Download PDF
CC BY 4.0 · Arq Neuropsiquiatr 2023; 81(02): 119-127
DOI: 10.1055/s-0042-1759761
Original Article

Cognitive evaluation in Parkinson's disease: applying the Movement Disorder Society recommendations in a population with a low level of formal education

Avaliação cognitiva na doença de Parkinson: aplicando as recomendações da Movement Disorder Society em uma população de baixa escolaridade
Natalia Pessoa Rocha 
1   Universidade Federal de Minas Gerais, Faculdade de Medicina, Laboratório Interdisciplinar de Investigação Médica, Belo Horizonte MG, Brazil.
2   The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Department of Psychiatry and Behavioral Sciences, Neuropsychiatry Program, Texas, United States.
,
Eduarda Xavier Carreira
1   Universidade Federal de Minas Gerais, Faculdade de Medicina, Laboratório Interdisciplinar de Investigação Médica, Belo Horizonte MG, Brazil.
2   The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Department of Psychiatry and Behavioral Sciences, Neuropsychiatry Program, Texas, United States.
,
Ana Carolina de Almeida Prado
1   Universidade Federal de Minas Gerais, Faculdade de Medicina, Laboratório Interdisciplinar de Investigação Médica, Belo Horizonte MG, Brazil.
3   Universidade Federal de Minas Gerais, Faculdade de Filosofia e Ciências Humanas, Departamento de Psicologia, Belo Horizonte MG, Brazil.
,
Fabíola Tavares 
4   Universidade Federal de Minas Gerais, Serviço de Neurologia, Unidade de Distúrbios do Movimento, Belo Horizonte MG, Brazil.
,
Mayra Tavares
1   Universidade Federal de Minas Gerais, Faculdade de Medicina, Laboratório Interdisciplinar de Investigação Médica, Belo Horizonte MG, Brazil.
3   Universidade Federal de Minas Gerais, Faculdade de Filosofia e Ciências Humanas, Departamento de Psicologia, Belo Horizonte MG, Brazil.
,
Francisco Cardoso 
4   Universidade Federal de Minas Gerais, Serviço de Neurologia, Unidade de Distúrbios do Movimento, Belo Horizonte MG, Brazil.
5   Universidade Federal de Minas Gerais, Faculdade de Medicina, Departamento de Medicina Interna, Belo Horizonte MG, Brazil.
,
Antônio Jaeger 
3   Universidade Federal de Minas Gerais, Faculdade de Filosofia e Ciências Humanas, Departamento de Psicologia, Belo Horizonte MG, Brazil.
,
Leonardo Cruz de Souza 
1   Universidade Federal de Minas Gerais, Faculdade de Medicina, Laboratório Interdisciplinar de Investigação Médica, Belo Horizonte MG, Brazil.
4   Universidade Federal de Minas Gerais, Serviço de Neurologia, Unidade de Distúrbios do Movimento, Belo Horizonte MG, Brazil.
5   Universidade Federal de Minas Gerais, Faculdade de Medicina, Departamento de Medicina Interna, Belo Horizonte MG, Brazil.
,
Antônio Lucio Teixeira 
1   Universidade Federal de Minas Gerais, Faculdade de Medicina, Laboratório Interdisciplinar de Investigação Médica, Belo Horizonte MG, Brazil.
2   The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Department of Psychiatry and Behavioral Sciences, Neuropsychiatry Program, Texas, United States.
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background The diagnosis of cognitive disorders in Parkinson disease (PD) can be very challenging. Aiming at establishing uniform and reliable diagnostic procedures, the International Parkinson's Disease and Movement Disorder Society (MDS) commissioned task forces to delineate diagnostic criteria for mild cognitive impairment (MCI) and dementia in PD.

Objectives To investigate the applicability of the MDS recommendations for cognitive evaluation in a Brazilian sample of patients with PD with low levels of formal education.

Methods A total of 41 patients with PD were subjected to a comprehensive neuropsychological evaluation based on tests proposed by the MDS, which included the Mini-Mental State Examination, the Mattis Dementia Rating Scale (MDRS), the Trail Making Test (TMT) parts A and B, in addition to language and memory skills assessment. Neuropsychiatric and daily functioning features were also evaluated. Spearman correlation analyses were used to evaluate the association between the scores obtained in the cognitive scales and demographic/clinical variables.

