One‐year survival of demented stroke patients: data from the Dijon Stroke Registry,France (1985–2008)

Background and purpose: Dementia is a frequent condition after stroke that may affect the prognosis of patients. Our aim was to determine whether post‐stroke dementia was a predictor of 1‐year case‐fatality and to evaluate factors that could influence survival in demented stroke patients. Methods: From 1985 to 2008, all first‐ever strokes were recorded in the population‐based stroke registry of Dijon, France (150 000 inhabitants). Dementia was diagnosed during the first month following stroke, according to DSM‐III and DSM‐IV criteria. Survival was evaluated at 1 year and multivariate analyses were performed using Cox proportional hazards to identify independent predictive factors. Results: We recorded 3948 first‐ever strokes. Among these stroke patients, 3201 (81%) were testable, and of these, 653 (20.4%) had post‐stroke dementia (337 women and 316 men). Demented patients had lower 1‐year survival than patients without dementia (82.9% vs. 86.9%, P = 0.013). However, in multivariate analysis, dementia did not appear as an independent predictor of 1‐year death. In demented stroke patients, age >80 years old, severe handicap at discharge, recurrent stroke within the first year and subarachnoid haemorrhage were associated with a higher risk of 1‐year death, and the risk was lower in the study period 2003–2008. Conclusions: Dementia after stroke is not independently associated with an increased risk of death at 1 year. In recent years, 1‐year case‐fatality decreased in demented as well as in and non‐demented patients suggesting that improvements in the management of stroke also benefited the most fragile patients.     

Semantic memory in DAT, MID and parkinsonism

Previous studies found the semantic system particularly affected in Dementia of Alzheimer's Type (DAT), which would have important implications for the clinical diagnosis of this disease. We compared 14 non-demented parkinsonian patients and 14 controls on one hand and demented patients suffering from multi-infarct dementia (n = 17), DAT (n = 18) and Parkinsonism + dementia (n = 7) on the other. Demented groups were well matched regarding severity of dementia. Two tasks of semantic memory (naming, word fluency) did not differentiate within demented groups, but were correlated with severity of dementia.     

A pilot study of risk factors for dementia in Parkinson's disease

To determine whether the risk factors for dementia in idiopathic Parkinson's disease (IPD) are similar to the risk factors for Alzheimer's disease, we conducted a case-control study of potential risk factors. A structured interview was administered to surrogates of 17 demented subjects with IPD and 54 nondemented subjects. Two factors emerged as possible risks for dementia. Demented patients were older than nondemented patients, although the duration of symptoms was similar. A family history of dementia was present in 30% of the demented group and 5.6% of the nondemented group. Dementia was most often reported among siblings. No difference was seen in toxic and occupational exposure, personal habits, or medical or surgical illnesses. We conclude that dementia in IPD shares some common risk factors with Alzheimer's disease. Efforts to assess the contribution of genetic susceptibility or shared environmental influences may clarify the relationship between these two diseases.     

The impact of argyrophilic grain disease on the development of dementia and its relationship to concurrent Alzheimer's disease-related pathology

Argyrophilic grain disease (AGD) constitutes a neurodegenerative disorder that occurs in the brains of the elderly and affects 5% of all patients with dementia. Tau protein-containing lesions known as argyrophilic grains and located predominantly in limbic regions of the brain characterize this disease. Dementia is encountered in only a subset of cases that display the morphological pattern of AGD. The aim of this study is to determine the role of concurrent Alzheimer's disease (AD)-related pathology for the development of dementia in AGD patients. A total of 204 post-mortem brains from 30 demented and 49 nondemented AGD patients, 39 AD patients, and from 86 nondemented controls without AGD were staged for AD-related neurofibrillary tangles (NFTs) as well as amyloid beta-protein (Abeta) deposition. To identify differences in AD-related pathology between demented and nondemented AGD cases, and to differentiate the pattern of AD-related changes in demented and nondemented AGD cases from that seen in AD and nondemented controls, we statistically compared the stages of Abeta and NFT distribution among these groups. Using a logistic regression model, we showed that AGD has a significant effect on the development of dementia beyond that attributable to AD-related pathology (P < 0.005). Demented AGD cases showed lower stages of AD-related pathology than did pure AD cases but higher stages than nondemented AGD patients. AGD associated dementia was seen in the presence of NFT (Braak)-stages II-IV and Abeta-phases 2-3, whereas those stages were not associated with dementia in the absence of AGD. In conclusion, AGD is a clinically relevant neurodegenerative entity that significantly contributes to the development of dementia by lowering the threshold for cognitive deficits in the presence of moderate amounts of AD-related pathology.     

