Page 43 - BH-2-1

Brain & Heart Practical tips for AD and PD

Table 5. Neuropsychiatric evaluation of the study participants
AD (n=60) PD‑D (n=60) Control (n=120) P
Median (min‑max) IQR Median (min‑max) IQR Median (min‑max) IQR
Delirium 4 (2 – 8) 4.00 – 6.00 4 (2 – 8) 3.00 – 5.00 2 (2 – 4) 2.00 – 4.00 0.002
Hallucination 4 (1 – 9) 4.00 – 6.00 4 (2 – 8) 2.00 – 6.00 2 (2 – 2) 2.00 – 2.00 0.155
Agitation 4 (2 – 12) 4.00 – 6.00 4 (2 – 8) 2.00 – 6.00 4 (2 – 4) 2.00 – 4.00 0.026
Depression 5 (1 – 8) 4.00 – 6.00 4 (2 – 12) 2.00 – 4.00 4 (1 – 12) 4.00 – 6.00 0.198
Anxiety disorders 4 (2 – 9) 3.00 – 4.00 4 (2 – 8) 3.00 – 6.00 4 (1 – 6) 2.00 – 4.00 0.422
Apathy 4 (1 – 8) 2.50 – 4.50 4 (1 – 9) 2.25 – 4.75 4 (2 – 6) 2.50 – 5.50 0.957
Disinhibition 4 (2 – 9) 2.75 – 5.25 3 (2 – 8) 2.00 – 4.00 - - 0.252
Irritability 4 (2 – 9) 3.00 – 5.00 3 (2 – 8) 1.50 – 5.50 - - 0.963
Abnormal motor behavior 4 (3 – 12) 3.25 – 10.00 3 (1 – 8) 2.00 – 4.00 - - 0.114
Sleep problem 4 (1 – 12) 2.00 – 4.00 4 (2 – 9) 2.00 – 6.00 4 (2 – 6) 4.00 – 4.00 0.730
Loss of appetite 4 (1 – 6) 1.75 – 4.25 2 (2 – 6) 2.00 – 4.00 2 (2 – 2) 2.00 – 2.00 0.682
NPI total score 12 (2 – 78) 8.00 – 20.00 16 (4 – 71) 12.00 – 27.00 7 (1 – 20) 4.00 – 10.00 <0.001
NPI distress score 8 (2 – 33) 5.00 – 13.50 11 (1 – 54) 8.00 – 15.00 4 (1 – 12) 2.00 – 6.00 <0.001
Note: Kruskal – Wallis test.
a
Abbreviations: AD: Alzheimer’s disease; IQR: Interquartile range; NPI: Neuropsychiatric inventory; PD-D: Parkinson’s disease with dementia.
tasks. Individuals with AD often exhibit difficulties in serve as a useful diagnostic discriminator between AD and
generating words within specific categories (semantic PD-D, highlighting the importance of a comprehensive
fluency) and in producing words beginning with certain neuropsychological evaluation.
letters (phonemic fluency). These deficits are reflective
of the widespread cortical atrophy and impairment of 4.1. Functional impairment in dementia
semantic memory systems seen in AD. In contrast, PD-D Functional impairment is a hallmark of dementia, with
patients may display selective impairments in phonemic its impact extending beyond cognitive domains to daily
fluency while retaining relatively intact semantic fluency. activities, behavior, and quality of life. This study focuses
This discrepancy likely relates to the differential patterns of on comparing the functional impairment between AD
brain involvement in PD-D, where executive dysfunction and PD-D, which is a critical indicator for distinguishing
and motor symptoms play a prominent role. Thus, verbal between different forms of dementia. Functional
fluency assessments can provide valuable insights into the assessments, such as the BDRS, are used to evaluate
distinct cognitive profiles of AD and PD-D, aiding in their performance in daily activities, personality changes,
[31]
differential diagnosis and management . interests, and habits . The recognition of these functional
[27]
The assessment of calculation abilities in AD and PDD changes can provide clinicians with valuable diagnostic
underscores the differing cognitive profiles of these two information and guide treatment strategies tailored to each
neurodegenerative disorders. Individuals with AD often patient’s specific needs.
exhibit marked impairments in numerical processing 4.2. Importance of current diagnostic tools
and calculation skills as the disease progresses . These
[32]
deficits may encompass impediments in basic arithmetic The study showcases the utilization of well-established
operations and higher-level mathematical tasks, reflecting diagnostic criteria, including the revised NIA-AA criteria
the widespread cortical deterioration that affects multiple for AD diagnosis and the MDS clinical diagnostic criteria
cognitive domains. In contrast, PD-D patients typically for PD-D diagnosis [16,17] . These criteria serve as essential
maintain their calculation abilities, even in the advanced tools that enable clinicians to accurately identify and
stages of the disease . This relative preservation of differentiate between types of dementia, aiding in the
[33]
numerical skills in PD-D may be attributed to the distinct selection of appropriate management strategies.
pattern of neurodegeneration in PD, which primarily
affects subcortical regions while sparing the parietal and 4.3. Physician’s practical perspectives
frontal cortices responsible for numerical processing. The significance of this study lies in the considerations
Consequently, the assessment of calculation abilities can of the challenges faced by physicians who manage a high

Volume 2 Issue 1 (2024) 7 https://doi.org/10.36922/bh.1712