Skip to main content
NCBI home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1998 Feb;64(2):178–183. doi: 10.1136/jnnp.64.2.178

Neuropsychological prediction of dementia in Parkinson's disease

F Mahieux 1, G Fenelon 1, A Flahault 1, M Manifacier 1, D Michelet 1, F Boller 1
PMCID: PMC2169963  PMID: 9489527

Abstract

OBJECTIVE—To identify neuropsychological characteristics predictive of later dementia in Parkinson's disease.
METHODS—A comprehensive neuropsychological test battery was administered to a cohort of 89 initially non-demented patients with Parkinson's disease consecutively enrolled at a specialised Parkinson's disease clinic. They were reassessed after a mean of 3.5 years for the diagnosis of dementia. The Cox proportional hazards model was used to identify baseline characteristics predictive of dementia.
RESULTS—Only four of the baseline clinical characteristics of Parkinson's disease and neuropsychological variables remained independently linked to subsequent development of dementia: the age of onset of Parkinson's disease (>60 years; relative risk (RR) 4.1, 95% confidence interval (95% CI) 1.8-24.0, p<0.03), the picture completion subtest of the Wechsler adult intelligence scale (score<10; RR 4.9, 95% CI 1.0-24.1, p<0.02), the interference section of the Stroop test (score<21; RR 3.8, p=0.08), and a verbal fluency task (score<9; RR 2.7, 95% CI 0.8-9.1, p=0.09). Depressive symptoms and the severity of motor impairment were not predictive of dementia.
CONCLUSION—These features are different from the neuropsychological characteristics predictive of Alzheimer's dementia in healthy elderly people (mainly memory and language performance). They are in keeping with the well known specificity of the impairments in Parkinson's disease for visuospatial abilities and difficulties in inhibiting irrelevant stimuli. It is postulated that the composite nature of the picture completion subtest, involving several cognitive abilities impaired in Parkinson's disease, explains its sensitivity.



Full Text

The Full Text of this article is available as a PDF (117.0 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aarsland D., Tandberg E., Larsen J. P., Cummings J. L. Frequency of dementia in Parkinson disease. Arch Neurol. 1996 Jun;53(6):538–542. doi: 10.1001/archneur.1996.00550060082020. [DOI] [PubMed] [Google Scholar]
  2. Benton A. L., Varney N. R., Hamsher K. D. Visuospatial judgment. A clinical test. Arch Neurol. 1978 Jun;35(6):364–367. doi: 10.1001/archneur.1978.00500300038006. [DOI] [PubMed] [Google Scholar]
  3. Biggins C. A., Boyd J. L., Harrop F. M., Madeley P., Mindham R. H., Randall J. I., Spokes E. G. A controlled, longitudinal study of dementia in Parkinson's disease. J Neurol Neurosurg Psychiatry. 1992 Jul;55(7):566–571. doi: 10.1136/jnnp.55.7.566. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Boyd J. L., Cruickshank C. A., Kenn C. W., Madeley P., Mindham R. H., Oswald A. G., Smith R. J., Spokes E. G. Cognitive impairment and dementia in Parkinson's disease: a controlled study. Psychol Med. 1991 Nov;21(4):911–921. doi: 10.1017/s0033291700029901. [DOI] [PubMed] [Google Scholar]
  5. Brown R. G., Marsden C. D. 'Subcortical dementia': the neuropsychological evidence. Neuroscience. 1988 May;25(2):363–387. doi: 10.1016/0306-4522(88)90246-1. [DOI] [PubMed] [Google Scholar]
