Cognition in People Aged 80 Years and Older: Determinants and Predictors of Change from a Population-Based Representative Study in Germany.

BACKGROUND: The number of people aged 80 years and older (80+) will increase drastically in the upcoming decades. The preservation of cognitive functions will contribute to their quality of life and independence. OBJECTIVES: To identify determinants of cognition and predictors of change in cognitive performance in the population 80+. DESIGN: Cross-sectional and longitudinal population-based on the representative NRW80+ survey. SETTING: Randomly drawn cases of people aged 80+ from the municipal registration offices, including people living in private homes and institutional settings. PARTICIPANTS: The participants in the cross-sectional sample (N=1503, 65.5%female) were 84.7 years old (95%CI[84.5,85.0]) and had 12.3 years of education (95%CI[12.1,12.4]). The participants in the longitudinal sample (N=840, 62.5%female) were 84.9 years old (95%CI[84.6,85.2]) and had 12.3 years of education (95%CI[12.0,12.5]). MEASUREMENTS: The cognitive screening DemTect, age, sex, education, and social, physical, and cognitive lifestyle activities, as well as subjective general health status and depressive symptoms, were assessed at baseline and 24-month follow-up. RESULTS: Younger age, more years of education, and more cognitive lifestyle activities were identified as the most consistent determinants of both better cognitive performance and preservation of cognitive performance for both global cognition as well as the DemTect subtests on memory and executive functions. CONCLUSIONS: Our findings reveal that commonly investigated determinants of, and change in, cognitive performance are valid for the people 80+ and highlight the importance of cognitive lifestyle activities for cognitive health. The maintenance of cognitive functions is a key aspect of healthy aging in terms of preserving independence in people 80+.

Cognition in older offenders in North Rhine-Westphalia: A comparison of prisoners and patients in forensic psychiatry hospitals.

The number of elderly delinquent individuals living in prisons and forensic hospitals is increasing. For both settings, complex needs have been described for the elderly related to age-related changes and frequent somatic disorders as well as mental disorders, primarily depressive symptoms.. One of the biggest challenges are cognitive impairments which have been described for both groups, probably not least due to frequent risk factors (e.g., substance abuse, depressive symptoms). Given that the group of forensic patients has a manifest mental illness, which is usually treated with psychopharmaceuticals, the question arises as to what extent cognitive deficits are more frequent here. For both groups, the detection of cognitive deficits with regard to therapy and release planning is of relevance. In sum, studies on cognitive function in both populations are rare, and the results are hard to compare due to different instruments to assess cognition. Sociodemographic, health-, and incarceration-related data were collected as well as neuropsychological functions using established instruments to evaluate global cognitive functioning (Mini-Mental State Examination [MMSE], DemTect), executive function (Frontal Assessment Battery [FAB], and Trail Making Test [TMT]). In the final sample, 57 prisoners and 34 forensic inpatients from North Rhine Westphalia, Germany being 60 years and older were included. The groups were comparable in age (prisoners: M = 66.5 years, SD ± 5.3; forensic inpatients: M = 66.8 years, SD ± 7.5) and education (prisoners: M = 11.47, SD ± 2.91; forensic inpatients: M = 11.39, SD ± 3.64), but the offenders in forensic psychiatry had spent significantly more time in the correctional setting than prisoners (prisoners: M = 8.6, SD ± 10.8; forensic inpatients: M = 15.6 years, SD ± 11.9). In both groups cognitive deficits were frequent. Depending on the tests and population, between 42% and 64% showed impairments in global cognition, and between 22% and 70% were classified with impaired executive functioning. We found no significant differences in global cognition or executive functions assessed with the TMT between the two groups. However, forensic inpatients were significantly more impaired in the FAB compared to the prisoners. The results emphasize the high frequency of cognitive dysfunction in both settings and a possibly higher frequency of "frontal" dysfunction in forensic inpatients, and, thus, indicate the relevance of routine neuropsychological diagnostic and treatment procedures in these settings.

[O-DEM: a new cognitive screening in patients with hearing loss]. / O-DEM: ein neues kognitives Screening bei Schwerhörigkeit.

