- Email: [email protected]
P1.036 Diagnosis of dementia in Parkinson's disease: a retrospective and a validation study in the clinical practice
S38
Poster presentations / Parkinsonism and Related Disorders 15S2 (2009) S29–S199
P1.035 The correlation on clinical characteristics between Parkinson disease with dementia and Alzheimer disease A. Ma. Neurology, Affiliated Hospital of Qingdao University, Qingdao, China Objective: To explore the incidence of dementia in Parkinson’s disease (PD) and the extrapyramidal signs (EPS) in Alzheimer disease (AD) and the similarities and the differences in neuropsychological characteristics between PDD and AD. Methods: 336 PD patients were enrolled and given detailed clinical investigations, physical examination and mini-mental state examination, while 112 AD patients were given investigations about the occurrence of EPS. Results: The incidence of PDD was 30.36 percent. There was significant positive correlation between MMSE score and the years of education, significant negative correlation between MMSE score and the degree of hallucination, the onset age, motor dysfunction. The incidence of EPS in AD was 29.51 percent. The risk factors were the age of patients and the course of AD. The occurrence of PDD was affected much more by environmental factors, while the occurrence of AD was affected more by genetic and vascular factors. The memory impairments of PDD were less than that of AD, but the executive functioning and visuospatial disturbance were more serious than that of AD. The incidence of hallucination in PDD is much more than that in AD. Conclusions: There are much more overlaps in clinical characteristics between PD and AD. About 30 percent patients show both dementia and EPS. There are much more overlaps and significant differences between the clinical characteristics of PDD and AD. P1.036 Diagnosis of dementia in Parkinson’s disease: a retrospective and a validation study in the clinical practice N. Vanacore1 , P. Stirpe2 , P. Giustini2 , E. Di Battista2 , S. Bernardi2 , G. Meco2 . 1 Istituto Superiore di Sanit` a, 2 Centro Malattia di Parkinson, D.A.I. Neurologia e Psichiatria, Universit` a di Roma ‘La Sapienza’, Roma, Italy Objective: In literature the incidence of dementia in Parkinson’s disease per 1000 person-years varies from 30 to 112.5 cases. This variability was due to numerous methodological problems. Recently, the Dementia in Parkinson’s disease (PD-D) Task force has proposed diagnostic criteria for the diagnosis of PD-D. In particular, two levels were identified, one as a screening tool, while the second level was more specific to define the pattern and the severity of PD-D. This two phase process has not been validated yet. The validation study will allow to establish the predictive positive and negative value of first level screening in comparison to second level phase of process proposed by PD-D task Force. The aim of this study is to estimate retrospectively the incidence of dementia in a cohort of Parkinson’s disease patients and to valuate the criteria proposed by PD-D Task Force. Materials and Methods: For retrospective study, 480 PD patients were recruited. On the basis of information reported in clinical records a diagnosis of dementia was fixed. Discussion and Conclusion: Thirty-five out of 374 (9.3%) prevalent Parkinson’s disease cases had developed dementia at mean of 5.1 years from first visit corresponding to an dementia incidence of 18.4 per 1000 (12.4–24.4) person-years. 30 PD patients were enrolled to valuate the criteria proposed by PD-D Task Force. On the basis of preliminary results the predictive positive and negative value of first level screening in comparison to second level phase seems to validate the process proposed by PD-D Task Force.
