Objective: Evaluate the relationship between magnetic resonance (MRI) abnormalities and neuropsychological assessment in Parkinson s disease mild cognitive impairment (PD-MCI) and controls with mild cognitive impairment (CO-MCI).

Background: The recognition and treatment of cognitive impairment are increasingly emphasized in the care of PD. PD-MCI is one of the most important risk factor related to dementia. Global Cerebral Atrophy (CGA), Medial Temporal Atrophy (MTA) and white matter hyperintensities could be found more frequently in Parkinson s disease dementia. We evaluated if these structural changes could be related with neuropsychological pattern of PD-MCI comparing with CO-MCI.

Methods: 75 PD and 88 controls (CO) were evaluated, 50 PD and 61 CO were excluded because didn t have MRI scan, presented one or more findings that could be related to cognitive impairment (use of benzodiazepine or anticholinergic, MRI or blood abnormalities) or fulfilled criteria for dementia or depression. The assessment consists of: neurology examination, Hoehn-Yahr, UPDRS, PDQ 39, Schwab-England, Beck scale, L-dopa dose, neuropsychological battery, Global Cerebral Atrophy (GCA), medial temporal atrophy (MTA), Evans Index, and Fazekas scale (FS).

Results: Both groups were classified by neuropsychological assessment in amnestic or non- amnestic. No differences were observed on several demographic data.

Sample characteristics

Variables	DP Amnestic MCI n=13 mean (sd)	DP Nonamnestic MCI n=12 mean (sd)	Control Amnestic MCI n=18 mean (sd)	Control Nonamnestic MCI n=9 mean (sd)	p-value
Age (years)	60.23 (7.132)	58.92 (6.908)	60.72 (6.323)	60.89 (6,451)	0.781 (a)
Education Level (years)	9.23 (4.126)	10.25 (2.864)	12.72 (3.893)	13.22 (4.147)	0.031(a)
Sex % (male / female)	53.8 / 46.2	83.3 / 16.7	27.8 / 72.2	11.1 / 88.9
MMSE	27.31 (1.601)	27.83 (1.337)	27.89 (1.278)	27.89 (1.269)	0.651(a)
MoCA	23.00 (2.915)	24.00 (3.191)	22.94 (2.754)	23.89 (3.180)	0.710(a)
BDI	8.38 (5.591)	5.33 (4.438)	7.50 (5.159)	8.22 (3.232)	0.404(a)
Years since diagnosis (months)	64.62 (31.574)	68.00 (37.717)	–	–	0.809(b)
Levodopa dosage equivalence (Mg)	636.31 (292.665)	1783.75 (4060.456)	–	–	0.350(b)
UPDRS-III	18.54 (9.421)	15.92 (5.791)	–	–	0.088(b)
PDQ39 (total)	28.50 (14.112)	19.55 (10.914)	–	–	0.408(b)
Schwab-England	83.08 (7.511)	88.33 (3.892)	–	–	0.039(b)
Cerebrovascular risk factor %	38.5	25.0	38.9	66.7
Smoking % (sim / não)	38.5 / 61.5	83.3 / 16.7	5.6 / 94.4	11.1 / 88.9
Global Cerebral Atrophy % (score 0/1/2/3)	46.2 / 46.2 / 7.7/0.0	50.0 / 50.0 / 0.0/0.0	33.3 / 44.4 / 5.6/0.0	55.6 / 44.4 / 0.0/0.0
MTA % (score 0/1/2/3/4)	46.2 / 46.2 / 7.7/0.0/0.0	58.3 / 41.7 / 0.0/0.0/0.0	61.1 / 33.3 / 5.6/0.0/0.0	55.6 / 44.4 / 0.0/0.0/0.0
FAZEKAS % (score 0/1/2/3)	38.5 / 46.2 / 7.7 / 7.7	58.3 / 25.0 / 8.3 / 8.3	38.9 / 38.9 / 11.1 / 55.6	11.1 / 55.6 / 33.3 / 0.0
(a) One-way ANOVA; (b) t-test

” PD-MCI amnestic group presented worse results on memory and executive function followed by PD-MCI non amnestic.

