Neuropsychiatric symptoms in Serbian patients with Parkinson's disease.

BACKGROUND: Parkinson's disease [PD] is associated with wide variety of neuropsychiatric symptoms, although it is primarily considered as a movement disorder. OBJECTIVE: To examine whether PD patients can be meaningfully classified into subgroups according to their neuropsychiatric symptoms, reported by their caregivers. METHODS: Three hundred and sixty PD patients [mean age=63.5, SD=10.3] from the academic clinical setting were assessed with the 12-subscale Neuropsychiatric Inventory Questionnaire [NPI]. A two-stage cluster analysis was used to identify the subgroups groups of patients with specific neuropsychiatric profile. RESULTS: Three hundred and twenty-one PD patients [89%] showed at least one psychiatric symptom. The most common symptoms were anxiety [73.1%], depression [64.7%], and apathy [51.7%], and nighttime disturbance [51.3%], whereas the least common were euphoria [0.3%], and delusions [1.7%]. The mean [SD] total NPI composite score was 16.9 [17.4]. Two hundred eight PD subjects [58%] of the total sample had at least one symptom with a score ≥4. Three clusters were identified: a] Cluster 1, with no or few NPI symptoms [n=200; 55.6%]; b] Cluster 2, with mild to moderate symptoms on depression, anxiety and apathy scales [n=140; 38.9%]; and c] Cluster 3 with high agitation, disinhibition and irritability scores [n=20 patients; 5.6%]. PD subjects with clinically significant neuropsychiatric symptoms were older with more severe motor and cognitive impairment. CONCLUSIONS: This study emphasizes the high prevalence and importance of neuropsychiatric symptoms in PD patients; therefore clinicians should also focus on treating in parallel with motor symptoms.

Mild Cognitive Impairment in Early Parkinson's Disease Using the Movement Disorder Society Task Force Criteria: Cross-Sectional Study in Hoehn and Yahr Stage 1.

BACKGROUND: Mild cognitive impairment (MCI) in Parkinson's disease (PD) is common and confers a higher risk for developing dementia. METHODS: In this cross-sectional study of MCI in PD conducted at a university hospital, a comprehensive neuropsychological battery covering five domains (attention/working memory, executive, verbal, and visual memory, language, and visuospatial) was administered to 111 nondemented PD patients in Hoehn and Yahr stage 1 and to 105 healthy matched control subjects (HC). MCI was diagnosed according to level 2 of the Movement Disorder Society Task Force criteria. RESULTS: Criteria for MCI associated with PD (PD-MCI) were fulfilled by 24% of PD patients in the initial stage of the disease at the z cutoff scores of -1.5 SD in contrast to 7% of HC fulfilling criteria for MCI. Memory and visuospatial domains were the most commonly affected at -1.5 SD. PD-MCI patients mostly had a multiple-domain MCI subtype (78%). They presented a more severe bradykinesia and higher mood and apathy scores in comparison with cognitively normal PD patients. Basic motor scores predicted performance on some cognitive tests and specific cognitive-motor relationships emerged. CONCLUSIONS: MCI, predominantly of a multiple-domain subtype, was quite prevalent even in the initial stage of PD.

Transcranial midbrain sonography and depressive symptoms in patients with Parkinson's disease.

Transcranial sonography (TCS) appeared to be a promising marker associated with depression: hypo/anechogenicity of the brainstem raphe (BR) was found in 50-70 % of patients with unipolar depression, in 40-60 % of depressed patients with Parkinson's disease (PD), but also in 8-28 % of healthy controls. Our study included 120 consecutive PD outpatients. Abnormal BR echogenicity was found in 51 (43 %), while normal findings were present in 67 PD patients (57 %). Patients with abnormal BR echogenicity had higher scores on the Montgomery-Asberg Depression Rating Scale (MADRS) items of apparent sadness (p = 0.03), reported sadness (p = 0.01), and pessimistic thoughts (p = 0.049), when compared to those with normal BR. In the second part of the study, previously suggested cut-off value at 14/15 on the MADRS was used to dichotomize patients into depressed (dPD) (46 patients; 39 %) and non-depressed PD patients (ndPD) (72 patients; 61 %). Abnormal TCS BR findings were obtained in 27 dPD (58.7 %) and in only 24 ndPD patients (33.3 %) (p = 0.007): the risk that PD patients with the TCS BR abnormality would display depressive symptoms was about 3.5 times higher when compared to PD patients with intact BR, controlling for the effect of motor difficulties (cross-odds ratio; OR = 3.48). Therefore, at least in a subgroup of dPD patients, TCS of the midbrain midline structure may potentially be a useful tool for depressive symptoms prediction.

Attentional set-shifting in Parkinson's disease patients with freezing of gait-acquisition and discrimination set learning deficits at the background?

