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Cognitive impairment in 873 patients with idiopathic Parkinson's disease

Results from the German Study on Epidemiology of Parkinson's Disease with Dementia (GEPAD)

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Abstract

Background

Parkinson's disease (PD) is often accompanied by non-motor complications, such as dementia, depression, and psychotic symptoms, which worsen the prognosis and increase the personal and socioeconomic burden of disease. Prevalence estimates of these complications are quite variable and are lacking for the outpatient care sector.

Methods

As part of a larger, nationwide, cross-sectional epidemiological study in n = 315 neurological outpatient settings in Germany, this paper estimates the frequency of dementia and cognitive impairment in n = 873 outpatients meeting the UK Brain Bank criteria for idiopathic PD. Assessments were based on a clinical interview and neuropsychological assessments, including the Hoehn & Yahr rating and Unified Parkinson's Disease Rating Scale (UPDRS). Cognitive impairment was assessed by the Mini-Mental State Exam (MMSE), Clock Drawing Test (CDT) and the Parkinson Neuropsychometric Dementia Assessment (PANDA) and the clinician's diagnosis of dementia was based on the diagnostic criteria of DSMIV.

Results

Using standardized cutoff scores, the prevalence of cognitive impairment in the study sample as measured by various methods was 17.5% by MMSE (≤ 24), 41.8% by CDT (≥ 3), 43.6% by PANDA (≤ 14), and 28.6% met the DSM-IV criteria for dementia. All estimates increased with age and PD severity. Gender was an inconsistent contributor while illness duration had no significant impact on cognition. Multiple regression analyses revealed PD severity to be the strongest predictor of dementia risk (OR = 4.3; 95% CI: 2.1–9.1), while neuropsychiatric syndromes had independent, although modest additional contributions (OR = 2.5, 95% CI: 1.6–3.8).

Conclusion

Estimates of cognitive impairment and dementia in PD patients are largely dependent on the diagnostic measure used. Using established clinical diagnostic standards for dementia the overall rate on routine outpatient neurological care is 28.6%, but using more sensitive neuropsychological measures, rates for cognitive impairment might be up to 2-fold higher. The MMSE revealed strikingly low sensitivity. Neuropsychiatric syndromes, in addition to PD severity and age, have an independent – although modest – additional contribution to patients' risk for cognitive impairment and dementia.

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References

  1. Aarsland D, Andersen K, Larsen JP, Lolk A, Kragh-Soerensen P (2003) Prevalence and Characteristics of Dementia in Parkinson's Disease – An 8-Year Prospective Study. Arch Neurol 60:387–392

    Article  PubMed  Google Scholar 

  2. Aarsland D, Andersen K, Larsen JP, Lolk A, Nielsen H, Kragh-Soerensen P (2001) Risk of dementia in Parkinson's disease: A community-based, prospective study. Neurology 56:730–736

    PubMed  CAS  Google Scholar 

  3. Aarsland D, Larsen JP, Lim NG, Janvin C, Karlsen K, Tandberg E, Cummings J (1999) Range of neuropsychiatric disturbances in patients with Parkinson's disease. J Neurol Neurosurg Ps 67:492–496

    CAS  Google Scholar 

  4. Adler C (2005) Nonmotor Complications in Parkinson's Disease. Movement Disord 20:S23–S29

    Article  PubMed  Google Scholar 

  5. American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders – Text revision. American Psychiatric Association, Washington, DC

  6. Campenhausen S, Bornschein B, Wick R, Bötzel K, Sampaio C, Poewe W, Oleson J, Oertel W, Siebert U, Berger K, Dodel R (2005) Prevalence and incidence of Parkinson's disease in Europe. Eur Neuropsychopharm 15:473–490

    Article  CAS  Google Scholar 

  7. Cormack F, Aarsland D, Ballard C, Tovee M (2004) Pentagon drawing and neuropsychological performance in Dementia with Lewy bodies, Alzheimer's disease, Parkinson's disease and Parkinson's disease with dementia. Int J Geriatr Psych 19:371–377

    Article  Google Scholar 

  8. Efron B, Tibshirani R (1993) An introduction to the bootstrap. Chapman and Hall, London

  9. Emre M (2003) What causes mental dysfunction in Parkinson's disease? Movement Disord 18:63–71

    Article  Google Scholar 

  10. Fahn S (1987) Unified Parkinson's Disease Rating Scale. In: Fahn S, Calne D (eds) Recent Developments in Parkinson's Disease. MacMillan Healthcare Information, Florham Park, NJ, pp 153–163

