Study Of Cognitive Impairment Of Parkinson's Disease In Neuropsychology

Objective:1. To study the characteristic of cognitive impairment accomplished with patients of Parkinson's disease (PD) in order to show the value of neuropsychological testing as tool used in early detection of cognitive impairment of PD.2. To study the characteristic of memory of Parkinson's disease accompanied with depression and the influence of memory of depression with of PD patients.3. To study the characteristic of executive function of Parkinson disease accompanied with depression and the influence of executive function of depression with cognition of PD patients.Subjects and Methods:Subjects1. Subjects:The idiopathic Parkinson's disease patients which visited Daping Hospital of Third Military Medical University of Chinese PLA from September 2004 to September 2006 were adopted as experimental group,and the healthy community old people were subjected as control group which were matched with age,gender and educational level.2. Exclusive criteria:All subjects were examined by CT or MRI and other relative auxiliary examination in order to exclude the serious systematic disorders. At the same time they should match with the diagnostic criteria of parkinsonism which was made by the nationwide extracorticospinal tract disease conference's diagnostic criteria in October 1984.3. Diagnostic criteria: Diagnostic criteria of PD: According to the nationwide extracorticospinal tract disease conference's diagnostic criteria of October 1984. Diagnostic criteria of depression: according to the DSM-IV criteria. The severity of depression: according to the SDS and HAMD criteria. Diagnostic criteria of dementia: according to the DSM- IV criteria. The severity of dementia: according to the CDR.4. Experiment subgroup:According to the revised Hoehn-Yahr staging there are two groups: early PD group (modified Hoehn-Yahr grade≤2)(n=30) , later PD group(modified Hoehn-Yahr grade>2)(n=16);According to whether accompanied with depression there are two groups:Parkinson disease with depression group(PDD)(n=36), nondepressed Parkinson's disease patients group (PDND)group(n=44).5. Clinical evaluation criteria of parkinsionian:modified Hoehn-Yahr staging;Webster rating scale;Unified Parkinson disease rating scale(UPDRS);Motor dysfunction rating scale for Parkinson's disease (MDRSPD).Methods:1. All subjects need to accept the professional physical examination and record the case history.2. Global cognition assessment: Mini-mental state examination (MMSE) and Clinical dementia rating (CDR).3. Single cognition assessment:3.1 Intelligence quotient test:Wechsler adult intelligence scale revised in China (WAIS-RC);3.2 Memory:Wechsler memory scale revised in China (WMS)3.3 Attention test:Symbol digital model test (SDMT)and trail making test A(TMA);3.4 Execution Function:(1) Stroop color-word test (SCWT).(2) Clock drawing test (CDT).(3) Frontal assessment battery at bedside (FAB).(4) Rapid Verbal Retrieve (RVR).3.5 Perception test:Block design test of WAIS-RC(BDT), Picture arrangement test(PAT).3.6 General psychology assessment:Self-rating depressive scale (SDS) and Hamilton's rating scale for depression (HAMD) .3.7 Non-cognition assessment: Activity of daily living by Barthel index (ADL-BI). Results1. There were significant differences between early PD group and later PD group in age of onset(61.13±7.17, 70.57±4.82),course of disease(2.60±1.18),UPDRS score (24.93±5.36, 69.00±12.13),Webster score(7.13±2.21,19.79±4.21),ADL score(76.83±8.04,31.43±13.36).2.The result of initial assessment of the whole cognition: There were significant differences in the early PD group ,later PD group and the healthy control group in the whole scores of MMSE(24.83±2.02,19.79±3.56,27.60±1.59) (P<0.01).The dementia incidence is (6.25%,64.29%,respectively),which is significantly different(P<0.01).3. There were significant differences in intelligence quotient(90.87±9.00,72.43±17.58,99.83±6.96), (90.87±9.00, 72.43±17.58,99.83±6.96),memory