Changes in motor subtype and risk for incident dementia in Parkinson's disease.
Identifieur interne : 002E25 ( PubMed/Checkpoint ); précédent : 002E24; suivant : 002E26Changes in motor subtype and risk for incident dementia in Parkinson's disease.
Auteurs : Guido Alves [Norvège] ; Jan Petter Larsen ; Murat Emre ; Tore Wentzel-Larsen ; Dag AarslandSource :
- Movement disorders : official journal of the Movement Disorder Society [ 0885-3185 ] ; 2006.
English descriptors
- KwdEn :
- Aged, Cognition Disorders (epidemiology), Dementia (epidemiology), Demography, Female, Humans, Male, Middle Aged, Motor Activity (physiology), Parkinson Disease (classification), Parkinson Disease (physiopathology), Parkinson Disease (psychology), Reference Values, Risk Assessment, Time Factors, Tremor (physiopathology).
- MESH :
- classification : Parkinson Disease.
- epidemiology : Cognition Disorders, Dementia.
- physiology : Motor Activity.
- physiopathology : Parkinson Disease, Tremor.
- psychology : Parkinson Disease.
- Aged, Demography, Female, Humans, Male, Middle Aged, Reference Values, Risk Assessment, Time Factors.
Abstract
The objective of this study was to assess the temporal relationship between changes in predominant motor symptoms and incident dementia in Parkinson's disease (PD). A community-based sample of 171 nondemented patients with PD was followed prospectively and examined at baseline and after 4 and 8 years. The motor subtype of Parkinsonism was classified into tremor-dominant (TD), indeterminate, or postural instability gait difficulty (PIGD) subtype at each visit, based on defined items in the Unified Parkinson's Disease Rating Scale, subscales II and III. Dementia was diagnosed according to DSM-III-R criteria, based on clinical interview, cognitive rating scales, and neuropsychological examination. Logistic regression was used to analyze the relationship between subtype of Parkinsonism and dementia. Transition from TD to PIGD subtype was associated with a more than threefold increase in the rate of Mini-Mental State Examination decline. Compared to patients with persistent TD or indeterminate subtype, the odds ratio for dementia was 56.7 (95% CI: 4.0-808.4; P = 0.003) for patients changing from TD or indeterminate subtype to PIGD subtype, and 80.0 (95% CI: 4.6-1400.1; P = 0.003) for patients with persistent PIGD subtype. Patients with TD subtype at baseline did not become demented until they developed PIGD subtype, and dementia did not occur among patients with persistent TD subtype of Parkinsonism. In a substantial proportion of PD patients who develop postural instability and gait disorder during the course of the disease, this transition is associated with accelerated cognitive decline and highly increased risk for subsequent dementia. These findings raise the question whether PIGD and dementia share common or parallel neuropathology.
DOI: 10.1002/mds.20897
PubMed: 16637023
Affiliations:
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Changes in motor subtype and risk for incident dementia in Parkinson's disease.</title><author><name sortKey="Alves, Guido" sort="Alves, Guido" uniqKey="Alves G" first="Guido" last="Alves">Guido Alves</name><affiliation wicri:level="1"><nlm:affiliation>The Norwegian Center for Movement Disorders, Stavanger, Norway. algu@sir.no</nlm:affiliation><country xml:lang="fr">Norvège</country><wicri:regionArea>The Norwegian Center for Movement Disorders, Stavanger</wicri:regionArea><wicri:noRegion>Stavanger</wicri:noRegion></affiliation></author><author><name sortKey="Larsen, Jan Petter" sort="Larsen, Jan Petter" uniqKey="Larsen J" first="Jan Petter" last="Larsen">Jan Petter Larsen</name></author><author><name sortKey="Emre, Murat" sort="Emre, Murat" uniqKey="Emre M" first="Murat" last="Emre">Murat Emre</name></author><author><name sortKey="Wentzel Larsen, Tore" sort="Wentzel Larsen, Tore" uniqKey="Wentzel Larsen T" first="Tore" last="Wentzel-Larsen">Tore Wentzel-Larsen</name></author><author><name sortKey="Aarsland, Dag" sort="Aarsland, Dag" uniqKey="Aarsland D" first="Dag" last="Aarsland">Dag Aarsland</name></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2006">2006</date><idno type="doi">10.1002/mds.20897</idno><idno type="RBID">pubmed:16637023</idno><idno type="pmid">16637023</idno><idno type="wicri:Area/PubMed/Corpus">002C84</idno><idno type="wicri:Area/PubMed/Curation">002C84</idno><idno type="wicri:Area/PubMed/Checkpoint">002E25</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Changes in motor subtype and risk for incident dementia in Parkinson's disease.</title><author><name sortKey="Alves, Guido" sort="Alves, Guido" uniqKey="Alves G" first="Guido" last="Alves">Guido Alves</name><affiliation wicri:level="1"><nlm:affiliation>The Norwegian Center for Movement Disorders, Stavanger, Norway. algu@sir.no</nlm:affiliation><country xml:lang="fr">Norvège</country><wicri:regionArea>The Norwegian Center for Movement Disorders, Stavanger</wicri:regionArea><wicri:noRegion>Stavanger</wicri:noRegion></affiliation></author><author><name sortKey="Larsen, Jan Petter" sort="Larsen, Jan Petter" uniqKey="Larsen J" first="Jan Petter" last="Larsen">Jan Petter Larsen</name></author><author><name sortKey="Emre, Murat" sort="Emre, Murat" uniqKey="Emre M" first="Murat" last="Emre">Murat Emre</name></author><author><name sortKey="Wentzel Larsen, Tore" sort="Wentzel Larsen, Tore" uniqKey="Wentzel Larsen T" first="Tore" last="Wentzel-Larsen">Tore Wentzel-Larsen</name></author><author><name sortKey="Aarsland, Dag" sort="Aarsland, Dag" uniqKey="Aarsland D" first="Dag" last="Aarsland">Dag Aarsland</name></author></analytic><series><title level="j">Movement disorders : official journal of the Movement