Neuropsychiatric Symptoms and Cognitive Impairment in Chinese Patients with Parkinson’s Disease in Han and Hui Ethnicity

Abstract

Neuropsychiatric symptoms are common in patients with Parkinson’s disease (PD) and they are likely to outweigh the motor symptoms and become a major factor affecting the quality of life of PD patients. However, the studies focusing on the non-motor symptoms in Chinese PD patients from different ethnicity are scarce. The aim of this retrospective study was to investigate neuropsychiatric symptoms and cognitive impairment in Chinese PD patients from Han and Hui populations from central China. Seventy-two Han Chinese PD patients (Han PD group) and 71 age-and sex-matched Hui Chinese PD patients (Hui PD group) were enrolled from Zhongnan Hospital of Wuhan University between Sept. 2011 and Aug. 2014 in the study. The neuropsychiatric symptoms and cognitive impairment were assessed using Neuropsychiatric Inventory (NPI) and Mini Mental State Examination (MMSE). We found that the proportion of depression, anxiety, apathy, irritability, euphoria and night time behavior disturbances were higher in the Han PD group than in the Hui PD group (P<0.05 or P<0.01). But the proportion of delusion, hallucination, agitation, disinhibition, aberrant motor behavior and change in appetite were not significantly different between the Han PD group and the Hui PD group (P>0.05). The total mean scores of the MMSE from patients in the Han PD group were similar to those in the Hui PD group (P>0.05). However, the subscale scores of recall domain and language domain in the Han PD group were significantly different from those in the Hui PD group (P<0.05). No significant difference was noted in the orientation, memory and calculation domains between the two PD groups (P>0.05). This study first showed the recall domain and language domain were different between the Han PD patients and the Hui PD patients. Depression, anxiety, apathy, irritability, euphoria and night time behavior disturbances were less presented in the Hui PD patients. All these differences may be related to the different ethnicity, which would be helpful for clinical physicians to recognize the different non-motor symptoms in Chinese PD patients with different ethnicity.

Keywords

Parkinson’s disease / neuropsychiatric symptoms / cognitive impairment / Han Chinese / Hui Chinese

References

[1] Martinez–MartinP, Rodriguez–BlazquezC, ForjazMJ, et al.. Measurement of nonmotor symptoms in clinical practice. Int Rev Neurobiol, 2017, 133: 291-345

[2] GarbayoE, AnsorenaE, Blanco–PrietoMJ. Drug development in Parkinson’s disease: From emerging molecules to innovative drug delivery systems. Maturitas, 2013, 76(3): 272-278

[3] KaliaSK, SankarT, LozanoAM. Deep brain stimulation for Parkinson’s disease and other movement disorders. Curr Opin Neurol, 2013, 26(4): 374-380

[4] Rodriguez–OrozMC, MoroE, KrackP. Long–term outcomes of surgical therapies for Parkinson’s disease. Mov Disord, 2012, 27(14): 1718-1728

[5] CounePG, SchneiderBL, AebischerP. Parkinson’s disease: gene therapies. Cold Spring Harb Perspect Med, 2012, 2(4): a009431

[6] MonteiroL, Souza–MachadoA, ValderramasS, et al.. The effect of levodopa on pulmonary function in Parkinson’s disease: a systematic review and metaanalysis. Clin Ther, 2012, 34(5): 1049-1055

[7] PolitisM, LindvallO. Clinical application of stem cell therapy in Parkinson’s disease. BMC Med, 2012, 10: 1

[8] LohleM, ReichmannH. Clinical neuroprotection in Parkinson’s disease–still waiting for the breakthrough. J Neurol Sci, 2010, 289(1–2): 104-114

[9] ZhangZX, RomanGC, HongZ, et al.. Parkinson’s disease in China: prevalence in Beijing, Xi’an, and Shanghai. Lancet, 2005, 365(9459): 595-597

[10] LangAE, LozanoAM. Parkinson’s disease. First of two parts. N Engl J Med, 1998, 339(15): 1044-1053

[11] RamirezA, HeimbachA, GründemannJ, et al.. Hereditary parkinsonism with dementia is caused by mutations in ATP13A2, encoding a lysosomal type 5 P–type ATPase. Nat Genet, 2006, 38(10): 1184-1191

[12] LiG, ZhangZ, XiaH, et al.. Analysis of Thr12Met and Ala1144Thr mutations of the ATP13A2 gene in Parkinson’s disease patients in Xinjiang Uygur and Han ethnic groups. Med Sci Monit, 2014, 20: 2177-2182