  6. Brown R. G., Marsden C. D. Cognitive function in Parkinson's disease: from description to theory. Trends Neurosci. 1990 Jan;13(1):21–29. doi: 10.1016/0166-2236(90)90058-i. [DOI] [PubMed] [Google Scholar]
  7. Brown R. G., Marsden C. D. How common is dementia in Parkinson's disease? Lancet. 1984 Dec 1;2(8414):1262–1265. doi: 10.1016/s0140-6736(84)92807-1. [DOI] [PubMed] [Google Scholar]
  8. Cummings J. L. Depression and Parkinson's disease: a review. Am J Psychiatry. 1992 Apr;149(4):443–454. doi: 10.1176/ajp.149.4.443. [DOI] [PubMed] [Google Scholar]
  9. Downes J. J., Roberts A. C., Sahakian B. J., Evenden J. L., Morris R. G., Robbins T. W. Impaired extra-dimensional shift performance in medicated and unmedicated Parkinson's disease: evidence for a specific attentional dysfunction. Neuropsychologia. 1989;27(11-12):1329–1343. doi: 10.1016/0028-3932(89)90128-0. [DOI] [PubMed] [Google Scholar]
  10. Downes J. J., Sharp H. M., Costall B. M., Sagar H. J., Howe J. Alternating fluency in Parkinson's disease. An evaluation of the attentional control theory of cognitive impairment. Brain. 1993 Aug;116(Pt 4):887–902. doi: 10.1093/brain/116.4.887. [DOI] [PubMed] [Google Scholar]
  11. Dubois B., Hauw J. J., Ruberg M., Serdaru M., Javoy-Agid F., Agid Y. Démence et maladie de Parkinson: corrélations biochimiques et anatomo-cliniques. Rev Neurol (Paris) 1985;141(3):184–193. [PubMed] [Google Scholar]
  12. Ebmeier K. P., Calder S. A., Crawford J. R., Stewart L., Besson J. A., Mutch W. J. Clinical features predicting dementia in idiopathic Parkinson's disease: a follow-up study. Neurology. 1990 Aug;40(8):1222–1224. doi: 10.1212/wnl.40.8.1222. [DOI] [PubMed] [Google Scholar]
  13. Flowers K. A., Robertson C. The effect of Parkinson's disease on the ability to maintain a mental set. J Neurol Neurosurg Psychiatry. 1985 Jun;48(6):517–529. doi: 10.1136/jnnp.48.6.517. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Folstein M. F., Folstein S. E., McHugh P. R. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975 Nov;12(3):189–198. doi: 10.1016/0022-3956(75)90026-6. [DOI] [PubMed] [Google Scholar]
  15. Gibb W. R. Dementia and Parkinson's disease. Br J Psychiatry. 1989 May;154:596–614. doi: 10.1192/bjp.154.5.596. [DOI] [PubMed] [Google Scholar]
  16. Girotti F., Soliveri P., Carella F., Piccolo I., Caffarra P., Musicco M., Caraceni T. Dementia and cognitive impairment in Parkinson's disease. J Neurol Neurosurg Psychiatry. 1988 Dec;51(12):1498–1502. doi: 10.1136/jnnp.51.12.1498. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Gotham A. M., Brown R. G., Marsden C. D. Depression in Parkinson's disease: a quantitative and qualitative analysis. J Neurol Neurosurg Psychiatry. 1986 Apr;49(4):381–389. doi: 10.1136/jnnp.49.4.381. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Growdon J. H., Corkin S. Cognitive impairments in Parkinson's disease. Adv Neurol. 1987;45:383–392. [PubMed] [Google Scholar]
  19. Guillard A., Chastang C., Fenelon G. Etude à long terme de 416 cas de maladie de Parkinson. Facteurs de pronostic et implications thérapeutiques. Rev Neurol (Paris) 1986;142(3):207–214. [PubMed] [Google Scholar]
