Cognitive impairment in Parkinson's disease is multifactorial: A neuropsychological study.

BACKGROUND: In Parkinson's disease, mild cognitive impairment and dementia are associated with α-synuclein deposition and spread. However, coexistent Alzheimer's disease and cerebrovascular disease are common at autopsy, and may affect cognition. Our objective was to map cognitive impairment in Parkinson's disease to these different causes using clinical assessment. METHODS: Neuropsychological testing was performed in a cross-sectional sample of cognitively impaired patients with Parkinson's disease. The pattern of deficits in varying cognitive domains was mapped to the presentations that typify different diseases. Data were analysed by an expert multidisciplinary panel, referencing diagnostic criteria, to reach a consensus diagnosis for the cognitive dysfunction. RESULTS: There were 45 participants with Parkinson's disease and cognitive impairment, 73.3% male, mean age 69.1 years (SD 8.3). Twenty-seven (60.0%) had mild cognitive impairment, and 18 had dementia (40.0%). Cognitive impairment was primarily attributable to Lewy body disease alone in 19 of 45 patients (42.2%), to Lewy body disease plus Alzheimer's in 14 of 45 (31.1%), to Lewy body plus cerebrovascular disease in 6 of 45 (13.3%), and to Lewy body plus Alzheimer's and cerebrovascular disease in 1 of 45 (2.2%). The cognitive decline was not primarily Lewy-related in 5 of 45 patients (11.1%); in 4 of 45 (8.9%), it was primarily attributable to Alzheimer's disease, and 1 of 45 (2.2%) had behavioural-variant frontotemporal dementia. CONCLUSION: Neuropsychological testing identifies distinct patterns of cognitive impairment in Parkinson's disease that provide clear pointers to comorbid disease processes, the most common being Alzheimer's disease. This approach may prove useful in clinical practice and has implications for clinical trials that target α-synuclein.

Underage binge drinking adolescents: sociodemographic profile and utilization of family doctors.

Context. Binge drinking (more than five drinks on one occasion) is a major public health problem among teenagers in the US, Canada, and Europe. Negative outcomes to binge drinking include alcohol related injuries and accidental death. Family physicians are the main point of contact between binging adolescents and the health care system. Design and Setting. This study was based on a secondary analysis of 6,607 respondents aged 15-17 from the regionally representative data acquired through the Canadian Community Health Survey 1.1. Results. According to our findings, one in every eight teens aged 15-17 binge drank monthly. The odds of binge drinking were higher among males, Whites, those living away from parents, teens who reported a decline in health status, and those experiencing back problems and depression. Smoking status was strongly associated with the binge drinking behavior. Three-quarters of binge drinking adolescents had seen their family doctor in the past year but only one in ten had spoken with any health professional about a mental health issue. Conclusions. Family physicians need to screen their adolescent patients for binge drinking in order to provide timely and effective interventions. Awareness of the profile of binge drinkers could improve the accuracy of targeting and outreaching strategies.