Dementia with Parkinson's disease: Clinical diagnosis, neuropsychological aspects and treatment

Otero, Jorge Lorenzo

doi:10.1590/S1980-57642009DN20400005

Abstract

Dementia with Parkinson's disease represents a controversial issue in the complex group of alpha-synucleinopathies. The author acknowledges the concept of a "continuum" between Parkinson disease's (PD), Lewy body dementia (LBD), and dementia in Parkinson's disease (PDD). However, the practicing neurologist needs to identify the phenotypic signs of each dementia. The treatment and prognosis are different in spite of the overlaps between them. The main aim of this review was to characterize the clinical diagnoses of dementia associated with Parkinson's disease (PDD). Secondarily, the review discussed some epidemiological and neuropsychological issues. Selection of articles was not systematic and reflects the author's opinion, where the main text selected was the recommendations from the Movement Disorder Society Task Force for PDD diagnosis. The Pub Med, OVID, and Proquest data bases were used for the search.

Key words:
dementia with Parkinson's disease; Parkinson's disease; cognitive impairment; Alzheimer's disease; Lewy body dementia; mild cognitive impairment.

Resumo

Demência com doença de Parkinson constitui um assunto controverso no complexo grupo das alfa-sinucleinopatias. O autor admite o conceito de um "continuum" entre doença de Parkinson (DP), demência com corpos de Lewy (DCL) e demência na doença de Parkinson (DDP). Todavia, neurologistas necessitam identificar os sinais fenotípicos de cada uma. O tratamento e prognóstico são diferentes, apesar das sobreposições entre elas. O primeiro objetivo desta revisão foi o de caracterizar o diagnóstico clínico de demência associada à DP. Secundariamente, a revisão discute alguns aspectos epidemiológicos e neuropsicológicos. A seleção dos artigos não foi sistemática e reflete a opinião do autor, escolhendo como texto principal as recomendações da Força Tarefa da Sociedade de Transtornos do Movimento para diagnóstico de DDP. Foram utilizados as bases de dados do Pub Med, OVID e Proquest como bases de dados.

Palavras-chave:
demência na doença de Parkinson; doença de Parkinson; comprometimento cognitivo; doença de Alzheimer; demência com corpos de Lewy; comprometimento cognitivo leve.

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Full text available only in PDF format.

