Disfunções neuropsicológicas na doença de Parkinson: estudo de 64 casos

Barbosa, Egberto Reis; Lefèvre, Beatriz Helena; Comerlatti, Luiz Roberto; Scaff, Milberto; Canelas, Horácio Martins

doi:10.1590/S0004-282X1987000200003

Resumos

Foram estudados 64 casos de doença de Parkinson idiopática mediante aplicação de questionário de 30 itens de avaliação neuropsicológica. Os casos com desempenho abaixo do normal e que preenchiam os critérios de demência do Manual de Diagnóstico e Estatística de Distúrbios Mentais, terceira edição (DSM III) foram considerados demenciados. O resultado dessa avaliação mostrou que a taxa de prevalência de demência no grupo de parkinsonianos estudado foi de 18,7%. Pacientes com desempenho abaixo do normal apresentavam oligocinesia em maior grau que o grupo dos normais. Das funções neuropsicológicas, as mais afetadas foram: memória imediata, abstração, gnosia visual, cálculo, função motora dinâmica das mãos, praxia construtiva e memória recente. Discutem-se os dados encontrados e comparam-se com os da literatura.

Sixty-four cases of idiopathic Parkinson's disease were studied focusing the neuropsychological performance. To all subjects a brief mental status questionnaire was administered (30 items). Cases with a performance below normal and meeting the dementia criteria of the Diagnosis and Statistical Manual of Mental Disorders, third edition (DSM III), were considered demented. This evaluation showed that 12 of the 64 patients had dementia, a prevalence rate of 18.7%. Patients that had neuropsychological performance below normal showed more severe bradykinesia than normals. Short term memory, abstract thinking, visual gnosia, calculations, dynamic motor function of hands, constructional ability and recent memory were the most affected psychological functions. The significance of the mentioned findings is discussed and the literature reviewed.

Disfunções neuropsicológicas na doença de Parkinson: estudo de 64 casos

Neuropsychologic dysfunctions in Parkinson's disease: a study of 64 cases

Egberto Reis Barbosa^I; Beatriz Helena Lefèvre^II; Luiz Roberto Comerlatti^I; Milberto Scaff^III; Horácio Martins Canelas^IV

^IMédico Assistente - Trabalho realizado na Divisão de Clínica Neurológica (Ambulatório de Moléstias Extrapiramidais) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

^IIPsicóloga - Trabalho realizado na Divisão de Clínica Neurológica (Ambulatório de Moléstias Extrapiramidais) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

^IIIProfessor Adjunto - Trabalho realizado na Divisão de Clínica Neurológica (Ambulatório de Moléstias Extrapiramidais) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

^IVProfessor Titular - Trabalho realizado na Divisão de Clínica Neurológica (Ambulatório de Moléstias Extrapiramidais) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

RESUMO

Foram estudados 64 casos de doença de Parkinson idiopática mediante aplicação de questionário de 30 itens de avaliação neuropsicológica. Os casos com desempenho abaixo do normal e que preenchiam os critérios de demência do Manual de Diagnóstico e Estatística de Distúrbios Mentais, terceira edição (DSM III) foram considerados demenciados. O resultado dessa avaliação mostrou que a taxa de prevalência de demência no grupo de parkinsonianos estudado foi de 18,7%. Pacientes com desempenho abaixo do normal apresentavam oligocinesia em maior grau que o grupo dos normais. Das funções neuropsicológicas, as mais afetadas foram: memória imediata, abstração, gnosia visual, cálculo, função motora dinâmica das mãos, praxia construtiva e memória recente. Discutem-se os dados encontrados e comparam-se com os da literatura.

SUMMARY

Sixty-four cases of idiopathic Parkinson's disease were studied focusing the neuropsychological performance. To all subjects a brief mental status questionnaire was administered (30 items). Cases with a performance below normal and meeting the dementia criteria of the Diagnosis and Statistical Manual of Mental Disorders, third edition (DSM III), were considered demented. This evaluation showed that 12 of the 64 patients had dementia, a prevalence rate of 18.7%. Patients that had neuropsychological performance below normal showed more severe bradykinesia than normals. Short term memory, abstract thinking, visual gnosia, calculations, dynamic motor function of hands, constructional ability and recent memory were the most affected psychological functions. The significance of the mentioned findings is discussed and the literature reviewed.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Agradecimentos - Agradecemos aos Drs. Sérgio Domingos Pitelli e Luís dos Ramos Machado pelo estudo estatístico, e a Marina San Martin Machado pelo trabalho datilográfico.