P1.037 The importance of oxidative stress in dementia progression M. Padurariu1 , C. Stefanescu1 , A. Ciobica2 , B. Stoica1 . 1 Gr. T. Popa University, 2 Alexandru Ioan Cuza University, Iasi, Romania Background: Mild cognitive impairment (MCI) is a transitional stage between normal cognitive aging and dementia. There is a great interest in understanding the relationship between MCI and the progression to dementia. Several studies showed the importance of oxidative stress in the pathogenesis of many neurodegenerative diseases including Alzheimer’s disease and Parkinson’s disease. The aim of this study was to determine the oxidative stress status in MCI and demented patients. Methods: The patients were selected using Petersen criteria for MCI and NINCDS ADRDA criteria for dementia. The cognitive performance was assessed using MMSE (Mini Mental State Examination), ADAS-cog (Alzheimer’s Disease Assessment Scale – cognitive subscale), Clock Drawing Test and Verbal Fluency Test. We assessed the levels of some enzymatic antioxidant defences like superoxide dismutase (SOD) and glutathione peroxidase (GPX), as well as lipid oxidation makers like MDA (malondialdehyde), using chemiluminometric and spectrophotometric methods. The results were compared to an aged-matched control group. Results: Alterations in the activity of the antioxidant enzymes (SOD and GPX) were found in MCI and demented patients peripheral blood compared to age-matched controls. Also, MDA levels were significantly increased in the demented and MCI patients, comparative with the control group. Moreover, in MCI patients, cognitive function positively correlates with antioxidant levels. Conclusions: These results support the hypothesis that oxidative damage is an important event in the pathogenesis of neurodegenerative diseases. Also, it seems that some peripheral markers of oxidative stress appear in MCI with a similar pattern to that observed in dementia. P1.038 Rivastigmine treatment effects and the relationship between executive function and cognition, behavior and ADLs in Parkinson’s disease dementia F. Schmitt1 , M. Farlow2 , J. Olin3 , X. Meng3 . 1 Sanders-Brown Center on Aging, Univerity of Kentucky, Lexington, KY, 2 Indiana University School of Medicine, Indianapolis, IL, 3 Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA Background: Rivastigmine has demonstrated significant improvements in cognition, behavior and activities of daily living (ADL) in Parkinson’s disease dementia (PDD). Methods: Retrospective analysis of a randomized trial of rivastigmine in PDD (EXPRESS, CENA713B2311). Pearson correlation coefficients were calculated between baseline or change from baseline in Delis-Kaplan Executive Function System letter fluency test (D-KEFS) and change from baseline to Week 24 in Alzheimer’s Disease Assessment Scale-cognitive (ADAS-cog), Alzheimer’s Disease Cooperative Study-Clinicians Global Impression of Change (ADCS-CGIC), ADCS-ADL and Neuropsychiatric Inventory (NPI-12) (observed case analysis). Results: 361 and 179 PDD patients were randomized to 12 mg/day rivastigmine and placebo, respectively. Rivastigmine showed statistically significant superiority versus placebo in terms of D-KEFS, ADAS-cog, ADCS-CGIC, ADCS-ADL, and NPI-10 at Week 24 (LOCF analysis). Overall, change from baseline to Week 24 in D-KEFS was correlated with change in ADAS-cog (r = −0.31, p < 0.0001), ADCS-CGIC (r = −0.22, p < 0.0001), and change in ADCS-ADL (r = 0.27, p < 0.0001). There were no significant correlations with baseline D-KEFS. Conclusion: Change in the D-KEFS measure of executive function correlated with changes in cognition and ADL scores in this study of PDD patients.
Poster presentations / Parkinsonism and Related Disorders 15S2 (2009) S29–S199
P1.035 The correlation on clinical characteristics between Parkinson disease with dementia and Alzheimer disease A. Ma. Neurology, Affiliated Hospital of Qingdao University, Qingdao, China Objective: To explore the incidence of dementia in Parkinson’s disease (PD) and the extrapyramidal signs (EPS) in Alzheimer disease (AD) and the similarities and the differences in neuropsychological characteristics between PDD and AD. Methods: 336 PD patients were enrolled and given detailed clinical investigations, physical examination and mini-mental state examination, while 112 AD patients were given investigations about the occurrence of EPS. Results: The incidence of PDD was 30.36 percent. There was significant positive correlation between MMSE score and the years of education, significant negative correlation between MMSE score and the degree of hallucination, the onset age, motor dysfunction. The incidence of EPS in AD was 29.51 percent. The risk factors were the age of patients and the course of AD. The occurrence of PDD was affected much more by environmental factors, while the occurrence of AD was affected more by genetic and vascular factors. The memory impairments of PDD were less than that of AD, but the executive functioning and visuospatial disturbance were more serious than that of AD. The incidence of hallucination in PDD is much more than that in AD. Conclusions: There are much more overlaps in clinical characteristics between PD and AD. About 30 percent patients show both dementia and EPS. There are much more overlaps and significant differences between the clinical characteristics of PDD and AD. P1.036 Diagnosis of dementia in Parkinson’s disease: a retrospective and a validation study in the clinical practice N. Vanacore1 , P. Stirpe2 , P. Giustini2 , E. Di Battista2 , S. Bernardi2 , G. Meco2 . 1 Istituto Superiore di Sanit` a, 2 Centro Malattia di Parkinson, D.A.I. Neurologia e Psichiatria, Universit` a di Roma ‘La Sapienza’, Roma, Italy Objective: In literature the incidence of dementia in Parkinson’s disease per 1000 person-years varies from 30 to 112.5 cases. This variability was due to numerous methodological problems. Recently, the Dementia in Parkinson’s disease (PD-D) Task force has proposed diagnostic criteria for the diagnosis of PD-D. In particular, two levels were identified, one as a screening tool, while the second level was more specific to define the pattern and the severity of PD-D. This two phase process has not been validated yet. The validation study will allow to establish the predictive positive and negative value of first level screening in comparison to second level phase of process proposed by PD-D task Force. The aim of this study is to estimate retrospectively the incidence of dementia in a cohort of Parkinson’s disease patients and to valuate the criteria proposed by PD-D Task Force. Materials and Methods: For retrospective study, 480 PD patients were recruited. On the basis of information reported in clinical records a diagnosis of dementia was fixed. Discussion and Conclusion: Thirty-five out of 374 (9.3%) prevalent Parkinson’s disease cases had developed dementia at mean of 5.1 years from first visit corresponding to an dementia incidence of 18.4 per 1000 (12.4–24.4) person-years. 30 PD patients were enrolled to valuate the criteria proposed by PD-D Task Force. On the basis of preliminary results the predictive positive and negative value of first level screening in comparison to second level phase seems to validate the process proposed by PD-D Task Force.
