Abstract
There is a high prevalence of mild cognitive impairment (MCI) and dementia in Parkinson's disease (PD) patients, but a Chinese version of cognitive rating scale that is specific and sensitive to PD patients is still lacking. The aims of this study are to test the reliability and validity of a Chinese version of Parkinson's disease-cognitive rating scale (PD-CRS), establish cutoff scores for diagnosis of Parkinson's disease dementia (PDD) and PD with mild cognitive impairment (PD-MCI), explore cognitive profiles of PD-MCI and PDD, and find cognitive deficits suggesting a transition from PD-MCI to PDD. PD-CRS was revised based on the culture background of Chinese people. Ninety-two PD patients were recruited in three PD centers and were classified into PD with normal cognitive function (PD-NC), PD-MCI, and PDD subgroups according to the cognitive rating scale (CDR). Those PD patients underwent PD-CRS blind assessment by a separate neurologist. The PD-CRS showed a high internal consistency (Cronbach's Alpha = 0.840). Intraclass Correlation coefficient (ICC) of test-retest reliability reached 0.906 (95% CI 0.860–0.935, p < 0.001). ICC of inter-rater reliability was 0.899 (95% CI 0.848–0.933, p < 0.001). PD-CRS had fair concurrent validity with MDRS (ICC = 0.731, 95% CI 0.602–0.816). All the frontal-subcortical items showed significant decrease in PD-MCI compared with the PD-NC group (p ≤ 0.001), but the instrument cortical items did not (confrontation naming p=0.717, copying a clock p=0.620). All the frontal-subcortical and instrumental-cortical functions showed significant decline in PDD compared with the PD-NC group (p ≤ 0.001). The cutoff value for diagnosis of PD-MCI is 80.5 with the sensitivity of 75.7% and the specificity of 75.0%, and for diagnosis of PDD is 73.5 with the sensitivity of 89.2% and the specificity of 98.9%. Revised Chinese version of PD-CRS is a reliable, acceptable, valid, and useful neuropsychological battery for assessing cognition in PD patients.
Highlights
Cognitive impairment is common in Parkinson’s disease (PD), even in its early stages
China has over 2 million PD patients, but cognitive impairment is substantially underestimated because of the lack of a Chinese version neuropsychological evaluation tool specific for PD patients. e aims of the present study are to test the reliability and validity of the Chinese version PDCRS; establish cutoff scores for diagnosis of Parkinson’s disease dementia (PDD) and PDMCI; explore cognitive profiles of PD-Mild cognitive impairment (MCI) and PDD; and find cognitive deficits suggesting a transition from PD with mild cognitive impairment (PD-MCI) to PDD
Ceiling scores were found in confrontation naming, clock drawing, and copying a clock in PD patients analyzed as a whole, but the ceiling scores were mainly distributed among PD with normal cognitive function (PD-NC) patients, and those items were still able to discriminate cognitive impairments in PD-MCI and PDD patients
Summary
Cognitive impairment is common in Parkinson’s disease (PD), even in its early stages. Four neuropsychological evaluation tools have been designed for PD patients so far. Scale for Outcomes of Parkinson’s Disease-Cognition (SCOPA-COG) is a reliable and valid instrument for assessing “frontal-subcortical” function, but the “instrumental-cortical” function is missing [12], which has been identified in approximately 15–20% of PD patients [6]. Parkinson’s disease-cognitive rating scale (PD-CRS), designed by Dr Kulisevsky, is a comprehensive, reliable, and valid instrument for assessing both “frontal-subcortical” functions (sustained attention, working memory, alternating and action verbal fluencies, clock drawing, and immediate and delayed free-recall verbal memory) and “instrumentalcortical” functions (confrontation naming, copying a clock) [13,14,15]. China has over 2 million PD patients, but cognitive impairment is substantially underestimated because of the lack of a Chinese version neuropsychological evaluation tool specific for PD patients. China has over 2 million PD patients, but cognitive impairment is substantially underestimated because of the lack of a Chinese version neuropsychological evaluation tool specific for PD patients. e aims of the present study are to test the reliability and validity of the Chinese version PDCRS; establish cutoff scores for diagnosis of PDD and PDMCI; explore cognitive profiles of PD-MCI and PDD; and find cognitive deficits suggesting a transition from PD-MCI to PDD
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