Abstract
Parkinson’s disease (PD) is a common, disabling, neurodegenerative disorder. In addition to classical motor symptoms, non-motor features are now widely accepted as part of the clinical picture, and cognitive decline is a very important aspect of the disease, as it brings an additional significant burden for the patient and caregivers. The diagnosis of cognitive decline in PD, namely mild cognitive impairment (MCI) and dementia, can be extremely challenging, remaining largely based on clinical and cognitive assessments. Diagnostic criteria and methods for PD dementia and MCI have been recently issued by expert work groups. This manuscript has synthesized relevant data in order to obtain a pragmatic and updated review regarding cognitive decline in PD, from milder stages to dementia. This text will summarize clinical features, diagnostic methodology, and therapeutic issues of clinical decline in PD. Relevant clinical genetic issues, including recent advances, will also be approached.
Highlights
Parkinson’s disease (PD) is the second most common neurodegenerative disorder, following Alzheimer’s disease
PD-D patients typically present with dysexecutive syndrome, fluctuating attentional deficits, visuospatial impairment, and memory dysfunction, associated with behavioral symptoms (Emre et al, 2007a), which include depression, anxiety, apathy, delusions, and recurrent prominent complex visual hallucinations that may seem disproportionate to the severity of dementia
False positives had less severe motor symptoms than true PD-D, the difference did not reach statistical significance. These findings suggest that the MDS criteria are more sensitive than DSM-IV for diagnosing PD-D, and that it could be more difficult to diagnose PD-D in older patients, as well as those with less psychotic symptoms or severe motor impairment (Martinez-Martin et al, 2011)
Summary
Parkinson’s disease (PD) is the second most common neurodegenerative disorder, following Alzheimer’s disease. Due to long term progression and the mode of pathological spreading, some of the non-motor features of PD may be present before any of the classical motor signs are noticeable, sometimes for years or even decades, which may lend them potential utility as supportive diagnostic features in early disease stages – these include hyposmia, rapid eye movement (REM) sleep behavior disorder, constipation, and depression (Chaudhuri and Schapira, 2009; Lim et al, 2009; Tolosa et al, 2009; Hawkes et al, 2010; Savica et al, 2010; Schapira and Tolosa, 2010) Patients may have these and other symptoms before overt motor signs emerge and the clinical diagnosis is established. The present manuscript will cover the clinical aspects of cognitive decline in PD, namely mild cognitive impairment (MCI), and dementia (PD-D), including typical features, diagnosis, and management issues
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