End-of-life experience of demented elderly patients at home: findings from DEATH project

Background: As the number of demented elderly patients choosing to die at home continues to rise, it is important to ascertain how cognitive impairment is associated with symptom experience and end‐of‐life care received at home. A number of studies have suggested that patients with dementia often receive poor end‐of‐life care, with inadequate pain or other symptom control, so far however, very little research has dealt with community settings. The aim of the present study is to compare symptom experience and end‐of‐life care received by home patients based on cognitive function. Methods: The present data was obtained from the Dying Elderly at Home (DEATH) project, a multicenter observational study conducted in Japan. The following information was collected: decedent characteristics, observed symptoms and end‐of‐life care provided during the last 48 h of life. A total of 98 decedents with dementia and 112 decedents without dementia were included in the analysis. To assess the differences in characteristics and clinical course among decedents, the survey data was divided into two groups: dementia and non‐dementia. Results: Demented decedents were prone to incontinence or cough, but experienced relatively little pain, nausea and vomiting. Demented decedents were given more antibiotics but less opioids than non‐demented decedents. Also, they received a larger volume of intravenous infusion at 24–48 h before death. After controlling for age and other differences in baseline characteristics, dementia was determined to be a significant independent predictor of incontinence or uncontrolled pain. After controlling for age, other differences in baseline characteristics and symptom experience, dementia was determined not to be a significant independent predictor of use of antibiotics or opioids. Conclusions: Our findings suggest that dementia itself was an independent predictor of incontinence or less pain, and that it was not a significant independent predictor of use of end‐of‐life in a home setting.     

Prevalence and implications of psychopathological non‐cognitive symptoms in dementia

Objective: Clinical experience and recent population studies suggest that psychopathological, non‐cognitive symptoms are both frequent and relevant in dementia. Method: A representative community sample (n = 4,803 individuals, 55 + years) was interviewed in a two‐phase design. The Geriatric Mental Sate (GMS) was used for assessment and cases were diagnosed according to DSM‐IV‐TR criteria. Results: The prevalence of non‐cognitive symptoms (1 + symptoms) in cases of dementia (n = 223) was 90.1%, and negative‐type symptoms were most frequently found. A GMS ‘apathy‐related symptom cluster’ (anergia, restriction of activities and anhedonia) was significantly more frequent in the demented (55.6%) than in non‐cases (0.7%; specificity = 99.2%). In both dementia of Alzheimer’s type and vascular dementia, number of symptoms tended to be inversely related to severity of dementia, but psychopathological profiles differed. Conclusion: Non‐cognitive, negative‐type symptoms are very frequent in cases of dementia living in the community. They have powerful specificity in the distinction with non‐cases, and might change current concepts of dementia.     

