Specific pattern of linguistic impairment in Parkinson's disease patients with subjective cognitive decline and mild cognitive impairment predicts dementia.

OBJECTIVE: Parkinson's disease patients with subjective cognitive decline (PD-SCD) and mild cognitive impairment (PD-MCI) have an increased risk of dementia (PDD). Thus, the identification of early cognitive changes that can be useful predictors of PDD is a highly relevant challenge. Posterior cortically based functions, including linguistic processes, have been associated with PDD. However, investigations that have focused on linguistic functions in PD-MCI are scarce and none of them include PD-SCD patients. Our aim was to study language performance in PD-SCD and PD-MCI. Moreover, language subcomponents were considered as predictors of PDD. METHOD: Forty-six PD patients and twenty controls were evaluated with a neuropsychological protocol. Patients were classified as PD-SCD and PD-MCI. Language production and comprehension was assessed. Follow-up assessment was conducted to a mean of 7.5 years after the baseline. RESULTS: PD-MCI patients showed a poor performance in naming (actions and nouns), action generation, anaphora resolution and sentence comprehension (with and without center-embedded relative clause). PD-SCD showed a poor performance in action naming and action generation. Deficit in action naming was an independent risk factor for PDD during the follow-up. Moreover, the combination of deficit in action words and sentence comprehension without a center-embedded relative clause was associated with a greater risk. CONCLUSIONS: The results are of relevance because they suggest that a specific pattern of linguistic dysfunctions, that can be present even in the early stages of the disease, can predict future dementia, reinforcing the importance of advancing in the knowledge of linguistic dysfunctions in predementia stages of PD.

Influence of mild cognitive impairment on clinical and functional prognosis in older candidates for cardiac surgery.

Introduction: In this study, we analyzed the prognostic impact of mild cognitive impairment (MCI) prior to cardiac surgery on 12-month clinical outcomes in older patients. Method: We performed a longitudinal prospective study of 48 patients undergoing cardiac surgery and 26 neurologically healthy participants aged 65 years or older. All participants underwent a neuropsychological assessment. Functional status, quality of life and frailty were assessed in candidates for surgery. One year after surgery, 24 patients remained in the study. Results: Mild cognitive impairment (MCI) was diagnosed in 35% of the patients at baseline. Postsurgical changes in functionality consisted of a tendency toward impaired basic activities of daily living (BADL) in the MCI group and a statistically significant worsening in instrumental activities of daily living (IADL) in women with MCI. Changes in quality of life consisted of a significant improvement in anxiety-depression in the MCI group and a tendency toward greater pain-discomfort in the non-MCI group. Cognitive status significantly declined only in the non-MCI group. Neither group showed significant changes in frailty. Relative risk analysis showed that patients with a diagnosis of MCI at baseline had a higher risk of cognitive decline at follow-up, while those without a diagnosis of MCI at baseline had a lower risk of impaired IADL. No association was found between MCI and resource use. Preoperative impairment in memory, visuospatial and executive functions was significantly associated with loss of quality of life at follow-up. Impairment of memory and visuospatial function was significantly associated with cognitive decline. Preserved memory was associated with a lower risk of impaired BADL at follow-up. Conclusion: The present study provides clue on the impact of MCI in candidates for cardiac surgery. Preoperative detection of cognitive impairment could be highly valuable to help guide pre- and post-operative management.

Analyses of Visuospatial and Visuoperceptual Errors as Predictors of Dementia in Parkinson's Disease Patients with Subjective Cognitive Decline and Mild Cognitive Impairment.

