Addenbrooke's Cognitive Examination and Individual Domain Cut-Off Scores for Discriminating between Different Cognitive Subtypes of Parkinson's Disease.

Dagmar Berankova,Irena Rektorova,Milena Kostalova,Martina Mrackova,Eva Janousova,Ilona Eliasova,Svetlana Skutilova

doi:10.1155/2015/579417

Abstract

Objective. The main aim of this study was to verify the sensitivity and specificity of Addenbrooke's Cognitive Examination-Revised (ACE-R) in discriminating between Parkinson's disease (PD) with normal cognition (PD-NC) and PD with mild cognitive impairment (PD-MCI) and between PD-MCI and PD with dementia (PD-D). We also evaluated how ACE-R correlates with neuropsychological cognitive tests in PD. Methods. We examined three age-matched groups of PD patients diagnosed according to the Movement Disorder Society Task Force criteria: PD-NC, PD-MCI, and PD-D. ROC analysis was used to establish specific cut-off scores of ACE-R and its domains. Correlation analyses were performed between ACE-R and its subtests with relevant neuropsychological tests. Results. Statistically significant differences between groups were demonstrated in global ACE-R scores and subscores, except in the language domain. ACE-R cut-off score of 88.5 points discriminated best between PD-MCI and PD-NC (sensitivity 0.68, specificity 0.91); ACE-R of 82.5 points distinguished best between PD-MCI and PD-D (sensitivity 0.70, specificity 0.73). The verbal fluency domain of ACE-R demonstrated the best discrimination between PD-NC and PD-MCI (cut-off score 11.5; sensitivity 0.70, specificity 0.73) while the orientation/attention subscore was best between PD-MCI and PD-D (cut-off score 15.5; sensitivity 0.90, specificity 0.97). ACE-R scores except for ACE-R language correlated with specific cognitive tests of interest.

Highlights

Parkinson’s disease (PD) is considered to be a motor disorder, but nonmotor symptoms have recently attracted more attention as they have a major impact on patient quality of life [1, 2]
69 patients with PD were enrolled in the study: 22 PD with normal cognition (PD-NC), 37 PD with mild cognitive impairment (PD-mild cognitive impairment (MCI)), and 10 PD with dementia (PD-D) according to published criteria [5, 6] (Table 1)
A comparison of the clinical characteristics of PD-NC, PD-MCI, and PD-D patients reveals that there were no differences between the groups in sex, age, PD duration, or UPDRS III (Table 1)

Summary

Introduction

Parkinson’s disease (PD) is considered to be a motor disorder, but nonmotor symptoms have recently attracted more attention as they have a major impact on patient quality of life [1, 2]. The major risk factors for developing dementia associated with PD are higher age, more severe Parkinsonism, postural instability with gait difficulty, and mild cognitive impairment at the time of evaluation. PD is often associated with some type of cognitive decline even in the absence of fully blown dementia, and mild cognitive impairment (MCI) is present in about 25% of PD patients [6,7,8]. MCI is characterized by subjective and objective deterioration of cognitive functions with retention of normal social life and daily functioning [9].

Methods

Results

Conclusion