Dementia and functional decline in patients with Parkinson's disease

Stella, Florindo; Banzato, Claudio Eduardo Muller; Quagliato, Elizabeth Maria Aparecida Barasnevicius; Viana, Maura Aparecida; Christofoletti, Gustavo

doi:10.1590/S1980-57642009DN20200004

Abstract

Functional decline in Parkinson's disease (PD), characterized by reduced ability to carry out activities of daily living, usually results from typical motor impairment and may be aggravated by concomitant cognitive impairment.

Objective:

To compare the functional decline in Parkinson's disease between patients with dementia and cognitively preserved patients.

Methods:

From an original sample composed of 50 patients with a clinical diagnosis of idiopathic PD seen in a consecutive series, 33 non-depressed patients were selected comprising 13 with dementia and 20 cognitively preserved individuals. All patients enrolled in this study were drawn from a public outpatient clinic, specialized in movement disorders. The clinical stage of PD was determined by the Hoehn & Yahr scale, and the functional capacity was verified using the Unified Parkinson's Disease Rating Scale UPDRS ADL (subscale II: activities of daily living) and the Schwab & England scale. The two last scales measure the functional degree of independence in activities of daily living. The neuropsychological assessment was performed using The Cambridge Examination for Mental Disorders of the Elderly - CAMCOG, Cognitive Section and the Stroop Color Word Test.

Results:

As expected, in comparison with cognitively preserved patients, the group with dementia presented significantly lower scores throughout the neuropsychological evaluation. The patients with dementia were found to have a longer period of disease, a more advanced clinical staging according to the Hoehn & Yahr, and greater functional decline according both to the UPDRS ADL and Schwab & England, with statistically significant difference between the groups.

Conclusion:

Patients with dementia were at a more advanced clinical stage of Parkinson's disease and evidenced greater functional decline in comparison with patients without dementia.

Key words:
Parkinson's disease; functional decline; dementia

Resumo

O declínio funcional na doença de Parkinson (DP), caracterizado pela redução da capacidade para as atividades de vida diária, usualmente resulta do comprometimento motor típico, podendo ainda ser agravado pelo declínio cognitivo concomitante.

Objetivos:

Comparar o declínio funcional de pacientes com e sem demência na doença de Parkinson.

Métodos:

De uma amostra original composta por 50 pacientes com diagnóstico clínico de DP idiopática, avaliados em uma série consecutiva, foram selecionados 33 pacientes não deprimidos, sendo 13 com demência e 20 cognitivamente preservados. Todos os pacientes eram acompanhados em um ambulatório público especializado em distúrbios do movimento. Aplicamos a Unified Parkinson's Disease Rating Scale - UPDRS (sub-escala II: atividades de vida diária - UPDRS ADL), a escala Schwab & England, a escala Hoehn & Yahr, o Cambridge Examination for Mental Disorders of the Elderly - Seção Cognitiva (CAMCOG) e o Stroop Color Word Test.

Resultados:

Como esperado, em comparação com pacientes cognitivamente preservados, o grupo com demência apresentou escores menores na avaliação neuropsicológica. Os pacientes com demência tinham, também, um tempo maior de doença, pertenciam a um estágio clínico mais avançado segundo a Hoehn & Yahr, e seu declínio funcional, segundo a UPDRS ADL e a Schwab & England, mostrava-se mais acentuado, com diferença estatisticamente significativa entre os grupos.

Conclusão:

Os pacientes com demência encontravam-se em um estágio clínico mais avançado da doença e seu declínio funcional mostrou-se mais acentuado em comparação com os pacientes sem demência.