OBJECTIVE: Subjective cognitive decline (SCD) and mild cognitive impairment (MCI) in Parkinson's disease (PD) are considered as the risk factors for dementia (PDD). Posterior cortically based functions, such as visuospatial and visuoperceptual (VS-VP) processing, have been described as predictors of PDD. However, no investigations have focused on the qualitative analysis of the Judgment of Line Orientation Test (JLOT) and the Facial Recognition Test (FRT) in PD-SCD and PD-MCI. The aim of this work was to study the VS-VP errors in JLOT and FRT. Moreover, these variables are considered as predictors of PDD. METHOD: Forty-two PD patients and 19 controls were evaluated with a neuropsychological protocol. Patients were classified as PD-SCD and PD-MCI. Analyses of errors were conducted following the procedure described by Ska, Poissant, and Joanette (1990). Follow-up assessment was conducted to a mean of 7.5 years after the baseline. RESULTS: PD-MCI patients showed a poor performance in JLOT and FRT total score and made a greater proportion of severe intraquadrant (QO2) and interquadrant errors (IQO). PD-SCD showed a poor performance in FRT and made mild errors in JLOT. PD-MCI and QO2/IQO errors were independent risk factors for PDD during the follow-up. Moreover, the combination of both PD-MCI diagnosis and QO2/IQO errors was associated with a greater risk. CONCLUSIONS: PD-MCI patients presented a greater alteration in VS-VP processing observable by the presence of severe misjudgments. PD-SCD patients also showed mild difficulties in VS-SP functions. Finally, QO2/IQO errors in PD-MCI are a useful predictor of PDD, more than PD-MCI diagnosis alone.

Subjective cognitive decline and progression to dementia in Parkinson's disease: a long-term follow-up study.

INTRODUCTION: Increasing evidence suggests that subjective cognitive decline is associated with Alzheimer's disease pathology and with an increased risk for future dementia development. However, the clinical value of subjective cognitive decline in Parkinson's disease (PD-SCD) is unclear. The aim of the present work was to characterize PD-SCD and its progression to dementia. METHODS: Forty-three PD patients and twenty normal controls were evaluated with a neuropsychological protocol. Patients were classified as PD-SCD and PD with mild cognitive impairment (PD-MCI). Follow-up assessment was conducted to a mean of 7.5 years after the baseline. RESULTS: Thirteen patients were diagnosed with PD-SCD (30.2%) and 22 patients were classified as PD-MCI (51.2%) at the baseline. Difficulties in language (60.5%) and memory (51.5%) were the most frequent cognitive complaints. PD-MCI showed alterations in processing speed, executive functions, visuospatial skills, memory and language. No significant differences were found between normal controls and PD-SCD in any of the neuropsychological measures. Conversion to clinically diagnosed dementia during the follow-up was 50% in PD-MCI, 33.3% in PD-SCD and 14.3% in patients without subjective cognitive complaints. Discriminant function analyses and logistic regression analyses revealed that language domain and, especially memory domain are good predictors of dementia. CONCLUSIONS: The present investigation is the first to conduct a long-term follow-up study of PD-SCD and its relationship with the development of dementia. The results provide relevant data about the characterization of SCD in PD patients and show that PD-SCD is a risk factor for progression to dementia.

Elevada incidencia de deterioro cognitivo en pacientes con estenosis carotídea asintomática / Elevated incidence of cognitive impairment in patients with asymptomatic carotid stenosis

Introducción. Los ictus se sitúan como una de las principales causas de mortalidad e incapacidad funcional en los países desarrollados. La estenosis carotídea (EC) se considera la causa del 20-30% de los ictus. No obstante, los estudios que han profundizado en el estado cognitivo de estos pacientes son escasos. Objetivo. Estudiar el rendimiento cognitivo de pacientes con EC y su relación con variables clínicas (obstrucción de la carótida, estilo de vida). Pacientes y métodos. Se evaluó a 33 pacientes con EC mediante un protocolo europsicológico amplio, distribuidos en dos grupos: EC sintomática y EC asintomática. Resultados. Un 50-57% de los pacientes con EC presentó una ejecución alterada en velocidad de procesamiento y memoria visual (recuerdo inmediato). Un 41,9% rindió de forma alterada en fluidez semántica, mientras que en el subtest de dígitos el porcentaje fue del 30%. En la memoria verbal (curva de aprendizaje, recuerdo demorado) y la memoria visual (recuerdo demorado), el porcentaje de alterados fue del 20-27%. No se encontraron diferencias significativas entre los grupos de EC asintomática y EC sintomática. El rendimiento cognitivo correlacionó significativamente con los factores de la escala de estilo de vida, pero no con el porcentaje de obstrucción de la carótida. Conclusión. Un elevado porcentaje de los pacientes con EC presentó un rendimiento clínicamente alterado en diferentes dominios cognitivos, con independencia de que hubieran experimentado o no sintomatología neurológica vascular (EC asintomática frente a sintomática). Se encontró una estrecha relación entre el estilo de vida y el estado cognitivo de los pacientes con EC (AU)

