Publication: Rendimiento cognitivo poblacional en enfermedad de parkinson y temblor esencial. ¿Qué ocurre en ausencia de demencia?
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2018-04-04
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Universidad Complutense de Madrid
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Abstract
La enfermedad de Parkinson y el temblor esencial son dos de las trastornos del movimiento más frecuentes. Sus manifestaciones fundamentales son motrices, pero también se han descrito alteraciones cognitivas. Existen pocos estudios poblacionales que las caractericen. Objetivos: Evaluar las alteraciones cognitivas producidas por el temblor esencial y la enfermedad de Parkinson en las fases precoces de la enfermedad en un estudio poblacional en ausencia de demencia. Métodos: Se analizaron los resultados del los test neuropsicológicos de los participantes del estudio NEDICES. Para ello se compararon sujetos con temblor esencial, enfermedad de Parkinson y controles sanos mediante test no paramétricos. Se ajustaron los resultados por potenciales variables confundidoras como son la edad y el nivel educativo. Resultados: Los participantes con enfermedad de Parkinson y temblor esencial tuvieron un peor rendimiento cognitivo que los sujetos sanos. Los primeros mostraron un peor rendimiento en test de memoria y lenguaje. Los participantes con temblor esencial tuvieron una menor velocidad de procesamiento cognitivo. Evidenciamos una caída en el rendimiento cognitivo global medido por el test MMSE-37 en participantes en fases prediagnósticas del temblor esencial. Conclusión: Se confirma la existencia de alteraciones precoces cognitivas en ambas enfermedades en ausencia de demencia. En nuestros hallazgos parece existir un perfil diferencial de las mismas y un gradiente de afectación mayor en los enfermos con Parkinson. La existencia de alteraciones en las fases preclínicas de sujetos con temblor esencial sugiere que se trate de una enfermedad neurodegenerativa.
Parkinson’s disease and essential tremor represent two of the most frequent movement disorders. Besides their motor manifestations, both entities can impair cognition. There are few population-based studies that characterize the cognitive status of participants with Parkinson’s disease or essential tremor. Aims: Understand the impact of Parkinson’s disease and essential tremor on cognition in a population-based study of dementia-free participants. Methods: We evaluated the neuropsychological performance of the participants enrolled in the NEDICES study. Three groups of subjects were compared using non-parametric techniques (i.e. Parkinson’s disease, essential tremor and healthy participants). The results were further adjusted for potential confounder such as age or literacy. Results: A poorer cognitive performance was found for the participant with Parkinson’s disease and essential tremor. It was particularly evident for memory and language tests in the former and for cognitive processing speed in the later. There was a greater cognitive decline in the MMSE-37 test at follow up in the participants with essential tremor in the years before they were diagnosed. Conclusion: We have confirmed a cognitive impairment in participants with Parkinson’s disease and essential tremor in the absence of dementia. There was some overlap in the affected functions and, generally, there was a gradient of impairment, showing a poorer performance the people with Parkinson’s. The existence of cognitive decline in the prediagnostic stage of essential tremor points towards a neurodegenerative etiology for this disease.
Parkinson’s disease and essential tremor represent two of the most frequent movement disorders. Besides their motor manifestations, both entities can impair cognition. There are few population-based studies that characterize the cognitive status of participants with Parkinson’s disease or essential tremor. Aims: Understand the impact of Parkinson’s disease and essential tremor on cognition in a population-based study of dementia-free participants. Methods: We evaluated the neuropsychological performance of the participants enrolled in the NEDICES study. Three groups of subjects were compared using non-parametric techniques (i.e. Parkinson’s disease, essential tremor and healthy participants). The results were further adjusted for potential confounder such as age or literacy. Results: A poorer cognitive performance was found for the participant with Parkinson’s disease and essential tremor. It was particularly evident for memory and language tests in the former and for cognitive processing speed in the later. There was a greater cognitive decline in the MMSE-37 test at follow up in the participants with essential tremor in the years before they were diagnosed. Conclusion: We have confirmed a cognitive impairment in participants with Parkinson’s disease and essential tremor in the absence of dementia. There was some overlap in the affected functions and, generally, there was a gradient of impairment, showing a poorer performance the people with Parkinson’s. The existence of cognitive decline in the prediagnostic stage of essential tremor points towards a neurodegenerative etiology for this disease.
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Medicina, leída el 29/09/2017