BACKGROUND: Hearing loss is a significant risk factor for dementia. To date, cognitive impairment and dementia in patients with hearing impairment (HI) cannot be adequately diagnosed by commonly administered cognitive screening tests due to sensory impairments. Therefore, an adapted screening is needed. The aim of the present study was to develop and evaluate a cognitive screening for people with HI. MATERIALS AND METHODS: The new cognitive screening, called O­DEM, entails a word fluency test, the Trail Making Test A (TMT-A), and a subtraction task. First, the O­DEM was tested in a large clinical sample (N = 2837) of people without subjective HI. In a second step, the O­DEM was evaluated in 213 patients with objectively assessed HI and compared with the Hearing-Impaired Montreal Cognitive Assessment (HI-MoCA). RESULTS: The results indicate that the O­DEM subtests significantly discriminate between participants with no, mild, and moderate to severe cognitive impairment. Based on the mean and standard deviation of the participants without cognitive impairment, a transformation of the raw scores was performed and a total score with a maximum value of 10 was determined. In the second part of the study, the O­DEM was shown to be as sensitive as the HI-MoCA in differentiating between people with and without cognitive impairment. CONCLUSION: Compared to other screenings, the O­DEM is a quickly administrable screening for the detection of mild and moderate cognitive impairment in people with HI.

A Reliable Tool for Assessing MCI and Dementia: Validation Study of DemTect for Turkish Population.

BACKGROUND AND AIM: Mild cognitive impairment (MCI) and dementia prevalence are expected to increase with aging. The DemTect is a very quick and easy tool to administer and recognize the early stages of dementia and MCI. In this study we aimed to evaluate the reliability and validity of a Turkish version of the DemTect and define cut off values for different age and educational levels. One of our aims is also to compare the sensitivity and specifity of the DemTect to other common screening tools. PATIENTS AND METHODS: Fifty-four patients with MCI, 55 patients with dementia and 91 patients with subjective memory complaints (SMC) were enrolled in the study. The DemTect was translated into Turkish by forward-backward translation and compared with the Mini Mental State Examination (MMSE), the Quick Mild Cognitive Impairment Turkish version (QMCI-TR) and the Montreal Cognitive Assessment (MoCA). In order to test interrater reliability, the DemTect was administered to 11 patients, on the same day, by 2 trained raters. To establish test-retest reliability, the same rater scored the tool a second time on 11 patients within 2 weeks. RESULTS: The median age of the patients was 73 (min-max: 65-90) years, 54.5% were female. We found a strong correlation between DemTect scores and the MMSE, the QMCI, and the MoCA (r = 0.725, r = 0.816, r = 0.821, respectively; p < 0.001). In ROC analysis, the cut-off point of the DemTect to differentiate MCI from SMC was 11.5 with 92.6% sensitivity, 91.2% specificity, AUC 0.973 and the cut-off point of the DemTect to differentiate dementia from SMC was 9.5 with 96.4% sensitivity, 100% specificity, AUC 0.916. Cronbach α was 0.823. Intraclass correlation coefficient was 0.873 (95% CI: 0.598-0.964) for interrater reliability and 0.966 (95% 0.777-0.982) for test-retest reliability (Cronbach α = 0.932, 0.966 respectively). CONCLUSION: The DemTect is a very reliable tool to assess Turkish patients with MCI and dementia.

The Multiple Sclerosis Inventory of Cognition for Adolescents (MUSICADO): A brief screening instrument to assess cognitive dysfunction, fatigue and loss of health-related quality of life in pediatric-onset multiple sclerosis.

OBJECTIVE: Screening for cognitive impairment (CI), fatigue and also Health-related quality of life (HRQoL) in patients with pediatric-onset multiple sclerosis (POMS) is of utmost importance in clinical practice. The aim of this study was to establish a new and validated pediatric screening tool "MUSICADO" that is easy to use and time economical. METHODS: 106 patients with POMS aged 12-18 years and 210 healthy controls (HCs) stratified for age and education underwent neuropsychological testing including a screening test "Multiple Sclerosis Inventory of Cognition" for adults and 8 standardized cognitive tests and established scales to assess fatigue and HRQoL. RESULTS: The phonemic verbal fluency task (RWT "s-words"), the Trail Making Test A (TMT-A), and the Digit Span Forward discriminated significantly between patients and HCs (p = 0.000, respectively) and showed the highest proportion of test failure in patients (24.5%, 17.9%; 15.1%, respectively). Therefore, they were put together to form the cognitive part of the "MUSICADO". After applying a scoring algorithm with balanced weighting of the subtests and age and education correction and a cut-off score for impairment, 35.8% of patients were categorized to be cognitively impaired (specificity: 88.6%). Fatigue was detected in 37.1% of the patients (specificity: 94.0%) and loss of HRQoL in 41.8% (specificity 95.7%) with the screening version, respectively. CONCLUSION: The MUSICADO is a newly designed brief and easy to use screening test to help to early identify CI, fatigue, and loss of HRQoL in patients with POMS as cut scores are provided for all three items. Further studies will have to show its usability in independent samples of patients with POMS.

