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KMID : 0828520080120040227
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Journal of the Korean Geriatrics Society
2008 Volume.12 No. 4 p.227 ~ p.234
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The Pattern of Cognitive Impairment Associated with the Motor Subtype in Parkinsons Disease
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Kim Joong-Seok
Song In-Uk
Lee Kwang-Soo
Kim Yeong-In
Lee Seung-Jae
Lee Kyu-Hwan
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Abstract
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Background: Previous studies have found over-representation of a postural instability and gait difficulty(PIGD) motor subtype in Parkinsons disease with dementia (PD-D).
Methods: One hundred twenty patients with Parkinson’s disease(PD) were included in this study. All patients were evaluated by the Unified Parkinson’s Disease Rating Scale (UPDRS) and neuropsychological tests. On the basis of the criteria for dementia (DSM-IV) and the results of the neuropsychological assessments, the patients were divided into the following three groups: ① non-dem ented (PD-ND), ② mild cognitive im pairm ent (PD-MCI), and ③ dementia (PD-D). In addition, patients were also grouped into the follow ing two phenotypes based on the UPDRS components: ① trem or and ② postural instability gait difficulty (PIGD)-predom inant. We also analyzed the clinical characteristics and subtypes of the disease. In addition, the relationship between the cognitive impairments and the parkinsonian motor handicaps was evaluated.
Results: There was a significant relationship between cognitive impairment and the motor subtypes. The PIGD group had a higher prevalence of PD-D than the other group. In addition, there were significant correlations between the general cognitive functions and motor handicaps, especially those with axial symptoms. Multiple logistic regression analysis show ed that the motor subtype was independently associated with the cognitive decline in PD .
Conclusion: These findings support that cognitive decline in patients with PD is associated with a specific motor subtype. This association might be explained by the involvement of non-dopaminergic pathways. These results have implications for the clinical management of PD with regard to the motor symptoms and cognition.
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KEYWORD
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Parkinsons disease, Cognition, Motor subtype
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