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Cognitive and SPECT characteristics predict progression of Parkinson’s disease in newly diagnosed patients

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Abstract

Objective

To identify features in cognitive functioning and regional cerebral blood flow (rCBF) in newly diagnosed Parkinson’s disease (PD) patients and to determine whether these factors are able to predict the progression of the disease in general and the development of cognitive decline in particular.

Methods

50 previously treatment-naive PD patients participated in the study. Cognitive assessment and SPECT were performed twice: at the time of diagnosis and then 3 years later. Six patients died or refused to continue. The Mattis dementia rating scale, the WAIS-R digit span test, a word list learning/recall test, a word fluency task and the Stroop word-colour test were used to assess cognitive function. rCBF was measured in 10 pairs of regions of interest. Principal component analysis of the data from the final examination was used to determine which variables allowed the formation of patient subgroups. Thereafter, factorial discriminant analysis (FDA) was performed in order to obtain a predictive model of these final classes.

Results

A stepwise procedure enabled the identification of 3 clusters (26, 16 and 2 patients).As the patients in the smallest cluster met the criteria for dementia at the final examination, they were discarded from further analyses. All the cognitive variables contributed to the constitution of the two other clusters. Age, educational level and all the rCBF parameters also contributed but to a lesser extent. Comparison of these groups showed reduced overall cognitive efficiency and an exacerbated subcorticofrontal syndrome in the 16-patient cluster. FDA showed that the best predictive model for the final classes was based on 7 variables: educational level, semantic and alternating word fluency, Stroop interference index and the right medial frontal, left parietal and left lenticular nucleus rCBF findings.

Conclusion

Even though both cognitive and rCBF parameters help predict the progression of newly diagnosed PD patients and bearing in mind the limitations of the SPECT method used here, it appears that the contribution of cognitive assessment is greater than that of rCBF measurement.

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References

  1. Aarsland D, Larsen JP, Karlsen K, Lim NG, Tandberg E (1999) Mental symptoms in Parkinson’s disease are important contributors to caregiver distress. Int J Geriatr Psychiatry 14(10):866–874

    CAS  PubMed  Google Scholar 

  2. Aarsland D, Larsen JP, Tandberg E, Laake K (2000) Predictors of nursing home placement in Parkinson’s disease; a population-based, prospective study. J Am Geriatr Soc 48(8):938–942

    CAS  PubMed  Google Scholar 

  3. Alexander GE, De Long MR, Strick PL (1986) Parallel organization of functionally segregated circuits linking basal ganglia and cortex. Ann Rev Neurosci 9:357–381

    Article  CAS  PubMed  Google Scholar 

  4. Antonini A, De Notaris R, Benti R, De Gaspari D, Pezzoli G (2001) Perfusion ECD/SPECT in the characterization of cognitive deficits in Parkinson’s disease. Neurol Sci 1:45–46

    Google Scholar 

  5. Bondi MW, Kaszniak AW, Bayles KA, Vance KT (1993) Contribution of frontal system dysfunction to memory and perceptual abilities in Parkinson’s disease. Neuropsychology 7:89–102

    Google Scholar 

  6. Booij J, Tissingh G, Winogrodzka A, von Royen EA (1999) Imaging of the dopaminergic neurotransmission system using single photon emission tomography and positron emission tomography in patients with parkinsonism. Eur J Nucl Med 26:171–182

    CAS  PubMed  Google Scholar 

  7. Brooks DJ (1997) PET and SPECT studies in Parkinson’s disease. Bailliere’s Clinical Neurology 6:69–87

    CAS  Google Scholar 

  8. Brooks DJ (1998) The early diagnosis of Parkinson’s disease. Ann Neurol 44(Suppl 1):10–18

    PubMed  Google Scholar 

  9. Brooks DJ, Salmon EP, Mathias CJ, Quinn N, Leenders KL, Bannister R, Marsden CD, Frackowiak RS (1990) The relationship between locomotor disability, autonomic dysfunction and the integrity of the striatal dopaminergic system in patients with multisystem atrophy, pure autonomic failure, and Parkinson’s disease, studied with PET. Brain 113:1539–1552

    PubMed  Google Scholar 

  10. Broussolle E, Dentresangle C, Landais P, Garcia-Larrea L, Pollak P, Croisile B, Hibert O, Bonnefoi F, Galy G, Froment JC, Comar D (1999) The relation of the putamen and caudate nucleus 18-F Dopa uptake to motor and cognitive performances in Parkinson’s disease. J Neurol Sci 166:141–151

    CAS  PubMed  Google Scholar 

  11. Brown RG, Marsden CD (1988) An investigation of the phenomenon of “set” in Parkinson’s disease. Mov Disord 3(2):152–161

    CAS  PubMed  Google Scholar 

  12. Brown RG, Marsden CD (1990) Cognitive function in Parkinson’s disease: from description to theory. Trends Neurosci 13(1):21–29

