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Cognitive function in Parkinson's disease. Francesco Le Pira Dipartimento di Neuroscienze Università di Catania.

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cognitive function in parkinson s disease
Cognitive function in Parkinson's disease

Francesco Le Pira

Dipartimento di Neuroscienze

Università di Catania

slide2
Mental deterioration, visuoperceptive disabilities and constructional apraxia in Parkinson's disease.Villardita C, Smirni P, Le Pira F, Zappalà G, Nicoletti F.Acta Neurol Scand. 1982 Jul;66(1):112-20.

20 patients with Parkinson's disease were tested for visuoperceptive disabilities and constructional apraxia versus a group of 20 controls. The visuoperceptive disabilities in the parkinsonians were relatively independent of mental deterioration, where present. The visuoperceptive disabilities were responsible for constructional apraxia.

slide3
In 1817, James Parkinson (1755-1824), in his “Essay on the Shaking Palsy” wrote:

“Involuntary tremulous motion, with lessened muscular power, in parts not in action and even when supported with a propensity to bend the trunk forwards and to pass from a walking to a running pace: the senses and intellects being uninjured”.

slide4
Frequency of dementia

in Parkinson disease

Aarsland D, Tandberg E, Larsen JP, Cummings JL.

Arch Neurol. 1996; 53:38-42

Approximately one quarter of the patients with PD had dementia with the motor manifestations of PD. Dementia was associated with depression, institutionalization, older age at onset of PD, and atypical neurologic features.

cognition and pd
Cognition and PD
  • Pathogenetic mechanisms
  • Neuropsychological features
  • Neuropsychological tests
  • Mild Cognitive Impairment and Dementia
  • Therapeutic issues
  • Deep Brain Stimulation
  • Dopamine and cognition
pathogenesis of cognitive dysfunctions
Pathogenesis of cognitive dysfunctions
  • Neuropathological markers
  • Neurotransmitters
  • Clinical features
neuropathology
Neuropathology
  • Brainstem pathology with involvement of the nigrostriatal pathway
  • Limbic or cortical Lewy body-type degeneration
  • Coincident Alzheimer-type pathology

(Emre M., 2003)

executive functions
Executive functions
  • Conceptualization and abstract reasoning
  • Mental flexibility
  • Motor programming
  • Resistance to interference
  • Self regulation
  • Inhibitory control
  • Enviromental autonomy
slide17
Visuospatial function in Parkinson's disease

Brown RG, Marsden CD.

Brain 1986; 109: 987-1002

Previous research on visuospatial function in Parkinson's disease is reviewed. The present experiment was designed to test two fundamental aspects of spatial ability, namely right-left discrimination and the manipulation of those concepts in different spatial perspectives. Measures of accuracy and reaction time were taken. The performance of patients with Parkinson's disease did not differ from that of normal subjects in the spatial components of the task. Neither a review of the literature, nor the results of the present study, give support to the idea of a generalized visuospatial deficit in Parkinson's disease.

slide21
A

AB

B

1

2

3

4

5

6

7

8

9

10

11

PD

Controls

p

12

RPM TOT

23.9 ± 4.7

26.7 ± 4

0.04

RPM SET1

10.8 ± 0.5

10.8 ± 0.4

ns

RPM SET2

12 ± 3.7

14.5 ± 2.3

0.01

RPM SET3

1.1 ± 1.6

1.4 ± 1.8

ns

Set 1

Set 2

Set 3

neuropsychological tests1
Raven Progressive Matrices

California Verbal Learning Test

Neuropsychological tests
  • FAB
  • Stroop test
  • Trail Making Test
  • Wisconsin Card Sorting Test
  • Weigl Test
  • COWAT
slide27
PRUGNE

California Verbal Learning Testversione ital. di G. Zappalà et. al.

TRAPANO

GONNA

PESCI

SALMONE

.......

FRUTTA

ALBICOCCHE

UTENSILI

CALAMARI

SCALPELLO

VESTITI

PIGIAMA

slide39
Cholinesterase inhibitors for Parkinson's disease dementia

I Maidment, C Fox, M Boustani

Cochrane Database of Systematic Reviews 2007 Issue 2

Rivastigmine appears to improve cognition and activities of daily living in patients with PDD. This results in clinically meaningful benefit in about 15% of cases. There is a need for more studies utilising pragmatic measures such as time to residential care facility and both patient and carer quality of life assessments. Future trials should involve other cholinesterase inhibitors, utilise tools to analyse the data that limit any bias and measure health economic factors. It is unlikely that relying solely on the last observation carried forward (LOCF) is sufficient. Publication of the observed case data in the largest trial would assist (Emre 2004). Adverse events were associated with the cholinergic activity of rivastigmine, but may limit patient acceptability as evidenced by the high drop out rate in the active arm.

slide49
There are generally no adverse or beneficial effects of levodopa therapy on cognition in moderate-to-severe Parkinson’s disease patients.
conclusions
Conclusions
  • There is now an increasing interest in the cognitive and non-motor aspects of Parkinson’s disease.
  • There is a significant impact of these cognitive defects on quality of life of patients and families.
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