[Conversions of cognitive screenings : Mini-Mental State Examination vs. Montreal Cognitive Assessment vs. DemTect]. / Konversionen von kognitiven Screenings : Mini-Mental-Status-Test vs. Montreal Cognitive Assessment vs. DemTect.

BACKGROUND: For a comprehensive specification and quantification of neuropsychological deficits, extensive neuropsychological assessment is needed. Due to its time intensiveness, this cannot be accomplished in every clinical setting and is not always necessary. Therefore, screening instruments provide a first step. Because the selection differs between and sometimes even within clinics, a comparison of results for different screening procedures would be helpful. The current study aimed at achieving this in the German-speaking area, i.e. conversions between sum scores of the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA) and Dementia Detection Test (DemTect) can be accomplished. METHOD: In the Department of Neurology at the University Hospital of Cologne, 8240 patients with different neurological diseases were examined between 2008 and 2017. Conversion scores using the results in the MMSE, MoCA and DemTect were computed by using the equipercentile equating method. RESULTS: The calculated bidirectional conversion tables enable a quick and easy comparison between the three most commonly used screening instruments. They are also similar to those from previous studies in English-speaking countries. CONCLUSION: The results enable an enhanced longitudinal assessment of cognitive functions in different clinical settings, provide comparability, and offer more flexibility for determination of patient status. An extension of the current study might be the transfer of the method presented to other cognitive or affective domains, such as memory and depression.

[Nonpharmacological treatment procedures for Parkinson's disease]. / Nichtmedikamentöse Therapieverfahren beim Morbus Parkinson.

Nonpharmacological treatment strategies in Parkinson' disease include heterogeneous treatment modalities, such as physiotherapy, occupational therapy, speech therapy, cognitive training and deep brain stimulation as well as noninvasive brain stimulation strategies. Even in the early stages of Parkinson's disease nonpharmacological interventions, such as active exercise therapy and speech therapy can be indicated taking the individual symptoms of a patient into account. Mild cognitive deficits are frequently detected in the course of the disease and progression of these disorders to dementia in the advanced stages of the disease is not uncommon. The starting point for a cognitive training, training strategy and training frequency is unknown and currently under investigation. Deep brain stimulation is an established treatment modality, which should be considered when motor fluctuations cannot be adequately controlled by pharmacological treatment. This therapeutic option depends on patient-specific needs and has to be managed by a multiprofessional team. Non-invasive neurostimulation techniques, such as transcranial magnetic stimulation and transcranial direct current stimulation are experimental tools and cannot currently be recommended for general use.

[A New Diagnostic Tool for Apraxia in Patients with Right-Hemisphere Stroke: The Revised Cologne Apraxia Screening (KAS-R)]. / Das revidierte Kölner Apraxie-Screening (KAS-R) als diagnostisches Verfahren für Patienten mit rechtshemisphärischem Schlaganfall.

The Cologne Apraxia Screening (KAS) was developed to diagnose apraxia following left-hemisphere (LH) stroke. The present study aims at developing a diagnostic tool for patients with right-hemisphere (RH) stroke (KAS-R) by modifying the test material of the KAS and reducing the test items based on psychometric analyses.A total of 100 patients with RH stroke and 77 healthy control participants were tested. Psychometric analyses led to the exclusion of 8 KAS items. The final KAS-R, consisting of 12 items, shows good internal consistency (α = 0.795) as well as high sensitivity (79.4 %) and specificity (84.4 %). Applying a cut-off value of ≤ 46 (out of 48) points, 39 RH stroke patients were diagnosed with apraxia. Significant correlations were found between the KAS-R and an imitation test as well as expert ratings, indicating high construct validity. The results suggest that the KAS-R is a reliable and valid diagnostic tool for apraxic deficits after RH stroke.

[Cognitive Training in Parkinson's Disease - A New Therapy Option?]. / Kognitives Training bei Parkinson-Patienten - eine neue Therapieoption?

