Erken evre Parkinson hastalığında kognitif profil

Year 2021, Volume: 46 Issue: 1, 233 - 239, 31.03.2021

Ahmet Evlıce , Meltem Demirkıran , Miray Erdem

Abstract

Amaç: Parkinson hastalığı (PH); striatal dopamin eksikliğine bağlı gelişen motor ve nonmotor semptomlarla karakterize nörodejeneratif bir hastalıktır. Kognitif disfonksiyon PH'ın nonmotor bulgularından biridir. Bu çalışmada erken evre Parkinson hastalığında (EPH) kognitif disfonksiyonların pratik tarama testleri ile belirlenmesi ve kognitif disfonksiyonun EPH’ın klinik şiddeti ile ilişkisinin saptanması amaçlanmıştır.
Gereç ve Yöntem: Çalışmaya erken evre Parkinson hastaları ve sağlıklı kontrol grubu alınmıştır. Olgulara mini mental durum değerlendirmesi (MMSE), sayı menzili (SM), saat çizme (SÇ), sözel ve görsel bellek testleri uygulanmıştır. Parkinson hastalarının kognitif durumları ile Unified Parkinson’s Disease Rating Scale (UPDRS) ve Hoehn & Yahr (H&Y) skorlarının ilişkisi incelenmiştir.
Bulgular: 30 Parkinson hastası (11 kadın/19 erkek) ve 20 sağlıklı (10 kadın/10 erkek) kontrol çalışmaya alınmıştır. Sadece saat çizme testinde PH ve sağlıklı kontrol grubu arasında istatistiksel olarak anlamlı fark gözlenmiştir. H&Y skoru 1 olan olguların H&Y skoru 2 olan olgulara göre görsel bellek, saat çizme ve sayı menzili test skorları daha yüksek saptanmıştır. Sözel bellek test skorlarıyla UPDRS skorları arasında negatif korelasyon gözlenmiştir.
Sonuç: Sağlıklı kontrol grubu ile karşılaştırıldığında EPH’da tek etkilenen kognitif test saat çizme testi olmuştur. Sayı menzili, saat çizme, sözel ve görsel bellek testleri ise hastalığın şiddetinin artmasıyla bozulma göstermiştir. MMSE control grubuna gore farklı olmadığı gibi hastalığın şiddeti ile de farklılık göstermemiştir. Bu durum erken evre Parkinson hastalarını değerlendirirken MMSE’nin yeterli olmadığını, diğer kognitif testlerden de yararlanmak gerektiğini göstermiştir.

Keywords

Parkinson hastalığı, kognisyon, bellek

Cognitive profile in early stage Parkinson disease

Abstract

Purpose: Parkinson’s disease (PD) is a neurodegenerative disorder characterized by both motor and nonmotor symptoms mainly due to striatal dopamine deficiency. Cognitive dysfunction is one of nonmotor symptoms. The purpose of this study is to determine the cognitive dysfunction with practical screening tests and to investigate relationship between cognitive dysfunction and clinical severity in early stage of PD (EPD)
Materials and Methods: EPD patients and healthy control group were included into the study. Mıni mental state examination (MMSE), digit span (DS), clock drawing (CD), verbal and visual memory tests were applied to all cases. Unified Parkinson’s Disease Rating Scale (UPDRS) and Hoehn & Yahr Staging (H&Y) tests were performed to EPD patients. Correlation of neurocognitive tests with UPDRS and H&Y scores were examined in EPD patients.
Results: There were 30 EPD patients (11 female/19 male) and 20 healthy controls (10 female/10 male). There was a significant difference only in CD test between EPD and healthy controls. EPD with H&Y stage 1. group had higher score on backward DS, CD, and visual memory tests than EPD with H&Y stage 2. Verbal memory test scores had negatively correlated with UPDRS scores.
Conclusion: The first impaired test was CD in EPD compared to control group. Other cognitive tests (backward DS, verbal and visual memory tests) were also impaired with increasing severity of disease. MMSE was not different from the control group and did not change with increasing severity of disease. MMSE alone is not enough for evaluating of EPD, other cognitive tests have to be used.

