Dement Neurocogn Disord.  2012 Sep;11(3):104-110. 10.12779/dnd.2012.11.3.104.

Behavioral and Psychological Symptoms in Patients with Parkinson's Disease According to Cognitive Function

• Han IT
• Ha CK
• Hong CG
• Choi JY
• Ahn JH
• Park JJ
• Ryoo NY
• Yoon BN
• Choi SH

• KMID: 2222354
• DOI: http://doi.org/10.12779/dnd.2012.11.3.104

Abstract

BACKGROUND
Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by motor and nonmotor symptoms such as cognitive impairment and neuropsychiatric symptoms. The aim of this study was to investigate the spectrum of neuropsychiatric symptoms in PD according to cognitive function.
METHODS
One hundred twenty seven patients with PD were consecutively recruited. They had undergone an intensive interview with a neurologist and the Seoul Neuropsychological Screening Battery-dementia version, and were divided into three groups: 27 patients in PD with normal cognition (PDNC), 57 in PD with mild cognitive impairment (PDMCI), and 43 in PD with Dementia (PDD). Forty five healthy controls without memory complaints were also recruited. The caregivers of all participants administered the Caregiver-Administered Neuropsychiatric Inventory (CGA-NPI).
RESULTS
There were significant differences in the CGA-NPI score (22.8+/-20.9 vs. 6.4+/-10.1 vs. 1.7+/-3.9 vs. 1.0+/-1.6, p<0.001), and the prevalence of neuropsychiatric symptoms (100% vs. 64.9% vs. 37.0% vs. 44.4%, p<0.001) among PDD, PDMCI, PDNC and control groups. Depression was the most common symptom (43.3%), followed by anxiety (31.5%), apathy (26.8%), and night-time behavior (26.8%) in all PD patients. Delusion, hallucination, and aberrant motor behavior were observed frequently in PDD, but were rare in PDMCI.
CONCLUSIONS
Depression was the most common neuropsychiatric symptom in PD. The presence of delusion, hallucination, or aberrant motor behavior may suggest PDD. The neuropsychiatric symptoms were not prevalent in PD with normal cognition.

Keyword

Parkinson's disease; Cognitive impairment; Neuropsychiatric symptoms

MeSH Terms

Anxiety
Apathy
Caregivers
Cognition
Delusions
Dementia
Depression
Hallucinations
Humans
Mass Screening
Memory
Mild Cognitive Impairment
Neurodegenerative Diseases
Parkinson Disease
Prevalence

Figure

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  Fig. 1 Prevalence of behavioral and psychiatric symptoms in the patients with dementia associated with Parkinson's disease (PPD), those with PD with mild cognitive impairment (PDMCI), those with PD with normal cognition (PDNC), and normal controls. *Items which were significantly different among four groups (p<0.05).

Reference

1. de Rijk MC, Launer LJ, Berger K, Breteler MM, Dartigues JF, Baldereschi M, et al. Prevalence of Parkinson's disease in Europe: a collaborative study of population-based cohorts. Neurologic Diseases in the Elderly Research Group. Neurology. 2000. 54:11 Suppl 5. S21–S23.

2. Aarsland D, Bronnick K, Williams-Gray C, Weintraub D, Marder K, Kulisevsky J, et al. Mild cognitive impairment in Parkinson disease: a multicenter pooled analysis. Neurology. 2010. 75:1062–1069.

3. Aarsland D, Andersen K, Larsen JP, Lolk A, Kragh-Sorensen P. Prevalence and characteristics of dementia in parkinson disease: an 8-year prospective study. Arch Neurol. 2003. 60:387–392.

4. Emre M. Dementia associated with parkinson's disease. Lancet Neurol. 2003. 2:229–237.

5. Henry LP, Matthew BS. Ray LW, William CK, editors. Clinical manifestations of Parkinson's disease. Movement Disorders. 2004. 2nd ed. USA: McGraw-Hill Co;233–245.

6. Shulman LM, Taback RL, Bean J, Weiner WJ. Comorbidity of the nonmotor symptoms of Parkinson's disease. Mov Disord. 2001. 16:507–510.