References

¹
Blennow K, de Leon MJ, Zetterberg H. Alzheimer's disease. Lancet 2006;368:387-403.
²
Sleegers K, Kumar-Singh S, Cruts M, Van Broeckhoven C. Molecular pathogenesis of frontotemporal lobar degeneration: basic science seminar in neurology. Arch Neurol 2008;65:700-704.
³
Polymeroulos MH, Lavedan C, Leroy E, et al. Mutation in the Alpha-synuclein gene identified in families with Parkinson's disease. Science 1997;276:2045-2047.
⁴
Spillantini MG, Schmidt ML, Lee VM, et al. Alpha-synuclein in Lewy bodies. Nature 1997;388:839-840.
⁵
Jellinger KA. Neuropathological spectrum of synucleinopathies. Mov Disord 2003;18(Suppl 6):22-12.
⁶
Aarsland D, Andersen K, Larsen JP, Lolk A, Kragh-Sørensen P. Prevalence and characteristic of dementia in Parkinson disease: an 8 years prospective study. Arch Neurol 2003;60:387-391.
⁷
de Lau LM, Schipper CM, Hofman A, et al. Prognosis of Parkinson disease: risk of dementia and mortality: the Rotterdam Study. Arch Neurol 2005;62:1265-1269.
⁸
Hobson P, Gallacher J, Meara J. Cross-sectional survey of Parkinson's disease and parkinsonism in a rural area of the United Kingdom. Mov Disord 2005;20:995-998.
⁹
Garder K, Tang MX, Cote L, Stern Y, Mayeux R. The frequency and associated risk factors for dementia in patients with Parkinson' disease. Arch Neurol 1995;52:695-701.
¹⁰
Buter TC, van den Hout A, Matthews FE, Larsen JP, Brayne C, Aarsland D. Dementia and survival in Parkinson disease: A 12-year population study. Neurology 2008;70:1017-1022.
¹¹
Mayeux R, Stern Y. Intellectual Dysfunction and Dementia in Parkinson Disease. In: Mayeux R, Rosen WG, editors. The Dementias. New York, Raven Press; 1983.
¹²
Muslimovic D, Post B, Speelman JD, et al. Cognitive profile of patients with newly diagnosed Parkinson disease. Neurology 2005;65:1239-1245.
¹³
Williams-Gray CH, Foltynie T, Brayne C E, Barker RA. Evolution of cognitive dysfunction in an incident Parkinson's disease cohort. Brain 2007;130:1787-1798.
¹⁴
Janvin C, Aarsland D , Larsen JP , Hugdahl K. Neuropsychological profile of patients with Parkinson's disease without dementia. Dement Geriatr Cogn Disord. 2003;15:126-131.
¹⁵
Levy G, Jacobs DM, Tang MX, et al. Memory and executive function impairment predict dementia in Parkinson disease. Mov Disord 2002;17:1221-1227.
¹⁶
Vingerhoest G, Verden S, Antens P, et al. Predictors of cognitive impairments in advances Parkinson's disease. J Neurol Neurosurg Psychiatry 2003;74:793-796.
¹⁷
Boyle PA, Wilson RS, Aggarwal NT, et al. Parkinsonian signs in subjects with mild cognitive impairment. Neurology 2005;65:1901-1906
¹⁸
Janvin CC, Larsen JP , Aarsland D . Subtypes of mild cognitive impairment in Parkinson's disease: progression to dementia. Mov Disord 2006;21:1343-1349.
¹⁹
Caviness JN, Driver-Dunckley E, Connor DJ Defining mild cognitive impairment in Parkinson's disease. Mov Disord 2007;22:1272-1277.
²⁰
Riedel O, Klotsche J, Spottke A, et al. Cognitive impairment in 873 patients with idiopathic Parkinson's disease: results from the German Study on Epidemiology of Parkinson's disease with Dementia (GEPAD). J Neurol 2008;255:255-264.
²¹
Carod-Artal FJ, Vargas AP. Martinez-Martin P. Determinants of quality of life in brazilian patients with Parkinson's disease. Mov Disord 2007;22:1408-1415.
²²
Emre M, Aarsland D , Brown R. Clinical diagnostic criteria for dementia associated with Parkinson's disease. Mov Disord 2007;22:1689-1707
²³
Dubois B, Burn D, Goetz C, Aarsland D , et al. Diagnostic Procedures for Parkinson's disease dementia: recommendations from the Movement Disorder Society Task Force. Mov Disord 2007;22:2314-2324.
²⁴
Folstein MF, Folstein SE, McHugh PR. "Mini-mental state." A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.
²⁵
Sunderland T, Hill JL, Mellow AM, et al. Clock drawing in Alzheimer's disease. J Am Geriatr Soc 1989;37:725-729.
²⁶
Benton AL, Hamsher KD. Multilingual aphasia examination. IowaCity, Iowa: AJA Associates; 1989.
²⁷
Merino JG, Luchsinger J, Huang Z. Parkinson disease dementia. 2004. Accessed July 7, 2008, online at: Accessed July 7, 2008, online at: http://www.emedicine.com/med/TOPIC3110.HTM
» http://www.emedicine.com/med/TOPIC3110.HTM
²⁸
Ballard CG, Aarsland D , McKeith I, et al. Fluctuations in attention: PD dementia vs. DLB with parkinsonism. Neurology 2002;59:1714-1720.
²⁹
McKeith G, Dickson DW, Lowe J, et al. Diagnosis and management of dementia with Lewy bodies: third report of the DLB consortium. Neurology 2005;65:1863-1872.
³⁰
Kuzis G, Sabe L, Tiberti C, Merello M, et al. Explicit and implicit learning in patients with Alzheimer disease and Parkinson disease with dementia. Neuropsychiatry Neuropsychol Behav Neurol 1999;12:265-269
³¹
Pillon B, Deweer B, Agid Y, Dubois B. Explicit memory in Alzheimer's disease, Huntington's disease, and Parkinson's disease. Arch Neurol 1993;50:374-379.
³²
Lippa CF, Duda JE, Grossman M. DLB and PDD boundary issues diagnosis, treatment, molecular pathology, and biomarkers. Neurology 2007;68:812-819.
³³
Piovezan MR, Teive HAG, Piovesan EJ, et al. Cognitive function assessment in idiopathic Parkinson's disease. Arq Neuropsiquiatr 2007;65:942-946.
³⁴
Sobreira EST, Pena MCS, Silva Filho JH, et al. Executive cognitive tests for the evaluation of patients with Parkinson´s Disease. Dement Neuropsychol 2008;2:206-210.
³⁵
Cotelli M, Borroni B, Manenti R, Action and object naming in Parkinson's disease without dementia. Eur J Neurol 2007;14:632-637.
³⁶
Cahn-Weiner DA, Williams K, Grace J, et al. Discrimination of dementia with Lewy bodies from Alzheimer disease and Parkinson disease using the clock drawing test. Cogn Behav Neurol 2003;16:85-92
³⁷
Silva MCP, Sobreira EST, Souza CP, et al. Visuospatial cognitive tests for the evaluation of patients with Parkinson's disease. Dement Neuropsychol 2008;2:201-205.
³⁸
Cummings JL. Subcortical dementia: neuropsychology, neuropsychiatry, and pathophysiology. Br J Psychiatry 2006; 149:682-697.
³⁹
McKeith IG, Galasko D, Kosaka K, et al. Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB: report of the consortium on DLB international workshop. Neurology 1996;47:1113-1124.
⁴⁰
Weintraub D, Comella CL, Horn S Parkinson's disease- part 3: neuropsychiatric symptoms. Am J Manag Care. 2008;14:S59-S69.