  11. Folstein M, Folstein S, McHugh P (1975) Mini-Mental state: a practical method for grading the mental state of patients by the clinician. J Psychiatr Res 12:189–198

    Article  PubMed  CAS  Google Scholar 

  12. Hobson P, Meara J (2004) Risk and incidence of dementia in a cohort of older subjects with Parkinson's disease in the United Kingdom. Movement Disord 19:1043–1049

    Article  PubMed  Google Scholar 

  13. Hoehn M, Yahr M (1967) Parkinsonism: onset, progression and mortality. Neurology 17:427–442

    PubMed  CAS  Google Scholar 

  14. Hughes A, Daniel S, Kilford L, Lees A (1992) Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinicopathological study of 100 cases. J Neurol Neurosurg Ps 55:181–184

    CAS  Google Scholar 

  15. Hughes T, Ross H, Musa S, Bhattacherjee S, Nathan R, Mindham R, Spokes E (2000) A 10-year-study of the incidence of and factors predicting dementia in Parkinson's disease. Neurology 54:1596–1603

    PubMed  CAS  Google Scholar 

  16. Huse D, Schulman K, Orsini L, Castelli- Haley J, Kennedy S, Lenhart G (2005) Burden of illness in Parkinson's disease. Movement Disord 20:1449–1454

    Article  PubMed  Google Scholar 

  17. Kalbe E, Calabrese P, Kohn N, Hilker R, Riedel O, Wittchen HU, Dodel R, Otto J, Ebersbach G, Kessler J (2007) Screening for cognitive deficits in Parkinson's Disease with the Neuropsychometric Dementia Assessment (PANDA) instrument. Parkinsonism Relat D (in press)

  18. Kalbe E, Riedel O, Kohn N, Dodel R, Calabrese P, Kessler J (2007) Sensitivitat und Spezifitat des "Parkinson Neuropsychometric Dementia Assessment" (PANDA): Ergebnisse der GEPAD-Studie. Aktuel Neurol 34:140–146

    Article  Google Scholar 

  19. Klockgether T (2004) Parkinson's disease: clinical aspects. Cell Tissue Res 318:115–120

    Article  PubMed  Google Scholar 

  20. Leentjens A, Verhey F, Lousberg R, Spitsbergen H, Wilmink F (2000) The validity of the Hamilton and Montgomery- Asberg Depression Rating Scales as screening and diagnostic tools for depression in Parkinson's disease. Int J Geriatr Psych 15:644–649

    Article  CAS  Google Scholar 

  21. Louis E, Schupf N, Manly J, Marder K, Tang M-X, Mayeux R (2005) Association between mild parkinsonian signs in mild cognitive impairment in a community. Neurology 64:1157–1161

    PubMed  CAS  Google Scholar 

  22. Miyasaki J, Shannon K, Voon V, Ravina B, Kleiner-Fisman G, Anderson K, Shulman L, Gronseth G, Weiner WJ (2006) Practice Parameter: Evaluation and treatment of depression, psychosis, and dementia in Parkinson disease (an evidence-based review). Neurology 66:996–1002

    Article  PubMed  CAS  Google Scholar 

  23. Montgomery S, Asberg M (1979) A new depression scale, designed to be sensitive to change. Brit J Psychiat 134:382–389

    Article  PubMed  CAS  Google Scholar 

  24. Muslimovic D, Post B, Speelman J, Schmand B (2005) Cognitive profile of patients with newly diagnosed Parkinson disease. Neurology 65:1239–1245

    Article  PubMed  Google Scholar 

  25. National Institute of Mental Health (1976) CGI: Clinical Global Impressions. National Institute of Mental Health, Chevy Chase, MD

  26. Nishiwaki Y, Breeze E, Smeeth L, Bulpitt C, Peters R, Fletcher A (2004) Validity of the Clock-Drawing-Test as a screening tool for cognitive impairment in the elderly. Am J Epidemiol 160:797–807

