Sarah Getz and Bonnie Levin have published a broad and wideranging
review of cognitive and neuropsychiatric symptoms in early PD.
The bottom line of this article underscores the tennet that PD is not
just a movement disorder!
Although a noticeable proportion of people with PD may develop
dementia, a significant body of work has shown that even at the earliest stages
(including the prodromal or pre-motor stages), there are detectable memory
deficits. One particular aspect of difficulty is in ‘executive function’ – the thinking
process that allows for planning, initiating and concentrating on a task as
well as ‘thinking outside the box’. I think this has interesting significance when
considering the daily function of people with Parkinson’s, such as driving
(see an earlier blog post from the PREDICT-PD blog).
Depression, fatigue and apathy are all very common symptoms that have a
major impact on the quality of life of people with PD, not to mention their
family and caregivers. Fatigue has been reported to occur in up to 2 in every 3
people with PD and has been described as the most debilitating symptom. Apathy
is a real danger – muscles, be they physical, cognitive or emotional, need use.
Apathy robs the person of the drive to exercise those muscles and thereby
jeopardises their future ability to move, think and feel as they once did. It
goes hand in hand with depression and also with increasing disability do to PD.
As we learn more about these less visible aspects of PD, we now need to
search for ways to treat them. This is particularly important as the bedrock of
PD treatment may make some aspects of thinking and feeling worse.
RNR
Cognitive and Neuropsychiatric Features of Early Parkinson's
Disease.
Getz SJ, Levin B.
Arch Clin Neuropsychol. 2017 Nov 1;32(7):769–85.
The clinical definition of Parkinson's disease (PD) is based
on cardinal motor features including bradykinesia as well as an additional
symptom of tremor, postural instability, or rigidity. Evidence from
neuropathological, imaging, and clinical research suggests a premotor, early phase
of PD pathology. Further understanding of the earliest biomarkers of PD is
crucial for the development of neuroprotective, disease modifying, cognitive,
and psychiatric interventions. Recent research has explored early non-motor
markers of PD pathology. This issue is especially timely as the International
Parkinson and Movement Disorder Society has recently provided a research
definition for prodromal PD which includes combinations of prodromal markers
and risk factors aimed at identifying target populations for disease-prevention
trials. In this review of early PD, we will outline early non-motor symptoms,
early cognitive and neuropsychiatric features, neuropsychological assessment
strategies, emerging evidence for early biomarkers, and treatment recommendations.
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