Departamento de Neurologia, FMUSP - C. Postal 3461 - 01000 - São Paulo, SP - Brasil.

1. BALL, B. - De l'insanité dans la paralysie agitante. Encéphale 2:22, 1882.
2. BALL, M.J. - The morphological basis of dementia in Parkinson's disease. Can. J. neurol. Sci. 11 (suppl.): 180, 1984.
3. BENSON, F.D. - Parkinsonian dementia: cortical or subcortical? In J.F. Christ & R.G. Hassler (eds.): Advances in Neurology, vol. 40. Raven, New York, 1984, pg. 235.
4. BOLDER, F.; MIZUTANI, T.; ROESSMANN, U. & GAMBETTI, P. - Parkinson disease, dementia, and Alzheimer disease: clinicopathological correlations. Ann. Neurol. 7:329, 1980.
5. BOLLER, F. ; PASSAFIUME, D. ; KEEFE, N.C. ; ROGERS, K. ; MORROW, L. & YOUNGJAI, K. - Visuospatial impairment in Parkinson s disease. Arch. Neurol. (Chicago) 41:485, 1984.
6. BOTEZ, M.L & BARBEAU, A. - Long-term mental changes in levodopa-treated patients. Lancet 2:1028, 1973.
7. CELESIA, G.G. & WANAMAKER, W.M. - Psychiatric disturbances in Parkinson's disease. Dis. nerv. Syst. 33:577, 1972.
8. DUBOIS, B. ; HAUW, J.J.; RUBERG, M. ; SERDARU, M. ; JAVOY-AGID, F. & AGID, Y. Démence et maladie de Parkinson: correlations biochimiques et anatomo-cliniques. Rev. neurol. (Paris) 141:184, 1985.
9. GARRON, D.C.; KLAWANS, H.L. & NARIN, F. - Intellectual functioning of persons with idiopathic parkinsonism. J. nerv. ment. Dis. 154:445, 1972.
10. HAKIM, A.M. & MATHIESON, G. - Dementia in Parkinson disease: a neuropathology study. Neurology 29:1209, 1978.
11. HANSCH, E.C.; SYNDULKO, K.; COHEN, S.N.; GOLDBERG, I.; POTVIN, A.R. & TOURTELLOTTE, W.W. - Cognition in Parkinson disease: an event-related potential perspective. Ann. Neurol. 11:599, 1982.
12. HIETANEN, M. & TERÄVÄINEN, H. - Cognitive performance in early Parkinson's disease. Acta neurol. scand. 73:151, 1986.
13. HOEHN, M.M. & YAHR, M.D. - Parkinsonism: onset, progression, and mortality. Neurology 17:427, 1967.
14. HORNYKIEWICZ, O. & KISH. S.J. - Neurochemical basis of dementia in Parkinson's disease. Can. J. neurol. Sci. 11 (suppl.): 185, 1984.
15. JACOBS, J.W.; BERNHARD, M.R.; DELGADO, A. & STRAIN, J.J. - Screening for organic mental syndromes in the medically ill. Ann. int. Med. 86:40, 1977.
16. JACKSON, J.A.; JANKOVIC, J. & FORA, J. - Progressive supranuclear palsy: clinical features and responses to treatment in sixteen patients. Ann. Neurol. 13:273, 1983.
17. LEES, A.J. & SMITH, E. - Cognitive deficits in the early stages of Parkinson's disease. Brain 106:257. 1983.
18. LEVITA, E. ; RIKLAN, M. & COOPER. I.S. - Cognitive and perceptual performance in parkinsonism as a function of age and neurological impairment. J. nerv. ment. Dis. 139:516, 1964.
19. LIEBERMAN, A. ; DZIATOLOWSKI. M. ; COOPERSMITH, M. ; CERB, M.; GOOD-GOLD, A. ; LOREIN, J. & GOLDSTEIN, M. - Dementia in Parkinson's disease. Ann. Neurol. 6:355, 1979.
20. LORANGER, A.W. ; GOODELL, H. ; McDOWELL, F.H. ; LEE, J.E. & SWEET, R.D. - Intellectual impairment in Parkinson's syndrome. Brain 95:405, 1972.
21. MARSDEN, CD. - Assessment of dementia. In I.A.M. Frederiks (ed.) : Handbook of Clinical Neurology, vol. 2: Neurobehavioral Disorders. Elsevier, Amsterdam, 1985, pg. 221.
22. MARTIN, W.E.; LOEWENSON, R.B.; RESCH, J.A. & BAKER, A.B. - Parkinson's disease: clinical analysis of 100 patients. Neurology 23:783, 1973.