Introduction. Stroke is one of the main causes of mortality and functional disability in developed countries. Carotid stenosis (CS) is considered the reason for 20-30% of strokes. However, the studies that have gone into depth on the cognitive status of these patients are limited. Aim. To investigate the cognitive performance of CS patients and its relationship with clinical variables (carotid obstruction, lifestyle). Patients and methods. 33 CS patients were evaluated using a broad neuropsychological protocol, and were divided into two groups: symptomatic CS and asymptomatic CS. Results. 50-57% of CS patients showed deficits in processing speed and visual memory (immediate recall). 41.9% showed altered performance in semantic fluency, whereas the percentage was 30% in digits subtest. The percentage of altered performance was 20-27% in verbal memory (learning curve, delayed recall) and visual memory (delayed recall). No significant differences were found between the symptomatic CS and asymptomatic CS groups. Cognitive performance correlated significantly with lifestyle scale factors, but not with the percentage of carotid obstruction. Conclusion. A high percentage of CS patients showed a clinically altered performance in different cognitive domains, regardless of suffering vascular neurological symptoms (symptomatic vs asymptomatic CS). A close relationship was found between lifestyle and cognitive status of CS patients (AU)

Mild Cognitive Impairment in Parkinson's Disease: Clustering and Switching Analyses in Verbal Fluency Test.

OBJECTIVES: Mild cognitive impairment is common in non-demented Parkinson disease patients (PD-MCI) and is considered as a risk factor for dementia. Executive dysfunction has been widely described in PD and the Verbal Fluency Tests (VFT) are often used for executive function assessment in this pathology. The Movement Disorder Society (MDS) published guidelines for PD-MCI diagnosis in 2012. However, no investigation has focused on the qualitative analysis of VFT in PD-MCI. The aim of this work was to study the clustering and switching strategies in VFT in PD-MCI patients. Moreover, these variables are considered as predictors for PD-MCI diagnosis. METHODS: Forty-three PD patients and twenty normal controls were evaluated with a neuropsychological protocol and the MDS criteria for PD-MCI were applied. Clustering and switching analysis were conducted for VFT. RESULTS: The percentage of patients diagnosed with PD-MCI was 37.2%. The Mann-Whitney U test analysis showed that PD-MCI performed poorly in different cognitive measures (digit span, Wisconsin Card Sorting Test, judgment of line orientation, and comprehension test), compared to PD patients without mild cognitive impairment (PD-nMCI). Phonemic fluency analyses showed that PD-MCI patients produced fewer words and switched significantly less, compared to controls and PD-nMCI. Concerning semantic fluency, the PD-MCI group differed significantly, compared to controls and PD-nMCI, in switches. Discriminant function analyses and logistic regression analyses revealed that switches predicted PD-MCI. CONCLUSIONS: PD-MCI patients showed poor performance in VFT related to the deficient use of production strategies. The number of switches is a useful predictor for incident PD-MCI. (JINS, 2017, 23, 511-520).

Addenbrooke's Cognitive Examination-Revised: Effects of Education and Age. Normative Data for the Spanish Speaking Population.

OBJECTIVE: Addenbrooke's Cognitive Examination-Revised is a brief test battery for the detection and classification of mild cognitive impairment and dementia. The aims were to investigate the influence of age and education on the Spanish version of the ACE-R and to propose normative data for the Spanish speaking population. METHOD: Three hundred thirty-four normal healthy volunteers were included in the study. They were classified in three age groups (48-64, 65-75, and 75-89 years of age) and four educational level groups (≤3; 4-8; 9-12, and ≥13 years of education). They were assessed with the version of ACE-R validated in Argentina with some modifications in order to adapt it to the Spanish population. RESULTS: Significant differences were obtained between all age groups in Total ACE-R, Memory, Fluency, and Language indexes. Differences were observed among the 48-64 and 76-89 age groups in the Attention-Orientation and Visuospatial indexes. Regarding education, significant difference between ≤3 years of education and the remaining groups were obtained in Total ACE-R and in all the indexes. Additionally, the group of 4-8 years of education performed significantly worse than the 9-12 and ≥13 groups in Total, Memory, Fluency, and Language indexes. Adjusted scores by education were obtained and percentiles for each age group were calculated. CONCLUSIONS: The results show that both age and education have an important effect on ACE-R performance. Consequently, age and education should be taken into account when interpreting results in ACE-R to improve diagnostic accuracy.

