Educational level and cognitive impairment in patients with Parkinson disease

Background and purposeParkinson disease (PD) is a risk factor for dementia. In addition, specific cognitive deficits can occur in PD patients without dementia. A patient's level of education could have an influence on the development of cognitive impairment in PD. The aim of this study was to examine the relationship between the level of education and cognitive performance in non-demented patients with PD.Material and methodsThirty-seven consecutive, nondemented PD patients and 40 healthy controls fulfilled the inclusion criteria and were enrolled in the case-control study. Each of the controls and PD patients were classified, for the purpose of this study, into one of three groups (low, intermediate, higher), categorized by the number of years of education. There were no differences in education and age between the controls and PD patients. All of the subjects were evaluated with a battery of neuropsychological tests: Mini-Mental State Examination, Trail Making Tests, Stroop Test, Mental Rotation Test, and Verbal Fluency Test.ResultsLess (low and intermediate) education was correlated with poor results from tests. The comparison of all groups of PD patients and controls demonstrated that PD subjects received lower test scores, especially for the low and intermediate groups. However, no statistically significant difference was reached between educationally advanced PD patients and the appropriate control subjects.ConclusionsAs compared to the controls, most non-demented PD patients presented executive-type cognitive dysfunction. The higher educational level, however, was associated with a lower risk of cognitive deterioration. We conclude that higher education might have protective effects in cognitive decline in PD.     

帕金森病患者认知功能与血糖水平的分析

目的探讨帕金森病(Parkinson disease,PD)患者的认知功能与血糖水平的关系。方法纳入PD患者200例,进行简易精神量表(mini-mental state examination,MMSE)、蒙特利尔认知量表(Montreal cognitive assessment,Mo CA)、韦氏智力和韦氏记忆的认知评估。将200例PD患者分为PD认知正常组91例,PD认知障碍组109例;另外纳入126例正常对照;比较各组的空腹血糖(fasting plasma glucose,FPG)、餐后2 h血糖(2 h postprandial plasma glucose,2 h PPG)和糖化血红蛋白(glycosylated hemoglobin,HbAlc)水平及糖尿病患病率,并采用二分类logistic回归分析血糖水平对PD患者认知功能的影响。结果 PD患者的FPG、HbAlc水平及糖尿病患病率[5.19(0.72),5.7%(0.5%),14%]都比正常对照组[4.85(0.79),5.6%(0.5%),6%]显著升高(P0.05)。PD认知障碍患者的FPG水平[5.21(1.32)]较PD认知正常组[4.81(0.95)]相比,显著升高(P0.05),而2 h PPG、HbAlc都稍有升高,但无统计学差异(P0.05)。二分类logistic回归分析显示,FPG(OR:1.764;95%CI:0.06~3.244;P=0.068)与PD患者认知功能受损相关无统计学意义。结论高血糖可能是PD的危险因素之一,本研究未发现PD患者认知障碍的发生与血糖水平相关。     

Autonomic features in Parkinson disease

Nonmotor symptoms such as autonomic and neuropsychiatric dysfunctions, are commonly seen in Parkinson disease (PD). Recent studies have shown that PD is accompanied by cardiac sympathetic denervation and constipation even in the early stage. Neuropathological studies confirmed changes in the cardiac sympathetic nerves and the gastrointestinal tract. These findings suggest that PD neuropathology may occur first in the peripheral autonomic pathways and extend to the central autonomic pathways, in agreement with the "Braak theory". This article will reviews the symptoms and pathophysiology of gastrointestinal dysfunction, urinary disturbance, sexual dysfunction, sweating dysfunction, pupillary autonomic dysfunction, and orthostatic and postprandial hypotension in PD patients, and discuss to organ selectiveness in autonomic dysfunction in PD.     

Dementia and cognitive impairment in Parkinson disease

Changes in cognitive function and disturbances in behavior are commonly seen in parkinsonian patients and they are inherent features of the disease. Estimates on the prevalence of dementia in this disorder are quite variable, ranging from 15 to 25%. Advanced age, depression, severity of akinesia, and the presence of dopaminomimetic psychosis, are considered as risk factors in the development of cognitive deterioration within this patient population. Cognitive dysfunction may manifest as relatively circumscribed deficits or overt dementia. The finding of mild cognitive deficits is common in Parkinson's disease, such as reduced flexibility, psychomotor slowing, reduction in learning capacity and information retrieval, and disturbances in visuospatial tasks. The most prevalent cognitive disturbance is an impairment in visuospatial tasks, not necessarily related to the degree of motor disability. Dementia, when present early on in the course of the disease may suggest alternative diagnoses (Diffuse Lewy body dementia, Alzheimer's disease with extrapyramidal features, Fronto-temporal dementia, etc.), while in those cases in whom the dementing disorder develops at a later stage, it is assumed to be an integral part of the disease, albeit corresponding to variable pathogenetic mechanisms.     