Keywords

Parkinson disease, cognition, memory

References

• 1) Litvan I, Bhatia KP, Burn DJ, Goetz CG, Lang AE, Mckeith I et al. Movement Disorders Society Scientific Issues Committee. Movement Disorders Society Scientific Issues Committee report: SIC Task Force appraisal of clinical diagnostic criteria for Parkinsonian disorders. Mov Disord. 2003; 18(5):467-86.
• 2)Kalaitzakis ME, Pearce RK. The morbid anatomy of dementia in Parkinson's disease. Review. Acta Neuropathol. 2009;118(5):587-98.
• 3) Zgaljardic DJ, Borod JC, Foldi NS, Mattis PJ, Gordon MF, Feigin A et al. An examination of executive dysfunction associated with frontostriatal circuitry in Parkinson's disease. J Clin Exp Neuropsychol. 2006; 28(7):1127-44.
• 4) Katz S, Ford AB, Moskowıtz RW, Jackson BA, Jaffe MW. Studıes Of Illness In The Aged. The Index Of Adl: A Standardızed Measure Of Bıologıcal And Psychosocıal Functıon. Jama. 1963; 21;185:914-9.
• 5) Yesavage JA. Geriatric Depression Scale. Psychopharmacol Bull. 1988; 24(4):709-11.
• 6) Keskinoglu P, Ucku R, Yener G, Yaka E, Kurt P, Tunca Z. Reliability And Validity Of Revised Turkish Version Of Mini Mental State Examination (Rmmse-T) İn Community-Dwelling Educated And Uneducated Elderly. Int J Geriatr Psychiatry. 2009; 24(11):1242-50.
• 7) Wechsler D.Wechsler Adult Intelligence Scale,3 Rd Ed. (Waıs Ш): Test Manual 3 Rd Edn. New York: Psychological Corporation, 1997.
• 8) Leazak D. Neuropsychological Assesment. Newyork: Newyork Univesity Press;1983.
• 9) Carlesimo Ga, Caltagirone C, Gainotti G. The Mental Deterioration Battery: normative data, diagnostic reliability and qualitative analyses of cognitive impairment. The Group for the Standardization of the Mental Deterioration Battery. Eur Neurol. 1996; 36(6):378-84.
• 10) Movement Disorder Society Task Force on Rating Scales for Parkinson's Disease. The Unified Parkinson's Disease Rating Scale (UPDRS): status and recommendations. Review. Mov Disord. 2003;18(7):738-50.
• 11) Hoehn MM, Yahr MD. Parkinsonism: onset, progression and mortality. Neurology. 1967; 17:427–42.
• 12) Silbert LC, Kaye J. Neuroimaging and cognition in Parkinson's disease dementia. Review. Brain Pathol. 2010 ;20(3):646-53.
• 13) Brown RG, Marsden CD. 'Subcortical dementia': the neuropsychological evidence. Neuroscience. 1988;25(2):363-87.
• 14) Riedel O, Klotsche J, Förstl H, Wittchen HU. GEPAD Study Group. Clock drawing test: is it useful for dementia screening in patients having Parkinson disease with and without depression. J Geriatr Psychiatry Neurol. 2013 ;26(3):151-7.
• 15) Saur R, Maier C, Milian M, Riedel E, Berg D, Liepelt-Scarfone I et al. Clock test deficits related to the global cognitive state in Alzheimer's and Parkinson's disease. Dement Geriatr Cogn Disord. 2012; 33(1):59-72.
• 16) Saka E, Elibol B. Enhanced cued recall and clock drawing test performances differ in Parkinson's and Alzheimer's disease-related cognitive dysfunction. Parkinsonism Relat Disord. 2009; 15(9):688-91.
• 17) Dalrymple-Alford JC, Kalders AS, Jones RD, Watson RW. A central executive deficit in patients with Parkinson's disease. J Neurol Neurosurg Psychiatry. 1994;57(3):360-7.
• 18) Whittington CJ, Podd J, Stewart-Williams S. Memory deficits in Parkinson's disease. J Clin Exp Neuropsychol. 2006; 28(5):738-54.
• 19) Brown RG, Marsden CD, Quinn N, Wyke MA. Alterations in cognitive performance and affect-arousal state during fluctuations in motor function in Parkinson's disease. J Neurol Neurosurg Psychiatry. 1984; 47(5):454-65.
• 20) Hughes TA, Ross HF, Musa S, Bhattacherjee S, Nathan RN, Mindham RH et al. A 10-year study of the incidence of and factors predicting dementia in Parkinson's disease. Neurology. 2000; 54(8):1596-602.