[13] LuoQ, YangX, YaoY, et al.. T313M polymorphism of the PINK1 gene in Parkinson’s disease. Exp Ther Med, 2014, 8(1): 286-290

[14] ShangY, ZhangX, LiY, et al.. Comparison of clinical symptoms for Uygur and Han Parkinson’s disease patients. Zhonghua Yi Xue Za Zhi (Chinese), 2014, 94(1): 31-35

[15] HughesAJ, DanielSE, KilfordL, et al.. Accuracy of clinical diagnosis of idiopathic Parkinson’s: a clinicpathological study of 100 cases. J Neurol Neurosurg Psychiatry, 1992, 55(3): 181-184

[16] LiH, ZhangM, ChenL, et al.. Nonmotor symptoms are independently associated with impaired health–related quality of life in Chinese patients with Parkinson’s disease. Mov Disord, 2010, 25(16): 2740-2746

[17] HoehnMM, YahrMD. Parkinsonism: onset, progression and mortality. Neurology, 1967, 17(5): 427-442

[18] FolsteinMF, FolsteinSE, McHughPR. “Mini–mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res, 1975, 12(3): 189-198

[19] JinYL, ZhangH, GaoYZ, et al.. Neuropsychiatric symptoms in patients with vascular dementia in mainland China. Transl Neurosci, 2015, 6(1): 157-161

[20] KlepacN, HajnsekS, TrkuljaV. Impact of pre–morbid depression on health–related quality of life in nondemented Parkinson’s disease patients. Parkinsonism Relat Disord, 2010, 16(1): 21-27

[21] CummingsJL, MegaM, GrayK, et al.. The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology, 1994, 44(12): 2308-2314

[22] CummingsJL. The Neuropsychiatric Inventory: assessing psychopathology in dementia patients. Neurology, 1997, 48: S10-S16

[23] LeroiI, PantulaH, McDonaldK, et al.. Neuropsychiatric symptoms in Parkinson’s disease with mild cognitive impairment and dementia. Parkinsons Dis, 2012, 2012: 308097

[24] LeungVP, LamLC, ChiuHF, et al.. Validation study of the Chinese version of the neuropsychiatric inventory (CNPI). Int J Geriatr Psychiatry, 2001, 16(8): 789-793

[25] WangT, XiaoS, LiX, et al.. Reliability and validity of the Chinese version of the neuropsychiatric inventory in mainland China. Int J Geriatr Psychiatry, 2012, 27(5): 539-544

[26] BraakH, Del TrediciK, RübU, et al.. Staging of brain pathology related to sporadic Parkinson’s disease. Neurobiol Aging, 2003, 24(2): 197-211

[27] SkogsethRE, BronnickK, PereiraJB, et al.. Associations between cerebrospinal fluid biomarkers and cognition in early untreated Parkinson’s disease. J Parkinsons Dis, 2015, 5(4): 783-792

[28] AarslandD, TandbergE, LarsenJP, et al.. Frequency of dementia in Parkinson disease. Arch Neurol, 1996, 53(6): 538-542

[29] TsaiCF, LeeYT, LeeWJ, et al.. Depression of family caregivers is associated with disagreements on lifesustaining preferences for treating patients with dementia. PLoS One, 2015, 10(7): e0133711

[30] CooneyJW, StacyM. Neuropsychiatric Issues in Parkinson’s disease. Curr Neurol Neurosci Rep, 2016, 16(5): 49

[31] AarslandD, LarsenJP, LimNG, et al.. Range of neuropsychiatric disturbances in patients with Parkinson’s disease. J Neurol Neurosurg Psychiatry, 1999, 67(4): 492-496

[32] FénelonG, AlvesG. Epidemiology of psychosis in Parkinson’s disease. J Neurol Sci, 2010, 289(1–2): 12-17

[33] PereiraJB, SvenningssonP, WeintraubD, et al.. Initial cognitive decline is associated with cortical thinning in early Parkinson disease. Neurology, 2014, 82(22): 2017-2025

[34] AarslandD, BronnickK, Williams–GrayC, et al.. Mild cognitive impairment in Parkinson disease: a multicenter pooled analysis. Neurology, 2010, 75(12): 1062-1069

[35] CavinessJN, Driver–DunckleyE, ConnorDJ, et al.. Defining mild cognitive impairment in Parkinson’s disease. Mov Disord, 2007, 22(9): 1272-1277