Dementia with Lewy bodies: early diagnostic challenges

Dementia with Lewy bodies (DLB) is defined pathologically as neurodegeneration associated with Lewy bodies (LB). LB‐related symptoms, including olfactory dysfunction, dysautonomia, and mood and sleep disorders, are increasingly recognized as clinical signs that enable the early detection of DLB, because these symptoms often antedate dementia by years or even decades. It remains unknown if the clinical history of LB‐related symptoms is sufficient for the prodromal state of DLB to be suspected in memory clinics. We retrospectively investigated the clinical courses, including olfactory dysfunction, dysautonomia, depression, and rapid eye movement sleep behaviour disorder, of 90 patients with probable DLB. The timing of LB‐related symptoms that preceded or followed relative to the onset of memory loss was calculated. LB‐related symptoms were present in 79 of 90 patients (87.8%) with probable DLB before or at the time of memory loss onset. These symptoms preceded the onset of memory loss between 1.2 and 9.3 years. We also report on four non‐demented patients with a clinical history of LB‐related symptoms in our memory clinic. All four patients showed reduced cardiac [¹²³I]‐metaiodobenzylguanidine levels. Moreover, [¹⁸F]fluoro‐D‐glucose positron emission tomography scans revealed glucose hypometabolism in the occipital cortex in two patients. One patient converted to probable DLB with the development of parkinsonism 2 years after major depression was diagnosed. Based on a clinical history of LB‐related symptoms, we propose a conceptual framework to identify these symptomatic but non‐demented individuals that led us to suspect the underlying pathophysiology of Lewy body disease. Further prospective study is warranted to determine the clinical significance of LB‐related symptoms in non‐demented patients.     

Clinical validity of Braak neuropathological staging in the oldest-old

Several studies have demonstrated a good correlation between clinical severity and Braak’s neuropathological staging in Alzheimer’s disease (AD). However, nonagenarians and centenarians display a different pattern of cortical vulnerability to the neurodegenerative process compared to younger elderly, and it is not known whether correlations between clinical severity and neuropathological stages remain valid in this age group. To address this issue we compared Clinical Dementia Rating scale (CDR) scores and Braak stages in 116 patients over 90 years of age with either no cognitive impairment or very mild to severe AD. There is a strong positive correlation between CDR scores and Braak staging (Spearman coefficient = 0.66; P < 0.01). However, neuropathological staging does not distinguish cases with normal cognition (CDR 0) from those with mild cognitive changes (CDR 0.5). Unlike younger cohorts, Braak stages I and II are frequently associated with questionable dementia in this age group. Braak stage III overlaps with all CDR levels and correlates poorly with cognitive function. Braak stages IV or greater are consistently associated with at least mild dementia. Consistent with our previous neuropathological analyses of nonagenarians and centenarians, the present data suggest that the substantial involvement of the hippocampus which characterizes Braak stage IV is a key step in the development of overt clinical signs of dementia in the oldest-old. Moreover, they indicate that Braak staging represents a broad concept of the evolution of neurofibrillary tangles rather than a precise hierarchical model associated with a stepwise deterioration of cognitive abilities near the upper limit of life. Received: 16 June 1999 / Revised, accepted: 6 September 1999     

Influence of prestroke dementia on early and delayed mortality in stroke patients

Causes of early and delayed death after stroke differ. It has been suggested that delayed mortality rate was increased in patients with post-stroke dementia. Prestroke dementia is frequent: its influence on survival in stroke patients has never been evaluated. The aim of this study was to evaluate the influence of prestroke dementia on early and delayed mortality rate after stroke. In a cohort of 202 consecutive stroke patients aged ≥ 40 years admitted between November 1995 and May 1996 in a primary care center, the prevalence of prestroke dementia was determined using the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) with a cut-off of 104. Patients were followed-up for 3 years. Statistics were performed using life-table methods. Of 202 patients, 33 had prestroke dementia. Of 142 survivors at month–6, 44 were demented, of them 15 having prestroke and 29 new-onset post-stroke dementia. No patient was lost to follow-up. The risk of death at month–6 was higher in patients with prestroke dementia (RR 2.7; 95 % CI: 1.6–4.8). However, independent predictors of early death were age, severity of the deficit at admission, type and etiology of stroke. The risk of delayed death was higher in patients with prestroke dementia (RR 4.97; 95 % CI: 1.76–13.98) as in patients with new-onset post-stroke dementia (RR 6.24; 95 % CI: 2.67–14.57), compared with non-demented patients. The mortality rate did not differ between patients with prestroke and new-onset post-stroke dementia. Dementia at month–6 was an independent predictor of delayed death (RR 5.7; 95 % CI: 2.4–13.4), with age and stroke recurrence. Causes of death did not differ between demented and non-demented patients. Dementia adversely influences vital outcome in stroke patients, perhaps partly because the therapeutic approach differs between demented and non-demented patients. Received: 5 September 2001, Received in revised form: 20 June 2002, Accepted: 26 June 2002 Correspondence to Hilde Hénon, MD, PhD     