    Article  CAS  PubMed  Google Scholar 

  13. Bullock R, Cameron A (2002) Rivastigmine for the treatment of dementia and visual hallucinations associated with Parkinson’s disease: a case series. Curr Med Res Opin 18(5):258–264

    Article  CAS  PubMed  Google Scholar 

  14. Cabanis EA, Tamraz J, Iba-Zizen MT (1986) Imagerie par résonance magnétique (IRM) de la tête à 0.5 Tesla. Atlas de corrélations anatomiques normales dans 3 dimensions, selon l’orientation du plan neuro-oculaire (PNO). Feuillets de Radiologie 26:309–416

    Google Scholar 

  15. Carter CS, Mintun M, Cohen JD (1995) Interference and facilitation effects during selective attention: an H2150 PET study of Stroop task performance. Neuroimage 2(4):264–272

    CAS  PubMed  Google Scholar 

  16. Charpentier P, Lavenu I, Defebvre L, Duhamel A, Lecouffe P, Pasquier P, Steinling M (2000) Alzheimer’s disease and fronto-temporal dementia are differentiated by discriminant analysis applied to 99mTcHmPao SPECT. J Neurol Neurosurg Psychiatry 69:661–663

    Article  CAS  PubMed  Google Scholar 

  17. Crevits L, De Ridder K (1997) Disturbed striatoprefrontal mediated visual behavior in moderate to severe parkinsonian patients. J Neurol Neurosurg Psychiatry 63:296–299

    CAS  PubMed  Google Scholar 

  18. Cummings JL (1988) The dementias of Parkinson’s disease; prevalence, characteristics, neurobiology, and comparison with dementia of the Alzheimer type. Eur Neurol 28(Suppl 1):15–23

    PubMed  Google Scholar 

  19. Cummings JL (2003) Use of cholinesterase inhibitors in clinical practice: evidence-based recommendations. Am J Geriatr Psychiatry 11(2):131–145

    PubMed  Google Scholar 

  20. Dalrymple-Alford JC, Kalders AS, Jones RD, Watson RW (1994) A central executive deficit in patients with Parkinson’s disease. J Neurol Neurosurg Psychiatry 57:360–367

    CAS  PubMed  Google Scholar 

  21. D’Antona R, Baron JC, Samson Y, Serdaru M, Viader F, Agid Y (1985) Subcortical dementia. Frontal cortex hypometabolism detected by positron tomography in patients with progressive supranuclear palsy? Brain 108:785–799

    PubMed  Google Scholar 

  22. Defebvre L, Lecouffe P, Destée A, Houdart P, Steinling M (1995) Tomographic measurements of regional cerebral blood flow in progressive supranuclear palsy and Parkinson’s disease. Acta Neurol Scand 92:235–241

    CAS  PubMed  Google Scholar 

  23. Defebvre L, Leduc V, Duhamel A, Lecouffe P, Pasquier F, Lamy C, Steinling M, Destée A (1999) Technetium HMPAO SPECT study in dementia with Lewy bodies, Alzheimer’s disease and idiopathic Parkinson’s disease. J Nucl Med 40:956–962

    CAS  PubMed  Google Scholar 

  24. Donnemiller E, Heilmann J, Wenning GK, Berger W, Decristoforo C,Moncayo R, Poewe W, Ransmayr G (1997) Brain perfusion scintigraphy with 99mTc-HMPAO or 99mTc-ECD and 123I-β-CIT single-photon emission tomography in dementia of the Alzheimer-type and diffuse Lewy body disease. Eur J Nucl Med 24:320–325

    CAS  PubMed  Google Scholar 

  25. Dujardin K, Degreef JF, Rogelet P, Defebvre L, Destée A (1999) Impairment of the supervisory attentional system in early untreated patients with Parkinson’s disease. J Neurol 246(9):783–788

    CAS  PubMed  Google Scholar 

  26. Fahn S, Elton RL and members of the UPDRS development committee (1987) Unified Idiopathic Parkinson’s disease Rating Scale. In: Fahn S, Marsden CD, Calne D, Goldstein M (eds) Recent developments in Parkinson’s disease (Vol. 2). Florham Park, New Jersey,Mac Millan Healthcare Information, USA, pp 153–164

  27. Flowers KA, Robertson C (1995) Perceptual abnormalities in Parkinson’s disease: top-down or bottom-up processes? Perception 24:1201–1221

    CAS  PubMed  Google Scholar 

  28. Folstein MF, Folstein SE, McHugh PR (1975) Mini Mental State: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198

    Article  CAS  PubMed  Google Scholar 

  29. Gibb WRG, Lees AJ (1988) The prevalence of the Lewy body to the pathogenesis of idiopathic Parkinson’s disease. J Neurol Neurosurg Psychiatry 51:745–752