Results Although none of the participants had a formal diagnosis of dementia, 50% presented some degree of cognitive impairment when considering the results of the MDRS. Of note, a noticeable number of patients was not able to complete the full neuropsychological assessment. The TMT part B was the most difficult task, being completed by only 22 participants (54%). As expected, the greater the educational level, the better the performance on the cognitive tests. Better motor function was also associated with better scores in cognition.

Conclusions Adopting strict inclusion/exclusion criteria and a comprehensive clinical evaluation, we found remarkable limitations for the MDS recommendations when individuals with low educational levels are considered. A revision of the current guidelines is necessary considering differences among populations, especially related to formal education.

Resumo

Antecedentes O diagnóstico de distúrbios cognitivos na doença de Parkinson (DP) pode ser muito desafiador. Com o objetivo de estabelecer procedimentos diagnósticos uniformes e confiáveis, a Sociedade Internacional da Doença de Parkinson e Distúrbios do Movimento (MDS, na sigla em inglês) encomendou forças-tarefa para delinear critérios diagnósticos para comprometimento cognitivo leve (CCL) e demência na DP.

Objetivos Investigar a aplicabilidade das recomendações da MDS para avaliação cognitiva em uma amostra brasileira de pacientes com DP de baixa escolaridade.

Métodos Um total de 41 pacientes com DP foram submetidos a uma avaliação neuropsicológica abrangente com base nos testes propostos pela MDS, que incluiu o Miniexame do Estado Mental, a Escala de Avaliação de Demência de Mattis (MDRS, na sigla em inglês), o teste de trilhas (TMT, na sigla em inglês) partes A e B, além da avaliação das habilidades de linguagem e memória. Características neuropsiquiátricas e de funcionamento diário também foram avaliadas. Análises de correlação de Spearman foram utilizadas para avaliar a associação entre os escores obtidos nas escalas cognitivas e variáveis demográficas/clínicas.

Resultados Apesar de nenhum dos participantes ter diagnóstico formal de demência, 50% apresentaram algum grau de comprometimento cognitivo ao levar em consideração os resultados da MDRS. Vale ressaltar que um número notável de pacientes não conseguiu completar a avaliação neuropsicológica completa. A parte B do TMT foi a tarefa mais difícil, sendo realizada por apenas 22 participantes (54%). Como esperado, quanto maior o nível educacional, melhor o desempenho nos testes cognitivos. Melhor função motora também foi associada a melhores escores em cognição.

Conclusões Adotando critérios rígidos de inclusão/exclusão e uma avaliação clínica abrangente, encontramos limitações marcantes para as recomendações da MDS quando considerados indivíduos com baixa escolaridade. É necessária uma revisão das diretrizes atuais considerando as diferenças entre as populações, principalmente relacionadas ao nível educacional.

Keywords

Parkinson Disease - Cognitive Dysfunction - Dementia - Neuropsychological Tests - Educational Status

Palavras-chave

Doença de Parkinson - Disfunção Cognitiva - Demência - Testes Neuropsicológicos - Escolaridade

Authors' Contributions

NPR, FC, LCS, ALT: worked on the design and conceptualization of the study; NPR, EXC, ACAP, FT, MT: executed the research project; NPR, EXC, ACAP: designed and executed the data analysis and interpretation; LCS, AJ: reviewed data analysis; NPR: wrote the first draft of the manuscript; LCS, AJ, FC, ALT: reviewed and criticized the manuscript. All authors approved the submitted version.