Cognitive impairment is a frequent and clinically relevant symptom in patients with Parkinson's disease (PD). Given that pharmacological therapy options are limited, non-pharmacological interventions for the prevention and treatment of cognitive impairment in PD patients are attracting increasing interest. This review summarizes the current state of research regarding cognition-based interventions in PD patients. Eleven randomized controlled studies (RCT) were found in a systematic literature search, all of which used cognitive training (CT). These studies and a recently published meta-analysis demonstrate that especially executive and memory functions can be enhanced by CT in PD patients. Future studies examining CT or cognitive stimulation should include large PD samples with well-defined cognitive inclusion criteria so that clear therapy recommendations can be defined for PD patients without cognitive dysfunctions, those with mild cognitive impairment, and those with dementia.

Verbal memory declines more in female patients with Parkinson's disease: the importance of gender-corrected normative data.

BACKGROUND: Data on gender-specific profiles of cognitive functions in patients with Parkinson's disease (PD) are rare and inconsistent, and possible disease-confounding factors have been insufficiently considered. METHOD: The LANDSCAPE study on cognition in PD enrolled 656 PD patients (267 without cognitive impairment, 66% male; 292 with mild cognitive impairment, 69% male; 97 with PD dementia, 69% male). Raw values and age-, education-, and gender-corrected Z scores of a neuropsychological test battery (CERAD-Plus) were compared between genders. Motor symptoms, disease duration, l-dopa equivalent daily dose, depression - and additionally age and education for the raw value analysis - were taken as covariates. RESULTS: Raw-score analysis replicated results of previous studies in that female PD patients were superior in verbal memory (word list learning, p = 0.02; recall, p = 0.03), while men outperformed women in visuoconstruction (p = 0.002) and figural memory (p = 0.005). In contrast, gender-corrected Z scores showed that men were superior in verbal memory (word list learning, p = 0.02; recall, p = 0.02; recognition, p = 0.04), while no difference was found for visuospatial tests. This picture could be observed both in the overall analysis of PD patients as well as in a differentiated group analysis. CONCLUSIONS: Normative data corrected for gender and other sociodemographic variables are relevant, since they may elucidate a markedly different cognitive profile compared to raw scores. Our study also suggests that verbal memory decline is stronger in women than in men with PD. Future studies are needed to replicate these findings, examine the progression of gender-specific cognitive decline in PD and define different underlying mechanisms of this dysfunction.

Cognitive screening in Parkinson's disease: Comparison of the Parkinson Neuropsychometric Dementia Assessment (PANDA) with 3 other short scales.

BACKGROUND: Cognitive screening is crucial in Parkinson's disease (PD). However, there is still a lack of short tools in French. In this study, we aimed to compare the Parkinson Neuropsychometric Dementia Assessment (PANDA) with the Mini Mental Parkinson (MMP), the Mini Mental State Examination (MMSE) and the Clock Test in French-speaking patients. We also aimed to propose cut-off scores for cognitive impairment and dementia for the French language version of the PANDA. METHOD: Fifty-one patients with PD took the PANDA, the MMSE, the MMP, and the Clock Test. They also underwent extensive neuropsychological testing by a neuropsychologist who was blinded to the above-mentioned screening test results. Patients were classified as either having normal cognition (n=15), mild cognitive impairment (n=20) or dementia (n=16). RESULTS: When compared with the three other screening tools, the PANDA exhibited the highest area under the curve (AUC) for both cognitive disorders and dementia. Using the cut-off scores proposed for the German version, the PANDA had 94% specificity and 100% sensitivity for dementia and 100% and 72%, respectively for cognitive disorders. CONCLUSIONS: In our study, the PANDA exhibited a higher discriminative power than the three other tests in detecting cognitive disorders and dementia. In PD patients, the PANDA should thus be considered for the detection of cognitive impairment in routine clinical practice.

Deep brain stimulation and cognitive decline in Parkinson's disease: The predictive value of electroencephalography.

Some Parkinson's disease (PD) patients treated with subthalamic nucleus deep brain stimulation (STN-DBS) develop new-onset cognitive decline. We examined whether clinical EEG recordings can be used to predict cognitive deterioration in PD patients undergoing STN-DBS. In this retrospective study, we used the Grand Total EEG (GTE)-score (short and total) to evaluate pre- and postoperative EEGs. In PD patients undergoing STN-DBS (N = 30), cognitive functioning was measured using Mini-Mental State Test and DemTect before and after surgery. Severity of motor impairment was assessed using the Unified Parkinson's Disease Rating Scale-III. Patients were classified into patients with or without cognitive decline after STN-DBS surgery. Epidemiological data, pre- and postoperative EEG recordings as well as neuropsychological and neurological data, electrode positions and the third ventricle width were compared. A logistic regression model was used to identify predictors of cognitive decline. Motor deficits significantly improved from pre- to post-surgery, while the mean GTE-scores increased significantly. Six patients developed cognitive deterioration 4-12 months postoperatively. These patients had significantly higher preoperative GTE-scores than patients without cognitive deterioration, although preoperative cognitive functioning was comparable. Electrode positions, brain atrophy and neurological data did not differ between groups. Logistic regression analysis identified the GTE-score as a significant predictor of postoperative cognitive deterioration. Data suggest that the preoperative GTE-score can be used to identify PD patients that are at high risk for developing cognitive deterioration after STN-DBS surgery even though their preoperative cognitive state was normal.