23. MARTTILA, R.J. & RLNNE, U.K. - Dementia in Parkinson's disease. Acta neurol. scand. 54:431, 1976.
24. MATISON, R.; MAYEUX, R.; ROSEN, J. & FAHN, S. - «Tip-of-the tongue» phenomenon in Parkinson disease. Neurology 32:567, 1982.
25. MAYEUX, R.; STERN, Y.; ROSEN, J. & LEVENTHAL, J. - Depression, intellectual impairment, and Parkinson disease. Neurology 31:645, 1981.
26. MAYEUX, R. - Depression and dementia in Parkinson's disease. In CD. Marsden & S. Fahn (eds.): Movement Disorders. Butterworth, London, 1982, pg. 75.
27. MAYEUX, R. & STERN, Y. - Intellectual dysfunction and dementia in Parkinson disease. In R. Mayeux & W. Rosen (eds.): Advances in Neurology, vol. 38. Raven, New York, 1983, pg. 211.
28. MAYEUX, R.; STERN, Y.; ROSEN, J. & BENSON, F. - Is «subcortical dementia» a recognizable clinical entity?. Ann. Neurol. 14:278, 1983.
29. MAYEUX, R. - Behavioral manifestations of movement disorders: Parkinson's and Huntington's disease. In J. Jankovic (ed.): Neurologic Clinics, vol. 2: Symposium on Movement Disorders. Saunders, Philadelphia, 1984, pg. 527.
30. MINDHAM, R.H.S.; AHMED, S.W.A. & CLOUGH, CG. - A controlled study of dementia in Parkinson's disease. J. Neurol. Neurosurg. Psychiatry 45:969, 1982.
31. MOHR, J. - Lacunes. Stroke, 13:3, 1982.
32. MORTIMER, J.A.; PIROZZOLO, F.J.; HANSCH, E.C & WEBSTER, D.D. Relationship of motor symptoms to intellectual deficits in Parkinson disease.. Neurology 32:133, 1982.
33. MORTIMER, J.A.; CHRISTENSEN, K.J. & WEBSTER, D.D. - Parkinsonian dementia. In J.A.M. Frederiks (ed.): Handbook of Clinical Neurology, vol. 46: Neurobehavioural Disorders. Elsevier, Amsterdam, 1985, pg. 371.
34. NAUSIEDA, P.A.; GLANTZ, R.; WEBER, S.; BAUM, R. & KLAWANS, H.L. Psychiatric complications of levodopa therapy of Parkinson's disease. In R.G. Hassler & J.F. Christ (eds.): Advances in Neurology, vol. 40: Parkinson-Specific Motor and Mental Disorders. Raven, New York, 1984, pg. 271.
35. POLLACK, M. & HORNABROOK, R.W. - The prevalence, natural history and dementia of Parkinson's disease. Brain 89:429, 1966.
36. RONDOT, P.; RECONDO, J.: COIGNET, A. & ZIEGLER, M. - Mental disorders in Parkinson's disease after treatment with D-Dopa. In R.G. Hassler & J.F. Christ (eds.): Advances in Neurology, vol. 40: Parkinson-Specific Motor and Mental Disorders. Raven, New York, 1984, pg. 259.
37. SILVA, A.B. - Doença de Parkinson e demência. Rev. bras. Neurol. 20:95, 1984.
38. SWEET, R.D.; McDOWELL, F.H.; FEIGENSON, J.S.; LORANGER, A.W. & GOODELL, H. - Mental symptoms in Parkinson's disease during chronic treatment with levodopa. Neurology 26:305, 1976.
39. VILLARDITA, C; SMIRNI, P.; LB PIRA, F.; ZAPPALA, G. & NICOLETTI, F. - Mental deterioration, visuoperceptive disabilities and constructional apraxia in Parkinson's disease. Acta neurol. scand. 66:112, 1982.
40. WEBSTER, D.D. - Critical analysis of the disability in Parkinson's disease. Mod. Treatm. 5:257, 1968.
41. WHITEHOUSE, P. J.; HEDREEN, J.C; WHITE, C.L. & PRICE, D.L. - Basal forebrain neuron3 in the dementia of Parkinson disease. Ann. Neurol. 13:243, 1983.
42. WILLIAMS, J. - Diagnostic and Statistical Manual of Mental Disorders. Ed. 3. American Psychiatric Association, Washington, 1980.