Disorder Society</title><idno type="ISSN">0885-3185</idno><imprint><date when="2006" type="published">2006</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged</term><term>Cognition Disorders (epidemiology)</term><term>Dementia (epidemiology)</term><term>Demography</term><term>Female</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Motor Activity (physiology)</term><term>Parkinson Disease (classification)</term><term>Parkinson Disease (physiopathology)</term><term>Parkinson Disease (psychology)</term><term>Reference Values</term><term>Risk Assessment</term><term>Time Factors</term><term>Tremor (physiopathology)</term></keywords><keywords scheme="MESH" qualifier="classification" xml:lang="en"><term>Parkinson Disease</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Cognition Disorders</term><term>Dementia</term></keywords><keywords scheme="MESH" qualifier="physiology" xml:lang="en"><term>Motor Activity</term></keywords><keywords scheme="MESH" qualifier="physiopathology" xml:lang="en"><term>Parkinson Disease</term><term>Tremor</term></keywords><keywords scheme="MESH" qualifier="psychology" xml:lang="en"><term>Parkinson Disease</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Aged</term><term>Demography</term><term>Female</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Reference Values</term><term>Risk Assessment</term><term>Time Factors</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">The objective of this study was to assess the temporal relationship between changes in predominant motor symptoms and incident dementia in Parkinson's disease (PD). A community-based sample of 171 nondemented patients with PD was followed prospectively and examined at baseline and after 4 and 8 years. The motor subtype of Parkinsonism was classified into tremor-dominant (TD), indeterminate, or postural instability gait difficulty (PIGD) subtype at each visit, based on defined items in the Unified Parkinson's Disease Rating Scale, subscales II and III. Dementia was diagnosed according to DSM-III-R criteria, based on clinical interview, cognitive rating scales, and neuropsychological examination. Logistic regression was used to analyze the relationship between subtype of Parkinsonism and dementia. Transition from TD to PIGD subtype was associated with a more than threefold increase in the rate of Mini-Mental State Examination decline. Compared to patients with persistent TD or indeterminate subtype, the odds ratio for dementia was 56.7 (95% CI: 4.0-808.4; P = 0.003) for patients changing from TD or indeterminate subtype to PIGD subtype, and 80.0 (95% CI: 4.6-1400.1; P = 0.003) for patients with persistent PIGD subtype. Patients with TD subtype at baseline did not become demented until they developed PIGD subtype, and dementia did not occur among patients with persistent TD subtype of Parkinsonism. In a substantial proportion of PD patients who develop postural instability and gait disorder during the course of the disease, this transition is associated with accelerated cognitive decline and highly increased risk for subsequent dementia. These findings raise the question whether PIGD and dementia share common or parallel neuropathology.</div></front></TEI><pubmed><MedlineCitation Owner="NLM" Status="MEDLINE"><PMID Version="1">16637023</PMID><DateCreated><Year>2006</Year><Month>08</Month><Day>30</Day></DateCreated><DateCompleted><Year>2007</Year><Month>01</Month><Day>04</Day></DateCompleted><Article PubModel="Print"><Journal><ISSN IssnType="Print">0885-3185</ISSN><JournalIssue CitedMedium="Print"><Volume>21</Volume><Issue>8</Issue><PubDate><Year>2006</Year><Month>Aug</Month></PubDate></JournalIssue><Title>Movement disorders : official journal of the Movement Disorder Society</Title><ISOAbbreviation>Mov. Disord.</ISOAbbreviation></Journal><ArticleTitle>Changes in motor subtype and risk for incident dementia in Parkinson's disease.</ArticleTitle><Pagination><MedlinePgn>1123-30</MedlinePgn></Pagination><Abstract><AbstractText>The objective of this study was to assess the temporal relationship between changes in predominant motor symptoms and incident dementia in Parkinson's disease (PD). A community-based sample of 171 nondemented patients with PD was followed prospectively and examined at baseline and after 4 and 8 years. The motor subtype of Parkinsonism was classified into tremor-dominant (TD), indeterminate, or postural instability gait difficulty (PIGD) subtype at each visit, based on defined items in the Unified Parkinson's Disease Rating Scale, subscales II and III. Dementia was diagnosed according to DSM-III-R criteria, based on clinical interview, cognitive rating scales, and neuropsychological examination. Logistic regression was used to analyze the relationship between subtype of Parkinsonism and dementia. Transition from TD to PIGD subtype was associated with a more than threefold increase in the rate of Mini-Mental State Examination decline. Compared to patients with persistent TD or indeterminate subtype, the odds ratio for dementia was 56.7 (95% CI: 4.0-808.4; P = 0.003) for patients changing from TD or indeterminate subtype to PIGD subtype, and 80.0 (95% CI: 4.6-1400.1; P = 0.003) for patients with persistent PIGD subtype. Patients with TD subtype at baseline did not become demented until they developed PIGD subtype, and dementia did not occur among patients with persistent TD subtype of Parkinsonism. In a substantial proportion of PD patients who develop postural instability and gait disorder during the course of the disease, this transition is associated with accelerated cognitive decline and highly increased risk for subsequent dementia. 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