Palavras-chave:
doença de Parkinson; declínio funcional; demência

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References

¹
Jankovic J, Kapadia AS. Functional decline in Parkinson disease. Arch Neurol 2001;58:1611-1615.
²
Potagas C, Papageorgiou SG. Phenomenology and management of cognitive and behavioral disorders in Parkinson's disease: rise and logic of dementia in Parkinson's disease. An Gen Psychiatry 2006;5:12.
³
Lauderbach EC. The neuropsychiatry of Parkinson's disease and related disorders. Psychiatr Clin North Am 2004;27:801-835.
⁴
Sabbagh MN, Silverberg N, Bircea S, et al. Is the functional decline of Parkinson's disease similar to the functional decline of Alzheimer's disease? Parkinsonism Relat Disord 2005;11:311-315.
⁵
Giladi N, Treves TA, Paleacu D, et al. Risk factors for dementia, depression and psychosis in long-standing Parkinson's disease. J Neurol Transm 2000;107:59-71.
⁶
Fahn S, Elton R. Members of the UPDRS. Development Committee. The unified Parkinson's disease rating scale. In: Fahn S, Marsden CD, Calne DB, Goldstein M, editors. Recent developments in Parkinson's disease. Vol. 2. Florham Park, NY, USA: MacMillan Health Care Information, 1987:153-163.
⁷
Schwab RS, England AC. Projection technique for evaluating surgery in Parkinson's disease. In: Gillingham FJ, Donaldson ML, editors. Third Symposium on Parkinson's Disease. Edinburgh, Scotland: Livingstone; 1969:152-157.
⁸
Weintraub D, Moberg PJ, Duda JE, Katz IR, Stern MB. Effect of psychiatric and other non-motor symptoms on disability in Parkinson's disease. J Am Geriatr Soc 2004;52:784-788.
⁹
Hughes AJ, Daniel SE, Kilford L, Lees AJ. Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry 1992;55:181-184.
¹⁰
Roth M, Tym E, Mountjoy CQ, et al. - CAMDEX - A standardized instrument for the diagnosis of mental disorder in the elderly with special reference to the early detection of dementia. Brit J Psychiatry 1986;149:698-709.
¹¹
Bottino CMC, Stoppe Jr A, Scalco AZ, et al. Validade e confiabilidade da versão brasileira do CAMDEX. Arq Neuropsiquiatr 2001;59(Suppl 3):20.
¹²
Gazzainiga MS, Ivry RB, Mangun GR. Cognitive Neuroscience: The Biology of the Mind. New York: Norton & Company; 1998:97-99.
¹³
American Psychiatric Association. Manual Diagnóstico e Estatístico dos Transtornos Mentais - 4 Ed., Texto - Revisado. Tradução de Cláudia Dornelles. Porto Alegre; 2003:168-182; 348-355.
¹⁴
Emre M, Aarsland D, Brown R et al. Clinical diagnostic criteria for dementia associated with Parkinson's disease. Mov Disord 2007;22:1689-1707.
¹⁵
Hoehn MM, Yarh MD. Parkinsonism: Onset, progression and mortality. Neurology 1967;17:427-442.
¹⁶
Marras C, McDermott MP, Rochon PA, Tanner CM, Naglie G, Lang AE. Predictors of deterioration in health-related quality of life in Parkinson's disease: Results from the DATATOP trial. Mov Disord 2007;22:2339-2345.
¹⁷
Janvin CC, Aarsland D, Larsen JP. Cognitive predictors of dementia in Parkinson's disease: a community-based, 4-year longitudinal study. J Geriatr Psychiatr Neurol 2005;18:149-154.
¹⁸
Martinez-Martin P, Prieto L, Forjaz MJ. Longitudinal metric properties of disability rating scales for Parkinson's disease. Value Health 2006;9:386-393.
¹⁹
Forjaz MJ, Martinez-Martin P. Metric attributes of the Unified Parkinson's Disease Rating Scale 3.0 Battery: Part II, construct and content validity. Mov Disord 2006;21:1892-1898.
²⁰
Carod-Artal FJ, Vargas AP, Martinez-Martin P. Determinants of quality of life in Brazilian with Parkinson's disease. Mov Disord 2007;22:1408-1415.
²¹
Calabresi P, Picconi B, Parnetti L, Di Filippo M. A convergent model for cognitive dysfunction in Parkinson's disease: the critical dopamine-acetylcholine synaptic balance. Lancet Neurol 2006;5:974-983.
²²
Galvin JE. Cognitive change in Parkinson disease. Alzheimer Dis Assoc Disord 2006;20:302-310.
²³
Braak H, Rub U, Del Tredici K. Cognitive decline correlates with neuropathological stage in Parkinson's disease. J Neurol Sci 2006;248:255-258.
²⁴
Bohnen NI, Kaufer DI, Hendrickson R et al. Cognitive correlates of cortical cholinergic denervation in Parkinson's disease and parkinsonian dementia. J Neurol 2006;253:242-247.
²⁵
Jellinger KA. The morphological basis of mental dysfunction in Parkinson's disease. J Neurol Sci 2006;248:167-172.
²⁶
Zgaljardic DJ, Foldi NS, Borod JC. Cognitive and behavioral dysfunction in Parkinson's disease: neurochemical and clinicopathological contributions. J Neural Transm 2004;111: 1287-301.
²⁷
Braak H, Del Tredici K, Rub U, de Vos RAI, Jansen Steur ENH, Braak E. Staging of brain pathology related to sporadic Parkinson's disease. Neurobiol Aging 2003;24:197-211.
²⁸
Hobson P, Meara J. The detection of dementia and cognitive impairment in a community population of elderly people with Parkinson's disease by use of the CAMCOG neuropsychological test. Age Aging 1999;28:39-43.
²⁹
Athey RJ, Walker RW. Demonstration of cognitive decline in Parkinson's disease using the Cambridge Cognitive Assessment (Revised) (CAMCOG-R). Int J Geriatr Psychiatry 2006;21:977-982
³⁰
Dujardin K, Defebvre L, Krystkowiak P, Degreef JF, Destee A. Executive function differences in multiple system atrophy and Parkinson's disease. Parkinsonism Relat Disord 2003;9:205-211.
³¹
Hughes TA, Ross HF, Musa S, et al. A 10-year study of the incidence of and factors predicting dementia in Parkinson's disease. Neurology 2000;54:1596-1602.
³²
Burn DJ, Rowan, EN, Allan LM, Molloy S, O'Brien JT, McKeith IG. Motor subtype and cognitive decline in Parkinson's disease, Parkinson's disease with dementia, and dementia with Lewy bodies. J Neurol Neurosurg Psychiatry 2006;77:585-589.
³³
Vingerhoets G, Verleden S, Santens P, Miaton M, De Reuck J. Predictors of cognitive impairment in advanced Parkinson's disease. J Neurol Neurosurg Psychiatry 2003;74:793-796.
³⁴
Papapetropoulos S, Gonzalez J, Lieberman A, Villar JM, Mash DC. Dementia in Parkinson's disease: a post mortem study in a population of brain donors. Int J Geriatr Psychiatry 2005;20:418-422.