Publication Dates

Publication in this collection
Oct-Dec 2008

History

Received
01 Aug 2008
Accepted
20 Oct 2008

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Blennow K, de Leon MJ, Zetterberg H. Alzheimer's disease. Lancet 2006;368:387-403.

[2] ²
Sleegers K, Kumar-Singh S, Cruts M, Van Broeckhoven C. Molecular pathogenesis of frontotemporal lobar degeneration: basic science seminar in neurology. Arch Neurol 2008;65:700-704.

[3] ³
Polymeroulos MH, Lavedan C, Leroy E, et al. Mutation in the Alpha-synuclein gene identified in families with Parkinson's disease. Science 1997;276:2045-2047.

[4] ⁴
Spillantini MG, Schmidt ML, Lee VM, et al. Alpha-synuclein in Lewy bodies. Nature 1997;388:839-840.

[5] ⁵
Jellinger KA. Neuropathological spectrum of synucleinopathies. Mov Disord 2003;18(Suppl 6):22-12.

[6] ⁶
Aarsland D, Andersen K, Larsen JP, Lolk A, Kragh-Sørensen P. Prevalence and characteristic of dementia in Parkinson disease: an 8 years prospective study. Arch Neurol 2003;60:387-391.

[7] ⁷
de Lau LM, Schipper CM, Hofman A, et al. Prognosis of Parkinson disease: risk of dementia and mortality: the Rotterdam Study. Arch Neurol 2005;62:1265-1269.

[8] ⁸
Hobson P, Gallacher J, Meara J. Cross-sectional survey of Parkinson's disease and parkinsonism in a rural area of the United Kingdom. Mov Disord 2005;20:995-998.

[9] ⁹
Garder K, Tang MX, Cote L, Stern Y, Mayeux R. The frequency and associated risk factors for dementia in patients with Parkinson' disease. Arch Neurol 1995;52:695-701.

[10] ¹⁰
Buter TC, van den Hout A, Matthews FE, Larsen JP, Brayne C, Aarsland D. Dementia and survival in Parkinson disease: A 12-year population study. Neurology 2008;70:1017-1022.

[11] ¹¹
Mayeux R, Stern Y. Intellectual Dysfunction and Dementia in Parkinson Disease. In: Mayeux R, Rosen WG, editors. The Dementias. New York, Raven Press; 1983.

[12] ¹²
Muslimovic D, Post B, Speelman JD, et al. Cognitive profile of patients with newly diagnosed Parkinson disease. Neurology 2005;65:1239-1245.

[13] ¹³
Williams-Gray CH, Foltynie T, Brayne C E, Barker RA. Evolution of cognitive dysfunction in an incident Parkinson's disease cohort. Brain 2007;130:1787-1798.

[14] ¹⁴
Janvin C, Aarsland D , Larsen JP , Hugdahl K. Neuropsychological profile of patients with Parkinson's disease without dementia. Dement Geriatr Cogn Disord. 2003;15:126-131.

[15] ¹⁵
Levy G, Jacobs DM, Tang MX, et al. Memory and executive function impairment predict dementia in Parkinson disease. Mov Disord 2002;17:1221-1227.

[16] ¹⁶
Vingerhoest G, Verden S, Antens P, et al. Predictors of cognitive impairments in advances Parkinson's disease. J Neurol Neurosurg Psychiatry 2003;74:793-796.

[17] ¹⁷
Boyle PA, Wilson RS, Aggarwal NT, et al. Parkinsonian signs in subjects with mild cognitive impairment. Neurology 2005;65:1901-1906

[18] ¹⁸
Janvin CC, Larsen JP , Aarsland D . Subtypes of mild cognitive impairment in Parkinson's disease: progression to dementia. Mov Disord 2006;21:1343-1349.