  20. Guillard A., Fénelon G., Mahieux F. Les altérations cognitives au cours de la maladie de Parkinson. Rev Neurol (Paris) 1991;147(5):337–355. [PubMed] [Google Scholar]
  21. Hantz P., Caradoc-Davies G., Caradoc-Davies T., Weatherall M., Dixon G. Depression in Parkinson's disease. Am J Psychiatry. 1994 Jul;151(7):1010–1014. doi: 10.1176/ajp.151.7.1010. [DOI] [PubMed] [Google Scholar]
  22. Hassler R. Striatal control of locomotion, intentional actions and of integrating and perceptive activity. J Neurol Sci. 1978 Apr;36(2):187–224. doi: 10.1016/0022-510x(78)90082-5. [DOI] [PubMed] [Google Scholar]
  23. Hoehn M. M., Yahr M. D. Parkinsonism: onset, progression and mortality. Neurology. 1967 May;17(5):427–442. doi: 10.1212/wnl.17.5.427. [DOI] [PubMed] [Google Scholar]
  24. Hughes A. J., Daniel S. E., Blankson S., Lees A. J. A clinicopathologic study of 100 cases of Parkinson's disease. Arch Neurol. 1993 Feb;50(2):140–148. doi: 10.1001/archneur.1993.00540020018011. [DOI] [PubMed] [Google Scholar]
  25. Hughes A. J., Daniel S. E., Kilford L., Lees A. J. Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry. 1992 Mar;55(3):181–184. doi: 10.1136/jnnp.55.3.181. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Hughes T., Ross H., Madeley P., Finlayson G., Mindham R. H., Biggins C. A. Subcortical dementia. BMJ. 1993 Aug 21;307(6902):503–503. doi: 10.1136/bmj.307.6902.503-b. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Jacobs D. M., Marder K., Côté L. J., Sano M., Stern Y., Mayeux R. Neuropsychological characteristics of preclinical dementia in Parkinson's disease. Neurology. 1995 Sep;45(9):1691–1696. doi: 10.1212/wnl.45.9.1691. [DOI] [PubMed] [Google Scholar]
  28. Jacobs D. M., Sano M., Dooneief G., Marder K., Bell K. L., Stern Y. Neuropsychological detection and characterization of preclinical Alzheimer's disease. Neurology. 1995 May;45(5):957–962. doi: 10.1212/wnl.45.5.957. [DOI] [PubMed] [Google Scholar]
  29. Jellinger K. Alzheimer pathology in Parkinson's disease. Neurology. 1989 Jun;39(6):874–875. doi: 10.1212/wnl.39.6.874-b. [DOI] [PubMed] [Google Scholar]
  30. Lavernhe G., Pollak P., Brenier F., Gaio J. M., Hommel M., Pellat J., Perret J. Maladie d'Alzheimer et maladie de Parkinson. Difféferenciation neuropsychologique. Rev Neurol (Paris) 1989;145(1):24–30. [PubMed] [Google Scholar]
  31. Lees A. J. Parkinson's disease and dementia. Lancet. 1985 Jan 5;1(8419):43–44. doi: 10.1016/s0140-6736(85)90986-9. [DOI] [PubMed] [Google Scholar]
  32. Lees A. J., Smith E. Cognitive deficits in the early stages of Parkinson's disease. Brain. 1983 Jun;106(Pt 2):257–270. doi: 10.1093/brain/106.2.257. [DOI] [PubMed] [Google Scholar]
  33. Lieberman A., Dziatolowski M., Kupersmith M., Serby M., Goodgold A., Korein J., Goldstein M. Dementia in Parkinson Disease. Ann Neurol. 1979 Oct;6(4):355–359. doi: 10.1002/ana.410060409. [DOI] [PubMed] [Google Scholar]
  34. Madeley P., Biggins C. A., Boyd J. L., Mindham R. H. Cognitive impairments and depression in Parkinson's disease. J Neurol Neurosurg Psychiatry. 1991 Oct;54(10):941–941. doi: 10.1136/jnnp.54.10.941. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Marder K., Flood P., Cote L., Mayeux R. A pilot study of risk factors for dementia in Parkinson's disease. Mov Disord. 1990;5(2):156–161. doi: 10.1002/mds.870050212. [DOI] [PubMed] [Google Scholar]