Performance of Patients and Controls in the Neuropsychological Tests (raw scores)

Neuropsychological Tests	DP Amnestic MCI n=13 mean (sd)	DP Nonamnestic MCI n=12 mean (sd)	p-value (a)	Control Amnestic MCI n=18 mean (sd)	Control Nonamnestic MCI n=9 mean (sd)	p-value(a)	PS
MI(b;1)	5.08 (1.038)	6.50 (1.508)	0.013	5.33 (1.188)	5.78 (1.202)	0.377	Storage of information that occurs passively (i.e., without conscious effort). MEMORY
M1(b;2)	6.92 (1.320)	8.25 (1.055)	0.011	8.11 (1.023)	8.78 (1.302)	0.202	Visual short-term memory MEMORY
M2(b;3)	8.92 (0.862)	9.25 (0.754)	0,323	8.56 (1.542)	9.67 (0.500)	0.011	Visual learning MEMORY
M5(b;4)	7.00 (2.345)	8.75 (0.754)	0.022	8.39 (1.243)	8.89 (1.054)	0.288	Visual long-term memory MEMORY
A6(c;6)	3.85 (2.410)	8.75 (2.491)	< 0.001	7.22 (3.135)	9.78 (3.153)	0.064	Verbal memory MEMORY
A7(c;7)	4.00 (2.121)	9.25 (2.417)	< 0.001	7.00 (3.881)	10.56 (3.005)	0.016	Verbal long-term memory MEMORY
LOT(c;8)	11.54 (5.487)	21.33 (7.228)	0.001	17.67 (8.260)	20.33 (6.124)	0.355	Verbal learning MEMORY
RI(c;9)	0.49 (0.275)	0.76 (0.203)	0.010	0,75 (0.286)	0.83 (0.132)	0.343	Interference MEMORY and EXECUTIVE FUNCTIONS
Recognition(c;10)	4.62 (4.053)	11.08 (2.811)	< 0.001	6.28 (4.417)	12.33 (2.646)	< 0.001	Recognition memory MEMORY
TMT A(d)	71.83 (18.914)	68.06 (18.895)	0.641	53.39 (17.431)	40.13 (9.040)	0.017	Processing Speed EXECUTIVE FUNCTIONS
FAS(f)	25.62 (6.449)	35.08 (8.458)	0.005	31.83 (7.710)	33.22 (5.191)	0.585	Phonemic verbal fluency EXECUTIVE FUNCTIONS
(a)t-Test; (b)Figures Memory Test – Nitrini (1994); (1)MI = incidental memory; (2)M1= number of figures recalled after 1-minute visualization;(3)M2= Learning; (4)M5= recall of memorized figures after 5 minutes; (c)Rey Auditory Verbal Learning Test – Malloy-Diniz (2007); (5)B1=retrieval of words included in the interference list of 15 new substantives; (6)A6= number of words memorized from list A without reread; (7)A7 = number of words memorized from list A, without reread, after 20-minute interval; (8)LOT=leaning curve of the wordsduring attempts A1 to A5; (9)RI= Retroactive Interference (A6/A5); (10)correct answers in recognitive list; (d)TMT A = trail making test – trail A (time in seconds); (e)FVS=semantic verbal fluency (animals); (f)FAS=phonemic verbal fluency (letters F, A and S)

” More severe motor impairment (UPDRS) presented worse scores in attention and memory. MRI variables: GCA correlates with executive function (EF) in PD amnestic & non amnestic, MTA with EF & memory (Me) in PD amnestic & CO amnestic, Fazekas with EF, Me & attention (AT) in PD amnestic & PD non amnestic, Evans Index with Me in all four groups, AT in PD amnestic & Language in PD non amnestic.

Conclusions: Structural abnormalities in MRI were more common in PD-MCI than MCI-CO. PD group presented more prominent impairment than control. MRI could be more useful in PD-MCI than MCI-CO and could reflect irreversible structural changes beyond basal ganglia in PD. Burton EJ, McKeith IG, Burn DJ et al. Cerebral atrophy in Parkinson s disease with and without dementia. Brain. 2004;127:791-800. Yarnall AJ, Rochester L, Burn DJ. Mild cognitive impairment in Parkinson s disease. Age Ageing. 2013;42(5):567-76.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/neuropsychology-and-magnetic-resonance-correlation-in-parkinsons-disease-mild-cognitive-impairment-case-control-study/