    Google Scholar 

  30. Grober E, Buschke H (1987) Genuine memory deficits in dementia. Dev Neuropsychol 3:13–36

    Google Scholar 

  31. Hartigan JA (1975) Clustering algorithms. John Wiley & Sons

  32. Hoehn MM, Yahr MD (1967) Parkinsonism: onset, progression and mortality. Neurology 17:427–442

    CAS  PubMed  Google Scholar 

  33. Hughes TA, Ross H, Musa S, Bhattacherjee S, Nathon RN, Mindham RH, Spokes EG (2000) A ten year study of the incidence of and factors predicting dementia in Parkinson’s disease. Neurology 54:1596–1602

    CAS  PubMed  Google Scholar 

  34. Ichise M, Kim YJ, Ballinger JR, Vines D, Erami SS, Tanaka F, Lang AE (1999) SPECT imaging of pre- and postsynaptic dopaminergic alterations in L-dopa-untreated PD. Neurology 52:1206–1214

    CAS  PubMed  Google Scholar 

  35. Jacobs DM, Marder K, Cote LJ, Sano M, Stern Y, Mayeux R (1995) Neuropsychological characteristics of preclinical dementia in Parkinson’s disease. Neurology 45(9):1691–1696

    CAS  PubMed  Google Scholar 

  36. Jagust WH, Johnson KA, Holman BL (1995) SPECT perfusion imaging in the diagnosis of dementia. J Neuroimag 5:545–552

    Google Scholar 

  37. Leung HC, Skudlarski P, Gatenby JC, Peterson BS, Gore JC (2000) An Event-related Functional MRI Study of the Stroop Color Word Interference Task. Cerebral Cortex 10(6):552–560

    CAS  PubMed  Google Scholar 

  38. Levy G, Jacobs DM, Tang MX, Cote LJ, Louis ED, Alfaro B, Mejia H, Stern Y, Marder K (2002) Memory and executive function impairment predict dementia in Parkinson’s disease. Mov Disord 17(6):1221–1226

    PubMed  Google Scholar 

  39. Mahieux F, Fénelon G, Flahault A, Manifacier MJ, Michelet D, Boller F (1998) Neuropsychological prediction of dementia in Parkinson’s disease. J Neurol Neurosurg Psychiatry 64:178–183

    CAS  PubMed  Google Scholar 

  40. Malapani C, Pillon B, Dubois B, Agid Y (1994) Impaired simultaneous cognitive task performance in Parkinson’s disease: a dopamine-related dysfunction. Neurology 44:319–326

    CAS  PubMed  Google Scholar 

  41. Marié RM, Barré L, Dupuy B, Viader F, Defer G, Baron JC (1999) Relationship between striatal dopamine denervation and frontal executive tests in Parkinson’s disease. Neurosci Lett 260:77–80

    PubMed  Google Scholar 

  42. Mattis S (1976) Mental status examination for organic mental syndrome in the elderly patient. In: Bellak L, Karasy TE (eds) Geriatric Psychiatry. New York, Grune and Stratton, pp 77–121

  43. McKeith IG, Galasko D, Kosaka K, Perry EK, Dickson DW, Hansen LA, Salmon DP, Lowe J, Mirra SS, Byrne EJ, Lennox G, Quinn NP, Edwardson JA, Ince PG, Bergeron C, Burns A, Miller BL, Lovestone S, Collerton D, Jansen EN, Ballard C, de Vos RA, Wilcock GK, Jellinger KA, Perry RH (1996) Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB): report of the consortium on DLB international workshop. Neurology 47(5):1113–1124

    CAS  PubMed  Google Scholar 

  44. McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM (1984) Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s disease. Neurology 34:939–944

    CAS  PubMed  Google Scholar 

  45. Mori S (2002) Responses to donepezil in Alzheimer’s disease and Parkinson’s disease, Ann N Y Acad Sci 977:493–500

    CAS  PubMed  Google Scholar 

  46. Neary D, Snowden JS, Shields RA, Burjan AWI, Northen B (1987) Single photon emission tomography using 99mTc-HM-PAO in the investigation of dementia. J Neurol Neurosurg Psychiatry 50:1101–1109

    CAS  PubMed  Google Scholar 

  47. Owen AM, James M, Leigh PN, Summers BA, Marsden CD, Quinn NP, Lange KW, Robbins TW (1992) Fronto-Striatal Cognitive Deficits at Different Stages of Parkinson’s Disease. Brain 115:1727–1751

    PubMed  Google Scholar 

  48. Owen AM, Roberts AC, Hodges JR, Summers BA, Polkey CE, Robbins TW (1993) Contrasting mechanisms of impaired attentional set-shifting in patients with frontal lobe damage or Parkinson’s disease. Brain 116:1159–1175

