Mild parkinsonian signs and psycho-behavioral symptoms in subjects with mild cognitive impairment
Luca Rozzini1, Barbara Vicini Chilovi, Erik Bertoletti
1Department of Neurology, University of Brescia, Italy. lrozzini@iol.it
Background:
Mild cognitive impairment (MCI) may be accompanied by extra pyramidal signs (EPS), which are related to the severity and type of cognitive impairment. We aimed to elucidate further the relationship between MCI and EPS, analyzing the correlation between the severity of EPS and cognitive functions, and the presence of EPS and neuro-psychiatric features.
Methods:
Data were obtained from a longitudinal study of 150 MCI outpatients. Participants underwent a clinical assessment including the Unified Parkinson Disease Rating Scale, the Neuropsychiatric Inventory, the Tinetti Scale, and a standardized neuropsychological battery. Mild EPS could be defined as being present (MCI with mild EPS) using a subscale of UPDRS, based on three specific symptoms: bradykinesia, rigidity and tremor.
Results:
The two groups, one with mild EPS (24%) and one without EPS (76%), differed in gait abnormalities and presence of extrapyramidal symptoms. Groups did not differ in terms of general cognitive functions evaluated using the Mini-mental State Examination, while subjects with MCI with mild EPS performed significantly worse than those with MCI without EPS in total global score and in non-memory items of the Alzheimer's Disease Assessment Scale. Moreover, severity of EPS was significantly correlated with low performance on executive functions and with high performance on episodic memory. The group with MCI with mild EPS were observed to have a greater prevalence of patients with anxiety, depression, apathy and sleep disturbances than in MCI without EPS.
Conclusion:
MCI may be associated with mild parkinsonian signs, the severity of which are related to the severity of cognitive impairment, in particular of non-memory functions, and to a differential pattern of psycho-behavioral symptoms.
Insights
Mild cognitive impairment (MCI) with mild extrapyramidal signs (EPS) is linked to worse non-memory cognitive function and more neuropsychiatric issues. The severity of EPS correlates with executive function deficits and episodic memory.
Area of Science:
- Neurology
- Neuropsychology
- Geriatrics
Background:
- Mild cognitive impairment (MCI) can present with extrapyramidal signs (EPS).
- EPS are associated with the severity and type of cognitive impairment.
- The relationship between MCI and EPS requires further elucidation.
Purpose of the Study:
- To analyze the correlation between EPS severity and cognitive functions in MCI patients.
- To investigate the presence of EPS and associated neuro-psychiatric features in MCI.
- To understand the link between mild parkinsonian signs and cognitive/behavioral patterns in MCI.
Main Methods:
- Longitudinal study of 150 MCI outpatients.
- Clinical assessment using Unified Parkinson Disease Rating Scale (UPDRS), Neuropsychiatric Inventory, and Tinetti Scale.
- Standardized neuropsychological battery and definition of mild EPS based on UPDRS subscale (bradykinesia, rigidity, tremor).
Main Results:
- 24% of MCI patients exhibited mild EPS.
- MCI with mild EPS showed worse performance in global cognitive scores and non-memory domains (Alzheimer's Disease Assessment Scale).
- EPS severity correlated with poorer executive functions and better episodic memory; increased anxiety, depression, apathy, and sleep disturbances were noted in MCI with mild EPS.
Conclusions:
- MCI can be associated with mild parkinsonian signs.
- The severity of these signs relates to cognitive impairment, particularly non-memory functions.
- A distinct pattern of psycho-behavioral symptoms accompanies MCI with mild EPS.
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