Publication History

Received: 03 February 2022

Accepted: 21 June 2022

Article published online:
22 March 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 Marras C, Tröster AI, Kulisevsky J, Stebbins GT. The tools of the trade: a state of the art “How to Assess Cognition” in the patient with Parkinson's disease. Mov Disord 2014; 29 (05) 584-596
    CrossrefPubMedSearch in Google Scholar
  • 2 Litvan I, Goldman JG, Tröster AI. et al. Diagnostic criteria for mild cognitive impairment in Parkinson's disease: Movement Disorder Society Task Force guidelines. Mov Disord 2012; 27 (03) 349-356
    CrossrefPubMedSearch in Google Scholar
  • 3 Massano J, Garrett C. Deep brain stimulation and cognitive decline in Parkinson's disease: a clinical review. Front Neurol 2012; 3: 66
    CrossrefPubMedSearch in Google Scholar
  • 4 Dubois B, Burn D, Goetz C. et al. Diagnostic procedures for Parkinson's disease dementia: recommendations from the movement disorder society task force. Mov Disord 2007; 22 (16) 2314-2324
    CrossrefPubMedSearch in Google Scholar
  • 5 Goldman JG, Holden S, Ouyang B, Bernard B, Goetz CG, Stebbins GT. Diagnosing PD-MCI by MDS Task Force criteria: how many and which neuropsychological tests?. Mov Disord 2015; 30 (03) 402-406
    CrossrefPubMedSearch in Google Scholar
  • 6 Emre M, Aarsland D, Brown R. et al. Clinical diagnostic criteria for dementia associated with Parkinson's disease. Mov Disord 2007; 22 (12) 1689-1707 , quiz 1837
    CrossrefPubMedSearch in Google Scholar
  • 7 Oliveira GN, Souza CP, Foss MP, Tumas V. An analysis of the cognitive items of the movement disorders society checklist for the diagnosis of dementia in patients with Parkinson's disease. Parkinsonism Relat Disord 2015; 21 (10) 1260-1263
    CrossrefPubMedSearch in Google Scholar
  • 8 Isella V, Mapelli C, Siri C. et al. Validation and attempts of revision of the MDS-recommended tests for the screening of Parkinson's disease dementia. Parkinsonism Relat Disord 2014; 20 (01) 32-36
    CrossrefPubMedSearch in Google Scholar
  • 9 Barton B, Grabli D, Bernard B. et al. Clinical validation of Movement Disorder Society-recommended diagnostic criteria for Parkinson's disease with dementia. Mov Disord 2012; 27 (02) 248-253
    CrossrefPubMedSearch in Google Scholar
  • 10 Di Battista ME, Giustini P, Bernardi S, Stirpe P, Vanacore N, Meco G. A simplified algorithm may lead to overestimate dementia in PD. A clinical and epidemiological study using criteria for PD-D proposed by the Movement Disorders Task Force. J Neural Transm (Vienna) 2011; 118 (11) 1609-1612
    CrossrefPubMedSearch in Google Scholar
  • 11 Stern Y. Cognitive reserve in ageing and Alzheimer's disease. Lancet Neurol 2012; 11 (11) 1006-1012
    CrossrefPubMedSearch in Google Scholar
  • 12 Hughes AJ, Daniel SE, Kilford L, Lees AJ. Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry 1992; 55 (03) 181-184
    CrossrefPubMedSearch in Google Scholar
  • 13 Fahn S, Elton R. Unified Parkinson's Disease Rating Scale. Recent developments in Parkinson's disease. Florham Park, NJ: Macmillan Health Care Information; 1987
    Search in Google Scholar
  • 14 Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12 (03) 189-198
    Search in Google Scholar
  • 15 Mattis S. Dementia Rating Scale: DRS: Professional Manual. 1988
    PubMedSearch in Google Scholar
  • 16 Reitan RMW. . D. The Trail-making Test. 2nd ed. Tucson, AZ, USA: Neuropsychology Press; 1993
    Search in Google Scholar
  • 17 Morris JC, Heyman A, Mohs RC. et al. The Consortium to Establish a Registry for Alzheimer's Disease (CERAD). Part I. Clinical and neuropsychological assessment of Alzheimer's disease. Neurology 1989; 39 (09) 1159-1165
    CrossrefPubMedSearch in Google Scholar
  • 18 Nitrini R, Caramelli P, Herrera Júnior E. et al. Performance of illiterate and literate nondemented elderly subjects in two tests of long-term memory. J Int Neuropsychol Soc 2004; 10 (04) 634-638
    CrossrefPubMedSearch in Google Scholar
  • 19 Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J. The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology 1994; 44 (12) 2308-2314
    CrossrefPubMedSearch in Google Scholar
  • 20 Starkstein SE, Mayberg HS, Preziosi TJ, Andrezejewski P, Leiguarda R, Robinson RG. Reliability, validity, and clinical correlates of apathy in Parkinson's disease. J Neuropsychiatry Clin Neurosci 1992; 4 (02) 134-139