Mild cognitive impairment in Parkinson's disease: Diagnosis and progression to dementia.

INTRODUCTION: Mild cognitive impairment is common in nondemented Parkinson disease patients (PD-MCI) and is considered as a risk factor for dementia (PDD). Recently, the Movement Disorder Society (MDS) published guidelines for PD-MCI, although the studies available are still limited. The aim of this work was to characterize PD-MCI and its progression to dementia. Moreover, the study variables could be considered as predictors for the progression of cognitive impairment. METHOD: The study included 43 patients with idiopathic PD (mean age = 59.19 years, SD = 9.64) and 20 healthy and neurologically normal controls (mean age = 60.85 years, SD = 12.26). The criteria proposed by the MDS Task Force were applied for the PD-MCI diagnosis. Follow-up assessments were conducted within six to eight years after the diagnosis of PD-MCI. RESULTS: The results showed that 60.5% of the patients were diagnosed with PD-MCI when a comprehensive assessment was performed (MDS criteria Level 2), while 23.3% of the patients met MCI criteria when a brief assessment was used (MDS criteria Level 1). Multiple domain impairment was the most frequent impairment (96.2%). A total of 42.3% of PD-MCI patients had dementia in the follow-up study. Logistic regression showed that the Hoehn and Yahr stage and education significantly contributed to the prediction of PD-MCI. Moreover, the Hoehn and Yahr stage and memory domain significantly contributed to the prediction of dementia. CONCLUSIONS: The results of the study: (a) provide relevant data about the process of validation of the MDS PD-MCI criteria, (b) reinforce the hypothesis that PD-MCI is more frequent than previous studies showed without applying MDS criteria, and (c) confirm that PD-MCI is a risk factor for the onset of dementia. Finally, the study shows that neurological impairment, educational level and memory impairment were predictors for the progression of cognitive impairment.

Cognitive impairment in Parkinson’s disease: more than a frontostriatal dysfunction

Cognitive deficit in Parkinson’s disease has been traditionally considered as being mainly related to executive dysfunction secondary to frontostriatal affectation. However, this traditional consideration has recently been challenged. Forty-three nondemented PD patients (mean age = 59.19; SD = 9.64) and twenty control group subjects (mean age = 60.85; SD = 12.26) were studied. They were assessed on a wide range of cognitive functions. Patients showed motor slowing (p = .012), along with alterations in visuoperceptive (p = .001), visuospatial (p = .007) and visuoconstructive functions (p = .017), as well as in visual span (direct: p = .008; inverse: p = .037). Regarding executive functions, differences were not observed in classical measures for verbal fluency (phonetic: p = .28; semantic: p = .27) or in response inhibition (Stroop test: p = .30), while execution was altered in other prefrontal tasks (Wisconsin Test: p = .003; action fluency: p = .039). Patients showed altered performance in verbal learning processes (p = .005) and delayed memory (free: p = .032; cued: p = .006), visuospatial learning (p = .016) and linguistic functions (naming: p < .001; comprehension: p = .007). Poor performance in visuospatial memory is predicted by deficits in working memory and visuospatial perception. Taken together, the observed alterations not only suggest prefrontal affectation, but also temporal and parietal systems impairment. Thus, cognitive dysfunction in nondemented PD patients cannot be exclusively explained by frontostriatal circuit affectation and the resulting executive dysfunction (AU)

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Cognitive impairment in Parkinson's disease: more than a frontostriatal dysfunction.

