 149-154.

[6] ⁶
Hely MA, Reid WG, Adena MA, Halliday GM, Morris JG. The Sydney multicenter study of Parkinson's disease: the inevitability of dementia at 20 years. Mov Disord 2008;23:837-844.

[7] ⁷
Silva-Filho, J.H., Validade e normas do Wisconsin Card Sorting Test em adultos da região de Ribeirão Preto, in Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto. Tese. Departamento de Psicologia e Educação; Universidade de São Paulo: Ribeirão Preto, SP. 2007.

[8] ⁸
Greene JDW. Apraxia, agnosias, and higher visual function abnormalities. J Neurol Neurosurg Psychiatry 2005;76(suppl 5):25-34.

[9] ⁹
Gelb DJ, Oliver E, Gilman S. Diagnostic criteria for Parkinson's disease. Arch Neurol 1999;56: 33.

[10] ¹⁰
Tumas V, Rodrigues GGR, Farias TLA, Crippa JAS. A precisão do diagnóstico de depressão na doença de Parkinson: um estudo comparativo entre a UPDRS, a escala geriátrica de depressão e o inventário de depressão de Beck. Arq Neuropsiquiatr 2008;66:152-156.

[11] ¹¹
Rabey JM, Bass H, Bonuccelli U, et al. Evaluation of the Short Parkinson´s Evaluation Scale: a new friendly scale for the evaluation of Parkinson's disease in clinical drug trials. Clin Neuropharmacol 1997;20:322-337.

[12] ¹²
Tumas V, Ujikawa LT, Ferreira, GM. Utility and reliability of a simplified clinical scale for Parkinson's disease. Arq Neuropsiquiatr 2004;62(suppl 2):220-221.

[13] ¹³
Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. Sugestões para o uso do mini-Exame do Estado Mental no Brasil. Arq Neuropsiquiatr 2003; 61:777-781.

[14] ¹⁴
Porto CSF, Fichman HC, Caramelli P, Bahia VS, Nitrini R. Brazilian version of the Mattis Dementia Rating Scale: Diagnosis of mild dementia in Alzheimer's Disease. Arq Neuropsiquiatr 2003; 61:339-345.

[15] ¹⁵
Marinus J, Visser M, Verwey NA, et al. Assessment of cognition in Parkinson's disease. Neurology 2003;61:1222-1228.

[16] ¹⁶
WPS, ed. Hooper Visual Organization Test (VOT) Manual. Ed. W.P.S.E.r.o.o.e.o. 1958. Los Angesles, California; 1975.

[17] ¹⁷
Benton ALV, Varney NR, Hamsher KS. Judgment of line orientation, form V., Iowa city, Iowa: Department of Neurology, University Hospitals; 1975.

[18] ¹⁸
Royall DR, Mahurin RK, Gray KF. Bedside assessment of executive cognitive impairment: the executive interview. J Am Geriatr Soc 1992;40:1221-1226.

[19] ¹⁹
Royall DR, Codes JA, Polk M. CLOX: an executive clock drawing task. J Neurol Neurosurg Psychiatry 1998;64:558-594.

[20] ²⁰
Foss MP, Vale FAC, Specialli JG. Influência da escolaridade na avaliação neuropsicológica de idosos. Arq Neuropsiquiatr 2003;63:119-126.

[21] ²¹
Piovezan MR, Teive HAG, Piovesan EJ, Mader MJ, Werneck LC. Cognitive function assessment in idiopathic Parkinsons's disease. Arq Neuropsiquiatr 2007; 65: 942-946.

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