Parkinson-Dementia Complex (PDC) is a neurodegenerative disorder that occurs almost exclusively in the indigenous Chamorro population on the Marianas island of Guam. Parkinsonism typically occurs concomitantly with the onset of dementia and is essentially identical to that of idiopathic Parkinson's disease (PD). PDC is a tauopathy characterized by neurofibrillary tangles and neuron loss in a number of brainstem nuclei, limbic structures, and association cortices. There is little deposition of amyloid and alpha-synuclein pathology is rare. A pure dementia syndrome without significant motor abnormality is also quite prevalent in Guam's elderly Chamorro population. Little is known about the underlying neuropathology of this late-life Guam dementia (GD), but it has been variably associated with Alzheimer's disease (AD) or PDC pathology in a handful of cases. The dementia syndromes of PDC and GD have not been carefully characterized, but clinical reports suggest that they usually begin with forgetfulness, disorientation, and difficulty with problem solving and calculations. A battery of culturally-adapted neuropsychological tests was administered to Chamorro patients with clinically-diagnosed PDC (n = 37) or GD (n = 55), and to healthy Chamorro elderly control (EC) subjects (n = 45). The tests were chosen to be sensitive to cognitive changes associated with PD or AD, and included measures of memory, attention, language, executive function, visuospatial ability, and psychomotor speed. Patients with PDC and GD were impaired relative to EC subjects on all neuropsychological tests and exhibited similar profiles of deficits that included frank amnesia (i.e., poor learning, abnormally rapid forgetting, impaired free recall and recognition memory), mild aphasia (i.e., anomia, verbal fluency impairment), executive dysfunction, and constructional apraxia. This qualitative pattern of deficits resembles that of the cortico-limbic dementia syndrome of AD. However, some features of fronto-striatal dysfunction were also evident (i.e., set shifting deficits, equally poor semantic and letter fluency), even in those without Parkinsonism. The striking similarities in the cognitive profiles associated with PDC and GD suggest that the two conditions may reflect different points along a spectrum of a single disease in the Chamorro population. The dementia syndrome appears largely cortico-limbic in nature and may reflect the tauopathy common to both disorders.
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