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Neuropsychological prediction of dementia in Parkinson's disease |
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| Authors: | F. Mahieux G. Fenelon A. Flahault M. Manifacier D. Michelet F. Boller |
| Affiliation: | Service de Neurologie, Hôpital Tenon, Paris, France. |
| Abstract: | OBJECTIVE—To identify neuropsychologicalcharacteristics predictive of later dementia in Parkinson's disease. METHODS—A comprehensive neuropsychological testbattery was administered to a cohort of 89 initially non-dementedpatients with Parkinson's disease consecutively enrolled at aspecialised Parkinson's disease clinic. They were reassessed after amean of 3.5 years for the diagnosis of dementia. The Coxproportional hazards model was used to identify baselinecharacteristics predictive of dementia. RESULTS—Only four of the baseline clinicalcharacteristics of Parkinson's disease and neuropsychologicalvariables remained independently linked to subsequent development ofdementia: the age of onset of Parkinson's disease (>60 years;relative risk (RR) 4.1, 95% confidence interval (95% CI) 1.8-24.0,p<0.03), the picture completion subtest of the Wechsler adultintelligence scale (score<10; RR 4.9, 95% CI 1.0-24.1, p<0.02), theinterference section of the Stroop test (score<21; RR 3.8, p=0.08),and a verbal fluency task (score<9; RR 2.7, 95% CI 0.8-9.1, p=0.09).Depressive symptoms and the severity of motor impairment were notpredictive of dementia. CONCLUSION—These features are different from theneuropsychological characteristics predictive of Alzheimer's dementiain healthy elderly people (mainly memory and language performance).They are in keeping with the well known specificity of the impairmentsin Parkinson's disease for visuospatial abilities and difficulties ininhibiting irrelevant stimuli. It is postulated that the compositenature of the picture completion subtest, involving several cognitive abilities impaired in Parkinson's disease, explains its sensitivity. |
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