Hostname: page-component-7c8c6479df-p566r Total loading time: 0 Render date: 2024-03-28T11:38:12.128Z Has data issue: false hasContentIssue false

Parkinsonian signs and cognitive function in old age

Published online by Cambridge University Press:  26 August 2005

DEBRA A. FLEISCHMAN
Affiliation:
Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois Department of Psychology, Rush University Medical Center, Chicago, Illinois
ROBERT S. WILSON
Affiliation:
Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois Department of Psychology, Rush University Medical Center, Chicago, Illinois
JULIA L. BIENIAS
Affiliation:
Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois Rush Institute for Healthy Aging and Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
DAVID A. BENNETT
Affiliation:
Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois

Abstract

Studies have shown that parkinsonian signs are related to cognitive function in aging. What remains unclear is whether this association is stronger for some cognitive domains than it is for others, and precisely how much variability in global and specific cognitive functions is explained by the motor signs. We examined the associations between four parkinsonian signs (gait, rigidity, bradykinesia, tremor) and five cognitive domains (episodic memory, semantic memory, working memory, perceptual speed, visuospatial ability) in a large cohort of older persons who were free of Parkinson's disease and dementia and were participating in the Rush Memory and Aging Project. In a series of regression equations that controlled for age, sex, and education, higher levels of three signs (gait, rigidity, and bradykinesia) were related to lower levels of cognitive function, but they accounted for less than 5% of the variance in most measures. The results did not change when the presence of depressive symptoms, diabetes, and hypertension were added to the models. The cross-sectional association between parkinsonian signs and cognitive function did not vary substantially across specific cognitive domains or specific cognitive tests. The results suggest that parkinsonian signs have a modest, but statistically reliable, association with level of cognitive function in old age. (JINS, 2005, 11, 591–597.)

Type
Research Article
Copyright
© 2005 The International Neuropsychological Society