Publication Dates

Publication in this collection
Apr-Jun 2008

History

Received
18 Feb 2008
Accepted
28 Apr 2008

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

[1] ¹
Jankovic J, Kapadia AS. Functional decline in Parkinson disease. Arch Neurol 2001;58:1611-1615.

[2] ²
Potagas C, Papageorgiou SG. Phenomenology and management of cognitive and behavioral disorders in Parkinson's disease: rise and logic of dementia in Parkinson's disease. An Gen Psychiatry 2006;5:12.

[3] ³
Lauderbach EC. The neuropsychiatry of Parkinson's disease and related disorders. Psychiatr Clin North Am 2004;27:801-835.

[4] ⁴
Sabbagh MN, Silverberg N, Bircea S, et al. Is the functional decline of Parkinson's disease similar to the functional decline of Alzheimer's disease? Parkinsonism Relat Disord 2005;11:311-315.

[5] ⁵
Giladi N, Treves TA, Paleacu D, et al. Risk factors for dementia, depression and psychosis in long-standing Parkinson's disease. J Neurol Transm 2000;107:59-71.

[6] ⁶
Fahn S, Elton R. Members of the UPDRS. Development Committee. The unified Parkinson's disease rating scale. In: Fahn S, Marsden CD, Calne DB, Goldstein M, editors. Recent developments in Parkinson's disease. Vol. 2. Florham Park, NY, USA: MacMillan Health Care Information, 1987:153-163.

[7] ⁷
Schwab RS, England AC. Projection technique for evaluating surgery in Parkinson's disease. In: Gillingham FJ, Donaldson ML, editors. Third Symposium on Parkinson's Disease. Edinburgh, Scotland: Livingstone; 1969:152-157.

[8] ⁸
Weintraub D, Moberg PJ, Duda JE, Katz IR, Stern MB. Effect of psychiatric and other non-motor symptoms on disability in Parkinson's disease. J Am Geriatr Soc 2004;52:784-788.

[9] ⁹
Hughes AJ, Daniel SE, Kilford L, Lees AJ. Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry 1992;55:181-184.

[10] ¹⁰
Roth M, Tym E, Mountjoy CQ, et al. - CAMDEX - A standardized instrument for the diagnosis of mental disorder in the elderly with special reference to the early detection of dementia. Brit J Psychiatry 1986;149:698-709.

[11] ¹¹
Bottino CMC, Stoppe Jr A, Scalco AZ, et al. Validade e confiabilidade da versão brasileira do CAMDEX. Arq Neuropsiquiatr 2001;59(Suppl 3):20.

[12] ¹²
Gazzainiga MS, Ivry RB, Mangun GR. Cognitive Neuroscience: The Biology of the Mind. New York: Norton & Company; 1998:97-99.

[13] ¹³
American Psychiatric Association. Manual Diagnóstico e Estatístico dos Transtornos Mentais - 4 Ed., Texto - Revisado. Tradução de Cláudia Dornelles. Porto Alegre; 2003:168-182; 348-355.

