Parkinson Disease With Dementia: Comparing Patients With and Without Alzheimer P

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Parkinson Disease With Dementia: Comparing Patients With and Without Alzheimer

Pathology

September 2009

Abstract

Subjects with Parkinson disease (PD) frequently develop dementia with greater

than one-third meeting neuropathologic diagnostic criteria for Alzheimer disease

(AD). The objective is to identify clinical and neuropathologic differences

between Parkinson disease with dementia (PDD) subjects, with and without

coexistent AD pathology. Neuropathologic examination was available on subjects

diagnosed by clinicopathologic criteria with PDD-AD (N=23) and PDD+AD (N=28). A

small subset of subjects with PDD-AD and PDD+AD had received at least 1

standardized neuropsychologic assessment. PDD+AD subjects were significantly

older at age of PD onset and death, progressed to onset of dementia in less

time, and had a shorter duration of PD symptoms before the onset of dementia.

Education, responsiveness of L-dopa and dopaminergic medications, presence of

cognitive fluctuations and hallucinations, and mean Mini-Mental State

Examination, Global Deterioration Scale, Functional Assessment Staging, and

Unified Parkinson Disease Rating Scale scores did not differ significantly

between the 2 groups. The PDD+AD group had significantly greater total plaques,

neuritic plaques, total tangles, and Braak stages compared with PDD-AD. This

study suggests that it is difficult to distinguish PDD+AD and PDD-AD on the

basis of movement, clinical, and neuropsychologic assessment. PDD-AD and PDD+AD

have similar degrees of dementia and approximately half of PDD subjects have

enough AD pathology to attain a neuropathologic diagnosis of AD. PDD can develop

in the absence of significant Alzheimer pathology.

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