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Cognitive function in Parkinson's disease

Cognitive function in Parkinson's disease. Francesco Le Pira Dipartimento di Neuroscienze Università di Catania.

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Cognitive function in Parkinson's disease

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  1. Cognitive function in Parkinson's disease Francesco Le Pira Dipartimento di Neuroscienze Università di Catania

  2. Mental deterioration, visuoperceptive disabilities and constructional apraxia in Parkinson's disease.Villardita C, Smirni P, Le Pira F, Zappalà G, Nicoletti F.Acta Neurol Scand. 1982 Jul;66(1):112-20. 20 patients with Parkinson's disease were tested for visuoperceptive disabilities and constructional apraxia versus a group of 20 controls. The visuoperceptive disabilities in the parkinsonians were relatively independent of mental deterioration, where present. The visuoperceptive disabilities were responsible for constructional apraxia.

  3. In 1817, James Parkinson (1755-1824), in his “Essay on the Shaking Palsy” wrote: “Involuntary tremulous motion, with lessened muscular power, in parts not in action and even when supported with a propensity to bend the trunk forwards and to pass from a walking to a running pace: the senses and intellects being uninjured”.

  4. Frequency of dementia in Parkinson disease Aarsland D, Tandberg E, Larsen JP, Cummings JL. Arch Neurol. 1996; 53:38-42 Approximately one quarter of the patients with PD had dementia with the motor manifestations of PD. Dementia was associated with depression, institutionalization, older age at onset of PD, and atypical neurologic features.

  5. Cognition and PD • Pathogenetic mechanisms • Neuropsychological features • Neuropsychological tests • Mild Cognitive Impairment and Dementia • Therapeutic issues • Deep Brain Stimulation • Dopamine and cognition

  6. Pathogenesis

  7. Pathogenesis of cognitive dysfunctions • Neuropathological markers • Neurotransmitters • Clinical features

  8. Neuropathology • Brainstem pathology with involvement of the nigrostriatal pathway • Limbic or cortical Lewy body-type degeneration • Coincident Alzheimer-type pathology (Emre M., 2003)

  9. Neuropsychological features

  10. Executive functions • Conceptualization and abstract reasoning • Mental flexibility • Motor programming • Resistance to interference • Self regulation • Inhibitory control • Enviromental autonomy

  11. Visuospatial function in Parkinson's disease Brown RG, Marsden CD. Brain 1986; 109: 987-1002 Previous research on visuospatial function in Parkinson's disease is reviewed. The present experiment was designed to test two fundamental aspects of spatial ability, namely right-left discrimination and the manipulation of those concepts in different spatial perspectives. Measures of accuracy and reaction time were taken. The performance of patients with Parkinson's disease did not differ from that of normal subjects in the spatial components of the task. Neither a review of the literature, nor the results of the present study, give support to the idea of a generalized visuospatial deficit in Parkinson's disease.

  12. A AB B 1 2 3 4 5 6 7 8 9 10 11 PD Controls p 12 RPM TOT 23.9 ± 4.7 26.7 ± 4 0.04 RPM SET1 10.8 ± 0.5 10.8 ± 0.4 ns RPM SET2 12 ± 3.7 14.5 ± 2.3 0.01 RPM SET3 1.1 ± 1.6 1.4 ± 1.8 ns Set 1 Set 2 Set 3

  13. Time perception

  14. Neuropsychological tests

  15. Raven Progressive Matrices California Verbal Learning Test Neuropsychological tests • FAB • Stroop test • Trail Making Test • Wisconsin Card Sorting Test • Weigl Test • COWAT

  16. PRUGNE California Verbal Learning Testversione ital. di G. Zappalà et. al. TRAPANO GONNA PESCI SALMONE ....... FRUTTA ALBICOCCHE UTENSILI CALAMARI SCALPELLO VESTITI PIGIAMA

  17. MCI AND DEMENTIA

  18. Therapy

  19. Cholinesterase inhibitors for Parkinson's disease dementia I Maidment, C Fox, M Boustani Cochrane Database of Systematic Reviews 2007 Issue 2 Rivastigmine appears to improve cognition and activities of daily living in patients with PDD. This results in clinically meaningful benefit in about 15% of cases. There is a need for more studies utilising pragmatic measures such as time to residential care facility and both patient and carer quality of life assessments. Future trials should involve other cholinesterase inhibitors, utilise tools to analyse the data that limit any bias and measure health economic factors. It is unlikely that relying solely on the last observation carried forward (LOCF) is sufficient. Publication of the observed case data in the largest trial would assist (Emre 2004). Adverse events were associated with the cholinergic activity of rivastigmine, but may limit patient acceptability as evidenced by the high drop out rate in the active arm.

  20. Deep Brain Stimulation

  21. Levodopa and cognition

  22. There are generally no adverse or beneficial effects of levodopa therapy on cognition in moderate-to-severe Parkinson’s disease patients.

  23. Conclusions • There is now an increasing interest in the cognitive and non-motor aspects of Parkinson’s disease. • There is a significant impact of these cognitive defects on quality of life of patients and families.

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