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Albert, M., Smith, L., Scherr, P., Taylor, J., Evans, D., & Funkenstein, H. (1991). Use of brief cognitive tests to identify individuals in the community with clinically diagnosed Alzheimer's disease. International Journal of Neurosciences, 57, 167178.Google Scholar
Arvanitakis, Z., Wilson, R.S., Bienias, J.L., Evans, D.A., & Bennett, D.A. (2004a). Diabetes mellitus and risk of Alzheimer's disease and decline in cognitive function. Archives of Neurology, 61, 661666.Google Scholar
Arvanitakis, Z., Wilson, R.S., Schneider, J.A., Bienias, J.L., Evans, D.A., & Bennett, D.A. (2004b). Diabetes mellitus and progression of rigidity and gait disturbance in older persons. Neurology, 63, 9961001.Google Scholar
Bennett, D.A., Beckett, L.A., Murray, A.M., Shannon, K.M., Goetz, C.G., Pilgrim, D.M., & Evans, D.A. (1996). Prevalence of parkinsonian signs and associated mortality in a community population of older people. New England Journal of Medicine, 334, 7176.Google Scholar
Bennett, D.A., Shannon, K.M., Beckett, L.A., & Wilson, R.S. (1999). Dimensionality of parkinsonian signs in aging and Alzheimer's disease. Journal of Gerontology: Aging, Biological Sciences, and Medical Sciences, 54A, M191M196.Google Scholar
Bennett, D.A., Shannon, K.M., Beckett, L.A., Goetz, C.G., & Wilson, R.S. (1997). Metric properties of nurses' ratings of parkinsonian signs with a modified Unified Parkinson's Disease Rating Scale. Neurology, 49, 15801586.Google Scholar
Benton, A.L., Sivan, A.B., Hamsher, K.DeS., Varney, N.R., & Spreen, O. (1994). Contributions to neuropsychological assessment (2nd ed). New York: Oxford University Press.
Cooper, J.A. & Sagar, H.J. (1993). Incidental and intentional recall in Parkinson's disease: An account based on diminished attentional resources. Journal of Clincal and Experimental Neuropsychology, 15, 713731.Google Scholar
Ditter, S. & Mirra, S. (1987). Neuropathologic and clinical features of Parkinson's disease in Alzheimer's disease. Neurology, 37, 754760.Google Scholar
Ekstrom, R.B., French, J.W., Harman, H.H., & Kermen, D. (1976). Manual for kit of factor-referenced cognitive tests. Princeton, NJ: Educational Testing Service.
Elias, M.F., Wolf, P.A., D'Agostino, R.B., Cobb, J., & White, L.R. (1993). Untreated blood pressure level is inversely related to cognitive functioning: The Framingham Study. American Journal of Epidemiology, 138, 353364.Google Scholar
Fahn, S. & Elton, R. (1987). Unified Parkinson's Disease Rating Scale. In S. Fahn, C. Marsden, M. Goldstein, & D. Calne (Eds.), Recent developments in Parkinson's Disease (Vol. 12, pp. 153163). Florham Park, NJ: MacMillan Healthcare Information.
Farmer, M.E., Kittner, S.J., Abbott, R.D., Wolz, M.M., Wolf, P.A., & White, L.R. (1990). Longitudinally measured blood pressure, antihypertensive medication use, and cognitive performance: The Framingham Study. Journal of Clinical Epidemiology, 43, 475480.Google Scholar
Folstein, M., Folstein, S., & McHugh, P. (1975). Mini-Mental State: A practical method for grading the mental state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.Google Scholar
Gregg, E.W., Yaffe, K., Cauley, J.A., Rolka, D.B., Blackwell, T.L., Venkat Narayan, K.M., & Cummings, S.R. (2000). Is diabetes associated with cognitive impairment and cognitive decline among older women? Archives of Internal Medicine, 160, 174180.Google Scholar
Kaplan, E.F., Goodglass, H., & Weintraub, S. (1983). The Boston Naming Test. Philadelphia: Lea & Febiger.
Kaye, J.A., Oken, B.S., Howieson, D.B., Howieson, J., Holm, L.A., & Dennison, K. (1994). Neurologic evaluation of the optimally healthy oldest old. Archives of Neurology, 51, 12051211.Google Scholar
Kohout, F.J., Berkman, L.F., Evans, D.A., & Cornoni-Huntley, J. (1993). Two shorter forms of the CES-D depression symptoms index. Journal of Aging and Health, 5, 179193.Google Scholar
Liu, Y., Stern, Y., Chun, M., Jacobs, D., Yau, P., & Goldman, J. (1997). Pathological correlates of extrapyramidal signs in Alzheimer's disease. Annals of Neurology, 41, 368374.Google Scholar
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D., & Standlan, E. (1984). Clinical diagnosis of Alzheimer's disease: Report of the NINCDS/ADRDA Work Group under the auspices of the Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology, 34, 939944.Google Scholar
Mitchell, S.L. & Rockwood, K. (2000). The association between parkinsonism, Alzheimer's disease, and mortality: A comprehensive approach. Journal of the American Geriatric Society, 48, 422425.Google Scholar
Morris, J., Heyman, A., Mohs, R., Hughes, J., van Belle, G., Fillenbaum, G., Mellits, E., Clark, C., & Investigators, C. (1989). The consortium to establish a registry for Alzheimer' s disease (CERAD). Part I. Clinical and neuropsychological assessment of Alzheimer's disease. Neurology, 39, 11591165.Google Scholar
Radloff, L.S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385401.Google Scholar
Raven, J.C., Court, J.H., & Raven, J. (1992). Manual for Raven's progressive matrices and vocabulary: Standard Progressive Matrices. Oxford: Oxford Psychologists Press.
Richards, M., McLoughlin, D., & Levy, R. (1995). The relationship between extrapyramidal signs and cognitive function in patients with moderate to severe Alzheimer's Disease. International Journal of Geriatric Psychiatry, 10, 395399.Google Scholar
Richards, M., Stern, Y., Marder, K., Cote, L., & Mayeux, R. (1993a). Relationships between extrapyramidal signs and cognitive function in a community-dwelling cohort of patients with Parkinson's disease and normal elderly individuals. Annals of Neurology, 33, 267274.Google Scholar
Richards, M., Stern, Y., & Mayeux, R. (1993b). Subtle extrapyramidal signs can predict the development of dementia in elderly individuals. Neurology, 43, 21842188.Google Scholar
Richards, M., Touchon, J., Ledesert, B., & Ritchie, K. (2002). Mild extrapyramidal signs and functional impairment in ageing. International Journal of Geriatric Psychiatry, 17, 150153.Google Scholar
SAS Institute Inc. (2000). SAS/STAT User's Guide, Version 8. Cary, NC: Author.
Smith, A. (1982). Symbol Digit Modalities Test manual–Revised. Los Angeles: Western Psychological Services.
Swan, G.E., DeCarli, C., Miller, B.L., Reed, T., Wolf, P.A., Jack, L.M., & Carmelli, D. (1998). Association of midlife blood pressure to late-life cognitive decline and brain morphology. Neurology, 51, 986993.Google Scholar
Wechsler, D. (1987). Wechsler Memory Scale–Revised manual. San Antonio, TX: Psychological Corporation.
Wilson, R.S., Barnes, L.L., & Bennett, D.A. (2003a). Assessment of lifetime participation in cognitively stimulating activities. Journal of Clinical and Experimental Psychology, 25, 634642.Google Scholar
Wilson, R.S., Beckett, L.A., Barnes, L.L., Schneider, J.A., Bach, J., Evans, D.A., & Bennett, D.A. (2002a). Individual differences in rates of change in cognitive abilities of older persons. Psychology and Aging, 17, 179193.Google Scholar
Wilson, R.S., Bennett, D.A., Gilley, D.W., Beckett, L.A., Schneider, J.A., & Evans, D.A. (2000a). Progression of parkinsonian signs in Alzheimer's disease. Neurology, 54, 12841289.Google Scholar
Wilson, R.S., Bennett, D.A., Gilley, D.W., Beckett, L.A., Schneider, J.A., & Evans, D.A. (2000b). Progression of parkinsonism and loss of cognitive function in Alzheimer's disease. Archives of Neurology, 57, 855860.Google Scholar
Wilson, R.S., Schneider, J.A., Beckett, L.A., Evans, D.A., & Bennett, D.A. (2002b). Progression of gait disorder and rigidity and risk of death in older persons. Neurology, 58, 18151819.Google Scholar
Wilson, R.S., Schneider, J.A., Bienias, J.L., Evans, D.A., & Bennett, D.A. (2003b). Parkinsonianlike signs and risk of incident Alzheimer's disease in older persons. Archives of Neurology, 60, 539544.Google Scholar
Winikates, J. & Jankovic, J. (1999). Clinical correlates of vascular parkinsonism. Archives of Neurology, 56, 98102.Google Scholar
Yaffe, K., Blackwell, T., Gore, R., Sands, L., Reus, V., & Browner, W.S. (1999). Depressive symptoms and cognitive decline in nondemented elderly women. Archives of General Psychiatry, 56, 425430.Google Scholar