Hilmi, Abdullah
(2007)
The unified parkinson's disease rating scale score in parkinson's disease patients with and without cognitive impairment.
Masters thesis, Universiti Sains Malaysia.
Abstract
Parkinson's disease (PD) is widely known as a 'motor' disease, but it also
has several non-motor features including cognitive impairment. Cognitive impairment has
significant impacts on several aspects of PD. There is as yet a study on cognitive
impairment and PD done involving our population.
Objectives: To compare the Unified Parkinson's Disease Rating Scale (UPDRS) score
between PD patients with and without cognitive impairment. Secondly, to determine the
prevalence of cognitive impairment in patients with PD under Hospital Universiti Sains
Malaysia (HUSM) follow-up.
Methods: This was a cross-sectional study done at the HUSM Neurology Clinic,
beginning from June till November 2006. Eighty PD patients who satisfied the study
criteria were recruited into the study. Their cognitive status was assessed using the
validated Malay version of the Mini-Mental State Examination (MMSE). A score of :S
24/30 signified presence of cognitive impairment while> 24/30 was normal. Regardless
of their MMSE scores, all the patients then underwent assessment using the UPDRS. The
UPDRS contains four items i.e. mentation, behaviour, and mood; activities of daily
living; motor examination; and complications of therapy. Scores were taken from each
item, and they were then totaled to obtain a total score. The study protocol was reviewed
and approved by the USM Ethics and Research Committee.
Results: Thirty two patients (40%) had cognitive impairment, ranging from mild to
severe, based on the MMSE. Patients with cognitive impairment had significantly worse
scores for each UPDRS item compared to the non-cognitive impairment group (p < 0.05).
They also had worse rigidity and bradykinesia compared to the other group (p < 0.05).
After adjusting for potential confounders e.g. age and disease duration, the cognitive
impairment group still performed worse in the UPDRS assessment (p < 0.05).
Conclusions: The study showed that the presence of cognitive impairment resulted in
worse UPDRS scores. There was a high prevalence of cognitive impairment in PD
patients under HUSM follow-up. Therefore, PD patients should be routinely screened for
cognitive impairment.
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