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Fluctuating cognition and different cognitive and behavioural profiles in Parkinson’s disease with dementia: comparison of dementia with Lewy bodies and Alzheimer’s disease

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Abstract

To examine the occurrence of fluctuating cognition (FC) in a group of patients with Parkinson’s disease with dementia (PDD), and to determine whether the presence of FC in PDD is associated with a pattern of cognitive and behavioural disturbances similar to the one shown by patients affected by dementia with Lewy bodies (DLB), a cluster analysis was carried out on the scores obtained by 27 PDD patients on the Clinician Assessment of Fluctuation Scale (CAF). The analysis separated the PDD patients into two subgroups, called PDD non-fluctuators (PDDNF; CAF ≤ 2) and PDD fluctuators (PDDF; CAF > 2). The two groups underwent a cognitive and behavioural evaluation. Their scores were compared with those obtained by DLB and Alzheimer’s disease (AD) patients. When exploring the cognitive performance of the patients with the Dementia Rating Scale-2 (DRS-2), PDDF had a similar pattern of impairments compared to DLB, which involved prevalently the attention and initiation/perseveration domains, and which was significantly more pronounced compared to that shown by PDDNF. The main behavioural finding of the study was the similar incidence of visual hallucinations in the PDDF and DLB groups, which was significantly higher compared to PDDNF and AD. Our results confirmed the hypothesis that subgroups with different cognitive profiles exist within PDD and that the occurrence of FC is the clinical variable associated with a DLB pattern of impairment in PDD. In conclusion, our study suggests that when FC occurs in PDD this syndrome becomes clinically undistinguishable from DLB.

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Acknowledgment

The first author would like to thank Prof. Alessandro Di Rocco for his kind revision and invaluable comments.

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Authors and Affiliations

  1. Oncology and Neuroscience Department, University “G. d’Annunzio”, Chieti-Pescara, Italy

    Sara Varanese, Bernardo Perfetti, Daniela Monaco, Astrid Thomas, Laura Bonanni & Marco Onofrj

  2. Division of Movement Disorders, Department of Neurology, New York University, 550 First Avenue RR311, New York, NY, 111016, USA

    Sara Varanese

  3. Department of Physiology and Pharmacology, Sophie Davis Medical School, City College of New York, New York, USA

    Bernardo Perfetti

  4. Department of Neurology, Niguarda Ca’ Grande Hospital, Milan, Italy

    Pietro Tiraboschi

Authors
  1. Sara Varanese
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  2. Bernardo Perfetti
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  4. Astrid Thomas
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  5. Laura Bonanni
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  7. Marco Onofrj
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Correspondence to Sara Varanese.

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Varanese, S., Perfetti, B., Monaco, D. et al. Fluctuating cognition and different cognitive and behavioural profiles in Parkinson’s disease with dementia: comparison of dementia with Lewy bodies and Alzheimer’s disease. J Neurol 257, 1004–1011 (2010). https://doi.org/10.1007/s00415-010-5453-3

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  • DOI: https://doi.org/10.1007/s00415-010-5453-3

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