Demência na doença de Parkinson: avaliação crítica da literatura

Pamplona, Luciana de Abreu e Lima; Mattos, James Pitágoras de

doi:10.1590/S0004-282X1996000400023

Resumos

Nos últimos trinta anos, avançou-se muito nos conhecimentos sobre a doença de Parkinson. A maioria dos pacientes consegue ter uma vida com qualidade por maior período de tempo com a moderna terapêutica oferecida. No entanto, a demência que pode ocorrer no processo evolutivo ainda não tem os aspectos neuropatológicos totalmente definidos. Sabemos que há alterações nos núcleos da base, na área ventral do tegmento mesencefálico, no tálamo, na substância negra e no córtex frontal. A presença dos corpúsculos de Lewy corticais tem sido associada à demência, da mesma forma que as alterações neuropatológicas da doença de Alzheimer, em alguns casos. O mais provável é que sua base seja multifatorial. Neurotransmissores diferentes, como a serotonina, a acetilcolina e a dopamina ou, ainda, hormônios como o cortisol, estão alterados quantitativamente em grande número de parkinsonianos demenciados. Encontrada em até 40% dos pacientes, a depressão do parkinsoniano já foi relacionada como fator predisponente à demência, presente em aproximadamente 25% destes. Pesquisas nessa área continuam conflitantes, afirmando, alguns, que há relação entre depressão, atrofia cortical, hipercortisolemia e doença de Parkinson. Os estudos neuropsicológicos indicam que a demência na doença de Parkinson é do tipo subcortical ou fronto-límbica. Sabe-se, também, que parkinsonianos sem distúrbios cognitivos clinicamente expressivos apresentam deficiências quando submetidos a testagens neuropsicológicas mais rígidas. Admite-se que os distúrbios cognitivos fazem parte do quadro clínico dessa doença, variando sua expressão entre os pacientes. Para o diagnóstico da demência, recomendam-se os critérios estabelecidos pela Associação Americana de Psiquiatria, publicados no seu manual de estatística e doenças mentais, assim como os métodos de neuroimagem. No que se refere ao tratamento, o quadro demencial parkinsoniano, até o momento, não reconhece agentes eficazes.

doença de Parkinson; demência; doença de Alzheimer

In the last 30 years, Parkinson's disease has been object of great progress. The majority of patients reaches a longer life with quality because of the modern therapeutic approach. However, dementia that can occur in the evolutive process, has its neuropathology not completelly defined until now. There are lesions in the basal ganglia, in the ventral area of the mesencephalic tegmentum, in the thalamus, in the substantia nigra and in the frontal cortex. The presence of Lewy bodies in the cortex is associated with dementia, in the same way that the anatomopathological features of Alzheimer's disease, in many cases. Dementia should have a multifactorial basis. Different types of neurotransmitters, like serotonin, acetylcholine and dopamine, or even hormones, like Cortisol, may be altered in a great number of demented parkinsonians. Depression, found in up to 40% of patients, have been related as a risk factor for dementia, present approximatelly in 25% of cases. Studies in this area are still conflicting, with some confirming the relation among depression, cortical atrophy, hypercortisolemia and Parkinson's disease. Neuropsychologic studies show that the dementia in Parkinson's disease is of subcortical type. It is also known that parkinsonians, even those without cognitive deficiencies clinically significant, present deficits if submitted to more detailed neuropsychological tests. It is assumed, so, that cognitive impairments are intrinsic to the disease, varying its expression among patients. Dementia shall be diagnosed based on the criteria established in the diagnostic and statistical manual of mental disorders of the American Psychiatry Association, as well as computed tomography and magnetic resonance. For treatment, parkinsonian dementia does not recognize efficacious agents until now.