Net costs of dementia by disease stage

Leicht H, Heinrich S, Heider D, Bachmann C, Bickel H, van den Bussche H, Fuchs A, Luppa M, Maier W, Mösch E, Pentzek M, Rieder‐Heller SG, Tebarth F, Werle J, Weyerer S, Wiese B, Zimmermann T, König H‐H, for the AgeCoDe study group. Net costs of dementia by disease stage. Objective: To estimate net costs of dementia by degree of severity from a societal perspective, including a detailed assessment of costs of formal and informal nursing care. Method: In a cross‐sectional study, costs of illness were analysed in 176 dementia patients and 173 matched non‐demented control subjects. Healthcare resource use and costs were assessed retrospectively by means of a questionnaire. Dementia patients were classified into three disease stages, and linear regression models were applied to estimate net costs of dementia by degree of severity. Results: Annual net costs of dementia by stage were approximately €15 000 (mild), €32 000 (moderate) and €42 000 (severe), corresponding to US‐$21 450, 45 760 and 60 060 respectively. Across disease stages, nursing care accounted for approximately three‐quarters of total costs, of which half resulted from informal care. In sensitivity analyses using different valuation methods for nursing care, total costs decreased or increased by more than 20%. Conclusion: Net costs more than double across stages of dementia. Informal care accounts for a considerable share of nursing care costs, and the approach to valuation of informal care has a large impact on cost‐of‐illness estimates.     

Differing patterns of psychiatric impairment in Alzheimer and demented parkinsonian patients

Psychiatric symptoms were investigated and compared in 95 patients with Alzheimer type dementia (DAT) and in 39 patients with Parkinson's disease with dementia (PD-D). The diagnosis of the dementia and psychiatric disorders was based on DSM III R criteria; dementia stage was assessed using the Clinical Dementia Rating Scale (CDR). PD-D were significantly older than DAT patients. Delirium was more frequent in the advanced stages of both PD-D and DAT, being mainly of the hypoactive type in PD-D and the hyperactive type in DAT. Delusions and hallucinations predominated in the early CDR stages of both illnesses and did not differ between groups; the same was true for depression. The results revealed different psychopathological profiles in DAT and PD-D patients.

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Sommario In questo studio sono stati valutati e confrontati i disturbi psichiatrici di 95 pazienti affetti da demenza a tipo Alzheimer (DAT) e di 39 parkinsoniani dementi (PD-D). La diagnosi di demenza e di disturbi psichiatrici è stata eseguita basandosi sui criteri del DSM III R, il livello di demenza è stato valutato secondo la Clinical Dementia Rating Scale (CDR). I PD-D erano significativamente più anziani dei DAT. Il delirium era significativamente più frequente negli stadi più avanzati, sia tra i PD-D che tra i DAT, manifestandosi prevalentemente come ipoattivo tra i PD-D, come iperattivo tra i DAT. I deliri e le allucinazioni predominavano ai livelli più bassi di CDR in entrambe le patologie, non differendo tra i due gruppi. Lo stesso avveniva per la depressione. I risultati hanno rivelato profili psicopatologici differenti nei PD-D e nei DAT.

