Neuropsychological follow up in patients with Parkinson's disease, striatonigral degeneration-type multisystem atrophy, and progressive supranuclear palsy
Paola Soliveri, Daniela Monza, Dominga Paridi, Francesco Carella, Silvia Genitrini, Daniela Testa, Floriano Girotti
Department of
Neurology, Istituto Nazionale Neurologico "C Besta", Via Celoria
11, 20133 Milano, Italy
Correspondence to: Dr Floriano Girotti, Istituto Nazionale Neurologico "C Besta", Via Celoria 11, 20133 Milano, Italy panigada{at}istituto-besta.it
Received 4 May 1999 and in revised form 29 December 1999;
Accepted 31 January 2000
OBJECTIVES
Impairment
of executive function is frequent in Parkinson's disease (PD),
striatonigral degeneration-type multisystem atrophy (SND), and
progressive supranuclear palsy (PSP); sometimes frank dementia is also
present. However, the progression of cognitive decline has not been
adequately studied. The objectives were to delineate the progression of
cognitive impairment in these parkinsonisms and to elucidate
interdisease differences.
METHODSTwenty three
patients with SND and 21 with PSP, referred consecutively, and 18 patients with PD matched for severity of parkinsonism were compared on
a comprehensive battery of cognitive tests and motor invalidity scales.
A mean of 21 months later (range 18-24 months) the patients were
called for retesting.
RESULTSOnly 12 patients with PD (66.6%), 14 with SND (60.8%), and 11 with PSP
(52.4%) were retested; those who dropped out refused, had died, or
were too disabled. The patients with PSP performed worse than patients
with PD or SND in the short tale, verbal fluency, visual search, and
Benton tests at first evaluation. Overall cognitive performance was
similar in the PD and SND groups except that the SND group did
significantly worse on the verbal fluency test. Between group
comparison of changes in scores from first to second evaluation showed
that patients with PSP deteriorated significantly in the Nelson test
compared with patients with PD or SND, and that patients with PSP or
SND declined significantly on the visual search test compared with
patients with PD. There was no difference between the groups for motor
decline. Two patients with PSP were demented (DSM IV criteria) at first
evaluation and six at second evaluation; no patients with PD or SND
were demented at either evaluation.
CONCLUSIONSThe
greater decline of patients with PSP in attention, set shifting, and
categorisation abilities is probably related to the conspicuous frontal
deafferentation associated with direct premotor and prefrontal
involvement, and to dysfunction of the midbrain ascending activating
system, known to occur in PSP.
Keywords: Parkinson's disease; striatonigral degeneration-type multisystem atrophy; progressive supranuclear palsy; neuropsychological follow up
© 2000 by Journal of Neurology, Neurosurgery, and Psychiatry
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