Parkinson disease and cognitive evoked potentials

Long latency auditory evoked potentials were recorded in 50 patients with Parkinson's disease, some case were also investigated by the Rapid Evaluation of Cognitive Functions test (RECF) and Trail Making A test (TMA). Latencies of P2, N2 and P300 waves were longer in the parkinsonian group than in a control group matched for age. Latencies of N2 and P300 waves were correlated significantly with scores for RECF and TMA presumed to be sensitive to organic brain lesions. On the other hand no significant correlation was found between RECF and P1 and P2 latencies. In addition, correlation was lacking between Verbal Automatism test scores, presumed to be resistant to organic brain lesions, and P300 wave latencies. Cognitive evoked potential (CEP) latency increases with age in normal subjects. In the parkinsonian group the coefficient of correlation between these two factors was lower but still significant. The parkinsonian patients with dementia as defined by DSM III criteria, or an RECF score of less than 46, showed longer N2 and P300 latencies but no significant difference in N1 and P2 latencies. In contrast, comparison of P300 and N2 wave latencies in depressed and non-depressed parkinsonian patients failed to show any significant difference. The bilateral akinetic forms had marked lengthening of P300 wave latencies and a lower TMA score. Neither the duration of the disease, type of treatment, duration of L-Dopa therapy significantly influenced the latency of cognitive event-related potentials.     

帕金森病伴轻度认知功能障碍的研究进展

帕金森病伴发的轻度认知功能障碍，对患者的基本生活功能影响较小，但往往会演变成 帕金森痴呆，从而显著影响患者的生存质量及预后。因此，了解这一疾病，并对其进行早期干预具有十 分重要的意义。现从帕金森病轻度认知功能障碍的定义、临床表型、诊断标准、鉴别诊断、发病机制、危 险因素及治疗等方面进行综述，为相关研究提供参考。     

Effects of cognitive rehabilitation in Parkinson disease: a meta-analysis

Neurological Sciences - Cognitive symptoms are common in Parkinson’s disease (PD) and affect patients’ quality of life. Pharmacological interventions often do not improve such...     

The rate of cognitive decline in Parkinson disease

OBJECTIVES: To measure the rate and predictors of change on the Mini-Mental State Examination in patients with Parkinson disease (PD) and to compare that change with the Mini-Mental State Examination changes of patients with Alzheimer disease and nondemented subjects. PATIENTS: Patients with PD were drawn from a community-based cohort in Rogaland County, Norway. Those who were without cognitive impairment at disease onset and participated in 1 or more assessments after visit 1 were included and examined after 4 years (visit 2) and 8 years (visit 3). Motor, cognitive, and psychiatric symptoms were rated using standardized scales at visit 1. Two population-based cohorts of patients with Alzheimer disease and nondemented control subjects were included for comparison. Data were analyzed using a mixed-effects model. RESULTS: One hundred twenty-nine PD patients (57% women) were included. The mean (SD) Mini-Mental State Examination score at visit 1 was 27.3 (5.7). The mean annual decline in score from visit 1 to visit 3 was 1.1 (95% confidence interval, 0.8 to 1.3; 3.9% change from visit 1). Patients with PD and dementia (n = 49) had an annual decline from visit 1 to visit 2 of 2.3 (95% confidence interval, 2.1 to 2.5; 9.1% change from visit 1), compared with 2.6 (95% confidence interval, 2.3 to 2.8; 10.6% change from visit 1) in the patients with Alzheimer disease (n = 34) (mean annual decline among patients with PD and dementia vs patients with Alzheimer disease, not significant). The change in score for nondemented PD patients (n = 80) was small and similar to that for nondemented control subjects (n = 1621). Old age, hallucinations, and more severe motor symptoms (rigidity and motor scores mediated by nondopaminergic lesions) at visit 1 were significantly associated with a more rapid cognitive decline in patients with PD. CONCLUSIONS: The mean annual decline on the Mini-Mental State Examination for PD patients was 1 point. However, a marked variation was found. In patients with PD and dementia, the mean annual decline was 2.3, which was similar to the decline observed in patients with Alzheimer disease.     

精神分裂症患者文化程度对疾病的影响

对两所医院精神分裂症患者２９７例及２００例的不同文化程度与疾病的关系进行分析，发现文化程度高低与临床症状有关，且文化程度高者自知力恢复好，其复发率亦低，两者之间存在着显著差异。说明精神分裂症患者的临床表现，康复期自知力恢复和病情复发发等情况与其文化程度有关。     

Elevated plasma homocysteine level in patients with Parkinson disease: motor, affective, and cognitive associations