  36. Marder K., Tang M. X., Cote L., Stern Y., Mayeux R. The frequency and associated risk factors for dementia in patients with Parkinson's disease. Arch Neurol. 1995 Jul;52(7):695–701. doi: 10.1001/archneur.1995.00540310069018. [DOI] [PubMed] [Google Scholar]
  37. Marttila R. J., Rinne U. K. Dementia in Parkinson's disease. Acta Neurol Scand. 1976 Nov;54(5):431–441. doi: 10.1111/j.1600-0404.1976.tb04375.x. [DOI] [PubMed] [Google Scholar]
  38. Massman P. J., Delis D. C., Butters N., Levin B. E., Salmon D. P. Are all subcortical dementias alike? Verbal learning and memory in Parkinson's and Huntington's disease patients. J Clin Exp Neuropsychol. 1990 Oct;12(5):729–744. doi: 10.1080/01688639008401015. [DOI] [PubMed] [Google Scholar]
  39. Masur D. M., Sliwinski M., Lipton R. B., Blau A. D., Crystal H. A. Neuropsychological prediction of dementia and the absence of dementia in healthy elderly persons. Neurology. 1994 Aug;44(8):1427–1432. doi: 10.1212/wnl.44.8.1427. [DOI] [PubMed] [Google Scholar]
  40. Mayeux R., Denaro J., Hemenegildo N., Marder K., Tang M. X., Cote L. J., Stern Y. A population-based investigation of Parkinson's disease with and without dementia. Relationship to age and gender. Arch Neurol. 1992 May;49(5):492–497. doi: 10.1001/archneur.1992.00530290076015. [DOI] [PubMed] [Google Scholar]
  41. Mayeux R., Stern Y., Rosenstein R., Marder K., Hauser A., Cote L., Fahn S. An estimate of the prevalence of dementia in idiopathic Parkinson's disease. Arch Neurol. 1988 Mar;45(3):260–262. doi: 10.1001/archneur.1988.00520270034017. [DOI] [PubMed] [Google Scholar]
  42. Mohr E., Mendis T., Grimes J. D. Late cognitive changes in Parkinson's disease with an emphasis on dementia. Adv Neurol. 1995;65:97–113. [PubMed] [Google Scholar]
  43. Nelson H. E. A modified card sorting test sensitive to frontal lobe defects. Cortex. 1976 Dec;12(4):313–324. doi: 10.1016/s0010-9452(76)80035-4. [DOI] [PubMed] [Google Scholar]
  44. O'Connor D. W., Pollitt P. A., Hyde J. B., Fellows J. L., Miller N. D., Brook C. P., Reiss B. B. The reliability and validity of the Mini-Mental State in a British community survey. J Psychiatr Res. 1989;23(1):87–96. doi: 10.1016/0022-3956(89)90021-6. [DOI] [PubMed] [Google Scholar]
  45. Pillon B., Dubois B., Bonnet A. M., Esteguy M., Guimaraes J., Vigouret J. M., Lhermitte F., Agid Y. Cognitive slowing in Parkinson's disease fails to respond to levodopa treatment: the 15-objects test. Neurology. 1989 Jun;39(6):762–768. doi: 10.1212/wnl.39.6.762. [DOI] [PubMed] [Google Scholar]
  46. Pirozzolo F. J., Hansch E. C., Mortimer J. A., Webster D. D., Kuskowski M. A. Dementia in Parkinson disease: a neuropsychological analysis. Brain Cogn. 1982 Jan;1(1):71–83. doi: 10.1016/0278-2626(82)90007-0. [DOI] [PubMed] [Google Scholar]
  47. Rajput A. H., Offord K. P., Beard C. M., Kurland L. T. A case-control study of smoking habits, dementia, and other illnesses in idiopathic Parkinson's disease. Neurology. 1987 Feb;37(2):226–232. doi: 10.1212/wnl.37.2.226. [DOI] [PubMed] [Google Scholar]
  48. Salganik I., Korczyn A. Risk factors for dementia in Parkinson's disease. Adv Neurol. 1990;53:343–347. [PubMed] [Google Scholar]
