Background: Cognitive deficits are common in Parkinson’s disease (PD), but the range of deficits is variable. The aim of this study was to identify different cognitive subgroups associated with PD. Methods: A broad range of neuropsychological measures and cognitive domains were used in a cluster analysis to identify subgroups of patients. Results: Three subgroups of patients were identified. Compared to controls, one PD subgroup showed no or minimal cognitive impairment (PD-NCI), a second group showed a variable or uncertain pattern of mild to severe cognitive impairments (PD-UCI), and a third group had evidence of severe cognitive impairment across most cognitive domains (mild cognitive impairment; PD-MCI). The subgroups did not differ with regard to age, motor impairment, or disease duration. Conclusions: Patients with PD are heterogeneous with regard to cognitive presentation and it may be possible to identify patients in the preclinical stage of dementia. The identification of preclinical dementia in PD patients (PD-MCI) provides an opportunity to understand cognitive decline in PD and its progression to dementia.
© 2009 S. Karger AG, Basel
- Parkinson’s disease with dementia
- Assessment of cognitive disorders/dementia
- Mild cognitive impairment
- Pillon B, Boller F, Levy R, Dubois B: Cognitive deficits and dementia in Parkinson’s disease; in Boller F, Cappa SF (eds): Handbook of Neuropsychology. New York, Elsevier Science B.V., 2001, pp 311–371.
- Lewis S, Foltynie T, Blackwell A, Robbins T, Owen A, Barker R: Heterogeneity of Parkinson’s disease in the early clinical stages using a data driven approach. J Neurol Neurosurg Psychiatry 2005;76:343–348.
- Janvin CC, Larsen JP, Aarsland D, Hugdahl K: Subtypes of mild cognitive impairment in Parkinson’s disease: progression to dementia. Mov Disord 2006;21:1343–1349.
- Burn D, McKeith I: Current treatment of dementia with Lewy bodies and dementia associated with Parkinson’s disease. Mov Disord 2003;18:S72–S79.
- Bouchard RW: Diagnostic criteria of dementia. Can J Neurol Sci 2007;34(suppl 1):S11–S18.
- Caviness J, Driver-Dunckley E, Connor D, Sabbagh M, Hentz J, Noble B, Evidente V, Shill H, Adler C: Defining mild cognitive impairment in Parkinson’s disease. Mov Disord 2007;22:1272–1277.
- Dubois B: Is PD-MCI a useful concept? Mov Disord 2007;9:1215–1216.
- Daniel SE, Lees AJ: Parkinson’s disease brain bank, London: overview and research. J Neural Trans 1993;39(suppl):165–172.
- Leentjens AF, Verhey FR, Luijckx GJ, Troost J: The validity of the Beck Depression Inventory as a screening and diagnostic instrument for depression in patients with Parkinson’s disease. Mov Disord 2000;15:1221–1224.
- Goetz CG, Stebbins GT, Chmura TA, et al: Teaching tape for the motor section of the unified Parkinson’s disease rating scale. Mov Disord 1995;10:263–266.
- Lewis SJ, Dove A, Robbins TW, Barker RA, Owen AM: Cognitive impairments in early Parkinson’s disease are accompanied by reductions in activity in frontostriatal neural circuitry. J Neurosci 2003;23:6351–6356.
- Hoehn MM, Yahr MD: Parkinsonism: onset, progression and mortality. Neurology 1967;17:427–442.
- Wechsler DA: WAIS-III, WMS-III Technical Manual. San Antonio, Psychological Corporation, 1997.
- Delis DC, Kaplan E, Kramer JH: The Delis-Kaplan Executive Function System. San Antonio, The Psychological Corporation, 2001.
- Wilson BA, Alderman N, Burgess PW, Emslie HC, Evans JJ: Behavioural Assessment of the Dysexecutive Syndrome. Bury St. Edmunds, Thames Valley Test Company, 1996.
- Owen AM, James M, Leigh PN, Summers BA, Marsden CD, Quinn NP, Lange KW, Robbins TW: Fronto-striatal cognitive deficits at different stages of Parkinson’s disease. Brain 1992;115:1727–1751.
- Royall DR, Cordes JA, Polk M: CLOX: an executive clock drawing task. J Neurol Neurosurg Psychiatry 1998;64:588–594.
- Daneman M, Carpenter P: Individual differences in working memory and reading. J Verb Learn Verb Behav 1980;19:450–466.
- Benton AL, Varney NR, Hamsher KD: Visuospatial judgment. A clinical test. Arch Neurol 1978;35:364–367.
