Poster session 3: Tuesday, March 8, Poster numbers 384–592
- Publisher
- John Wiley and Sons
- Year
- 2005
- Tongue
- English
- Weight
- 657 KB
- Volume
- 20
- Category
- Article
- ISSN
- 0885-3185
No coin nor oath required. For personal study only.
✦ Synopsis
Objective: To obtain new insights into the clinical course of sporadic PD and its correlation with the underlying disease process as proposed in a cross-sectionally based postmortem staging procedure.
Background: The Hoehn & Yahr (H&Y) rating system is the most accepted scale for assessing PD motor symptoms. Until recently, its counterpart for assessing cognitive decline was the MMSE. The PD staging procedure is used to map the distribution pattern and severity of brain pathology at subcortical and cortical sites: PD develops in 6 stages. It begins in the lower brainstem and moves upwards towards the cortex.
Methods: This clinicopathological correlation study included 88 consecutive cases (36 females, 76.2 Ϯ 6.7 years; 52 males, 75.2 Ϯ 6.6 years) with clinical and postmortal diagnoses of PD. All had met clinical criteria for PD. None was diagnosed with DLB. H&Y and MMSE scores were assessed at least 18 months before death. MMSE scores were grouped as follows: 0 ϭ intact or marginally impaired cognition (30 -25), 1 ϭ mild (24 -31), 2 ϭ moderate (20 -11), 3 ϭ severe cognitive decline (10 -0). PD staging was done using ␣-synuclein immunoreactions. We applied the Kruskall-Wallis H-test to see if H&Y stages were associated with PD stages and with cognitive decline. Statistically significant results were analyzed with a nonparametric trend test.
Results: All 88 cases could be assigned to one of the PD stages 3-6. H&Y stages correlated highly significantly with PD stages (Kruskall-Wallis H-test: H corr ϭ 33.62; P Ͻ 0.0005) and with MMSE scores (Kruskall-Wallis H-test: H cor ϭ 20.67; P Ͻ 0.0005). Both of these relationships were characterized by a linear trend (nonparametric trend test: H lin ϭ 16.39; P Ͻ 0.0005; H lin ϭ 12.06; P Ͻ 0.01). Cognitive status was linearly correlated with the PD stage (Kruskal-Wallis H-test: H corr ϭ 15.79; P Ͻ 0.005; nonparametric trend test: H lin ϭ 6.16; P Ͻ 0.025).
Conclusions: This study aimed to see if the PD staging system reflects progressive disease symptoms. Our results indicate: 1) progressive motor and cognitive decline are reflected by an overall increase in the extent and severity of PD brain pathology, 2) progressive motor symptoms as expressed by H&Y stages are attended by an increasing risk of cognitive decline.