Parkinson's disease; dementia; Alzheimer's disease

Demência na doença de Parkinson: avaliação crítica da literatura

Dementia in Parkinson's disease: a critical review of literature

Luciana de Abreu e Lima Pamplona^I; James Pitágoras de Mattos^II

^IServiço de Neurologia do Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro (UFRJ) (Chefia: Prof. Dr. Sérgio Novis): Mestranda

^IIServiço de Neurologia do Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro (UFRJ) (Chefia: Prof. Dr. Sérgio Novis): Professor Adjunto e Chefe do Setor de Doenças Extrapiramidais

RESUMO

Nos últimos trinta anos, avançou-se muito nos conhecimentos sobre a doença de Parkinson. A maioria dos pacientes consegue ter uma vida com qualidade por maior período de tempo com a moderna terapêutica oferecida. No entanto, a demência que pode ocorrer no processo evolutivo ainda não tem os aspectos neuropatológicos totalmente definidos. Sabemos que há alterações nos núcleos da base, na área ventral do tegmento mesencefálico, no tálamo, na substância negra e no córtex frontal. A presença dos corpúsculos de Lewy corticais tem sido associada à demência, da mesma forma que as alterações neuropatológicas da doença de Alzheimer, em alguns casos. O mais provável é que sua base seja multifatorial. Neurotransmissores diferentes, como a serotonina, a acetilcolina e a dopamina ou, ainda, hormônios como o cortisol, estão alterados quantitativamente em grande número de parkinsonianos demenciados. Encontrada em até 40% dos pacientes, a depressão do parkinsoniano já foi relacionada como fator predisponente à demência, presente em aproximadamente 25% destes. Pesquisas nessa área continuam conflitantes, afirmando, alguns, que há relação entre depressão, atrofia cortical, hipercortisolemia e doença de Parkinson. Os estudos neuropsicológicos indicam que a demência na doença de Parkinson é do tipo subcortical ou fronto-límbica. Sabe-se, também, que parkinsonianos sem distúrbios cognitivos clinicamente expressivos apresentam deficiências quando submetidos a testagens neuropsicológicas mais rígidas. Admite-se que os distúrbios cognitivos fazem parte do quadro clínico dessa doença, variando sua expressão entre os pacientes. Para o diagnóstico da demência, recomendam-se os critérios estabelecidos pela Associação Americana de Psiquiatria, publicados no seu manual de estatística e doenças mentais, assim como os métodos de neuroimagem. No que se refere ao tratamento, o quadro demencial parkinsoniano, até o momento, não reconhece agentes eficazes.

Palavras-chave: doença de Parkinson, demência, doença de Alzheimer.

ABSTRACT

In the last 30 years, Parkinson's disease has been object of great progress. The majority of patients reaches a longer life with quality because of the modern therapeutic approach. However, dementia that can occur in the evolutive process, has its neuropathology not completelly defined until now. There are lesions in the basal ganglia, in the ventral area of the mesencephalic tegmentum, in the thalamus, in the substantia nigra and in the frontal cortex. The presence of Lewy bodies in the cortex is associated with dementia, in the same way that the anatomopathological features of Alzheimer's disease, in many cases. Dementia should have a multifactorial basis. Different types of neurotransmitters, like serotonin, acetylcholine and dopamine, or even hormones, like Cortisol, may be altered in a great number of demented parkinsonians. Depression, found in up to 40% of patients, have been related as a risk factor for dementia, present approximatelly in 25% of cases. Studies in this area are still conflicting, with some confirming the relation among depression, cortical atrophy, hypercortisolemia and Parkinson's disease. Neuropsychologic studies show that the dementia in Parkinson's disease is of subcortical type. It is also known that parkinsonians, even those without cognitive deficiencies clinically significant, present deficits if submitted to more detailed neuropsychological tests. It is assumed, so, that cognitive impairments are intrinsic to the disease, varying its expression among patients. Dementia shall be diagnosed based on the criteria established in the diagnostic and statistical manual of mental disorders of the American Psychiatry Association, as well as computed tomography and magnetic resonance. For treatment, parkinsonian dementia does not recognize efficacious agents until now.

Key words: Parkinson's disease, dementia, Alzheimer's disease.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Aceite:3-junho-1996.

Estudo realizado no Serviço de Neurologia do Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro (UFRJ) (Chefia: Prof. Dr. Sérgio Novis)

Dra. Luciana de Abreu e Lima Pamplona - Rua Conde de Bonfim 897/101/bl 2 - 20530-000 Rio de Janeiro RJ - Brasil.

