Date Presented 03/27/20
The current guideline criteria for diagnosing people with PD with MCI include neuropsychological tests to assess cognitive functioning. Assessments that reflect real-life confrontations can identify functional cognitive decline. OTs can contribute in implementing evaluations and developing performance-based interventions to promote daily life performance and quality of life and prevent the onset of increased disability.
Primary Author and Speaker: Sonya Meyer
Additional Authors and Speakers: Sara Rosenblum
Contributing Authors: Netta Gemerman, Lilia Mentzer, Ariella Richardson, Simon Israeli-Korn, Vered Livneh, Tsvia Fay Karmon, Tal Nevo, Gilad Yahalom, Sharon Hassin-Baer
PURPOSE: The study aimed to explore neuropsychological and daily functional-related cognitive deficits among people diagnosed with Parkinson’s disease (PD) accompanied with mild cognitive impairment (MCI). Occupational therapy plays an important role at the critical stage of diagnosis, when people are fully participating in daily life routines, specifically concerning the non-motor and psychosocial changes that occur (Waite, 2014). Diagnostic criteria for PD-MCI include an abbreviated global cognitive assessment comprised of neuropsychological tests that assess cognitive functioning in attention, executive functions, language, memory, and visuo-spatial (Litvan et al., 2012). A call for detection of PD prior to the emergence of motor manifestations emerged (Stern, Lang, & Poewe, 2012). Yet, knowledge about cognitive deficits in the context of daily functioning and the contribution of evaluating them at the diagnostic in this population is scarce.
DESIGN: This cross-sectional study included 119 participants aged 40-79. A group diagnosed by a neurologist with PD-MCI (n=78) by the Unified Parkinson Disease Rating Scale (UPDRS) who scored 22 to 25 on the Montreal Cognitive Assessment (MoCA) and 41 healthy controls (HC) matched for gender, age, and education level (MoCA ≥ 23).
METHOD: Neuropsychological assessment tools were administered (e.g., the Trail Making Test (TMT-A and B), the Rey Osterrieth Complex Figure Test). Participants completed self-report questionnaires that focused on their daily function abilities, such as the Time Organization and Participation Scale (TOPS) and the Daily Living Questionnaire (DLQ) and performed varied handwriting tasks. Descriptive statistics described the demographic characteristics, neuropsychological and questionnaire scores. T-tests or multivariate analysis of variance (MANOVA) tested group differences. Discriminant analysis was performed to assess the relative importance in differentiating between groups.
RESULTS: No significant group differences were found in demographic variables. A surprisingly low number of participants were identified in the PD-MCI group with cognitive deficit, according to the neuropsychological tests cut-off scores (0-59.5%). Cognitive deficit was also identified in the control group (0-20%). Highest rates were identified by the TMT-A (PD: 59.5%; HC: 19.5%), TMT-B (PD: 40.5%; HC: 22.0%), and the Complex Figure Test (copying PD: 26.0%; HC: 4.9%). The questionnaires provided a significantly different picture of daily functioning challenges between the groups (e.g., TOPS items about the ability to perform daily tasks at a suitable pace, and DLQ items that reflect perception of functional change in daily roles and feelings of satisfaction). Discriminant analysis of the neuropsychological tests revealed that 67.0% of the original group cases correctly classified 59.7 % of PD and 40.3% of the HC participants. When adding the questionnaires and functional tests, 91.4 % of PD and 94.4% of the health participants were correctly classified.
CONCLUSION: These results support the ongoing discussion of the complexity of capturing PD-MCI. Considering the neuropsychological tests results, assessments which reflect the cognitive encounters in these people’s real-life daily confrontations are warranted among people diagnosed with PD who are at risk for cognitive decline. Cognitive decline can weaken one’s emotional state and lead to lack of activity and participation.
IMPACT STATEMENT: Identifying the functional difficulties among people with PD is vital. Occupational therapy practitioners can contribute in implementing functional evaluations and developing performance-based interventions to promote daily life performance and quality of life and prevent the onset of increased disability.
References
Waite, A. (2014). Steady progression: Occupational therapy’s evolving role in helping people with Parkinson’s disease. OT Practice, 19(9), 13–15.
Litvan, I., Goldman, J. G., Tröster, A. I., Schmand, B. A., Weintraub, D., Petersen, R. C., ... & Aarsland, D. (2012). Diagnostic criteria for mild cognitive impairment in Parkinson’s disease: Movement disorder society task force guidelines. Movement Disorders, 27(3), 349-356.
Stern, M. B., Lang, A., & Poewe, W. (2012). Toward a redefinition of Parkinson’s disease. Movement Disorders, 27(1), 54-60.