    Article  PubMed  Google Scholar 

  27. Noe E, Marder K, Bell K, Jacobs D, Manly J, Stern Y (2004) Comparison of dementia with Lewy bodies to Alzheimer's disease and Parkinson's disease with dementia. Movement Disord 19:60–67

    Article  PubMed  Google Scholar 

  28. Riedel O, Dodel R, Spottke A, Deuschl G, Forstl H, Henn F, Heuser I, Oertel W, Reichmann H, Riederer P, Trenkwalder C, Wittchen H-U (2006) Wie beurteilen Arzte die Haufigkeit demenzieller, depressiver und psychotischer Symptome bei Patienten mit der Parkinson- Krankheit? Eine Befragung von 500 Facharzten im ambulanten Versorgungssektor Deutschlands. Aktuel Neurol 33:374–380

    Article  Google Scholar 

  29. Royall RM (1986) Model robust confidence intervals using maximum likelihood estimators. Int Stat Rev 54:221–226

    Article  Google Scholar 

  30. Schrag A, Jahanshahi M, Quinn N (2001) What contributes to depression in Parkinson's disease? Psychol Med 31:65–73

    Article  PubMed  CAS  Google Scholar 

  31. Seigerschmidt E, Mosch E, Siemen M, Forstl H, Bickel H (2002) The clock drawing test and questionable dementia: reliability and validity. Int J Geriatr Ps 17:1048–1054

    Article  Google Scholar 

  32. Shulman K (2000) Clock-drawing: Is it the ideal cognitive screening test? Int J Geriatr Ps 15:548–561

    Article  CAS  Google Scholar 

  33. Vingerhoets G, Verleden S, Santens P, Miatton M, De Reuck J (2003) Predictors of cognitive impairment in advanced Parkinson's disease. J Neurol Neurosurg Ps 74:793–796

    Article  CAS  Google Scholar 

  34. Wichowicz H, Slawek J, Derejko M, Cubala W (2006) Factors associated with depression in Parkinson's disease: a cross-sectional study in a Polish population. Eur Psychiat 21:516–520

    Article  Google Scholar 

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Authors and Affiliations

  1. Institute of Clinical Psychology and Psychotherapy, Technical University of Dresden, Chemnitzer Straße 46, 01187, Dresden, Germany

    O. Riedel, J. Klotsche & H.-U. Wittchen

  2. Dept. of Neurology, Friedrich-Wilhelms-University Bonn, Bonn, Germany

    A. Spottke

  3. Dept. of Neurology, Philipps-University Marburg, Marburg, Germany

    W. Oertel & R. Dodel

  4. Dept. of Neurology, Christian-Albrechts-University Kiel, Kiel, Germany

    G. Deuschl

  5. Dept. of Psychiatry and Psychotherapy, Technical University of Munich, Munich, Germany

    H. Förstl

  6. Brookhaven National Laboratory, NY Upton, USA

    F. Henn

  7. Charite-Campus-Benjamin Franklin, Universitatsmedizin, Berlin, Germany

    I. Heuser

  8. Dept. of Neurology, Faculty of Medicine Carl Gustav Carus, Dresden, Germany

    H. Reichmann

  9. Dept. of Clinical Neurochemistry, Clinical Neurochemistry and NPF-Center of Excellence Laboratories University, Würzburg, Germany

    P. Riederer

  10. Paracelsus-Elena-Clinic, Kassel, Germany

    C. Trenkwalder

Authors
  1. O. Riedel
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  2. J. Klotsche
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  3. A. Spottke
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  4. G. Deuschl
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  6. F. Henn
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  7. I. Heuser
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  8. W. Oertel
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  9. H. Reichmann
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  10. P. Riederer
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  11. C. Trenkwalder
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  12. R. Dodel
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  13. H.-U. Wittchen
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Corresponding author

Correspondence to H.-U. Wittchen.

Additional information

The GEPAD study was supported by an unrestricted educational grant of Novartis Pharma GmbH and received support from the German Ministry of Education and Research through award number BMBF No. 01GI9901/1 (R.D.;W.H.O.)

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Riedel, O., Klotsche, J., Spottke, A. et al. Cognitive impairment in 873 patients with idiopathic Parkinson's disease. J Neurol 255, 255–264 (2008). https://doi.org/10.1007/s00415-008-0720-2

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  • DOI: https://doi.org/10.1007/s00415-008-0720-2

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