Search

Objective: To compare diagnostic classification differences for Parkinson9s disease dementia (PDD) patients between the new Movement Disorder Society (MDS) criteria for detecting PDD and routine neuropsychological testing. Background Diagnostic criteria for PDD have been proposed by a MDS Task Force. MDS PDD diagnosis includes criteria based on a checklist (Level 1) and additional specific criteria based on more complete neuropsychological tests (Level II). Few studies have compared outcomes of these MDS criteria to the diagnosis of PDD based on routine neuropsychological testing that does not utilize the MDS criteria. Design/Methods: Parkinson9s disease (PD) subjects were recruited from those scheduled for neuropsychological testing at two specialty PD centers. All subjects were categorized as having PDD or no PDD based on routine neuropsychological test results and clinical judgment of the neuropsychologist. In addition, Level 1 and Level II MDS diagnostic criteria for PDD were applied to each subject based on the same test results by a blinded neurologist. Results: We tested 91 PD subjects, with mean age 66.3 (SD=9.7). All subjects classified as PDD by the neuropsychologists (n = 9) were also classified as having PDD using the MDS checklist criteria (Level 1). However, there were an additional 6 subjects diagnosed with PDD using the MDS Level II criteria who were classified as having no dementia by the neuropsychologists. These 6 cases had more significantly more education (15.5 vs 10.6 years), better MMSE scores (26.33 vs 20.4), and less impairment on several cognitive tests compared to the group concordant for PDD by both MDS criteria and the neuropsychologist designation. Conclusions: MDS Level II criteria diagnoses PDD more frequently compared to routine neuropsychological testing and may be more sensitive to impairment in cases with higher education levels and where the cognitive function is not as severely impaired. Supported by: Salary support for the Rush University Medical Center study participants was provided by the Parkinson9s Disease Foundation. Disclosure: Dr. Barton has received personal compensation for activities with Teva Neurosciences, Allergan, Inc., Merz Pharma, Lundbeck Research USA, Inc., Merck-Serono, IMPAX, Allergan and Parkinson Disease Foundation. Dr. Bernard has nothing to disclose. Dr. Stebbins has received personal compensation for activities with Impax Laboratories, Inc., Ceregene, Inc., Biovail Technologies, Ltd., Santhera Pharmaceuticals, and Ingenix Pharmaceutical Services. Dr. Stebbins has received research support from the National Institutes of Health, American Cancer Society, the Michael J. Fox Foundation, and Fragile-X Foundation. Dr. Goldman has received personal compensation for activities with Movement Disorder Society, American Geriatric Society, Johns Hopkins Dystonia and Spasticity Practicum as a speaker. Dr. Goldman has received research support from the Parkinson9s Disease Foundation and the National Institute of Health. Dr. Dubois has received personal compensation for activities with Bristol-Myers Squibb, Roche, Elan, Eli Lilly, Eisai, and Janssen as a consultantDr. Dubois has received personal compensation for serving on the advisory board of Bristol-Myers Squibb, Roche, Elan, Eli Lilly, Eisai, and Janssen.Dr. Dubois has received research support from Novartis and Sanofi-Aventis. Dr. Goetz has received personal compensation for activities with Asubio Pharmaceuticals Inc., Campbell Alliance, CNS Therapeutics, Curry Rockerfeller Group, Health Advances, Impax Pharmaceuticals, Ingenix, Juvantia Pharma LTD as a consultant and participant on an advisory board. Dr. Goetz has received personal compensation in an editorial capacity for Movement Disorders and Oxford University Press. Dr. Goetz has received research support from Michael J. Fox Foundation, National Institute of Health and Parkinson9s Disease Foundation.

Objective: To assess cognitive functioning in patients with Parkinson9s disease (PD) following unilateral and subsequent contralateral deep brain stimulation of the subthalamic nucleus (STN-DBS). Background Bilateral STN-DBS is associated with mild decline in executive functioning. Staged surgery may be able to reduce such changes. However, there is little research on the cognitive effects of staged surgery. The present study examined cognitive functioning in PD patients before and after unilateral and subsequent contralateral STN-DBS. Design/Methods: We evaluated 16 consecutive PD patients (9 men, 7 women; mean age 67.4 ± 9.9) with the Mattis Dementia Rating Scale (MDRS), Rey Auditory and Verbal Learning Test (RAVLT), Controlled Oral Word Association (COWA; FAS), Digit Ordering Test, Symbol Digit Modalities Test (SDMT), Raven9s Progressive Matrices (modified), and Montgomery and Asberg Depression Rating Scale. Subjects were evaluated before the first surgery, about 8 months after the first surgery, and about 3.5 years after the second surgery. Differences between baseline and follow-up were assessed with repeated measures ANOVA. Results: Mean MDRS total score declined from 136.4 ± 2.0 at baseline, to 134.8 ± 2.4 after the first surgery, and to 129.5 ± 4.0 after the second surgery (p=0.02). Of the MDRS subscales, Initiation/Perseveration was the only scale to decline over time (p=0.02). There was decline for both letter fluency (p=0.0005) and category fluency (p=0.003). The SDMT raw score also showed decline (p=0.005). There were no significant changes for Digit Ordering Test, delayed memory, conceptual reasoning, or depression. Conclusions: Staged STN-DBS is associated with mild decline in overall level of functioning, fluency, and some aspects of executive functioning, similar to simultaneous bilateral surgery. However, since the second follow-up assessment occurred approximately 6 years after the baseline assessment, the observed decline may not be different from the natural progression of the disease. These results suggest that staged STN-DBS does not reduce frontal/striatal executive changes. Disclosure: Dr. Bernard has nothing to disclose. Dr. Stebbins has received personal compensation for activities with Impax Laboratories, Inc., Ceregene, Inc., Biovail Technologies, Ltd., Santhera Pharmaceuticals, and Ingenix Pharmaceutical Services. Dr. Stebbins has received research support from the National Institutes of Health, American Cancer Society, the Michael J. Fox Foundation, and Fragile-X Foundation. Dr. Bakay has received personal compensation for activities with Bayer/Schering for serving on their Safety Monitoring Board. Dr. Bakay has received research support from Ceregene, Inc., Medtronic, ANS and NIH. Dr. Verhagen has received personal compensation for activities with Medtronic, Inc., and Impax. Dr. Verhagen has received research support from Medtronic, Inc., ANS/St. Jude, Ceregene, Impax, Bayer-Schering, National Institutes of Health, and the Michael J Fox Foundation.