RESEARCH: Dementia and Parkinson's Syndromes

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Ideggyogy Sz 2002 Jul 20;55(7-8):220-5

[Article in Hungarian]

Szirmai I, Kovacs T.

Semmelweis Egyetem, Altalanos Orvosi Kar, Neurologiai Klinika, 1083

Budapest, Balassa u. 6. szirmai@...

The cognitive (executive) ability of patients with Parkinson's-disease (PD)

deteriorates gradually during the progression of the disease. Fluency of

speech, word finding, working memory, ability to plan the future and

flexibility decline. Cognitive disturbance was found to be proportional with

the speech, posture, gait and balance problems and can not be influenced by

L-dopa substitution. Apart the dorsal and ventral mesolimbic dopaminergic

systems the coerulo-cortical noradrenergic, serotoninergic and cholinergic

systems are also impaired in PD. Subcortical dementia in PD can also be

explained by the functional disability of dorsolateral and anterior cingular

circuits. Attention deficit can be explained by the dopamine depletion of

cingular cortex. Cortical Lewy bodies, neurofibrillary tangles, neurit

plaques and additional vascular pathology should also play a role in

cognitive impairment of PD. In several systemic degenerative diseases

associating with Parkinson's syndrome (PS) i.e. progressive supranuclear

palsy (PSP), corticobasal degeneration (CBD), multiple system atrophy (MSA)

dementia can be detected with various severity, therefore the question

arises concerning the correlation between cognitive disability and PS.

Parkinson syndrome can also develop in frontotemporal dementias (FTD),

Alzheimer's disease and cortical Lewy body disease (CLBD) but no correlation

exists between motor disability and severity of dementia. In CLBD dementia

can be the initial symptom in 18% of cases but PS can also preceeds the

dementia. In PSP profound depletion of other monoaminergic neurotransmitter

system was also reported. In FTDs associated with PS degeneration of

substantia nigra, locus coeruleus and basal nucleus of Meynert has been

reported with increased number of neurofibrillary tangles. In patients with

vascular PS (VP) there is generally no tremor and rigidity, but pseudobulbar

palsy, dementia, gate disturbance, incontinency appears; L-dopa treatment is

generally ineffective. In VP no cellular loss can be found within the

substantia nigra, but leukoaraiosis, lacunae in the white matter and basal

ganglia are commonly demonstrated.

PMID: 12201229 [PubMed - in process]