Cognitive loading aggravates the freezing of gait (FoG), which is observed in approximately 50% of patients with Parkinson's disease (PD) in the advanced stages. To investigate whether a specific pattern of executive deficits, that is, attentional set-shifting and/or inhibitory control, are associated with FoG in PD, 30 PD patients with FoG (PD-FoG+) and 36 PD patients without FoG (PD-FoG-) and 22 control healthy subjects were examined with a comprehensive neuropsychological battery. Intra-Extra Dimensional Set shifting Test (IED) and Stop Signal Task (SST), selected from the Cambridge Automated Neuropsychological Battery (CANTAB battery), were administered to analyze set-shifting and motor inhibition, respectively. The IED task was significantly sensitive for differentiating between PD-FoG+ and PD-FoG- groups (p<.01), as well Adenbrook's clock drawing task (p=.033). By contrast, no differences emerged on any aspect of the SST task and other cognitive tasks. The attrition rate during the IED task showed that the problem in the PD-FoG+ group appeared at the pre-ID level, on the discrimination-learning set; the 32% PD-FoG+ subjects did not achieve the ID level of the task in comparison to negligible 4% of the PD-FoG- patients (p=.011). The logistic regression analysis, indicated the higher the IED stage successfully completed, the less likely presence of FoG in PD subjects. These results demonstrate that the complex cognitive-motor interplay might be responsible for FoG in PD and have had real life implication for the patients.

Screening for anxiety symptoms in Parkinson disease: a cross-sectional study.

BACKGROUND: A limited number of studies examined anxiety in Parkinson disease (PD). Questionable validity of the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) defined anxiety disorders in PD population as well as a lack of validated rating scales hampered the investigation in this field. OBJECTIVE: To screen for prevalence of anxiety symptoms and their associated demographic and clinical features in an outpatient-based cohort with PD. PATIENTS AND METHODS: A consecutive series of 360 patients with PD underwent investigation with the Hamilton Anxiety Rating Scale (HARS), the 17-item Hamilton Depression Rating Scale, Neuropsychiatric Inventory, section E (anxiety), motor scoring with Hoehn and Yahr staging, the Unified Parkinson's Disease Rating Scale, and cognitive screening with the Mini-Mental State Examination. RESULTS: In all, 136 (37.8%) patients with PD of our cohort had anxiety symptoms, whereas both depression and anxiety were recorded in 5.6% of the patients, while in 56.7% neither anxiety nor depression was present. Female gender, motor disability, and core depression symptoms were the main markers of anxiety in patients with PD. The severity of anxiety symptoms was not associated with asymmetry of motor symptoms. Education, disease duration, and levodopa dose were poor predictors in the model. The HARS had a satisfactory inter-item correlation, convergent validity, and factorial structure. CONCLUSIONS: Anxiety may be present as an isolated symptom, with specific demographic and clinical markers, and not only as a feature of depression in PD population. This highlighted the importance of identifying anxiety symptoms when treating patients with PD.

Depression predicts the pattern of cognitive impairment in early Parkinson's disease.

OBJECTIVE: To estimate the pattern of cognitive impairment in early Parkinson's disease (PD) associated with depression. Also, the prediction of potentially relevant demographic/clinical factors in early PD on cognitive functioning was tested. METHOD: The study comprised 80 consecutive early PD patients (16 with major depression (PDMD), 10 PD patients with dysthimic disorder (PDDD), and 54 nondepressed PD patients (PDND)). Thirty_seven healthy subjects matched for age, gender and education were also included in the study. The cognitive evaluation included the comprehensive classical neuropsychological battery and the Cambridge Neuropsychological Test Automated Battery (CANTAB). RESULTS: The two different patterns of cognitive impairment in early PD patients were obtained even when the confounding influences of general cognitive abilities and motor slowness were taken in account. One pattern was common to all PD patients either they were depressed or not, and it is conceived etiologically as dysexecutive. The PDDD group presented only the quantitative increment of the common deficit observed in PD. The second pattern was present in PDMD patients, involved episodic/working memory and language deficits alongside with background executive impairment. Depression was extensively associated with the cognitive dysfunction in early PD, whereas severity of the disease, age at onset and treatment were less favorable as predictors. CONCLUSIONS: This study provides evidence that the pattern of cognitive impairment in early PD may be predicted by depression severity. Therefore, the recognition and treatment of depressive disorder in early PD is important.

Serial position learning effects in patients with aneurysms of the anterior communicating artery.

Ruptured and repaired Anterior Communicating Artery (ACoA) aneurysm can result in devastating impairments involving memory, executive function, confabulation, and personality changes. This study tested serial position learning effects (SPEs) in patients following repaired and ruptured ACoA aneurysm, using results on the Rey Auditory Verbal Learning Test (RAVLT). Thirty patients with ruptured aneurysms of the ACoA and 31 matched controls were included in the study. The primacy-recency effects were maintained during five learning trials in ACoA group, albeit at an overall lower level than in the controls. There was no difference in primacy-recency relation across five learning trials in ACoA group. On the delayed recall trial the patient group demonstrated neither a primacy, nor a recency phenomenon, reflecting a lack of recall of any parts of the word list. This kind of primacy-recency profile across learning trials in ACoA group has no similarity with SPE results in frontal lesion groups, or with SPE distributions in other amnesic disorders, despite the fact that memory and executive deficits were evident in our ACoA group.