[Effects of combined cognitive and physical training on cognition of healthy older adults: a literature review]. / Effekte kombinierten kognitiven und physischen Trainings auf die Kognition gesunder älterer Menschen: ein Literaturüberblick.

There is significant evidence for the positive effects of cognitive and physical training on cognition in healthy older adults. Recently, it has been discussed whether stronger effects could be reached with a combination of both interventions. This review analyses the current state of research about this topic. Four randomised controlled trials (RCTs) and four controlled trials were found. Three of these studies (none of which were RCTs) in fact showed the superiority of combined training when compared to single interventions. However, even if positive evidence exists, the current state of research has to be evaluated as insufficient due to the small number of studies, the lack of evidence from RCTs and the lack of comparability of study designs, types of interventions, and test intervals used so far. Gaps in the current state of research are identified, relevant aspects of future studies are listed and possible neurobiological mechanisms of training effects are discussed.

[Cognitive stimulation and music intervention for people with dementia in nursing homes: A pilot study, problems and perspectives]. / Kognitive Stimulation und Musikintervention bei stationär versorgten Menschen mit Demenz: Eine Pilotstudie, Probleme und Perspektiven.

BACKGROUND: Nonpharmacological interventions in people with dementia are becoming an increasingly important addition to pharmacological therapy. However, the current state of research in this field is limited. OBJECTIVES: The aim of this pilot study was to evaluate the effects of a cognitive stimulation program and a music intervention program on cognitive function, quality of life and activities of daily living in persons with dementia residing in nursing homes. In addition, specific challenges of randomized controlled trials in nursing homes should be identified to define recommendations for further studies. METHODS: Over a period of 6 weeks, 24 individuals with mild to moderate dementia were randomly allocated to participation in a cognitive stimulation program or in a music intervention. Each program consisted of twelve group-sessions of 90 min with two sessions per week. A neuropsychological test battery was performed before and after the training period. RESULTS: There were no significant improvements on the group level. In fact, performance declined in some domains. Nonetheless, heterogeneous results were evident in both groups after analysis on a single-case approach and some persons significantly improved their performance. CONCLUSION: At least on a single-case approach, the study provides additional support for the potential of nonpharmacological interventions. Future studies should target logistical aspects in nursing homes, realistic planning of sample size, formulating adequate inclusion and exclusion criteria, and choosing suitable neuropsychological tests.

Cognitive training in Parkinson's disease reduces cognitive decline in the long term.

BACKGROUND AND PURPOSE: Patients with Parkinson's disease (PD) are at high risk for cognitive dysfunction. Non-pharmacological interventions have attracted increasing interest for enhancing PD patients' cognitive functions. METHODS: One-year follow-up data (T2 ) of a randomized controlled trial evaluating two 6-week cognitive trainings - a structured (NEUROvitalis, NV) and an unstructured (mentally fit, MF) program - compared with a waiting list control group (CG) in non-demented PD patients (Hoehn and Yahr I-III) are presented. Forty-seven PD patients were examined at T2 . Effects on overall cognitive functions (Mini-Mental State Examination and DemTect) were compared between all groups with repeated measurement analyses of variance. A combined score of the percentage change value from baseline (T0 ) to T2 was calculated to identify patients who retained or improved their cognitive state (responders). The risk of developing mild cognitive impairment (MCI) was analyzed. RESULTS: Significant time × treatment effects on overall cognitive functions were found for both training groups, each compared separately to the CG (DemTect, P < 0.05). Nine patients (56.3%) of the NV group, seven (41.2%) of the MF group and three (21.4%) of the CG were responders. Comparing NV to CG the odds ratio was 4.7 [95% confidence interval (0.8; 33.3)], and comparing MF to CG it was 2.6 [95% confidence interval (0.4; 17.4)]. MCI risk for patients without prior MCI was 40.0% in CG, 18.2% in MF and 18.2% in NV. The odds ratio was 3 comparing NV to CG, MF to CG. DISCUSSION: This study gives evidence that cognitive training may be effective to prevent cognitive decline and onset of MCI in PD patients.