     

Cerebral vasomotor reactivity and dementia after ischemic stroke

Gur AY, Gücüyener D, Korczyn AD, Üzüner N, Gilutz Y, Özdemir G, Bornstein NM. Cerebral vasomotor reactivity and dementia after ischemic stroke.
Acta Neurol Scand: 2010: 122: 383–388.
© 2010 The Authors Journal compilation © 2010 Blackwell Munksgaard. Objectives – Cerebral hemodynamic features of patients with post‐stroke dementia (PSD) are still obscure. We compared cerebral vasomotor reactivity (VMR) assessed in the acute phase of ischemic stroke (IS) in patients with and without PSD. VMR was also assessed and compared in demented and non‐demented patients in the late phase of IS. Materials and methods – VMR was assessed by transcranial Doppler and the Diamox test (1 g acetazolamide i.v.). PSD was confirmed by the National Institute of Neurological Disorders and Stroke and the Association Internationale pour la Recherche et I’Enseignement en Neurosciences (NINDS‐AIREN) and the Diagnostic and Statistical Manual of Mental Disorders (DSM‐IV) criteria. VMR% values were compared to verify correlation with dementia. Results – Thirty patients with acute IS (AIS) were studied and followed for 3–6 months. An additional group of 37 patients was studied in the late post‐stroke period (PIS). VMR% values in the AIS groups with and without PSD were similar (25.3 ± 20.3% and 36.5 ± 22.4%, respectively, NS). The mean VMR% in the PIS groups with and without PSD were similar (32.3 ± 19.5% and 41.2 ± 24.8%, respectively, NS). Conclusions – VMR cannot predict the development of dementia after AIS and cannot identify patients with dementia in the late phase of stroke.     

Rates of progression in mild cognitive impairment and early Alzheimer's disease

OBJECTIVE: To compare rates of progression in the very mildest stages of AD, including the stage currently identified as mild cognitive impairment (MCI), and to identify predictors of those rates. METHODS: Demented (n = 289) and nondemented (n = 230) individuals enrolled in longitudinal studies at an Alzheimer Disease Research Center received annual clinical and psychometric examinations for up to 20 years. In order of increasing dementia severity, demented individuals were diagnosed with incipient, very mild, or mild dementia; the incipient stage is equivalent to MCI. Outcome measures included death, nursing home placement, and psychometric scores. RESULTS: Rate of progression increased with dementia severity as staged by the Clinical Dementia Rating at entry into the study. With respect to the dichotomous outcomes, the increase with dementia severity was more dramatic for the endpoint of nursing home entry than it was for the endpoint of death. Increased rates of cognitive decline with increased dementia severity were also obtained for psychometric scores. There was limited evidence of other predictors of progression. CONCLUSIONS: The lack of effective predictors of the rate of dementia progression extends to the very earliest stages of the disease, including what is often called MCI. A new approach to the identification of correlates of rates of progression is needed.     

Hypertension and incident dementia in community-dwelling elderly Yoruba Nigerians

Ogunniyi A, Lane KA, Baiyewu O, Gao S, Gureje O, Unverzagt FW, Murrell JR, Smith‐Gamble V, Hall KS, Hendrie HC. Hypertension and incident dementia in community‐dwelling elderly Yoruba Nigerians.
Acta Neurol Scand: 2011: 124: 396–402.
© 2011 John Wiley & Sons A/S. Objectives – To investigate the relationship between hypertension and dementia incidence in community‐dwelling elderly Yoruba (aged 70 years and above) because of sparse information on dementia and its risk factors in developing countries. Materials and Methods – Community‐based, prospective study of consenting elderly Yoruba using two‐stage design. Blood pressure was measured during the baseline evaluation at 2001 and hypertension was defined as BP ≥ 140/90 mmHg. Diagnosis of dementia and normal cognition was by consensus using standard criteria. Non‐demented subjects from the 2001 evaluation wave were re‐evaluated during the 2004 and 2007 waves for dementia. Logistic regression was used to examine the association of baseline hypertension and incident dementia, after adjusting for age, gender, education, and histories of stroke and smoking. P‐values <0.05 were considered significant. Results – During the 6‐year follow‐up, 120 individuals developed dementia, while 1633 remained non‐demented. The frequency of hypertension in the demented group was significantly higher than in the non‐demented (70.0% vs 60.2%, P = 0.034). Baseline hypertension was a significant risk factor for dementia (OR = 1.52; 95% CI 1.01–2.30). Higher systolic, diastolic or pulse pressure was associated with increased risk (P < 0.05). Participants with diastolic BP ≥ 90 mmHg were at a significantly greater risk than those with readings below 70 mmHg (OR = 1.65; 95% CI 1.01–2.69). Conclusions – Hypertension was associated with increased risk of dementia in elderly Yoruba and its appropriate treatment may lower the risk.     