1. Albeit M, Feldman RG, Willis AL. The subcortical dementia of progressive supranuclear palsy. J Neurol Neurosurg Psychiatry 1974;37:121-130.
2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Ed3 revised. Washington DC: American Psychiatric Association; 1987.
3. Baldwin RC, Byrne EJ. Psychiatric aspects of Parkinson's disease. Br Med J 1989;299:3-4.
4. Bloxham CA, Dick DJ, Moore M. Reaction times and attention in Parkinson's disease. J Neurol Neurosurg Psychiatry 1987;50:1178-1183.
5. Brown RG, Marsden CD. How common is dementia in Parkinson's disease?. Lancet 1984;1:1262-1265.
6. Brown RG, Marsden CD. Neuropsychology and cognitive function in Parkinson's disease: an overview. In Marsden CD, Fahn S (eds.) Movement disorders 2. London: Butterworth,1987;99-123.
7. Chui HC, Mortimer JA, Slager U, Zarow C, Bondareff W, Webster DD. Pathologic correlates of dementia in Parkinson's disease. Arch Neurol 1986;43:991-995.
8. De Smet Y, Ruberg M, Serdaru M, Dubois B, Lhermitte F, Agid Y. Confusion, dementia, and anticholinergics in Parkinson's disease. J Neurol Neurosurg Psychiatry 1982;45:1161-1164.
9. Drayer BP. Imaging of the aging brain. Part II: pathologic conditions. Radiology 1988; 166:797-806.
10. Gibb WRG. Dementia and Parkinson's disease. Br J Psychiatry 1989; 154:596-614.
11. Gibb WRG, Lees AJ. A comparison of clinical and pathological features in young and old-onset Parkinson's disease. Neurology 1988;38:1402-1406.
12. Gibb WRG, Lees AJ. The relevance of the Lewy body in the diagnosis of idiopathic Parkinson's disease. In Marsden CD. Parkinson's disease. Lancet 1990;335:948-952.
13. Hakim AM, Mathieson G. Dementia in Parkinson's disease: aneuropathological study. Neurology 1979;29:209-214.
14. Hornykiewicz O. Dopamine and brain function. In Marsden CD. Parkinson's disease. Lancet 1990;335:948-952.
15. Huber SJ, Shuttleworth EC, Christy JA, Chakeres DW, Curtin A, Paulson GW. Magnetic resonance imaging in dementia of Parkinson's disease. J Neurol Neurosurg Psychiatry 1989;52:1221-1227.
16. Johnson TN, Rosvold H, Mishkin M. Projections from behaviorally defined sectors of the pre-frontal cortex to the basal ganglia, septum, and diencephalon of the monkey. In Lichter DG, Corbett AJ, Fitzgibbon GM, et al. Cognitive and motor disfuntion in Parkinson's disease: clinical, performance, and CT correlations. Arch Neurol 1988;45:854-860.
17. Kaplan HI, Sadock BJ. Perturbações organomentais. In Compêndio de Psiquiatria Dinâmica. Porto Alegre: Artes Médicas Sul, 1986:342-377.
18. Kemp JM, Powell TPS. The cortico-striate projections in the monkey. Brain 1970;262:441-457.
19. Mayeux R, Chen J, Mirabello E, Marder K, Bell K, Dooneief G, Cote L, Stern Y. An estimate of the incidence of dementia in idiopathic Parkinson's disease. Neurology 1990,40:1513-1517.
20. Mayeux R, Stern Y, Rosental R et al. An estimate of the prevalence of dementia in idiopathic Parkinson's disease. Arch Neurol 1988;45:260-263.
21. Mohr E, Juncor J, Cox C, Litvan I, Fedio P, Chase TN. Sellective deficits in cognition and memory in high-functioning parkinsonian patients. J Neurol Neurosurg Psychiatry 1990;53:603-606.
22. Oliveira IR. Neurolépticos. In Oliveira IR. Manual de psicofarmacologia clínica. Rio de Janeiro: MEDSI, 1994:71-99.
23. Quinn NP, Rossor MN, Marsden CD. Dementia and Parkinson's disease: pathological and neurochemical considerations. Br Med Bull 1989;299:3-4.
24. Rogers D, Lees AJ, Smith E, et al. Bradyphrenia in Parkinson's disease and psychomotor retardation in depressive illness. Brain 1987;110:761-776.
25. Ruberg M, Ploska A, Javoy-Agid F, et al. Muscarinic binding and choline acetyltransferase activity in parkinsonian patients with reference to dementia. In Gibb WRG. Dementia and Parkinson's disease. Br J Psychiatry 1989;154:596-614.
26. Sahakian BJ, Morris RG, Evenden JL, Heald A, Levy R, Philpot M, Robbins TW. A comparative study of visuospatial memory and learning in Alzheimer-type dementia and Parkinson's disease. Brain 1988; 111:695-718.
27. Spampinato U, Habert MO, Mas JL, et al. (99mTc>HM-PAO-SPECT and cognitive impairment in Parkinson's disease: a comparison with dementia of the Alzheimer type. J Neurol Neurosurg Psychiatry 1991 ¡54:878-892.
28. Stacy M, Jankovic J. Differential diagnosis of Parkinson's disease and the parkinsonism plus syndromes. Neurol Clin 1992;10:341-359.
29. Starkstein SE, Leiguardo R. Neuropsychological correlates of brain atrophy in Parkinson's disease: a Ct scan study. Mov Dis 1993;8:51-55.
30. Starkstein SE, Preziosi TJ, Robinson RG. Depression in Parkinson's disease. J Nerv Ment Dis 1990;178:27-31.
31. Torack RM, Morris JR. The association of ventral tegmental area histopathology with adult dementia. Arch Neurol 1988;45:497-501.
32. Wilson BA, Moffat N. Clinical management of memory problems! In Marsden CD, Fahn S, (eds). Movement disorders 2. London: Butterworth, 1987:99-123.
33. Wilson JA, Smith RG. Dementia in Parkinson's disease. Lancet 1987:861.
34. Yoshimura M. Cortical changes in parkinsonian brain: a contribution to the delineation of diffuse Lewy body disease. In Gibb WRG. Dementia and Parkinson's disease. Br J Psychiatry 1989;154:596-614.

