TY - JOUR
T1 - Neuropsychology, neuroimaging or motor phenotype in diagnosis of Parkinson's disease-dementia
T2 - Which matters most?
AU - Di Biasio, Francesca
AU - Vanacore, Nicola
AU - Fasano, Alfonso
AU - Modugno, Nicola
AU - Gandolfi, Barbara
AU - Lena, Francesco
AU - Grillea, Giovanni
AU - Pietracupa, Sara
AU - Caranci, Giovanni
AU - Ruggieri, Stefano
PY - 2012/5
Y1 - 2012/5
N2 - Parkinson's disease (PD) is a neurodegenerative disorder affecting not only the motor system but also the cognitive and behavioral domains. Although there are many studies addressing the issue of cognition, a universally recognized method to diagnose patients with dementia is still lacking. The aim of this study was to determine which neuropsychological test is the most reliable in the diagnosis of dementia in PD and to establish if mini mental state examination (MMSE) is enough to detect this condition. We studied 200 consecutive PD patients through an extensive neuropsychological battery, clinical evaluation and brain magnetic resonance imaging over a period of 4 years. A logistic regression model was used to evaluate the interplay between possible risk factors and the accuracy of different neuropsychological tests. PD patients with dementia performed significantly worse in all the tests as compared to patients with PD alone: phonological verbal fluency, attentional matrices, Rey auditory verbal learning test and digit span were the most useful tools. Age and disease duration were correlated with cognitive impairment. No relevant differences were detected in phenotype, affected body side at onset, levodopa equivalent daily dose or neuroimaging findings (except for the occurrence of atrophy). Despite reasonable accuracy of MMSE (90%), its positive predictive value is only 74%. Using at least 3 neuropsychological tests, among those more significant detected with logistic regression analysis, the positive predictive value rises to 91%. In conclusion, the use of an extensive neuropsychological battery is still recommended in the diagnosis of dementia in PD.
AB - Parkinson's disease (PD) is a neurodegenerative disorder affecting not only the motor system but also the cognitive and behavioral domains. Although there are many studies addressing the issue of cognition, a universally recognized method to diagnose patients with dementia is still lacking. The aim of this study was to determine which neuropsychological test is the most reliable in the diagnosis of dementia in PD and to establish if mini mental state examination (MMSE) is enough to detect this condition. We studied 200 consecutive PD patients through an extensive neuropsychological battery, clinical evaluation and brain magnetic resonance imaging over a period of 4 years. A logistic regression model was used to evaluate the interplay between possible risk factors and the accuracy of different neuropsychological tests. PD patients with dementia performed significantly worse in all the tests as compared to patients with PD alone: phonological verbal fluency, attentional matrices, Rey auditory verbal learning test and digit span were the most useful tools. Age and disease duration were correlated with cognitive impairment. No relevant differences were detected in phenotype, affected body side at onset, levodopa equivalent daily dose or neuroimaging findings (except for the occurrence of atrophy). Despite reasonable accuracy of MMSE (90%), its positive predictive value is only 74%. Using at least 3 neuropsychological tests, among those more significant detected with logistic regression analysis, the positive predictive value rises to 91%. In conclusion, the use of an extensive neuropsychological battery is still recommended in the diagnosis of dementia in PD.
KW - Cognition
KW - Dementia
KW - Diagnosis
KW - Neuropsychology
KW - Parkinson's disease
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U2 - 10.1007/s00702-011-0733-3
DO - 10.1007/s00702-011-0733-3
M3 - Article
C2 - 22160550
AN - SCOPUS:84863430594
VL - 119
SP - 597
EP - 604
JO - Journal of Neuro-Visceral Relations
JF - Journal of Neuro-Visceral Relations
SN - 0375-9245
IS - 5
ER -