P1.037 The importance of oxidative stress in dementia progression M. Padurariu1 , C. Stefanescu1 , A. Ciobica2 , B. Stoica1 . 1 Gr. T. Popa University, 2 Alexandru Ioan Cuza University, Iasi, Romania Background: Mild cognitive impairment (MCI) is a transitional stage between normal cognitive aging and dementia. There is a great interest in understanding the relationship between MCI and the progression to dementia. Several studies showed the importance of oxidative stress in the pathogenesis of many neurodegenerative diseases including Alzheimer’s disease and Parkinson’s disease. The aim of this study was to determine the oxidative stress status in MCI and demented patients. Methods: The patients were selected using Petersen criteria for MCI and NINCDS ADRDA criteria for dementia. The cognitive performance was assessed using MMSE (Mini Mental State Examination), ADAS-cog (Alzheimer’s Disease Assessment Scale – cognitive subscale), Clock Drawing Test and Verbal Fluency Test. We assessed the levels of some enzymatic antioxidant defences like superoxide dismutase (SOD) and glutathione peroxidase (GPX), as well as lipid oxidation makers like MDA (malondialdehyde), using chemiluminometric and spectrophotometric methods. The results were compared to an aged-matched control group. Results: Alterations in the activity of the antioxidant enzymes (SOD and GPX) were found in MCI and demented patients peripheral blood compared to age-matched controls. Also, MDA levels were significantly increased in the demented and MCI patients, comparative with the control group. Moreover, in MCI patients, cognitive function positively correlates with antioxidant levels. Conclusions: These results support the hypothesis that oxidative damage is an important event in the pathogenesis of neurodegenerative diseases. Also, it seems that some peripheral markers of oxidative stress appear in MCI with a similar pattern to that observed in dementia. P1.038 Rivastigmine treatment effects and the relationship between executive function and cognition, behavior and ADLs in Parkinson’s disease dementia F. Schmitt1 , M. Farlow2 , J. Olin3 , X. Meng3 . 1 Sanders-Brown Center on Aging, Univerity of Kentucky, Lexington, KY, 2 Indiana University School of Medicine, Indianapolis, IL, 3 Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA Background: Rivastigmine has demonstrated significant improvements in cognition, behavior and activities of daily living (ADL) in Parkinson’s disease dementia (PDD). Methods: Retrospective analysis of a randomized trial of rivastigmine in PDD (EXPRESS, CENA713B2311). Pearson correlation coefficients were calculated between baseline or change from baseline in Delis-Kaplan Executive Function System letter fluency test (D-KEFS) and change from baseline to Week 24 in Alzheimer’s Disease Assessment Scale-cognitive (ADAS-cog), Alzheimer’s Disease Cooperative Study-Clinicians Global Impression of Change (ADCS-CGIC), ADCS-ADL and Neuropsychiatric Inventory (NPI-12) (observed case analysis). Results: 361 and 179 PDD patients were randomized to 12 mg/day rivastigmine and placebo, respectively. Rivastigmine showed statistically significant superiority versus placebo in terms of D-KEFS, ADAS-cog, ADCS-CGIC, ADCS-ADL, and NPI-10 at Week 24 (LOCF analysis). Overall, change from baseline to Week 24 in D-KEFS was correlated with change in ADAS-cog (r = −0.31, p < 0.0001), ADCS-CGIC (r = −0.22, p < 0.0001), and change in ADCS-ADL (r = 0.27, p < 0.0001). There were no significant correlations with baseline D-KEFS. Conclusion: Change in the D-KEFS measure of executive function correlated with changes in cognition and ADL scores in this study of PDD patients.