    PubMed  Google Scholar 

  49. Owen AM, Sahakian BJ, Hodges JR, Summers BA, Polkey CE, Robbins TW (1995) Dopamine-Dependent Frontostriatal Planning Deficits in Early Parkinson’s Disease. Neuropsychology 9(1):126–140

    Google Scholar 

  50. Pardo JV, Pardo PJ, Janer KW, Raichle ME (1990) The anterior cingulate cortex mediates processing selection in the Stroop attentional conflict paradigm. Proc Natl Acad Sci USA 87(1):256–259

    CAS  PubMed  Google Scholar 

  51. Parent A, Hazrati LN (1995) Functional anatomy of the basal ganglia. I. The cortico-basal ganglia-thalamo-cortical loop. Brain Res Rev 20:91–127

    Article  CAS  PubMed  Google Scholar 

  52. Perlmutter JS, Raichle ME (1985) Regional blood flow in hemiparkinsonism. Neurology 35:1127–1134

    CAS  PubMed  Google Scholar 

  53. Peterson BS, Skudlarski P, Gatenby JC, Zhang H, Anderson AW, Gore JC (1999) An fMRI study of Stroop Word-Color Interference: evidence for cingulate subregions subserving multiple distributed attentional systems. Biol Psychiatry 45(10):1237–1258

    CAS  PubMed  Google Scholar 

  54. Picirilli M, D’Alessandro P, Finali G, Piccini GL, Agostini L (1989) Frontal lobe dysfunction in Parkinson’s disease: prognostic value for dementia? Eur Neurol 29:71–76

    PubMed  Google Scholar 

  55. Pillon B, Deweer B, Agid Y, Dubois B (1993) Explicit memory in Alzheimer’s, Huntington’s and Parkinson’s diseases. Arch Neurol 50:374–379

    CAS  PubMed  Google Scholar 

  56. Pillon B, Dubois B, Agid Y (1996) Testing cognition may contribute to the diagnosis of movement disorders. Neurology 46:324–334

    Google Scholar 

  57. Pillon B, Ertle S, Deweer B, Sarazin M, Agid Y, Dubois B (1996) Memory for spatial location is affected in Parkinson’s disease. Neuropsychologia 34(1):77–85

    CAS  PubMed  Google Scholar 

  58. Pillon B, Gouider-Khouja N, Deweer B, Vidaihet M, Malapani C, Dubois B, Agid Y (1995) Neuropsychological pattern of striatonigral degeneration: comparison with Parkinson’s disease and progressive supranuclear palsy. J Neurol Neurosurg Psychiatry 58:174–179

    CAS  PubMed  Google Scholar 

  59. Rinne JO, Portin R, Ruottinen H, Nurmi E, Bergman J, Haaparanta M, Solin O (2000) Cognitive impairment and the brain dopaminergic system in Parkinson disease: [18F]fluorodopa positron emission tomographic study. Arch Neurol 57:470–475

    CAS  PubMed  Google Scholar 

  60. Sarle WS (1993) SAS technical report A-108: cubic clustering criterion. SAS Institute Inc, Cary, NC

  61. Steinling M, Mazingue A, Kassiastis P, Gaudet Y, Fialdes P, Duhamel A, Dubois P, Vergnes R (1988) Le HmPaO-Tc comme indicateur du débit sanguin cérébral local: étude quantifiée comparée à la méthode par inhalation du Xenon 133. Ann Radiol 4:229–237

    Google Scholar 

  62. Swick D, Jovanovic J (2002) Anterior cingulate cortex and the Stroop task; neuropsychological evidence for topographic specificity. Neuropsychologia 40(8):1240–1253

    PubMed  Google Scholar 

  63. Wang SJ, Liu RS, Liu HC, Lin KN, Shan DE, Liao KK, Fuh JL, Lee LS (1993) Technetium99m hexamethylpropylene amine oxime single photon emission tomography of the brain in early Parkinson’s disease: correlation with dementia and lateralization. Eur J Nucl Med 4:339–344

    Google Scholar 

  64. West R, Bell MA (1997) Stroop color-word interference and electroencephalogram activation: evidence for age-related decline of the anterior attention system. Neuropsychology 11(3):421–427

    CAS  PubMed  Google Scholar 

  65. Woods SP, Troster AI (2003) Prodromal frontal/executive dysfunction predicts incident dementia in Parkinson’s disease. J Int Neuropsychol Soc 9(1):17–24

    PubMed  Google Scholar 

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Correspondence to Kathy Dujardin.

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Dujardin, K., Defebvre, L., Duhamel, A. et al. Cognitive and SPECT characteristics predict progression of Parkinson’s disease in newly diagnosed patients. J Neurol 251, 1383–1392 (2004). https://doi.org/10.1007/s00415-004-0549-2

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  • DOI: https://doi.org/10.1007/s00415-004-0549-2

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