Cognitive deficit in Parkinson's disease has been traditionally considered as being mainly related to executive dysfunction secondary to frontostriatal affectation. However, this traditional consideration has recently been challenged. Forty-three nondemented PD patients (mean age = 59.19; SD = 9.64) and twenty control group subjects (mean age = 60.85; SD = 12.26) were studied. They were assessed on a wide range of cognitive functions. Patients showed motor slowing (p = .012), along with alterations in visuoperceptive (p = .001), visuospatial (p = .007) and visuoconstructive functions (p = .017), as well as in visual span (direct: p = .008; inverse: p = .037). Regarding executive functions, differences were not observed in classical measures for verbal fluency (phonetic: p = .28; semantic: p = .27) or in response inhibition (Stroop test: p = .30), while execution was altered in other prefrontal tasks (Wisconsin Test: p = .003; action fluency: p = .039). Patients showed altered performance in verbal learning processes (p = .005) and delayed memory (free: p = .032; cued: p = .006), visuospatial learning (p = .016) and linguistic functions (naming: p < .001; comprehension: p = .007). Poor performance in visuospatial memory is predicted by deficits in working memory and visuospatial perception. Taken together, the observed alterations not only suggest prefrontal affectation, but also temporal and parietal systems impairment. Thus, cognitive dysfunction in nondemented PD patients cannot be exclusively explained by frontostriatal circuit affectation and the resulting executive dysfunction.

Deterioro del aprendizaje visoespacial en la enfermedad de Parkinson / Visuospatial learning impairment in Parkinson Disease

A pesar del hecho de que en la Enfermedad de Parkinson (EP) se han encontrado alteraciones en diferentes procesos mnésicos, la capacidad de aprendizaje espacial es aún un aspecto poco estudiado. Nuestro objetivo es estudiar el estado de la capacidad de aprendizaje visoespacial y verbal en una muestra de pacientes con enfermedad de Parkinson, sin demencia, en estadio leve-moderado, y analizar la posible influencia de la velocidad de procesamiento, funciones atencionales, memoria de trabajo y percepción visoespacial. Los pacientes (N= 20) rindieron significativamente peor que los controles (N= 20) en Localización Espacial, Juicio de Orientación de Líneas (JOLT) y 8/30 SRT. No se observaron diferencias en el resto de funciones evaluadas. El análisis de regresión mostró que el rendimiento en Localización Espacial y el JOLT explican un 58,2% de la varianza de la curva de aprendizaje visoespacial. Nuestros resultados ponen de manifiesto una alteración temprana en la EP de la percepción y memoria de trabajo visoespacial y, debido en gran medida a estas alteraciones primarias, un déficit de aprendizaje espacial. Estos resultados sugieren una amplia afectación de los procesos visoespaciales, explicable por la disfunción de los circuitos córtico-estriatales que implican tanto al córtex prefrontal como al córtex parietal posterior (AU)

Despite the fact that different mnesic processes have been found to be impaired in Parkinson’s disease, spatial learning is still an unstudied aspect. The aims of the present study were to evaluate visuospatial and verbal learning in nondemented patients with Parkinson’s disease (PD) (N= 20), and to assess the influence of processing speed, attention, working memory, and visuospatial perception. Compared to controls (N= 20), PD patients had a poorer performance on Spatial Span, Judgment Line Orientation Test (JLOT), and 8/30 SRT. No differences were found between patients and controls in other functions assessed. Regression analysis showed that performance on Spatial Span and JOLT explains 58.2% of the variance of total spatial learning. Our results suggest an early impairment of spatial working memory and visuospatial perception in patients with PD. The visuospatial learning impairment may result from a primary deficit in these functions. These results suggest a global affectation of visuospatial processes, which may arise from dysfunction of the cortico-striatal circuits that include prefrontal and posterior parietal cortex (AU)

[Visuospatial learning impairment in Parkinson Disease]. / Deterioro del aprendizaje visoespacial en la enfermedad de Parkinson.

Visuospatial learning impairment in Parkinson Disease. Despite the fact that different mnesic processes have been found to be impaired in Parkinson's disease, spatial learning is still an unstudied aspect. The aims of the present study were to evaluate visuospatial and verbal learning in nondemented patients with Parkinson's disease (PD) (N= 20), and to assess the influence of processing speed, attention, working memory, and visuospatial perception. Compared to controls (N= 20), PD patients had a poorer performance on Spatial Span, Judgment Line Orientation Test (JLOT), and 8/30 SRT. No differences were found between patients and controls in other functions assessed. Regression analysis showed that performance on Spatial Span and JOLT explains 58.2% of the variance of total spatial learning. Our results suggest an early impairment of spatial working memory and visuospatial perception in patients with PD. The visuospatial learning impairment may result from a primary deficit in these functions. These results suggest a global affectation of visuospatial processes, which may arise from dysfunction of the cortico-striatal circuits that include prefrontal and posterior parietal cortex.