- Spreen O, Strauss E: A Compendium of Neuropsychological Tests, ed 3. Victoria, Oxford University Press, 1998.
- McKinlay A: An Investigation of the Cognitive and Psychiatric Profile for People with Parkinson’s Disease without Dementia, in Psychology; thesis, University of Canterbury, Christchurch, 2008, p 517.
- Marsh L: Neuropsychiatric aspects of Parkinson’s disease. Psychosomatics 2000;41:15–23.
- Jellinger KA: Post mortem studies in Parkinson’s disease – is it possible to detect brain areas for specific symptoms? J Neural Transm Suppl 1999;56:1–29.
- Tan E, Skipper LM: Pathogenic mutations in Parkinson disease. Hum Mutat 2007;28:641–653.
- Slaughter JR, Slaughter KA, Nichols D: Prevalence, clinical manifestations, etiology, and treatment of depression in Parkinson’s disease. J Neuropsychiatry Clin Neurosci 2001;13:187–196.
- Murai T, Müller U, Werheid K, Sorger D, Reuter M, Becker T, Yves von Cramon D, Barthel H: In vivo evidence for differential association of striatal dopamine and midbrain serotonin systems with neuropsychiatric symptoms in Parkinson’s disease. J Neuropsychiatry Clin Neurosci 2001;13:222–228.
- Braak H, Braak E: Pathoanatomy of Parkinson’s disease. J Neurol 2000;247(suppl 2):II3–II10.
- Mattay VS, Tessitore A, Callicott JH, Bertolino A, Goldberg TE, Chase TN, Hyde TM, Weinberger DR: Dopaminergic modulation of cortical function in patients with Parkinson’s disease. Ann Neurol 2002;51:156–164.
- Aarsland D, Andersen K, Larsen JP, Lolk A, Kragh-Sorensen P: Prevalence and characteristics of dementia in Parkinson disease: an 8-year prospective study. Archives of Neurology 2003;60:387–392.
- Emre M, Aarsland D, Brown R, Burn D, Duyckaerts C, Mizuno Y, et al: Clinical diagnostic criteria for dementia associated with Parkinson’s disease. Mov Disorders 2007;22:1689–1707.
- Woods SP, Troster AI: Prodromal frontal/executive dysfunction predicts incident dementia in Parkinson’s disease. J Int Neuropsychol Soc 2003;9:17–24.
- Mahieux F, Fenelon G, Flahault A, Manifacier M, Michelet D, Boller F: Neuropsychological prediction of dementia in Parkinson’s disease. J Neurol Neurosurg Psychiatry 1998;64:178–183.
- 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.
- Levy G, Jacobs DM, Tang MX, Cote LJ, Louis ED, Alfaro B, Mejia H, Stern Y, Marder K: Memory and executive function impairment predict dementia in Parkinson’s disease. Mov Disord 2002;17:1221–1226.
- Hobson P, Meara J: Risk and incidence of dementia in a cohort of older subjects with Parkinson’s disease in the United Kingdom. Mov Disord 2004;19:1043–1049.
- Levin BE, Llabre MM, Reisman S, Weiner WJ, Sanchez-Ramos J, Singer C, Brown MC: Visuospatial impairment in Parkinson’s disease. Neurology 1991;41:365–369.
- Goetz C, Emre M, Dubois B: Parkinson’s disease dementia: definitions, guidelines, and research perspectives in diagnosis. Ann Neurol 2008(suppl 2):S81–S92.
- Muslimovic D, Post B, Speelman JD, Schmand B: Cognitive profile of patients with newly diagnosed Parkinson disease. Neurology 2005;65:1239–1245.
- Janvin C, Aarsland D, Larsen JP, Hugdahl K: Neuropsychological profile of patients with Parkinson’s disease without dementia. Dement Geriatr Cogn Disord 2003;15:126–131.
- Graham JM, Sagar HJ: A data-driven approach to the study of heterogeneity in idiopathic Parkinson’s disease: identification of three distinct subtypes. Mov Disord 1999;14:10–20.
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Accepted: June 27, 2009
Published online: August 18, 2009
Number of Print Pages : 9
Number of Figures : 2, Number of Tables : 3, Number of References : 40
Dementia and Geriatric Cognitive Disorders
Vol. 28, No. 2, Year 2009 (Cover Date: September 2009)
Journal Editor: Chan-Palay V. (New York, N.Y.)
ISSN: 1420-8008 (Print), eISSN: 1421-9824 (Online)
For additional information: http://www.karger.com/DEM
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