Datas de Publicação

Publicação nesta coleção
22 Jun 2011
Data do Fascículo
Jun 1987

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. BALL, B. - De l'insanité dans la paralysie agitante. Encéphale 2:22, 1882.

[2] 2. BALL, M.J. - The morphological basis of dementia in Parkinson's disease. Can. J. neurol. Sci. 11 (suppl.): 180, 1984.

[3] 3. BENSON, F.D. - Parkinsonian dementia: cortical or subcortical? In J.F. Christ & R.G. Hassler (eds.): Advances in Neurology, vol. 40. Raven, New York, 1984, pg. 235.

[4] 4. BOLDER, F.; MIZUTANI, T.; ROESSMANN, U. & GAMBETTI, P. - Parkinson disease, dementia, and Alzheimer disease: clinicopathological correlations. Ann. Neurol. 7:329, 1980.

[5] 5. BOLLER, F. ; PASSAFIUME, D. ; KEEFE, N.C. ; ROGERS, K. ; MORROW, L. & YOUNGJAI, K. - Visuospatial impairment in Parkinson s disease. Arch. Neurol. (Chicago) 41:485, 1984.

[6] 6. BOTEZ, M.L & BARBEAU, A. - Long-term mental changes in levodopa-treated patients. Lancet 2:1028, 1973.

[7] 7. CELESIA, G.G. & WANAMAKER, W.M. - Psychiatric disturbances in Parkinson's disease. Dis. nerv. Syst. 33:577, 1972.

[8] 8. DUBOIS, B. ; HAUW, J.J.; RUBERG, M. ; SERDARU, M. ; JAVOY-AGID, F. & AGID, Y. Démence et maladie de Parkinson: correlations biochimiques et anatomo-cliniques. Rev. neurol. (Paris) 141:184, 1985.

[9] 9. GARRON, D.C.; KLAWANS, H.L. & NARIN, F. - Intellectual functioning of persons with idiopathic parkinsonism. J. nerv. ment. Dis. 154:445, 1972.

[10] 10. HAKIM, A.M. & MATHIESON, G. - Dementia in Parkinson disease: a neuropathology study. Neurology 29:1209, 1978.

[11] 11. HANSCH, E.C.; SYNDULKO, K.; COHEN, S.N.; GOLDBERG, I.; POTVIN, A.R. & TOURTELLOTTE, W.W. - Cognition in Parkinson disease: an event-related potential perspective. Ann. Neurol. 11:599, 1982.

[12] 12. HIETANEN, M. & TERÄVÄINEN, H. - Cognitive performance in early Parkinson's disease. Acta neurol. scand. 73:151, 1986.

[13] 13. HOEHN, M.M. & YAHR, M.D. - Parkinsonism: onset, progression, and mortality. Neurology 17:427, 1967.

[14] 14. HORNYKIEWICZ, O. & KISH. S.J. - Neurochemical basis of dementia in Parkinson's disease. Can. J. neurol. Sci. 11 (suppl.): 185, 1984.

[15] 15. JACOBS, J.W.; BERNHARD, M.R.; DELGADO, A. & STRAIN, J.J. - Screening for organic mental syndromes in the medically ill. Ann. int. Med. 86:40, 1977.

[16] 16. JACKSON, J.A.; JANKOVIC, J. & FORA, J. - Progressive supranuclear palsy: clinical features and responses to treatment in sixteen patients. Ann. Neurol. 13:273, 1983.

[17] 17. LEES, A.J. & SMITH, E. - Cognitive deficits in the early stages of Parkinson's disease. Brain 106:257. 1983.

[18] 18. LEVITA, E. ; RIKLAN, M. & COOPER. I.S. - Cognitive and perceptual performance in parkinsonism as a function of age and neurological impairment. J. nerv. ment. Dis. 139:516, 1964.

[19] 19. LIEBERMAN, A. ; DZIATOLOWSKI. M. ; COOPERSMITH, M. ; CERB, M.; GOOD-GOLD, A. ; LOREIN, J. & GOLDSTEIN, M. - Dementia in Parkinson's disease. Ann. Neurol. 6:355, 1979.

[20] 20. LORANGER, A.W. ; GOODELL, H. ; McDOWELL, F.H. ; LEE, J.E. & SWEET, R.D. - Intellectual impairment in Parkinson's syndrome. Brain 95:405, 1972.

[21] 21. MARSDEN, CD. - Assessment of dementia. In I.A.M. Frederiks (ed.) : Handbook of Clinical Neurology, vol. 2: Neurobehavioral Disorders. Elsevier, Amsterdam, 1985, pg. 221.

[22] 22. MARTIN, W.E.; LOEWENSON, R.B.; RESCH, J.A. & BAKER, A.B. - Parkinson's disease: clinical analysis of 100 patients. Neurology 23:783, 1973.

