Sensitivität und Spezifität des „Parkinson Neuropsychometric Dementia Assessment” (PANDA): Ergebnisse der GEPAD-Studie

Abstract

INTRODUCTION Cognitive dysfunctions and dementia frequently occur in patients with idiopathic Parkinson's disease (PD) but are often underestimated in daily routine diagnosis. We examined the sensitivity of the new cognitive screening tool, the Parkinson Neuropsychometric Dementia Assessment (PANDA), in a patient population that was independent of the tool's normative study and compared its sensitivity and specifity to that of Folstein's Mini Mental State Examination (MMSE). METHODS PANDA and MMSE scores of 304 PD patients taken from the German large-scale GEPAD” study on the epidemiology of PD with dementia were analysed and compared with those of the control group (CG) from the PANDA normative study (108 healthy subjects, mean age 60.3, SD = 9.9). The patients were classified as either having no cognitive impairment (PD, n = 221, mean age: 68.9, SD = 8.3 years) or dementia (PDD, n = 84, mean age 72.7, SD = 5.8 years) based on a neurologist's expert rating. RESULTS In a multivariate analysis of variance controlled for age and education followed by post-hoc tests for multiple comparisons, the PDD patients were impaired both in the PANDA and the MMSE compared to the CG and the PD group (p < 0.001). The PD group did not differ significantly from the CG in either test. The specificity and sensitivity (CG versus PDD) of the PANDA were 91 % and 86 %, respectively, and 98 % and 55 % for the MMSE. 27 % of the non-demented PD patients scored below the cut-off score for cognitive dysfunction in the PANDA and, in fact, were impaired in the word generation task according to a subtest analysis. In the MMSE only 2 % of the PD patients were classified to have cognitive impairment. CONCLUSION With its high specificity and sensitivity, the PANDA is an efficient tool to detect dementia in PD patients in an outpatient setting, and its sensitivity is higher than that of the MMSE. Mild cognitive dysfunctions which do not reach the level of dementia according to an expert rating can be detected with the PANDA.