Using Birmingham Cognitive Screen To Investigate The Cognitive Disorder Of Mild-moderate Parkinson’s Disease And Its Relationship With Depression

【Background】Cognitive impairment is a main non-motor symptom of Parkinson’s disease(PD).PD patients may have cognitive impairment that involve multiple domains.However,due to the inconsistency of cognitive assessment scale used by previous scholars,there is inconsistent reports on cognitive impairment in PD patients.Depression is another major non-motor symptom of PD patients.Studies have shown that PD patients with depression have severe cognition impairment,but the specific cognitive domains related to depression are still unknown.Birmingham Cognitive Screen was introduced to China recently.It covers many areas of cognition and can be used comprehensively and objectively to identify their specific impaired cognitive domains.【Objective】(1)The Mandarin version of Birmingham Cognitive Screen(BCoS)was used to investigate the characteristics of cognitive impairment in patients with mild-moderate PD.Its clinical value was compared with Mini-Mental State Examination(MMSE)and Montreal Cognitive Assessment(Mo CA).(2)BCoS was used to investigate the relationship between depression and cognitive impairment in patients with mild-moderate PD.【Method】62 patients with mild-moderate PD(modified Hoehn-Yahr grades 1-3)diagnosed in the Department of Neurology of Guangzhou first people’s Hospital from March2018 to December 2019 were enrolled,who were compared with 62 healthy participants matched with age,gender and education.The general demographic data were recorded:(1)PD patients were tested with Unified Parkinson’s Disease Rating Scale,Freezing Of Gait,modified Hoehn-Yahr grades scale and Hamilton depression scale-24(HAMD).Participants were tested by BCoS,MMSE and Mo CA.(2)According to the score of HAMD,patients were divided into two groups: PD with depression(HAMD+,32)and PD without depression(HAMD-,30).The scores of scales between two groups were compared.【Results】(1)66.13% patients had at least one cognitive domain impairment,which was mainly involved visual spatial impairment(46.77%),attention abnormality(24.19%),abnormal language expression and comprehension(40.32%),abnormal language reading and writing(27.42%),abnormal memory(43.55%),abnormal executive function(43.55%).Besides,70.73% of patients with impaired cognition had multiple cognitive domains impairment and 29.27% suffered from single cognitive domain impairment.(2)Compared with healthy controls on BCoS,PD patients had lower scores on complex figure copy test,sentence construction and task recognition and the differences were statistically significant respectively(all p<0.001);differences on dictation test and gesture imitation test between two groups were also statistically significant respectively(both p<0.05).(3)The cognitive impairment rates of BCoS,Mo CA and MMSE were 66.13%,54.84%and 24.19% respectively and the differences among three groups were statistically significant(p<0.001).Multiple comparisons were conducted between every two groups: abnormal rate of cognitive function testd by BCoS was higher than that testd by MMSE and the difference was statistically significant(p<0.001);the abnormal rate of cognitive function testd by BCoS was higher than that testd by Mo CA,the difference was statistically significant(p=0.007).(4)The score of HAMD was negatively correlated with score of Mo CA,MMSE and subitems of BCoS which included complex figure copy,auditory attention,rule finding and concept switching,rules of rule finding,dictation,orientation,story recognition and gesture imitation test(all p<0.05).Besides,it was positively correlated with subitems of BCoS including number of practice required for auditory attention test(p<0.05).(5)Compared with PD HAMD-group,PD HAMD + patients had higher abnormal rates on complex figure copy,sentence construction,sentence reading,dictation,task recognition,gesture production and imitation in the BCoS and the differences between two groups were statistically significant respectively(all p<0.05).【【Conclusions】(1)BCoS is a comprehensive and multi-dimensional cognitive assessment scale with wide cognitive domains,which is suitable for the assessment of cognitive function in PD.(2)Most patients with mild-moderate PD have impairment at least in one cognitive domain.The impairment was mainly involved multiple cognitive domains,which are executive function,visual space,episodic memory,language expression and dictation skills and attention.(3)Compared with mild-moderate PD patients without depression,mild-moderate PD patients with depression are more prone to have cognitive impairments on visual space,episodic memory,execution ability,language expression,verbal fluency and dictation.