Spatial disorientation and executive dysfunction in elderly nondemented patients with Parkinson’s disease

Abstract

Objectives

Patients with Parkinson’s disease (PD) present with a wide range of cognitive deficits. Cognitive impairment is recognized as an independent nonmotor aspect of the disorder and has a critical role in functional outcome and conversion into PD dementia. To date, everyday memory impairment in elderly patients with PD is underinvestigated and its relationship with executive dysfunction was not clearly explained. Our study aims at clarifying the neuropsychological pattern of everyday memory and executive deterioration in elderly patients with PD.

Methods

Forty nondemented PD patients (mean age 71.2 years; M:F = 29:11) and 30 well-matched controls (mean age 70.7 years; M:F = 15:15) were assessed on everyday memory (Rivermead Behavioral Memory Test [RBMT]) and executive functioning (Frontal Assessment Battery [FAB]) measures. Mann–Whitney U-tests (Bonferroni corrected) were used to compare groups on these measures and Spearman’s rank correlations were performed to highlight their associations.

Results

PD patients performed worse than controls on recall for novel tasks and geographic recall (RMBT) as well as lexical fluency and mental flexibility (FAB). Particularly, spatial orientation depending on egocentric navigation seems to be altered in PD patients. The clinical group showed poorer performances than controls in mental flexibility, sensitivity to interference, and inhibitory control. Such measures were associated with immediate and delayed recall, picture recognition, prospective memory, and orientation tasks of everyday memory.

Conclusion

Executive-type difficulties and memory-type difficulties have an impact on cognitive performances of elderly patients with PD. We recommend using the RBMT and the FAB as part of routinely neuropsychological battery for assessing PD patients.

Keywords:

• spatial disorientation
• recall impairment
• executive dysfunction
• elderly people
• Parkinson’s disease

Acknowledgments

The authors gratefully thank clinicians from the Neurology Service (Felice Lotti Hospital of Pontedera, Pisa, Italy) for inviting patients to be further examined at the Neuropsychology Clinic of Pontedera (Pisa, Italy) and Marco Timpano Sportiello, Emanuela Castro, Baroncini Matteo, Michele Gnoffo, Stefania Tocchini, and her colleagues for their help in collecting neuropsychological data of PD patients and controls from Valdera (Pisa, Italy) area.

Author contributions

DMC provided substantial contributions to conception and design, acquisition of data, analysis, interpretation of data, and drafting the article. SC provided substantial contribution for data analysis and results interpretation and revised the article for intellectual content. Both authors approved the final version.

Disclosure

DMC has received research funding from the Michael J. Fox Foundation for Parkinson’s Research as a member of the Italian Network of Parkinson’s Disease-Mild Cognitive Impairment for Pisa site (Italy). The authors report no other conflicts of interest in this work.