Effect of clinical autonomic dysfunction on cognitive functions in Parkinson’s disease

Year 2017, Volume: 44 Issue: 3, 225 - 231, 20.09.2017

Dursun Aygun Cetin Kursad Akpinar , Serpil Yon Musa Kazım Onar

https://doi.org/10.5798/dicletip.338976

Cited By: 3

Abstract

Objective: Parkinson’s disease (PD) is a chronic progressive neurodegenerative disorder characterized by tremor, rigidity, bradykinesia, and postural instability. PD also involves nonmotor manifestations such as autonomic failure, cognitive disorders, and sleep disorders. These clinical characteristics are not identical in severity, frequency, and onset time in all PD patients. We assessed whether there is a negative effect on cognition of clinical autonomic
dysfunction in PD patients.

Methods: This prospective
study includes 37 PD patients with autonomic failure. From each patient, a questionnaire (SCOPA-AUT) including
 symptoms
 associated  with  clinical
 autonomic
 dysfunction such  as
 constipation,  urinary
incontinence, orthostatic
hypotension, and hyperhydrosis was obtained and the patient’s clinical condition was rated
on the Hoehn and Yahr (H-Y) scale in the ON-medication
state. The patients’ cognitive function was assessed by the Mini-Mental State Examination (MMSE), Blessed score, Frontal Assessment Battery (FAB), and Digid Span Test (DST)
(forward, reverse). Cognitive test scores were compared with SCOPA-OUT scores.

Results: Mean age was 66,5±11.2 years. There was no correlation between cognitive test scores and SCOPA
-OUT scores  (p>0.05).  However,
 H-Y
 scores  were
 negatively correlated 
with  the  DSTf,  DSTr,  FAB,
 and
 MMSE  scores
(p50.005, r:-0.451;
p50.025, r: -0.367; p50.040, r:
-0.340; p50.044, r5-0.333, respectively).

Conclusions: According to our results, clinical autonomic dysfunction did not seem to ha ve an effect on cognition. In addition, severity of cognitive dysfunction showed a strong negative correlation with the stage of disease.

Keywords

Blessed score, Clinical autonomic dysfunction, Cognitive test, Parkinson’s disease

References

• 1. Aarsland D, Anderson K, Larsen JP, et al. Prevalence and characteristics of dementia in Parkinson disease. A8-year prospective study. Arch Neurol. 2003; 60:387–92.
• 2. Werner Poewe. Dysautonomia and Cognitive Dysfunction in Parkinson’s Disease. Mov Disord. 2007;22:374-8.
• 3. Hughes AJ, Daniel SE, Kilford L, Lees AJ. Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinico pathological study of 100 cases. J Neurol Neurosurg Psychiatry. 1992; 55:181–4.
• 4. Pfeiffer RF. Non-motor Parkinsonism. Parkinsonism Relat Disord. 2007; 13:211–20.
• 5. Chaudhuri KR, Naidu Y. Early Parkinson's disease and non-motor issues. J Neurol. 2008; 5:33-8.

• 6. Idiaquez J, Benarroch EE, Rosales H, et al. Autonomic and Cognitive dysfunction in Parkinson’s disease. Clin Auton Res. 2007; 17:93–8.
• 7. Dubois B, Slachevsky A, Litvan I, Pillon B. The FAB a frontal assessment battery at bedside. Neurology.2000;55: 1621–6.
• 8. Martínez-Martín P, Benito-León J, Burguera JA, et al. The SCOPA-Motor Scale for assessment of Parkinson’s disease is a consistent and valid measure. J Clin Epidemiol. 2005; 58:674–9.
• 9. Hoehn M, Yahr M. Parkinsonism: onset, progression and mortality. Neurology. 1967; 17:427–42.
• 10. O’Sullivan SS, Williams DR, Gallagher DA, et al. Non motor symptoms as presenting complaints in Parkinson’s disease: a clinicopathological study. Mov Disord. 2008; 23: 101-6. 

• 11. Braak H, Del Tredici K, Rüb U, et al. Staging of brain pathology related to sporadic Parkinson’s disease. Neurobiol Aging. 2003; 24:197-210.
• 12. Aarsland D, Kurtz MW. The epidemiology of dementia associated with Parkinson’s disease. J Neurol Sci. 2010; 289:18-22.
• 13. Braak H, Rüb U, Del Tredici K. Cognitive decline correlates with neuropathological stage in Parkinson's disease. J Neurol Sci. 2006; 248:255-8.
• 14. Anang JBM, Gagnon JF, Bertrand JA, et al. Predictors of dementia in Parkinson disease. A prospective cohort study. Neurology. 2014; 83:1253–60.
• 15. Uc EY, McDermott MP, Marder KS, et al.; Parkinson Study Group DATATOP Investigators. Incidence of and risk factors for cognitive impairment in an early Parkinson disease clinical trial cohort. Neurology.2009; 73: 1469–77.
• 16. Hely MA, Morris JG, Reid WG, Trafficante R. Sydney Multicenter Study of Parkinson's disease: non-L-dopa- responsive problems dominate at 15 years. Mov Disord.2005; 20:190-9.
• 17. Pillon B, Boller F, Levy R, Dubois B. Cognitive deficits and dementia in parkinson's disease: In: Boller F, Cappa S. editors. Handbook of Neuropsychology. Amsterdam: Elsevier; 2001:ed: 2, pp 311-71.
• 18. Martinez-Martin P, Schapira AH, Stocchi F, et al. Prevalence of nonmotor symptoms in Parkinson’s disease in an international setting; study using nonmotor symptoms questionnaire in 545 patients. Mov Disord. 2007; 22:1623-9.
• 19. Oh ES, Lee JH, Seo JG, et al. Autonomic and cognitive functions in Parkinson’s disease (PD). Arch of Gerontol Geriatr. 2011; 52:84–8.
• 20. Magerkurth C, Schnitzer R, Braune S. Symptoms of autonomic failure in Parkinson’s disease: prevalence and impact on daily life. Clin Auton Res. 2005; 15:76–82.
• 21. Allcock L. Orthostatic hypotension in Parkinsons disease. ACNR. 2010; 10:51-2.
• 22. Rowe JB, Hughes L, Ghosh BC, et al. Parkinson's disease and dopaminergic therapy – differential effects on movement reward and cognition. Brain. 2008; 131:2094-105. 

• 23. Kaye JM, Young TM, Mathias CJ, et al. Neuro- endocrine and behavioural responses to CO2 inhalation in central versus peripheral autonomic failure. Clin Auton Res. 2006; 16:121-9.