Datas de Publicação

Publicação nesta coleção
12 Nov 2010
Data do Fascículo
Dez 1996

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Albeit M, Feldman RG, Willis AL. The subcortical dementia of progressive supranuclear palsy. J Neurol Neurosurg Psychiatry 1974;37:121-130.

[2] 2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Ed3 revised. Washington DC: American Psychiatric Association; 1987.

[3] 3. Baldwin RC, Byrne EJ. Psychiatric aspects of Parkinson's disease. Br Med J 1989;299:3-4.

[4] 4. Bloxham CA, Dick DJ, Moore M. Reaction times and attention in Parkinson's disease. J Neurol Neurosurg Psychiatry 1987;50:1178-1183.

[5] 5. Brown RG, Marsden CD. How common is dementia in Parkinson's disease?. Lancet 1984;1:1262-1265.

[6] 6. Brown RG, Marsden CD. Neuropsychology and cognitive function in Parkinson's disease: an overview. In Marsden CD, Fahn S (eds.) Movement disorders 2. London: Butterworth,1987;99-123.

[7] 7. Chui HC, Mortimer JA, Slager U, Zarow C, Bondareff W, Webster DD. Pathologic correlates of dementia in Parkinson's disease. Arch Neurol 1986;43:991-995.

[8] 8. De Smet Y, Ruberg M, Serdaru M, Dubois B, Lhermitte F, Agid Y. Confusion, dementia, and anticholinergics in Parkinson's disease. J Neurol Neurosurg Psychiatry 1982;45:1161-1164.

[9] 9. Drayer BP. Imaging of the aging brain. Part II: pathologic conditions. Radiology 1988; 166:797-806.

[10] 10. Gibb WRG. Dementia and Parkinson's disease. Br J Psychiatry 1989; 154:596-614.

[11] 11. Gibb WRG, Lees AJ. A comparison of clinical and pathological features in young and old-onset Parkinson's disease. Neurology 1988;38:1402-1406.

[12] 12. Gibb WRG, Lees AJ. The relevance of the Lewy body in the diagnosis of idiopathic Parkinson's disease. In Marsden CD. Parkinson's disease. Lancet 1990;335:948-952.

[13] 13. Hakim AM, Mathieson G. Dementia in Parkinson's disease: aneuropathological study. Neurology 1979;29:209-214.

[14] 14. Hornykiewicz O. Dopamine and brain function. In Marsden CD. Parkinson's disease. Lancet 1990;335:948-952.

