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PRoBaND Launch Event: Cognitive Assessment

PRoBaND Launch Event: Cognitive Assessment. David J Burn (david.burn@ncl.ac.uk). Why Are We Doing This?. Dementia occurs in up to 80% of people with PD Better treatment of motor complications has “ right-shifted the curve ”

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PRoBaND Launch Event: Cognitive Assessment

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  1. PRoBaND Launch Event:Cognitive Assessment David J Burn (david.burn@ncl.ac.uk)

  2. Why Are We Doing This? • Dementia occurs in up to 80% of people with PD • Better treatment of motor complications has “right-shifted the curve” • Early recognition of high risk phenotypes (& genotypes) will enable better use of targeted interventions • Remember: dementia < 1 year of motor symptom onset is NOT PD

  3. Mild Cognitive Impairment in PD • Mild cognitive impairment in PD (PD-MCI) is common • mean prevalence 27%, range 19-38% • PD-MCI • is associated with development of PDD • has a heterogeneous clinical profile • Non-amnestic, single domain impairment may be most common sub-type • Few studies have evaluated the relationship between specific PD-MCI subtypes & development of PDD • Generalizability of findings limited by use of prevalent samples & widely varying disease durations

  4. Relevant Study Hypotheses • Cognitive decline in PD can be predicted from the pattern of early cognitive performance • Genetic factors contribute to cognitive decline & may determine the profile of early cognitive impairment in PD

  5. How Will Cognition Be Assessed? • Montreal Cognitive Assessment (MoCA) • Semantic Fluency • Interlocking pentagons

  6. Montreal Cognitive Assessment • Rapid screening assessment (3 parallel versions) • Assesses • attention & concentration • executive functions • memory & language • visuoconstructional skills • conceptual thinking, calculations & orientation • Time to administer ~ 10 mins • Max score = 30 (> 26 considered normal) http://www.mocatest.org

  7. Visuospatial / Executive Function Contour: circle (minor distortion permitted) Numbers: All clock numbers present Hands: indicate correct time & hour hand shorter One point allocated if: drawing is 3D & all lines drawn (but nil added) lines ~ parallel & same length One point if successfully draws 1-A-2-B-3-C-4-D-5-E, without lines that cross

  8. Naming & Memory The examiner reads a list of 5 words at a rate of one per second, giving the following instructions: “This is a memory test. I am going to read a list of words that you will have to remember now and later on. Listen carefully. When I am through, tell me as many words as you can remember. It doesn’t matter in what order you say them”.

  9. Attention & Language “I am going to read a sequence of letters. Every time I say the letter A, tap your hand once. If I say a different letter, do not tap your hand”. “Tell me as many words as you can think of that begin with a certain letter of the alphabet that I will tell you in a moment. You can say any kind of word you want, except for proper nouns (like Bob or Boston), numbers, or words that begin with the same sound but have a different suffix, for example, love, lover, loving. I will tell you to stop after one minute. Are you ready? [Pause] Now, tell me as many words as you can think of that begin with the letter F.”

  10. Abstraction, Delayed Recall & Orientation The examiner gives the following instruction: “I read some words to you earlier, which I asked you to remember. Tell me as many of those words as you can remember.” Make a check mark ( √ ) for each of the words correctly recalled spontaneously without any cues, in the allocated space. Allocate 1 point for each word recalled freely without any cues.

  11. Additional Tests Semantic Fluency • Tell me as many animals as you can.  It doesn't matter what letter they start with.  However, please try to avoid giving me lots of different breeds of the same animal or different versions of the same animal.  • Just try to think of as many different animals as you can.  • You will have 90 seconds before I tell you to stop.  Do you have any questions? • Score: Total count, set-loss & repetition errors Interlocking Pentagons Score 0/1

  12. Cognitive Testing Frequency • Diagnosis < 3 years • V1 (0 months), V4 (18 months) & V7 (36 months) • Onset < 50 years age • V1 (0 months) only • Relatives • V0 (screening) & V1 (36 months)

  13. NINDS CDE Workgroup-Cognitive Recommended Scales • Each scale rated based on its utility in each of 4 usage categories: • as a screening instrument for initial identification of a possible disorder or population of interest • as a rating scale for measurement of severity of the disorder or performance within the domain of interest • as a scale that is sensitive to longitudinal change • as a diagnostic instrument that can categorize individuals into those with & without a disorder

  14. NINDS CDE Scale Assessment http://www.commondataelements.ninds.nih.gov/PD.aspx#stds

  15. CamPaIGN Study 17% incident patients developed dementia over 5 yrs Williams-Gray 2009

  16. CamPaIGN: Risk Factors for PDD Williams-Gray 2009

  17. Conclusion • Cognitive test battery not comprehensive • Balances what is known with pragmatic approach to assessment • Estimated completion time ~ 15 mins • Strength in numbers, other assessments & follow-up

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