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Mild cognitive impairment in Parkinson's disease and its progression onto dementia: a 16-year outcome evaluation of the Denbighshire cohort
- Authors:
- HOBSON Peter, MEARA Jolyon
- Journal article citation:
- International Journal of Geriatric Psychiatry, 30(10), 2015, pp.1048-1055.
- Publisher:
- Wiley
Objective: Mild cognitive impairment in Parkinson's disease (PD-MCI) has been suggested to be a predictor for the development of PD dementia (PDD). This study explored the incidence and possible neuropsychological domain differences between PD patients with PD-MCI and without cognitive impairment (normal cognitive function with PD), on the basis of the Movement Disorders Task Force Guidelines for PD-MCI. Methods: At baseline (T1), 4 years (T2) and 6 years (T3), 166 patients with PD were administered global neuropsychological assessments. At 16 years, case note and neuropsychological assessment review was employed to calculate the number of patients who had progressed to PDD. Results: At baseline, 68 patients were classified as normal cognitive function with PD, 18 with PD-MCI and 80 with PDD. At T2, 12 of the PD-MCI cohort at T1 had progressed to PDD, and there were 15 incident cases of PD-MCI. At T3, nine PD-MCI cases at T2 had progressed to PDD. There were 10 incident cases of PD-MCI at T3. The incidence of progression from PD-MCI to PDD was 98.0 per 1000 person-years, with an annual conversion rate to PDD of 11%. Neuropsychological predictors for conversion from PD-MCI to PDD were semantic language, praxis (figure drawing/copying) and visuospatial deficits. At 16 years, 91% of the PD-MCI cohort had progressed to PDD. Conclusions: Mild cognitive impairment in Parkinson's disease is an important predictor for the progression to PDD. This investigation also confirmed that if PD patients live long enough, they will develop cognitive impairment or dementia. Early detection of cognitive impairment in these individuals is possible with existing standardised global cognitive assessments, which include semantic language assessment. (Edited publisher abstract)
The Weigl Colour-Form Sorting Test: a quick and easily administered bedside screen for dementia and executive dysfunction
- Authors:
- HOBSON Peter, MEARA Jolyon, TAYLOR Carolyn
- Journal article citation:
- International Journal of Geriatric Psychiatry, 22(9), September 2007, pp.909-915.
- Publisher:
- Wiley
Screening for cognitive impairment in hospital and the community requires a valid, reliable, concise, well tolerated, easily administered instrument. In this investigation, we have studied a non-verbal cognitive screening instrument; Weigl's Colour-Form Sorting Test (WCFT), to determine its utility as a brief cognitive screen in a community based sample of stroke survivors, Parkinson's disease (PD) patients and age/sex matched controls. A total of 236 subjects consented to participate in this investigation, consisting of 105 stroke survivors, 40 PD and 91 control subjects. The sensitivity and specificity of the WCFT to detect significant cognitive impairment was based upon psychiatric interview, cognitive assessment and application of DSMIV criteria. The optimal cut-point of the WCFT to detect cases of cognitive impairment was 2/4 in all of the groups in this investigation. The sensitivity and specificity of the WCFT at the cut point of 2 in the stroke survivors was 77.8% and 78.3, in the PD patients, it was 78.6% and 85.5% and, in the control group 83.3% and 94.1% respectively. The diagnostic accuracy of the WCFT as calculated by the area under the receiver operating curve was greater than 0.70 in all subject groups, which suggests that it has acceptable psychometric properties to discriminate between case and non-cases of cognitive impairment. The WCFT was able to demonstrate good sensitivity and specificity, at detecting cognitive impairments in all of the subjects. This instrument will prove to be a useful adjunct to existing cognitive screens in clinical practice, due to its excellent psychometric properties, and lack of dependency on language skills.
The coping methods of patients with Parkinson's disease their carers and the associations between health-related quality of life and depression
- Authors:
- HOBSON Peter, LEEDS Lesley, MEARA Jolyon
- Journal article citation:
- Quality in Ageing, 2(4), December 2001, pp.12-19.
- Publisher:
- Pier Professional
- Place of publication:
- Brighton
The methods of coping and their relationship to disease severity, cognitive function, depression and health-related quality of life (HRQoL) were examined in 79 Parkinson's disease (PD) patients and their carers. The coping methods of the PD patients were not associated with disease severity, cognitive function, or depression. In general the majority of correlations were weak. However, patients who used avoidance and cognitive coping methods reported improved HRQoL. Impaired cognitive function, poorer HRQoL and increased disease severity were associated with depression in patients. In carers, avoidance coping was associated with depression and cognitive impairment in the patient being cared for. These findings demonstrate the complex relationship in PD between impairment, quality of life, depression, cognitive function and the coping styles adopted by patients and carers. The study also highlights the difficulties in measuring these interactions with quantitative outcome measures.
‘Still-face’ interactions between mothers with borderline personality disorder and their 2-month-old infants
- Authors:
- CRANDELL Lisa E., PATRICK Matthew P. H., HOBSON Peter
- Journal article citation:
- British Journal of Psychiatry, 18(9), September 2003, pp.239-247.
- Publisher:
- Cambridge University Press
There is evidence that psychopathology in mothers may be associated with dysfunctional mother-infant interactions. Eight mothers with borderline personality disorder and twelve mothers without psychiatric disorder were videotaped interacting with their 2-month-old infants in three successive phases of interaction: face-to-face play; an episode when the mother adopted a ‘still face’ and was unreactive; and a period when play interactions were resumed. The videotapes were rated by judges blind to the diagnostic group of the mother. The mothers with borderline personality disorder were more intrusively insensitive towards their infants. During the still-face period, their infants showed increased looking away and dazed looks. Following this, mother-infant interactions were less satisfying and their infants showed dazed looks and lowering of affect. The diagnosis of borderline personality disorder is associated with a particular pattern of mother-infant interaction. The infants’ responses to the still-face challenge might suggest dysfunctional self-regulation, but the developmental significance remains to be assessed.
How mothers with borderline personality disorder relate to their year-old infants
- Authors:
- HOBSON R. Peter, et al
- Journal article citation:
- British Journal of Psychiatry, 195(4), October 2009, pp.325-330.
- Publisher:
- Cambridge University Press
Individuals with borderline personality disorder have severely troubled interpersonal relations. This study aimed to assess how women with borderline personality disorder engage with their 12 to 18 month old infants. The methodology was to videotape mother-infant interactions in separation-reunion episodes using the Strange Situation test, where the mothers were women with borderline personality disorder, with depression, or without psychopathological disorder. In the results, a higher proportion (85%) of women with borderline personality disorder than women in the comparison groups showed disrupted affective communication with their infants. The conclusions were that maternal borderline personality disorder is associated with disturbances in mother-infant communication, and that intervention to support mothers with borderline personality disorder and develop more optimal mother-infant relations might be indicated.