[14] ¹⁴
Emre M, Aarsland D, Brown R et al. Clinical diagnostic criteria for dementia associated with Parkinson's disease. Mov Disord 2007;22:1689-1707.

[15] ¹⁵
Hoehn MM, Yarh MD. Parkinsonism: Onset, progression and mortality. Neurology 1967;17:427-442.

[16] ¹⁶
Marras C, McDermott MP, Rochon PA, Tanner CM, Naglie G, Lang AE. Predictors of deterioration in health-related quality of life in Parkinson's disease: Results from the DATATOP trial. Mov Disord 2007;22:2339-2345.

[17] ¹⁷
Janvin CC, Aarsland D, Larsen JP. Cognitive predictors of dementia in Parkinson's disease: a community-based, 4-year longitudinal study. J Geriatr Psychiatr Neurol 2005;18:149-154.

[18] ¹⁸
Martinez-Martin P, Prieto L, Forjaz MJ. Longitudinal metric properties of disability rating scales for Parkinson's disease. Value Health 2006;9:386-393.

[19] ¹⁹
Forjaz MJ, Martinez-Martin P. Metric attributes of the Unified Parkinson's Disease Rating Scale 3.0 Battery: Part II, construct and content validity. Mov Disord 2006;21:1892-1898.

[20] ²⁰
Carod-Artal FJ, Vargas AP, Martinez-Martin P. Determinants of quality of life in Brazilian with Parkinson's disease. Mov Disord 2007;22:1408-1415.

[21] ²¹
Calabresi P, Picconi B, Parnetti L, Di Filippo M. A convergent model for cognitive dysfunction in Parkinson's disease: the critical dopamine-acetylcholine synaptic balance. Lancet Neurol 2006;5:974-983.

[22] ²²
Galvin JE. Cognitive change in Parkinson disease. Alzheimer Dis Assoc Disord 2006;20:302-310.

[23] ²³
Braak H, Rub U, Del Tredici K. Cognitive decline correlates with neuropathological stage in Parkinson's disease. J Neurol Sci 2006;248:255-258.

[24] ²⁴
Bohnen NI, Kaufer DI, Hendrickson R et al. Cognitive correlates of cortical cholinergic denervation in Parkinson's disease and parkinsonian dementia. J Neurol 2006;253:242-247.

[25] ²⁵
Jellinger KA. The morphological basis of mental dysfunction in Parkinson's disease. J Neurol Sci 2006;248:167-172.

[26] ²⁶
Zgaljardic DJ, Foldi NS, Borod JC. Cognitive and behavioral dysfunction in Parkinson's disease: neurochemical and clinicopathological contributions. J Neural Transm 2004;111: 1287-301.

[27] ²⁷
Braak H, Del Tredici K, Rub U, de Vos RAI, Jansen Steur ENH, Braak E. Staging of brain pathology related to sporadic Parkinson's disease. Neurobiol Aging 2003;24:197-211.

[28] ²⁸
Hobson P, Meara J. The detection of dementia and cognitive impairment in a community population of elderly people with Parkinson's disease by use of the CAMCOG neuropsychological test. Age Aging 1999;28:39-43.

[29] ²⁹
Athey RJ, Walker RW. Demonstration of cognitive decline in Parkinson's disease using the Cambridge Cognitive Assessment (Revised) (CAMCOG-R). Int J Geriatr Psychiatry 2006;21:977-982

[30] ³⁰
Dujardin K, Defebvre L, Krystkowiak P, Degreef JF, Destee A. Executive function differences in multiple system atrophy and Parkinson's disease. Parkinsonism Relat Disord 2003;9:205-211.

[31] ³¹
Hughes TA, Ross HF, Musa S, et al. A 10-year study of the incidence of and factors predicting dementia in Parkinson's disease. Neurology 2000;54:1596-1602.

[32] ³²
Burn DJ, Rowan, EN, Allan LM, Molloy S, O'Brien JT, McKeith IG. Motor subtype and cognitive decline in Parkinson's disease, Parkinson's disease with dementia, and dementia with Lewy bodies. J Neurol Neurosurg Psychiatry 2006;77:585-589.

[33] ³³
Vingerhoets G, Verleden S, Santens P, Miaton M, De Reuck J. Predictors of cognitive impairment in advanced Parkinson's disease. J Neurol Neurosurg Psychiatry 2003;74:793-796.

[34] ³⁴
Papapetropoulos S, Gonzalez J, Lieberman A, Villar JM, Mash DC. Dementia in Parkinson's disease: a post mortem study in a population of brain donors. Int J Geriatr Psychiatry 2005;20:418-422.

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