Trends in autopsy‐verified dementia prevalence over 29 years of the Hisayama study

We investigated the trends in dementia over the past 29 years in the town of Hisayama, Japan using 1266 autopsy specimens. The Hisayama study is a prospective cohort study of lifestyle‐related diseases that was started in 1961. Clinical examination of dementia was started in 1985 with five detailed cross‐sectional assessments conducted in 1985, 1992, 1998, 2005 and 2012. To examine the trends in dementia, we divided the 1266 autopsy samples into five groups according to the year of death: I (1986–1991, 257 cases), II (1992–1997, 268 cases), III (1998–2004, 318 cases), IV (2005–2011, 296 cases) and V (2012–2014, 127 cases). The prevalence of all‐cause dementia significantly increased over time (28.4% in group I, 22.4% in group II, 32.1% in group III, 30.1% in group IV, 51.2% in group V; P for trend <0.001). A similar trend was observed for Alzheimer's disease (AD) (15.2%, 11.9%, 17.3%, 20.6% and 33.1%, respectively; P for trend <0.001). A significant increasing trend was observed in both men and women. A rapid increase in senile dementia of the NFT type (SD‐NFT) in recent years was notable. Vascular dementia was the most common type of dementia in men prior to 2004; however, its prevalence decreased over time. Our study revealed that tauopathies, including AD and SD‐NFT, significantly increased in the aged Japanese population over the course of this study. The neuritic plaque pathology of AD was associated with metabolic disorders such as insulin resistance and abnormal lipid metabolism, whereas the risk factors for tau pathology remain unclear. Although aging is considered one of the important risk factors accelerating tau pathology, there could be other risk factors associated with lifestyle diseases.     

Point of view: Dementia in Parkinson's disease

The prevalence of dementia in Parkinson's disease (PD) was analyzed in eight reports from peer-reviewed journals. Each report examined at least 100 patients, the period covered being 1966 to 1996. Among 1907 patients, 513,27%, were demented. The prevalence of dementia was similar in prospective and retrospective reports, and in clinic- and community-based reports. Demented patients were older than non-demented patients: 70.3 yr versus 64.3 yr. Disease duration was similar in demented and non-demented patients: 7.7 yr versus 7.9 yr. The incidence of dementia in PD was calculated from two prospective community-based reports and one retrospective clinic-based report. For the age range 55 to 64 yr, the incidence is 2.7 patients per 100 patients per year (2.7% per year). For the age range 70 to 79 yr, the incidence increased to 13.7%. For the age range 80 + yr, the incidence is 9.3%. The pathology of PD dementia was analyzed in 15 reports, each report examined at least 10 patients. Among 412 demented patients, 28%, had a pathology characterized primarily by Lewy bodies (Lbs) and 40% of the patients with Lbs (10% of all demented PD patients), had subcortical changes, only 60% of the patients with Lbs (17% of all demented PD patients), had subcortical and cortical Lbs. Among the 412 demented patients, 72%, the pathology consisted of subcortical Lbs and cortical AD changes: plaques and neurofibrillary tangles (nfts). Some of these patients also had cortical Lbs. It is postulated there are two types of PD dementia, and by inference two types of PD. One type, which may include familial PD, is characterized by cortical Lbs. The second, related to AD, or frontotemporal dementia (FTD), is characterized by cortical senile plaques and nfts. As 90% of demented PD patients have cortical changes, it is argued that PD dementia should be referred to as a cortical not a subcortical dementia.     

