To identify the cognitive characteristics predictive of incident dementia in Parkinson's disease (PD), we examined the baseline neuropsychological profiles of 18 initially non-demented patients with ...PD who met diagnostic criteria for dementia (PDD) at one-year follow-up. PDD participants' baseline neuropsychological test scores were compared to the baseline performance of 18 patients with PD who did not meet criteria for dementia at one-year follow-up (PDND) and 18 normal controls (NC). The three groups were matched on baseline demographic and disease variables. Relative to the PDND group, the incident PDD participants demonstrated significantly poorer performance on digits backward (Wechsler Memory Scale-Revised), word list learning and recognition (California Verbal Learning Test), and perseverative errors on the Wisconsin Card Sorting Test. Each of these baseline neuropsychological variables exhibited adequate diagnostic classification accuracy in predicting PDD and PDND group membership at follow-up. These results suggest that subtle frontal/executive dysfunction is evident during the immediate PDD prodrome and may be of prognostic value in identifying PD patients at risk for dementia. Accordingly, neuropsychological evaluation may facilitate early identification of PDD and thereby inform appropriate dispositional planning.
Welding-generated metallic fumes contain a substantial amount of manganese (Mn), making welders susceptible to Mn toxicity. Although overt Mn toxicity manifests as a type of parkinsonism, the ...consequences of chronic, low-level Mn exposure are unknown. To explore region-specific Mn accumulation and its potential functional consequences at subclinical levels of Mn exposure, we studied seven welders without obvious neurological deficits and seven age- and gender-matched controls. Mn exposure for welders was estimated by an occupational questionnaire. High-resolution brain magnetic resonance imaging (MRI), Grooved Pegboard performance of both hands, Trail making, and olfactory function tests were obtained from all subjects. Compared with controls, the welders had a significantly higher T1 relaxation rate (R1) in the olfactory bulb (OB, p = 0.02), mean T1-weighted intensity at frontal white matter (FWM; p = 0.01), bilateral globus pallidus (GP; p = 0.03), and putamen (p = 0.03). The welders scored worse than the controls on the Grooved Pegboard test for both dominant (p = 0.06) and nondominant hand (p = 0.03). The dominant hand Grooved Pegboard scores correlated best with mean MRI intensity of FWM (R² = 0.51, p = 0.004), GP (R² = 0.51, p = 0.004), putamen (R² = 0.49, p= 0.006), and frontal gray matter (R² = 0.42, p = 0.01), whereas the nondominant hand scores correlated best with intensity of FWM (R² = 0.37, p = 0.02) and GP (R² = 0.28, p = 0.05). No statistical differences were observed in either the Trail-making test or the olfactory test between the two groups. This study suggests that Mn accumulates in OB and multiple other brain regions in "asymptomatic" welders and that MRI abnormalities correlate with fine motor but not cognitive deficits. Further investigations of subclinical Mn exposure are warranted.
About deep brain stimulation Massano, João; Tröster, Alexander I.
Neurology,
2015-March-31, 2015-Mar-31, 2015-03-31, 20150331, Letnik:
84, Številka:
13
Journal Article
Objective: The aim of the current study was to clarify the nature and extent of impairment in time- versus event-based prospective memory in Parkinson's disease (PD). Prospective memory is thought to ...involve cognitive processes that are mediated by prefrontal systems and are executive in nature. Given that individuals with PD frequently show executive dysfunction, it is important to determine whether these individuals may have deficits in prospective memory that could impact daily functions, such as taking medications. Although it has been reported that individuals with PD evidence impairment in prospective memory, it is still unclear whether they show a greater deficit for time- versus event-based cues. Method: Fifty-four individuals with PD and 34 demographically similar healthy adults were administered a standardized measure of prospective memory that allows for a direct comparison of time-based and event-based cues. In addition, participants were administered a series of standardized measures of retrospective memory and executive functions. Results: Individuals with PD demonstrated impaired prospective memory performance compared to the healthy adults, with a greater impairment demonstrated for the time-based tasks. Time-based prospective memory performance was moderately correlated with measures of executive functioning, but only the Stroop Neuropsychological Screening Test emerged as a unique predictor in a linear regression. Conclusions: Findings are interpreted within the context of McDaniel and Einstein's (2000) multiprocess theory to suggest that individuals with PD experience particular difficulty executing a future intention when the cue to execute the prescribed intention requires higher levels of executive control.
Serial assessments of cognitive functioning in individuals with Parkinson's disease (PD) are commonly used for the detection of incident dementia and neurobehavioral changes associated with ...treatments using neuromodulation (e.g., deep brain stimulation) and pharmacological agents (e.g., cholinesterase inhibitors). This study provides test–retest stability, expected practice effects, and practice-corrected reliable change indices for several commonly used neuropsychological tests from 62 older adults with mostly mild PD who underwent repeat evaluations approximately 17 months apart. At the group level, results showed adequate test–retest reliability (Spearman's rho range
=
0.24–0.86) and generally small practice effects (Cohen's
d range
=
0.00–0.50). Application of reliable change indices using 90% confidence intervals showed the expected number of individuals (generally 10% or fewer) with statistically meaningful improvements (range
=
0–12%) or declines (range
=
2–8%) in cognitive performance at retest. Limitations discussed include ceiling effects at test baseline, sample homogeneity, interpretative cautions, and generalizability of study results. These data may be useful to researchers and clinicians interested in determining the statistical significance of changes in cognitive test performance in persons with PD over a 1- to 2-year interval.
Objective
This study aims to investigate the influence of deep brain stimulation (DBS) on caregiver burden and quality of life in Parkinson's disease.
Methods
A cross‐sectional retrospective study ...utilizing the National Parkinson Foundation Quality Improvement Initiative clinical study was conducted. A group of 275 patients who had undergone DBS for Parkinson's disease were extracted from 2916 subjects who were included in this data base. The data were compared to an age, sex, and disease severity matched control group. A secondary analysis was then performed on two more control groups that were matched to account for presence or absence of motor fluctuations. The multidimensional caregiver strain index and Parkinson's disease quality‐of‐life questionnaire 39 summary index were compared.
Results
The multidimensional caregiver strain index did not differ between the DBS group (16.9 ± 11.8) and a matched non‐DBS group (16.1 ± 17.6, p = 0.618). The quality‐of‐life index was, however, significantly better in the DBS group (28.9 ± 15.6) than in the non‐DBS group (32.3 ± 17.6, p = 0.034). A secondary analysis revealed that the total caregiver strain score was lower in the no motor fluctuation control group than the other two groups (p < 0.05). Regression analysis revealed significant relationships between the quality‐of‐life index and caregiver strain index total scores (p < 0.001), between caregiver strain index total score and age at surgery (p = 0.027), and also between the interval since surgery (p = 0.048).
Conclusions
Although there were several limitations to this study, DBS seems to improve quality of life without significantly increasing caregiver burden.
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