[DemTect 40- and DemTect 80+: New scoring routines for these age groups]. / DemTect 40- und DemTect 80+: Neue Auswertungsroutinen für diese Altersgruppen.

The DemTect, a frequently used cognitive screening tool for the German-speaking population, has been proven to be age-, but not education-dependent. To date, scoring routines for persons under and over 60 years of age have been available. In order to describe the age-effect more specifically, the DemTect was administered to persons under 40 (n = 105; median 33 years [18 - 39]) and over 80 years of age [n = 68; median 83 years [80 - 93}). After transformation of the raw scores, which are based on the mean and standard deviation of the respective reference group, an adequate attribution of scores could be achieved and no differences between the groups can be observed in the total score or the subtest scores. The median of the transformed total score was 16 [5 ­ 18] for the younger and 15 [5 ­ 18] for the older age group. The new scoring routines supplement the scoring procedures of the DemTect for these age groups.

[Neuropsychological assessment early after stroke--an overview of diagnostic instruments available in German and introduction of a new screening tool]. / Neuropsychologische frühdiagnostik nach einem schlaganfall--ein überblick im deutschsprachigen raum verfügbarer instrumente und vorstellung eines neuen screening-verfahrens.

Stroke-induced neuropsychological sequelae are frequent and highly relevant for the patient's prognosis, so that their diagnostic assessment at an early point in time is highly advisable to allow for the initiation of appropriate treatment. Because stroke patients in the acute and sub-acute phase of a stroke often show a general slowing and restricted resilience, investigation may be limited and is often only manageable by means of instruments that can be used at bedside. Preferably such neuropsychological tests should also be normalised for the target group. An overview of the neuropsychological instruments available in German, which were developed for or applied to stroke patients in the early phases of stroke and rehabilitation, is provided here. One of the nine instruments presented is the newly developed Cologne Neuropsychological Screening for Stroke Patients (German: Kölner Neuropsychologisches Screening für Schlaganfall-Patienten), which is introduced here. The instruments differ in form of investigation, duration, material volume and standardisation. The choice of a particular instrument in a given clinical or scientific context explicitly depends on the diagnostic goal as well as the resilience of the patient.

[Early recognition of Parkinson's disease. Objectifiable non-motor symptoms and biomarkers]. / Früherkennung der Parkinson-Krankheit. Objektivierbare nichtmotorische Symptome und Biomarker.

The clinical diagnosis of Parkinson's disease (PD) according to the UK Brain Bank criteria is based on the presence of motor symptoms and the response to dopaminergic medication. According to these criteria the clinical diagnosis is delineated too late when more than 50 % of the dopaminergic neurons are already degenerated. In recent years interest has shifted increasingly more towards non-motor symptoms (NMS), such as rapid eye movement (REM) sleep behavior disorder (RBD), constipation, hyposmia and neuropsychiatric as well as cognitive symptoms. It was shown that NMS can precede the motor symptoms by some years and may thus possibly enable support of an earlier clinical diagnosis. Furthermore, cerebrospinal fluid or blood biomarkers as well as brain imaging techniques can objectively support an earlier diagnosis of PD. This article reviews important NMSs (e.g. RBD, hyposmia and neuropsychiatric/cognitive symptoms) as well as the current status on biomarkers and brain imaging in early (premotor) phases of PD and their relevance for the early diagnosis.

[Dementia in morbus Parkinson: reasonable diagnostics and rational therapy]. / Demenz bei Morbus Parkinson: Sinnvolle Diagnostik und rationale Therapie.

Cognitive decline is a common disorder in idiopathic Parkinson's syndrome, the risk for the development of a dementia is four- to six-fold higher for Parkinsonian patients. The cognitive profile in Parkinson's disease dementia (PDD) differs from that of Alzheimer-type dementias. The affected cognitive functions include attention, executive functions, visual-spatial functions and recall. The main differential diagnosis for PDD is the Lewy body dementia (LBD), which can be differentiated through the temporal development of motor and cognitive symptoms. Cognitive symptoms in Parkinsonian syndromes have a relevant negative impact on quality of life, on the burden for the care-givers, on the prognosis of the disease and on the possible referral to a nursing home. Dementias in Parkinsonian syndromes (PDD and LBD) need a confirmatory diagnosis at an early stage in order to initiate further therapeutic steps with, e. g., acetylcholine esterase inhibitors or, perspectively, neuropsychological training methods.