Dementia in Parkinson Disease

In 520 patients with parkinsonism seen over eight years, 168 (32%) had moderate to marked dementia. Although the demented patients were older than the nondemented patients (70.4 versus 65.5 years), the incidence of dementia in Parkinson's disease (PD) was tenfold higher than among controls (similarly aged spouses of PD patients), and dementia is held to be related more to the disease than to age. Demented patients, in addition to being older, developed PD later, were more severely involved in a shorter time, and responded less well to levodopa. It is suggested that PD with dementia may represent a different disorder from PD without dementia.     

Cut‐off score of the Mattis Dementia Rating Scale for screening dementia in Parkinson's disease

The prevalence of dementia in Parkinson's disease (PD) is close to 30%, and its incidence is 4 to 6 times higher than in age‐matched general population. PD with dementia (PDD) is mainly characterized by a predominant and progressive frontal‐subcortical impairment. The Mattis Dementia Rating Scale (MDRS) is a commonly used screening test that sensitively measures the degree of frontal‐subcortical defects. Although the MDRS has been validated as a screening test of cognitive dysfunction in nondemented PD patients (PD‐ND), its utility for screening dementia in PD is unknown. In order to validate the MDRS for diagnosis of PDD it was prospectively administered to 92 PD patients (57 PD‐ND, 35 PDD) fulfilling UK‐PDSBB criteria. Dementia was diagnosed according to DSM‐IV‐TR and a Clinical Dementia Rating (CDR) scale score ≥1. Univariate, logistic regression, and ROC curve analysis were carried out to measure the discriminative power of MDRS in PDD. Regression analysis showed MDRS total scores to independently differentiate PD‐ND from PDD (P < 0.001). Age and education did not predict the presence of dementia. ROC curve analysis showed a cut‐off score of ≤123 on the MDRS total scores to yield high sensitivity (92.65%), specificity (91.4%), positive and negative predictive values (PPV 83.3%, NPV 96.4%). A brief version of the MDRS obtained by the addition of the memory, initiation/perseveration, and conceptualization subscores yielded similar discriminant properties. The MDRS has an excellent discriminant ability to diagnose dementia in PD and provides an objective measure to distinguish PD‐ND from PDD. © 2008 Movement Disorder Society     

Psychosis in Parkinson's disease without dementia: Common and comorbid with other non‐motor symptoms

Psychosis in Parkinson's disease (PD) is common and associated with a range of negative outcomes. Dementia and psychosis are highly correlated in PD, but the frequency and correlates of psychosis in patients without cognitive impairment are not well understood. One hundred and ninety‐one non‐demented PD patients at two movement disorders centers participated in a study of neuropsychiatric complications in PD and completed a detailed neurological and neuropsychiatric assessment, including the rater‐administered Parkinson Psychosis Rating Scale for hallucinations, delusions, and minor symptoms of psychosis (illusions and misidentification of persons). Psychotic symptoms were present in 21.5% of the sample. Visual hallucinations were most common (13.6%), followed by auditory hallucinations (6.8%), illusions or misidentification of people (7.3%), and paranoid ideation (4.7%). Visual hallucinations and illusions or misidentification of people were the most common comorbid symptoms (3.1%). Depression (P = 0.01) and rapid eye movement behavior disorder symptoms (P = 0.03) were associated with psychosis in a multivariable model. The odds of experiencing psychotic symptoms were approximately five times higher in patients with comorbid disorders of depression and sleep‐wakefulness. Even in patients without global cognitive impairment, psychosis in PD is common and most highly correlated with other non‐motor symptoms. Screening for psychosis should occur at all stages of PD as part of a broad non‐motor assessment. In addition, these findings suggest a common neural substrate for disturbances of perception, mood, sleep‐wakefulness, and incipient cognitive decline in PD. © 2012 Movement Disorder Society