Neuropsychological prediction of dementia in Parkinson’s disease
- Florence Mahieuxa,c,
- Gilles Fénelona,
- Antoine Flahaultb,
- Marie-José Manifaciera,
- Denyse Micheleta,
- François Bollerc
- aService de Neurologie, Hôpital Tenon, Paris, France, bAntenne de Biostatistique et Informatique Médicale, Hôpital Tenon, Paris, France, cUnité INSERM U 324, Centre Paul Broca, Paris, France
- Dr F Mahieux, Service de Neurologie, Hôpital Tenon, 4 rue de la Chine, 75970 Cedex Paris, France.
- Received 11 November 1996
- Revised 24 July 1997
- Accepted 31 July 1997
OBJECTIVE To identify neuropsychological characteristics predictive of later dementia in Parkinson’s disease.
METHODS A comprehensive neuropsychological test battery was administered to a cohort of 89 initially non-demented patients with Parkinson’s disease consecutively enrolled at a specialised Parkinson’s disease clinic. They were reassessed after a mean of 3.5 years for the diagnosis of dementia. The Cox proportional hazards model was used to identify baseline characteristics predictive of dementia.
RESULTS Only four of the baseline clinical characteristics of Parkinson’s disease and neuropsychological variables remained independently linked to subsequent development of dementia: the age of onset of Parkinson’s disease (>60 years; relative risk (RR) 4.1, 95% confidence interval (95% CI) 1.8–24.0, p<0.03), the picture completion subtest of the Wechsler adult intelligence scale (score<10; RR 4.9, 95% CI 1.0–24.1, p<0.02), the interference section of the Stroop test (score<21; RR 3.8, p=0.08), and a verbal fluency task (score<9; RR 2.7, 95% CI 0.8–9.1, p=0.09). Depressive symptoms and the severity of motor impairment were not predictive of dementia.
CONCLUSION These features are different from the neuropsychological characteristics predictive of Alzheimer’s dementia in healthy elderly people (mainly memory and language performance). They are in keeping with the well known specificity of the impairments in Parkinson’s disease for visuospatial abilities and difficulties in inhibiting irrelevant stimuli. It is postulated that the composite nature of the picture completion subtest, involving several cognitive abilities impaired in Parkinson’s disease, explains its sensitivity.