7. Aarsland D, Påhlhagen S, Ballard CG, Ehrt U, Svenningsson P. Depression in Parkinson disease--epidemiology, mechanisms and management. Nat Rev Neurol. 2011. 8:35–47.

8. Aarsland D, Brønnick K, Ehrt U, De Deyn PP, Tekin S, Emre M, et al. Neuropsychiatric symptoms in patients with Parkinson's disease and dementia: frequency, profile and associated care giver stress. J Neurol Neurosurg Psychiatry. 2007. 78:36–42.

9. McKinlay A, Grace RC, Dalrymple-Alford JC, Anderson T, Fink J, Roger D. A profile of neuropsychiatric problems and their relationship to quality of life for Parkinson's disease patients without dementia. Parkinsonism Relat Disord. 2008. 14:37–42.

10. Aarsland D, Brønnick K, Alves G, Tysnes OB, Pedersen KF, Ehrt U, et al. The spectrum of neuropsychiatric symptoms in patients with early untreated Parkinson's disease. J Neurol Neurosurg Psychiatry. 2009. 80:928–930.

11. Stella F, Banzato CE, Quagliato EM, Viana MA, Christofoletti G. Psychopathological features in patients with Parkinson's disease and related caregivers' burden. Int J Geriatr Psychiatry. 2009. 24:1158–1165.

12. Hughes AJ, Daniel SE, Kilford L, Lees AJ. Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinicopathological study of 100 cases. J Neurol Neurosurg Psychiatry. 1992. 55:181–184.

13. Kang SJ, Choi SH, Lee BH, Jeong Y, Hahm DS, Han IW, et al. Caregiver-Administered Neuropsychiatric Inventory (CGA-NPI). J Geriatr Psychiatry Neurol. 2004. 17:32–35.

14. Emre M, Aarsland D, Brown R, Burn DJ, Duyckaerts C, Mizuno Y, et al. Clinical diagnostic criteria for dementia associated with Parkinson's disease. Mov Disord. 2007. 22:1689–1707.

15. Winblad B, Palmer K, Kivipelto M, Jelic V, Fratiglioni L, Wahlund LO, et al. Mild cognitive impairment--beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. J Intern Med. 2004. 256:240–246.

16. Ahn HJ, Chin J, Park A, Lee BH, Suh MK, Seo SW, et al. Seoul Neuropsychological Screening Battery-dementia version (SNSB-D): a useful tool for assessing and monitoring cognitive impairments in dementia patients. J Korean Med Sci. 2010. 25:1071–1076.

17. Kang Y. Normative data on the Korean Mini-Mental State Examination (K-MMSE) in Korean elderly. Korean J Psychol Gen. 2006. 25:1–12.

18. Choi SH, Na DL, Lee BH, Hahm D, Jeong JH, Yoon SJ, et al. Dementia Research Group. Estimating the validity of the Korean version of Expanded Clinical Dementia Rating (CDR) scale. J Korean Neurol Assoc. 2001. 19:585–591.

19. Ku HM, Kim J, Kwon EJ, Kim SH, Lee HS, Ko H, et al. A study on the reliability and validity of Seoul-Instrumental Activities of Daily Living. J Korean Neuropsychiatr Assoc. 2004. 43:189–199.

20. Spalletta G, Musicco M, Padovani A, Rozzini L, Perri R, Fadda L, et al. Neuropsychiatric symptoms and syndromes in a large cohort of newly diagnosed, untreated patients with Alzheimer disease. Am J Geriatr Psychiatry. 2010. 18:1026–1035.

21. Choi SH, Na DL, Kwon HM, Yoon SJ, Jeong J, Ha CK. The Korean version of the Neuropsychiatric Inventory: A Scoring Tool of Neuropsychiatric Disturbance in Dementia Patients. J Korean Med Sci. 2000. 15:609–615.

22. Burn DJ, Troster AI. Neuropsychiatric complications of medical and surgical therapies of Parkinson's disease. J Geriatr Psychiatry Neurol. 2004. 17:172–180.