    CrossrefPubMedSearch in Google Scholar
  • 21 Marin RS, Biedrzycki RC, Firinciogullari S. Reliability and validity of the Apathy Evaluation Scale. Psychiatry Res 1991; 38 (02) 143-162
    CrossrefPubMedSearch in Google Scholar
  • 22 Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961; 4: 561-571
    CrossrefPubMedSearch in Google Scholar
  • 23 Tumas V, Rodrigues GG, Farias TL, Crippa JA. The accuracy of diagnosis of major depression in patients with Parkinson's disease: a comparative study among the UPDRS, the geriatric depression scale and the Beck depression inventory. Arq Neuropsiquiatr 2008; 66 (2A): 152-156
    CrossrefPubMedSearch in Google Scholar
  • 24 Sanchez MADS, Correa PCR, Lourenço RA. Cross-cultural Adaptation of the “Functional Activities Questionnaire - FAQ” for use in Brazil. Dement Neuropsychol 2011; 5 (04) 322-327
    CrossrefPubMedSearch in Google Scholar
  • 25 Pfeffer RI, Kurosaki TT, Harrah Jr CH, Chance JM, Filos S. Measurement of functional activities in older adults in the community. J Gerontol 1982; 37 (03) 323-329
    CrossrefPubMedSearch in Google Scholar
  • 26 Bertolucci PH, Brucki SM, Campacci SR, Juliano Y. [The Mini-Mental State Examination in a general population: impact of educational status]. Arq Neuropsiquiatr 1994; 52 (01) 1-7
    CrossrefPubMedSearch in Google Scholar
  • 27 Llebaria G, Pagonabarraga J, Kulisevsky J. et al. Cut-off score of the Mattis Dementia Rating Scale for screening dementia in Parkinson's disease. Mov Disord 2008; 23 (11) 1546-1550
    CrossrefPubMedSearch in Google Scholar
  • 28 Yassuda MS, da Silva HS, Lima-Silva TB. et al. Normative data for the Brief Cognitive Screening Battery stratified by age and education. Dement Neuropsychol 2017; 11 (01) 48-53
    CrossrefPubMedSearch in Google Scholar
  • 29 Fernández AL, Marcopulos BA. A comparison of normative data for the Trail Making Test from several countries: equivalence of norms and considerations for interpretation. Scand J Psychol 2008; 49 (03) 239-246
    CrossrefPubMedSearch in Google Scholar
  • 30 de Azeredo Passos VM, Giatti L, Bensenor I. et al. Education plays a greater role than age in cognitive test performance among participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). BMC Neurol 2015; 15: 191
    CrossrefPubMedSearch in Google Scholar
  • 31 Arroyo V, Fernandez J, Ginès P. Pathogenesis and treatment of hepatorenal syndrome. Semin Liver Dis 2008; 28 (01) 81-95
    Thieme ConnectPubMedSearch in Google Scholar
  • 32 Willis AW, Schootman M, Kung N, Evanoff BA, Perlmutter JS, Racette BA. Predictors of survival in patients with Parkinson disease. Arch Neurol 2012; 69 (05) 601-607
    CrossrefPubMedSearch in Google Scholar
  • 33 Biundo R, Weis L, Fiorenzato E, Antonini A. Cognitive Rehabilitation in Parkinson's Disease: Is it Feasible?. Arch Clin Neuropsychol 2017; 32 (07) 840-860
    CrossrefPubMedSearch in Google Scholar
  • 34 Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa Nacional por Amostra de Domicílios. 2016
    PubMedSearch in Google Scholar
  • 35 Kierzynka A, Kaźmierski R, Kozubski W. Educational level and cognitive impairment in patients with Parkinson disease. Neurol Neurochir Pol 2011; 45 (01) 24-31
    CrossrefPubMedSearch in Google Scholar
  • 36 Wilson RS, Yu L, Lamar M, Schneider JA, Boyle PA, Bennett DA. Education and cognitive reserve in old age. Neurology 2019; 92 (10) e1041-e1050
    CrossrefPubMedSearch in Google Scholar
  • 37 Armstrong MJ, Naglie G, Duff-Canning S. et al. Roles of Education and IQ in Cognitive Reserve in Parkinson's Disease-Mild Cognitive Impairment. Dement Geriatr Cogn Disord Extra 2012; 2 (01) 343-352
    CrossrefPubMedSearch in Google Scholar
  • 38 Hindle JV, Martyr A, Clare L. Cognitive reserve in Parkinson's disease: a systematic review and meta-analysis. Parkinsonism Relat Disord 2014; 20 (01) 1-7
    CrossrefPubMedSearch in Google Scholar
  • 39 Burdick DJ, Cholerton B, Watson GS. et al. People with Parkinson's disease and normal MMSE score have a broad range of cognitive performance. Mov Disord 2014; 29 (10) 1258-1264
    CrossrefPubMedSearch in Google Scholar
  • 40 Turner TH, Hinson V. Mattis Dementia Rating Scale cutoffs are inadequate for detecting dementia in Parkinson's disease. Appl Neuropsychol Adult 2013; 20 (01) 61-65
    CrossrefPubMedSearch in Google Scholar