BACKGROUND: An elevated plasma homocysteine (Hcy) level has been prospectively associated with an increased risk of vascular and degenerative dementias. An Hcy elevation is prevalent in patients with Parkinson disease (PD) in part because levodopa metabolism produces Hcy. The clinical relevance of an elevated Hcy level in patients with PD is unknown. OBJECTIVE: To determine if hyperhomocysteinemia in patients with PD is associated with depression or with cognitive or physical impairments. DESIGN: Ninety-seven people with a mean (SD) PD duration of 3.6 (1.6) years completed the Beck Depression Inventory, a battery of 11 cognitive tests, and the motor and function components of the Unified Parkinson's Disease Rating Scale. Normalized scores for the affective, cognitive, and physical measures were compared between those with a normal Hcy level (n = 66) and those with hyperhomocysteinemia (n = 31) (Hcy level, >1.89 mg/L [>14 micro mol/L]), controlling for age, sex, disease duration, and treatment. RESULTS: Subjects with an elevated Hcy level were slightly older (68 vs 62 years), but had similar plasma concentrations of vitamin B(12) and folate. Hyperhomocysteinemic patients were more depressed (P =.02) and had worse cognition (P<.01), but the physical measure did not differ. CONCLUSIONS: Patients with PD and hyperhomocysteinemia are more likely to be depressed and to perform worse on neuropsychometric tasks compared with normohomocysteinemic patients. Further research is warranted to see if hyperhomocysteinemia is a reversible risk factor for neuropsychiatric burden in patients with PD.     

C.elegans as a model system for Parkinson disease

Parkinson disease(PD) is characterized by the selective loss of dopaminergic neurons in the substantia nigra. Although investigation in mammalian animal models of PD has enhanced our understanding of PD, the complexity of the mammalian nervous system and our inability to visualize DA neurons in vivo restricts the advances in elucidating the molecular mechanisms of PD. Conservation between C. elegans and mammals in genomic, biosynthetic and metabolic pathways as well as the advantages of observing DA neurons morphology in vivo and the ease of transgenic and genetic manipulation make C. elegans an excellent model organism for PD.     

C. elegans as a model system for Parkinson disease

Parkinson disease （PD） is characterized by the selective loss of dopaminergic neurons in the substantia nigra.Although investigation in mammalian animal models of PD has enhanced our understanding of PD, the complexity of the mammalian nervous system and our inability to visualize DA neurons in vivo restricts the advances in elucidating the molecular mechanisms of PD. Conservation between C. elegans and mammals in genomic, biosynthetic and metabolic pathways as well as the advantages of observing DA neurons morphology in vivo and the ease of transgenic and genetic manipulation make C. elegans an excellent model organism for PD.     

Relations between on-off phenomena and cognitive functions in Parkinson disease

10 patients with Parkinson disease on long term levodopa therapy and with fluctuations in motor performance unrelated to drug administration (on-off phenomena) were assessed on the following neuropsychological tests during the on and off phases: tests of attention (Toulouse-Pieron), memory (Digit Span, Rey forms 1 and 2), psychomotor capacity (maze test, single and multiple choice reaction times) and mood (Maudley Adjective Check List). The extrapyramidal symptoms were assessed on the Webster Rating Scale. We found no significant differences in attention, cognitive performance or mood between the on and off phases despite large fluctuations in motor performance.

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Sommario 10 pazienti affetti da Morbo di Parkinson, in terapia cronica con L-Dopa e con fluttuazioni della performance motoria non correlate alla somministrazione di L-Dopa (fenomeni on-off) sono stati valutati mediante alcuni tests neuropsicologici durante le fasi di on e off: Tests di attenzione (Toulouse-Pieron Test), di memoria (Digit Span; Reattivo di Rey, forma 1 e 2), di valutazione della Psicomotricità (Test del labirinto, Tempi di reazione semplici e complessi) e Test per la valutazione del tono dell'umore (Maudley Adjective Check List). La sintomatologia extrapiramidale è stata valutata mediante Webster Rating Scale. A fronte di importanti fluttuazioni della performance motoria tra fasi on e off, non abbiamo osservato significative modificazioni delle performances attentive, cognitive e del tono dell'umore

     

Mild cognitive impairment in Parkinson disease: heterogenous mechanisms

Cognitive impairment is common in Parkinson disease (PD), with long-term longitudinal studies reporting that most PD patients develop dementia. A high proportion of patients with PD and mild cognitive impairment (MCI) progress to dementia within a short time. Impairments occur in a range of cognitive domains, but single-domain impairment is more common than multiple one, non-amnestic more common than amnestic impairment. Although the term MCI applied to PD (PD-MCI) is not without controversy due to the lack of uniform diagnostic consensus criteria, the biological validity of PD-MCI is supported by many recent studies that show heterogenous mechanisms in the clinical presentation, neuropsychology, neuroimaging, biomarkers, and neuropathology, suggesting abnormal metabolic network activities involving several cortical and subcortical nervous systems. Prospective studies using specific biomarkers, including amyloid imaging, and cerebro-spinal fluid biomarkers are warranted for an exact diagnosis and prognostic assessment of early cognitive deficits in PD patients.     

帕金森病运动亚型及认知功能的研究进展

帕金森病患者在疾病中晚期常合并认知障碍,严重影响其社会功能和生活质量.根据运动症状的差异可将帕金森病患者进行运动分型,不同运动亚型患者的认知障碍的发生率以及认知受损亚型存在一定差异,其中神经递质网络失调起到关键作用.文章回顾近年来对帕金森病运动亚型和认知功能的神经递质网络研究,对帕金森病运动亚型分型、不同运动亚型与认知...