[19] ¹⁹
Caviness JN, Driver-Dunckley E, Connor DJ Defining mild cognitive impairment in Parkinson's disease. Mov Disord 2007;22:1272-1277.

[20] ²⁰
Riedel O, Klotsche J, Spottke A, et al. Cognitive impairment in 873 patients with idiopathic Parkinson's disease: results from the German Study on Epidemiology of Parkinson's disease with Dementia (GEPAD). J Neurol 2008;255:255-264.

[21] ²¹
Carod-Artal FJ, Vargas AP. Martinez-Martin P. Determinants of quality of life in brazilian patients with Parkinson's disease. Mov Disord 2007;22:1408-1415.

[22] ²²
Emre M, Aarsland D , Brown R. Clinical diagnostic criteria for dementia associated with Parkinson's disease. Mov Disord 2007;22:1689-1707

[23] ²³
Dubois B, Burn D, Goetz C, Aarsland D , et al. Diagnostic Procedures for Parkinson's disease dementia: recommendations from the Movement Disorder Society Task Force. Mov Disord 2007;22:2314-2324.

[24] ²⁴
Folstein MF, Folstein SE, McHugh PR. "Mini-mental state." A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.

[25] ²⁵
Sunderland T, Hill JL, Mellow AM, et al. Clock drawing in Alzheimer's disease. J Am Geriatr Soc 1989;37:725-729.

[26] ²⁶
Benton AL, Hamsher KD. Multilingual aphasia examination. IowaCity, Iowa: AJA Associates; 1989.

[27] ²⁷
Merino JG, Luchsinger J, Huang Z. Parkinson disease dementia. 2004. Accessed July 7, 2008, online at: Accessed July 7, 2008, online at: http://www.emedicine.com/med/TOPIC3110.HTM
» http://www.emedicine.com/med/TOPIC3110.HTM

[28] ²⁸
Ballard CG, Aarsland D , McKeith I, et al. Fluctuations in attention: PD dementia vs. DLB with parkinsonism. Neurology 2002;59:1714-1720.

[29] ²⁹
McKeith G, Dickson DW, Lowe J, et al. Diagnosis and management of dementia with Lewy bodies: third report of the DLB consortium. Neurology 2005;65:1863-1872.

[30] ³⁰
Kuzis G, Sabe L, Tiberti C, Merello M, et al. Explicit and implicit learning in patients with Alzheimer disease and Parkinson disease with dementia. Neuropsychiatry Neuropsychol Behav Neurol 1999;12:265-269

[31] ³¹
Pillon B, Deweer B, Agid Y, Dubois B. Explicit memory in Alzheimer's disease, Huntington's disease, and Parkinson's disease. Arch Neurol 1993;50:374-379.

[32] ³²
Lippa CF, Duda JE, Grossman M. DLB and PDD boundary issues diagnosis, treatment, molecular pathology, and biomarkers. Neurology 2007;68:812-819.

[33] ³³
Piovezan MR, Teive HAG, Piovesan EJ, et al. Cognitive function assessment in idiopathic Parkinson's disease. Arq Neuropsiquiatr 2007;65:942-946.

[34] ³⁴
Sobreira EST, Pena MCS, Silva Filho JH, et al. Executive cognitive tests for the evaluation of patients with Parkinson´s Disease. Dement Neuropsychol 2008;2:206-210.

[35] ³⁵
Cotelli M, Borroni B, Manenti R, Action and object naming in Parkinson's disease without dementia. Eur J Neurol 2007;14:632-637.

[36] ³⁶
Cahn-Weiner DA, Williams K, Grace J, et al. Discrimination of dementia with Lewy bodies from Alzheimer disease and Parkinson disease using the clock drawing test. Cogn Behav Neurol 2003;16:85-92

[37] ³⁷
Silva MCP, Sobreira EST, Souza CP, et al. Visuospatial cognitive tests for the evaluation of patients with Parkinson's disease. Dement Neuropsychol 2008;2:201-205.

[38] ³⁸
Cummings JL. Subcortical dementia: neuropsychology, neuropsychiatry, and pathophysiology. Br J Psychiatry 2006; 149:682-697.

[39] ³⁹
McKeith IG, Galasko D, Kosaka K, et al. Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB: report of the consortium on DLB international workshop. Neurology 1996;47:1113-1124.

[40] ⁴⁰
Weintraub D, Comella CL, Horn S Parkinson's disease- part 3: neuropsychiatric symptoms. Am J Manag Care. 2008;14:S59-S69.

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