[15] 15. Huber SJ, Shuttleworth EC, Christy JA, Chakeres DW, Curtin A, Paulson GW. Magnetic resonance imaging in dementia of Parkinson's disease. J Neurol Neurosurg Psychiatry 1989;52:1221-1227.

[16] 16. Johnson TN, Rosvold H, Mishkin M. Projections from behaviorally defined sectors of the pre-frontal cortex to the basal ganglia, septum, and diencephalon of the monkey. In Lichter DG, Corbett AJ, Fitzgibbon GM, et al. Cognitive and motor disfuntion in Parkinson's disease: clinical, performance, and CT correlations. Arch Neurol 1988;45:854-860.

[17] 17. Kaplan HI, Sadock BJ. Perturbações organomentais. In Compêndio de Psiquiatria Dinâmica. Porto Alegre: Artes Médicas Sul, 1986:342-377.

[18] 18. Kemp JM, Powell TPS. The cortico-striate projections in the monkey. Brain 1970;262:441-457.

[19] 19. Mayeux R, Chen J, Mirabello E, Marder K, Bell K, Dooneief G, Cote L, Stern Y. An estimate of the incidence of dementia in idiopathic Parkinson's disease. Neurology 1990,40:1513-1517.

[20] 20. Mayeux R, Stern Y, Rosental R et al. An estimate of the prevalence of dementia in idiopathic Parkinson's disease. Arch Neurol 1988;45:260-263.

[21] 21. Mohr E, Juncor J, Cox C, Litvan I, Fedio P, Chase TN. Sellective deficits in cognition and memory in high-functioning parkinsonian patients. J Neurol Neurosurg Psychiatry 1990;53:603-606.

[22] 22. Oliveira IR. Neurolépticos. In Oliveira IR. Manual de psicofarmacologia clínica. Rio de Janeiro: MEDSI, 1994:71-99.

[23] 23. Quinn NP, Rossor MN, Marsden CD. Dementia and Parkinson's disease: pathological and neurochemical considerations. Br Med Bull 1989;299:3-4.

[24] 24. Rogers D, Lees AJ, Smith E, et al. Bradyphrenia in Parkinson's disease and psychomotor retardation in depressive illness. Brain 1987;110:761-776.

[25] 25. Ruberg M, Ploska A, Javoy-Agid F, et al. Muscarinic binding and choline acetyltransferase activity in parkinsonian patients with reference to dementia. In Gibb WRG. Dementia and Parkinson's disease. Br J Psychiatry 1989;154:596-614.

[26] 26. Sahakian BJ, Morris RG, Evenden JL, Heald A, Levy R, Philpot M, Robbins TW. A comparative study of visuospatial memory and learning in Alzheimer-type dementia and Parkinson's disease. Brain 1988; 111:695-718.

[27] 27. Spampinato U, Habert MO, Mas JL, et al. (99mTc>HM-PAO-SPECT and cognitive impairment in Parkinson's disease: a comparison with dementia of the Alzheimer type. J Neurol Neurosurg Psychiatry 1991 ¡54:878-892.

[28] 28. Stacy M, Jankovic J. Differential diagnosis of Parkinson's disease and the parkinsonism plus syndromes. Neurol Clin 1992;10:341-359.

[29] 29. Starkstein SE, Leiguardo R. Neuropsychological correlates of brain atrophy in Parkinson's disease: a Ct scan study. Mov Dis 1993;8:51-55.

[30] 30. Starkstein SE, Preziosi TJ, Robinson RG. Depression in Parkinson's disease. J Nerv Ment Dis 1990;178:27-31.

[31] 31. Torack RM, Morris JR. The association of ventral tegmental area histopathology with adult dementia. Arch Neurol 1988;45:497-501.

[32] 32. Wilson BA, Moffat N. Clinical management of memory problems! In Marsden CD, Fahn S, (eds). Movement disorders 2. London: Butterworth, 1987:99-123.

[33] 33. Wilson JA, Smith RG. Dementia in Parkinson's disease. Lancet 1987:861.

[34] 34. Yoshimura M. Cortical changes in parkinsonian brain: a contribution to the delineation of diffuse Lewy body disease. In Gibb WRG. Dementia and Parkinson's disease. Br J Psychiatry 1989;154:596-614.