Relationships between extrapyramidal signs and cognitive function in a community‐dwelling cohort of patients with Parkinson's disease and normal elderly individuals

The relationship between extrapyramidal sign(DPS) severity and cognitive funcition was investigated in 184 patients with indiopathic Parkinson's disease (PD) and 301 normal elderly individuasls from a community‐dwelling cohort in northern Manhattan, New York City. Fifiy‐six of the patients with PD met criteria for dementia of the Diagnostic and Statistical Manual of Mental Disorders third edition, revised, and of the National Institute of Neurological and Communicative Disorders and Stroke‐Alzbeimer's Disease and Related Disorders Association. EPS were rated according to the Unified Parkinson's Disease Rating Scale. Cognitive function was assessed by neuropsychological rests of memory, orientation, abstract reasoning, language, construcion, and psychomotor speed. Significant associations were found between EPS and neuropsychological performance in PD partients without dementia. Yet EPS severity was unable to account for the pronounced cognitive impairment in PD dementia. Individuals in the normal group with subtle EPS, but withtout overt idiopathic PD, showed widespread cognitive changes, including imparment in most of the tests that differentiated PD patients from normal subjects. Prospective follow‐up of these individuals will determine whether this represents a preclinical stage of PD or constitutes an early manifestation of dementia.

[1]  M CRITCHLEY,et al.  Neurologic changes in the aged. , 1956, Journal of chronic diseases.

[2]  Á. Carracedo,et al.  PGM1 subtypes in Galicia (NW Spain). , 1982, Human heredity.

[3]  HERMAN BUSCHKE,et al.  Evaluating storage, retention, and retrieval in disordered memory and learning , 1974, Neurology.

[4]  G. V. Goddard,et al.  Cognitive and motor dysfunction in Parkinson's disease. Clinical, performance, and computed tomographic correlations. , 1988, Archives of neurology.

[5]  J. Rinne,et al.  [18F]‐6‐Fluorodopa PET scanning in Parkinson's disease after selective COMT inhibition with nitecapone (OR‐462) , 1992, Neurology.

[6]  E. Sullivan,et al.  Cognitive impairment in early, untreated Parkinson's disease and its relationship to motor disability. , 1991, Brain : a journal of neurology.

[7]  N. Dadmehr,et al.  Is there a premorbid personality typical for Parkinson's disease? , 1991, Neurology.

[8]  B. Schoenberg,et al.  Prevalence surveys of neurologic disorders: methodologic implications of the Copiah County Study. , 1988, Journal of clinical epidemiology.

[9]  J. Tetrud,et al.  Preclinical Parkinson's disease , 1991, Neurology.

[10]  K. Marder,et al.  A population-based investigation of Parkinson's disease with and without dementia. Relationship to age and gender. , 1992, Archives of neurology.

[11]  M. Roth,et al.  The Association Between Quantitative Measures of Dementia and of Senile Change in the Cerebral Grey Matter of Elderly Subjects , 1968, British Journal of Psychiatry.

[12]  J. Jankovic,et al.  The heterogeneity of Parkinson's disease , 1985, Neurology.

[13]  A. Lees,et al.  Cognitive deficits in the Steele-Richardson-Olszewski syndrome (progressive supranuclear palsy). , 1985, Journal of neurology, neurosurgery, and psychiatry.

[14]  J. Fleiss,et al.  Intraclass correlations: uses in assessing rater reliability. , 1979, Psychological bulletin.

[15]  H. Kaiser.  An index of factorial simplicity , 1974 .

[16]  R. Mayeux,et al.  Intellectual dysfunction and dementia in Parkinson disease. , 1983, Advances in neurology.

[17]  J. Mortimer,et al.  Relationship of motor symptoms to intellectual deficits in Parkinson disease , 1982, Neurology.

[18]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[19]  Marcus Richards,et al.  Comparison of medical conditions and neurological examination in early Alzheimer's disease and normal elderly. , 1992 .

[20]  R. Mayeux,et al.  Diagnosis of dementia in a heterogeneous population. Development of a neuropsychological paradigm-based diagnosis of dementia and quantified correction for the effects of education. , 1992, Archives of neurology.

[21]  W. Rocca,et al.  Prevalence of Parkinson's disease and other types of parkinsonism , 1992, Neurology.

[22]  M. Folstein,et al.  Clinical diagnosis of Alzheimer's disease , 1984, Neurology.

[23]  R. Katzman.,et al.  Validation of a short Orientation-Memory-Concentration Test of cognitive impairment. , 1983, The American journal of psychiatry.

[24]  K. Syndulko,et al.  Human Neurologic Function and the Aging Process † , 1980, Journal of the American Geriatrics Society.

[25]  F Lhermitte,et al.  Heterogeneity of cognitive impairment in progressive supranuclear palsy, Parkinson's disease, and Alzheimer's disease , 1986, Neurology.

[26]  J. Mortimer.  Human Motor Behavior and Aging , 1988, Annals of the New York Academy of Sciences.

[27]  Dallas W. Anderson,et al.  Prevalence of Parkinson's disease in the biracial population of Copiah County, Mississippi , 1985, Neurology.

[28]  K. Marder,et al.  Interrater reliability of extrapyramidal signs in a group assessed for dementia. , 1991, Archives of neurology.

[29]  R. Marttila,et al.  DEMENTIA IN PARKINSON'S DISEASE , 1976, Acta neurologica Scandinavica.

[30]  F Lhermitte,et al.  Does cognitive impairment in Parkinson's disease result from non-dopaminergic lesions? , 1989, Journal of neurology, neurosurgery, and psychiatry.

[31]  Z. Schwab,et al.  Projection technique for evaluating surgery in Parkinson’s disease , 1969 .

[32]  A. Lees.  Cognitive Deficits in Parkinson’s Disease , 1985 .

[33]  C. Marsden,et al.  Cognitive function in Parkinson's disease: From description to theory , 1990, Trends in Neurosciences.

[34]  Clinical features predicting dementia in idiopathic Parkinson??s disease: a follow-up study , 1991 .

[35]  G. Paulson,et al.  Relationship of motor symptoms, intellectual impairment, and depression in Parkinson's disease. , 1988, Journal of neurology, neurosurgery, and psychiatry.

[36]  Mahoney Fi,et al.  FUNCTIONAL EVALUATION: THE BARTHEL INDEX. , 1965 .