[23] 23. MARTTILA, R.J. & RLNNE, U.K. - Dementia in Parkinson's disease. Acta neurol. scand. 54:431, 1976.

[24] 24. MATISON, R.; MAYEUX, R.; ROSEN, J. & FAHN, S. - «Tip-of-the tongue» phenomenon in Parkinson disease. Neurology 32:567, 1982.

[25] 25. MAYEUX, R.; STERN, Y.; ROSEN, J. & LEVENTHAL, J. - Depression, intellectual impairment, and Parkinson disease. Neurology 31:645, 1981.

[26] 26. MAYEUX, R. - Depression and dementia in Parkinson's disease. In CD. Marsden & S. Fahn (eds.): Movement Disorders. Butterworth, London, 1982, pg. 75.

[27] 27. MAYEUX, R. & STERN, Y. - Intellectual dysfunction and dementia in Parkinson disease. In R. Mayeux & W. Rosen (eds.): Advances in Neurology, vol. 38. Raven, New York, 1983, pg. 211.

[28] 28. MAYEUX, R.; STERN, Y.; ROSEN, J. & BENSON, F. - Is «subcortical dementia» a recognizable clinical entity?. Ann. Neurol. 14:278, 1983.

[29] 29. MAYEUX, R. - Behavioral manifestations of movement disorders: Parkinson's and Huntington's disease. In J. Jankovic (ed.): Neurologic Clinics, vol. 2: Symposium on Movement Disorders. Saunders, Philadelphia, 1984, pg. 527.

[30] 30. MINDHAM, R.H.S.; AHMED, S.W.A. & CLOUGH, CG. - A controlled study of dementia in Parkinson's disease. J. Neurol. Neurosurg. Psychiatry 45:969, 1982.

[31] 31. MOHR, J. - Lacunes. Stroke, 13:3, 1982.

[32] 32. MORTIMER, J.A.; PIROZZOLO, F.J.; HANSCH, E.C & WEBSTER, D.D. Relationship of motor symptoms to intellectual deficits in Parkinson disease.. Neurology 32:133, 1982.

[33] 33. MORTIMER, J.A.; CHRISTENSEN, K.J. & WEBSTER, D.D. - Parkinsonian dementia. In J.A.M. Frederiks (ed.): Handbook of Clinical Neurology, vol. 46: Neurobehavioural Disorders. Elsevier, Amsterdam, 1985, pg. 371.

[34] 34. NAUSIEDA, P.A.; GLANTZ, R.; WEBER, S.; BAUM, R. & KLAWANS, H.L. Psychiatric complications of levodopa therapy of Parkinson's disease. In R.G. Hassler & J.F. Christ (eds.): Advances in Neurology, vol. 40: Parkinson-Specific Motor and Mental Disorders. Raven, New York, 1984, pg. 271.

[35] 35. POLLACK, M. & HORNABROOK, R.W. - The prevalence, natural history and dementia of Parkinson's disease. Brain 89:429, 1966.

[36] 36. RONDOT, P.; RECONDO, J.: COIGNET, A. & ZIEGLER, M. - Mental disorders in Parkinson's disease after treatment with D-Dopa. In R.G. Hassler & J.F. Christ (eds.): Advances in Neurology, vol. 40: Parkinson-Specific Motor and Mental Disorders. Raven, New York, 1984, pg. 259.

[37] 37. SILVA, A.B. - Doença de Parkinson e demência. Rev. bras. Neurol. 20:95, 1984.

[38] 38. SWEET, R.D.; McDOWELL, F.H.; FEIGENSON, J.S.; LORANGER, A.W. & GOODELL, H. - Mental symptoms in Parkinson's disease during chronic treatment with levodopa. Neurology 26:305, 1976.

[39] 39. VILLARDITA, C; SMIRNI, P.; LB PIRA, F.; ZAPPALA, G. & NICOLETTI, F. - Mental deterioration, visuoperceptive disabilities and constructional apraxia in Parkinson's disease. Acta neurol. scand. 66:112, 1982.

[40] 40. WEBSTER, D.D. - Critical analysis of the disability in Parkinson's disease. Mod. Treatm. 5:257, 1968.

[41] 41. WHITEHOUSE, P. J.; HEDREEN, J.C; WHITE, C.L. & PRICE, D.L. - Basal forebrain neuron3 in the dementia of Parkinson disease. Ann. Neurol. 13:243, 1983.

[42] 42. WILLIAMS, J. - Diagnostic and Statistical Manual of Mental Disorders. Ed. 3. American Psychiatric Association, Washington, 1980.