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Cognitive impairments in advanced PD without dementia

From the Departments of Neurology (Drs. Green, Vitek, Evatt, Freeman, and DeLong, and S. Triche and B. Sirockman), Psychiatry (Dr. McDonald), and Neurosurgery (Dr. Bakay), Emory University School of Medicine; and Department of Biostatistics (Dr. Haber), Rollins School of Public Health, Emory University, Atlanta, GA.

Address correspondence and reprint requests to Dr. Joanne Green, Emory University Department of Neurology, Wesley Woods Center, 1841 Clifton Road, Atlanta, GA 30329; e-mail: jgreen{at}emory.edu

Objective: To determine the nature and frequency of cognitive impairments in nondemented patients with advanced PD and their relationship to other variables potentially predictive of neuropsychological performance.

Methods: The neuropsychological performance of nondemented, nondepressed patients with idiopathic PD (n = 61) was quantified with respect to clinically available normative data. The relationship of neuropsychological measures to motor symptoms, age, years of education, disease duration, age at disease onset, disease deterioration rate, and dopaminergic therapy was assessed.

Results: Impairment was most frequent on measures sensitive to frontal lobe function (67% on Wisconsin Card Sorting Test number of categories, 30% on letter fluency, 30% on verbal learning). Poorer performance on multiple neuropsychological measures was related to greater overall motor abnormality (total Unified Parkinson’s Disease Rating Scale score), increased bradykinesia on medication, older age, longer disease duration, and reduced education.

Conclusions: Even in the absence of dementia or depression, patients with advanced PD are likely to show clinically significant impairments on neuropsychological measures sensitive to changes in dorsolateral prefrontal regions participating in cognitive basal ganglia-thalamocortical circuits.

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