quotient(76.23±9.54, 62.43±8.70, 99.57±8.21),attention(25.53±8.74, 10.00±11.14, 35.60±6.03),perception (12.80±2.95, 5.07±6.71, 20.13±5.20),executive function(6.03±1.35, 3.57±1.83, 9.57±2.10) between early PD group and later PD group, so as to the healthy control group (P<0.01).There were no significant differences in immediate memory between the earlier PD group(9.60±1.75)and healthy control group(P>0.05),as well as the verbal intelligence quotient.4. In single cognition testing, the result of DST that there are no significant differences between the early PD group and later PD group by(9.60±1.75, 9.97±1.59,respectively) indicate that the there are no dysfunction in immediate memory.There are great significant differences in the three groups in other tests such as SDMT,TMA,SCWT,FAB,CDT,BDT,PAT,VFT except the area: the verbal intelligence quotient between the early PD group and healthy control group (P<0.05). The cognitive impairment of PD is positive relative with the age, the age onset, the course of disease ,the UPDRS score, Webster score , the modified Hoehn-Yahr staging and the ADL score,but is negative correlated with the education level.The result of Pearson correlation analysis is that SDS and HAMD scores is positive with executive function scores,excluding age,MDRSPD,Webster,the modified Hoehn-Yahr stage,ADL scores(P>0.05).5. The memory quotient (MQ)(PDD group 40.28±8.91,PDND group76.55±7.04),short-term memory(PDD group 20.39±7.02 , PDND group 34.25±6.69) , long-term memory(PDD group 15.28±3.56 , PDND group 34.25±6.69) , Fuld Object-Memory Evaluation(PDD group 9.89±2.23,PDND group 12.73±1.66),PDD group were changed significantly than PDND group. Immediate memory( PDD group 4.61±2.38,PDND group5.11±2.20)is not influenced. The severe depression patients are declined more significantly in LTM(16.68±3.0,12.09±2.59), STM(23.28±5.8,13.82±4.79), MQ(61.40±5.75,50.73±1.27) than the light and moderate depression group by one-factor analysis of variance, There is no significantly difference in IM(4.40±2.63,5.09±1.70) (P>0.05).The dysmnesia incidence rate in PDD group is 28/36(77.78%) is significantly different to the PDND group's 25/44 (56.82%) through chi square test(P<0.01).The result of Pearson correlation analysis is that SDS and HAMD scores is positive with memory scores and ADL scores ,excluding age,MDRSPD,Webster,the modified Hoehn-Yahr stage scores(P>0.05).6. Execution Function evaluation: The PDD group scores are shorter the PDND group in (PDD group and PDND group, respectively) SCWT:Stroop1(14.14±5.09,8.66±4.73),Stroop2(212.33±59.501,125.32±55.51);CDT(5.42±2.05,6.59±2.50), RVR:AR(6.97±1.46,8.84±2.93),FR(6.69±1.67,11.30±2.79), VR(7.47±2.38,9.45±2.89), there were significant differences between PDD group and PDND group(P<0.01).The result of Pearson correlation analysis is that SDS and HAMD scores is positive with the executive functional scores and is negative with the age,MDRSPD,Webster,the modified Hoehn-Yahr stage and ADL scores(P>0.05).7. The dementia incidence rate in PDD group is 23/36(63.89%) is significantly difference to the PDND group's dementia incidence rate 15/44(34.09%) through chi square test(P<0.01).Conclusions:1. Early PD patients already changed in single cognition item evaluating even the MMSE and CDR did not achieve the dementia level which sometimes was similar to the dementia of PD, especially in frontal lobe cognition assessment. MMSE is not sensitive to detect the cognitive impairment of PD.We should use multiple single neuropsychological tests to assessment the cognitive disturbances in Parkinson's disease. By neuropsychological testing we can get data on PD cognitive impairment that can be used for diagnostic, therapeutic. 2. Depression and its severity degree can influence the cognition of PD. PD patients accompanied with depression have short term memory and long term memery impairment .3. Depression can significant influence the executive function. The executive function of Parkinson's disease patients with depression changed significant.