INTRODUCTION:
Parkinson‟s disease (PD) is a degenerative disease named after James Parkinson (1755-1824) who described this condition in his publication in 1817 called „Essay on Shaking Palsy. Among the neurodegenerative diseases it ranks second after Alzheimer‟s disease (AD). It is more common in the elderly, although early onset disease is well known. It has characteristic clinical features of bradykinesia and at least one the following: muscular rigidity, 4-6Hz. rest tremor and postural instability. Diagnosis is usually made by the well validated criteria called “UKPDS” (UK Parkinson‟s Disease Society Brain Bank criteria). Apart from motor manifestations there are number of non-motor manifestations which is a common source of disability in PD.
AIM OF THE STUDY:
1. To identify the range of cognitive impairment if any inpatients with Idiopathic Parkinson‟s disease.
2. To identify subclinical cognitive impairment in newly diagnosed idiopathic Parkinson‟s disease.
MATERIALS AND METHODS:
100 patients with Idiopathic Parkinson‟s disease who attended Neurological services at Rajiv Gandhi Govt. General hospital, Chennai were included for the study.
Study Design: Single centre, non- randomized prospective study.
Study Period: Study was conducted between September 2012 and January 2014. Ethical committee approval was obtained.
Inclusion Criteria:
Newly diagnosed patients with Idiopathic Parkinson‟s disease aged between 55and 75 years and not started on anti parkinsonian drugs were included for the study.
Exclusion Criteria:
1. Very ill patients (moribund state),
2. Presence of depression (pseudodementia), behavior disorders or delirium,
3. Symptomatic parkinsonism dementia complex [vascular, tumor, NPH],
4. Coincident degenerative dementia like AD.
5. Degenerative diseases presenting with Parkinsonism and dementia namely Progressive supranuclear palsy (PSP), Cortico basal degeneration (CBD) and Dementia in Lewy body disease (DLB).
6. Vascular risk factors like Diabetes mellitus, Hypertension and also history of stroke
RESULTS:
The total number of patients included in the study was 100. The parameters analysed were Age, Duration of illness, Educational status, Hoehn and Yahr stage, and UPDRS score. Each of these parameters was compared with the individual cognitive scalenamely MMSE, ACE-R scale, MoCA and FAB test. Other non- motor manifestations quoted in the review of literature like behavioural disturbances, psychosis, mood disorders, sleep disorders, autonomic disturbances, sensory disturbances and sensation of smell are beyond the scope of this study, and therefore were not analyzed.
CONCLUSION:
1. Patients with Parkinson‟s disease were found to have cognitive impairment on formal neuropsychological testing, though they do not show functional restriction in activities of daily living.
2. There is clear linear relationship between age of patients and duration of illness in developing cognitive impairment.
3. Mild cognitive impairment is seen in early stages of Parkinson‟s disease. This is observed even in patients with low score for UPDRS and Hoehn and Yahr scales. This trend is reflected across all domains of cognitive testing used. This is particularly so with the frontal lobe functions and less so with testing for fluency and language.
4. Frank dementia however, was found only in proportion of patients especially those with more advanced disease.
5. This study highlights the importance of screening of cognition in patients with Parkinson‟s disease. If cognitive impairment is found, it will help to intervene in the early stages of the illness