  49. Sano M., Stern Y., Williams J., Coté L., Rosenstein R., Mayeux R. Coexisting dementia and depression in Parkinson's disease. Arch Neurol. 1989 Dec;46(12):1284–1286. doi: 10.1001/archneur.1989.00520480026014. [DOI] [PubMed] [Google Scholar]
  50. Stam C. J., Visser S. L., Op de Coul A. A., De Sonneville L. M., Schellens R. L., Brunia C. H., de Smet J. S., Gielen G. Disturbed frontal regulation of attention in Parkinson's disease. Brain. 1993 Oct;116(Pt 5):1139–1158. doi: 10.1093/brain/116.5.1139. [DOI] [PubMed] [Google Scholar]
  51. Starkstein S. E., Bolduc P. L., Mayberg H. S., Preziosi T. J., Robinson R. G. Cognitive impairments and depression in Parkinson's disease: a follow up study. J Neurol Neurosurg Psychiatry. 1990 Jul;53(7):597–602. doi: 10.1136/jnnp.53.7.597. [DOI] [PMC free article] [PubMed] [Google Scholar]
  52. Starkstein S. E., Preziosi T. J., Berthier M. L., Bolduc P. L., Mayberg H. S., Robinson R. G. Depression and cognitive impairment in Parkinson's disease. Brain. 1989 Oct;112(Pt 5):1141–1153. doi: 10.1093/brain/112.5.1141. [DOI] [PubMed] [Google Scholar]
  53. Stern Y., Marder K., Tang M. X., Mayeux R. Antecedent clinical features associated with dementia in Parkinson's disease. Neurology. 1993 Sep;43(9):1690–1692. doi: 10.1212/wnl.43.9.1690. [DOI] [PubMed] [Google Scholar]
  54. Strömgren L. S. The influence of depression on memory. Acta Psychiatr Scand. 1977 Aug;56(2):109–128. doi: 10.1111/j.1600-0447.1977.tb06670.x. [DOI] [PubMed] [Google Scholar]
  55. Sullivan E. V., Sagar H. J., Gabrieli J. D., Corkin S., Growdon J. H. Different cognitive profiles on standard behavioral tests in Parkinson's disease and Alzheimer's disease. J Clin Exp Neuropsychol. 1989 Dec;11(6):799–820. doi: 10.1080/01688638908400937. [DOI] [PubMed] [Google Scholar]
  56. Tandberg E., Larsen J. P., Aarsland D., Cummings J. L. The occurrence of depression in Parkinson's disease. A community-based study. Arch Neurol. 1996 Feb;53(2):175–179. doi: 10.1001/archneur.1996.00550020087019. [DOI] [PubMed] [Google Scholar]
  57. Taylor A. E., Saint-Cyr J. A. The neuropsychology of Parkinson's disease. Brain Cogn. 1995 Aug;28(3):281–296. doi: 10.1006/brcg.1995.1258. [DOI] [PubMed] [Google Scholar]
  58. Taylor A., Saint-Cyr J. A., Lang A. E. Dementia prevalence in Parkinson's disease. Lancet. 1985 May 4;1(8436):1037–1037. doi: 10.1016/s0140-6736(85)91631-9. [DOI] [PubMed] [Google Scholar]
  59. Tison F., Dartigues J. F., Auriacombe S., Letenneur L., Boller F., Alpérovitch A. Dementia in Parkinson's disease: a population-based study in ambulatory and institutionalized individuals. Neurology. 1995 Apr;45(4):705–708. doi: 10.1212/wnl.45.4.705. [DOI] [PubMed] [Google Scholar]
  60. Tombaugh T. N., McIntyre N. J. The mini-mental state examination: a comprehensive review. J Am Geriatr Soc. 1992 Sep;40(9):922–935. doi: 10.1111/j.1532-5415.1992.tb01992.x. [DOI] [PubMed] [Google Scholar]
  61. Tröster A. I., Stalp L. D., Paolo A. M., Fields J. A., Koller W. C. Neuropsychological impairment in Parkinson's disease with and without depression. Arch Neurol. 1995 Dec;52(12):1164–1169. doi: 10.1001/archneur.1995.00540360042014. [DOI] [PubMed] [Google Scholar]
  62. Zung W. W. A rating instrument for anxiety disorders. Psychosomatics. 1971 Nov-Dec;12(6):371–379. doi: 10.1016/S0033-3182(71)71479-0. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES