Clinical comparison of dementia in Parkinson’s and Alzheimer’s disease

  • I. Marschall
  • P. Dal-Bianco
  • J. Maly
  • E. Auff
  • J. Hufgard
  • M. Mraz
  • L. Deecke
Part of the Journal of Neural Transmission book series (NEURAL SUPPL, volume 33)


Neuropsychological, neuropathological and neurochemical findings show different types of dementias. Few of them have been able to confirm a division into “subcortical” and “cortical” dementia, so this concept has to be questioned. The present clinical study compared type and severity of dementia in 12 Parkinson-patients (PD) and 12 Alzheimer-patients (AD). The age-adjusted normal value differed a significantly from both patient groups. No significant difference in pattern of neuropsychological deficits between PD- and AD-patients was apparent. However, after similar duration of illness, dementia was more severe in AD- than in PD-patients.


Parkinson Disease Neurol Neurosurg Psychiatry Progressive Supranuclear Palsy Intellectual Impairment Clinical Comparison 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Albert ML, Feldmann RG, Willis AL (1974) The “subcortical dementia” of progressive supranuclear palsy. J Neurol Neurosurg Psychiatry 37: 121–130PubMedCrossRefGoogle Scholar
  2. Atack JR, May C, Kaye JA, et al (1988) Cerebrospinal fluid cholinesterases in aging and in dementia of the Alzheimer type. Ann Neurol 23: 161–167PubMedCrossRefGoogle Scholar
  3. Birkmayer W, Riederer P (1987) Die Parkinson-Krankheit/Biochemie, Klinik, Therapie, 2. Aufl. Springer, Wien New YorkGoogle Scholar
  4. Boller F, Mizutani T, Roessmann O, Gambetti P (1980) Parkinson disease, dementia, and Alzheimer disease: clinicopathological relations. Ann Neurol 7: 329–335PubMedCrossRefGoogle Scholar
  5. Boller F, Passafinne D, Keefe NC, et al (1984) Visuospatial impairment in Parkinson’s disease. Role of perceptual and motor factors. Arch Neurol 41: 485–490Google Scholar
  6. Boller F, Lopez OL, Moosey J (1989) Diagnosis of dementia: clinicopathologic correlations. Neurology 39: 76–79PubMedGoogle Scholar
  7. Bondareff W, Mountjoy ChQ, Roth M (1982) Loss of neurons of origin of the adrenergic projection to cerebral cortex (nucleus locus ceruleus) in senile dementia. Neurology 32: 164–168PubMedGoogle Scholar
  8. Bowen FP, Kamienny RS, Burns MM, Yahr MD (1975) Parkinsonism: effects of levodopa treatment on concept formation. Neurology 25: 701–704PubMedGoogle Scholar
  9. Bowen DM, Smith CB, White P, et al (1977) Chemical pathology of the organic dementias. Brain 100: 427–453PubMedCrossRefGoogle Scholar
  10. Brown RG, Marsden CD (1984) How common is dementia in Parkinson’s disease? Lancet ii: 1262–1265CrossRefGoogle Scholar
  11. Brown RG, Marsden CD, Quinn N, Wyke MA (1984) Alterations in cognitive performance and affect-arousal state during fluctuations in motor function in Parkinson’s disease. J Neurol Neurosurg Psychiatry 47: 454–465PubMedCrossRefGoogle Scholar
  12. Caltagirone C, Carlesimo A, Nocentini U, Vicari S (1989) Defective concept formation in Parkinsonians is independent from mental deterioration. J Neurol Neurosurg Psychiatry 52: 334–337PubMedCrossRefGoogle Scholar
  13. Candy JM, Perry RH, Perry EK, et al (1983) Pathological changes in the nucleus of Meynert in Alzheimer’s and Parkinson’s disease. J Neurol Sci 59: 277–289PubMedCrossRefGoogle Scholar
  14. Cash R, Dennis T, L’Henreux R, et al (1987) Parkinson’s disease and dementia: norepinephrine and dopamin in locus ceruleus. Neurology 37: 42–46PubMedGoogle Scholar
  15. Cools AR, Van Den Bercken JHL, Horstink MWI, et al (1984) Cognitive and motor shifting aptitude disorder in Parkinson’s disease. J Neurol Neurosurg Psychiatry 47: 443–453PubMedCrossRefGoogle Scholar
  16. Cummings JL (1988) The dementia of Parkinson’s disease: prevalence, characteristics, neurobiology, and comparison with dementia of the Alzheimer type. Eur Neurol 28: 15–23PubMedGoogle Scholar
  17. Delis D, Direnfeld L, Alexander MP, Kaplan E (1982) Cognitive fluctuations associated with on-off phenomenon in Parkinson’s disease. Neurology 32: 1049–1052PubMedGoogle Scholar
  18. Denzler P, Kessler J, Markowitsch HJ (1986) Möglichkeiten and Mängel der psychometrischen Demenz-Diagnostik. Fortschr Neurol Psychiat 54: 382–392PubMedCrossRefGoogle Scholar
  19. Dick JPR, Guiloff RJ, Stewart A (1984) Mini mental state examination in neurological patients. J Neurol Neurosurg Psychiatry 47: 496–499PubMedCrossRefGoogle Scholar
  20. Direnfeld LK, Albert ML, Volicer L, et al (1984) Parkinson’s disease. The possible relationship of laterality to dementia and neurochemical findings. Arch Neurol 41: 935–941Google Scholar
  21. Drachman DA, Stahl S (1975) Extrapyramidal dementia and levodopa. Lancet is 809 Drachman DA, Leavitt J (1975) Are neurotransmitter systems specific for cognitive functions? Neurology 25: 349Google Scholar
  22. Duvoisin RC (1970) The evaluations of extrapyramidal disease. In: Ajuriaguerra dee, Gauthier G (eds) Monoamine, Noyeaux gris centraux et Syndrome de Parkinson. George and Cie, Geneva, pp 313–325Google Scholar
  23. Earnest MP, Heaton RK, Wilkinson WE, Mauke WF (1979) Cortical atrophy, ventricular enlargement and intellectual impairment in the aged. Neurology 29: 1138–1143PubMedGoogle Scholar
  24. Eggertson DE, Sima AAF (1986) Dementia with cerebral lewy bodies. A mesocortical dopaminergic defect. Arch Neurol 43: 524–527Google Scholar
  25. Evarts EV, Teräväinen H, Calne DB (1981) Reaction time in Parkinson’s disease. Brain 104: 167–186PubMedCrossRefGoogle Scholar
  26. Flowers KA, Pearce I, Pearce JMS (1984) Recognition memory in Parkinson’s disease. J Neurol Neurosurg Psychiatry 47; 1174–1181PubMedCrossRefGoogle Scholar
  27. Flowers KA, Robertson C (1985) The effect of Parkinson’s disease on the ability to maintain a mental set. J Neurol Neurosurg Psychiatry 48: 517–529PubMedCrossRefGoogle Scholar
  28. Freedman M, Oscar-Berman M (1986) Selective delayed response deficits in Parkinson’s and Alzheimer’s diseases. Arch Neurol 43: 886–890PubMedCrossRefGoogle Scholar
  29. Garron DA, Klawans HL, Norin F (1972) Intellectual functioning of persons with idiopathic Parkinsonism. J Nery Ment Dis 154: 445–452CrossRefGoogle Scholar
  30. Gaspar P, Gray F (1984) Dementia in idiopathic Parkinson’s disease. A neuropathological study. Acta Neuropathol 64: 43–52Google Scholar
  31. Girott F, Carella F, Grassi MP, et al (1986) Motor and cognitive performances of Parkinsonian patients in the on and off phases of the disease. J Neurol Neurosurg Psychiatry 49: 657–660CrossRefGoogle Scholar
  32. Hakim AM, Mathieson G (1978) Basis of dementia in Parkinson’s disease. Lancet ii: 729 Hakim AM, Mathieson G (1979) Dementia in Parkinson disease: a neuropathologie study. Neurology 29: 1209–1214Google Scholar
  33. Halgin R, Riklan M, Misiak H (1977) Levodopa, Parkinsonism, and recent memory. J Nery Ment Dis 164: 268–272Google Scholar
  34. Hare M (1978) Clinical check list for diagnosis of dementia. Br Med J 2: 266–267PubMedCrossRefGoogle Scholar
  35. Hart RP, Kwentus JA (1987) Psychomotor slowing and subcortical-type dysfunction in depression. J Neurol Neurosurg Psychiatry 50: 1263–1266PubMedCrossRefGoogle Scholar
  36. Haxby JV, Grady ChL, Duara R, et al (1986) Neocortical metabolic abnormalities precede nonmemory cognitive defects in early Alzheimer’s type dementia. Arch Neurol 43: 882–885PubMedCrossRefGoogle Scholar
  37. Heilig ChW, Knopman DS, Mastri AR, Frey W (1985) Dementia without Alzheimer pathology. Neurology 35: 762–765PubMedGoogle Scholar
  38. Heston LL (1980) Dementia associated with Parkinson’s disease: a genetic study. J Neurol Neurosurg Psychiatry 43: 846–848PubMedCrossRefGoogle Scholar
  39. Hietanen M, Teräväinen H (1984) Psychomotor and cognitive performance in Parkinsonism. Acta Neurol Scand 69: 61–62CrossRefGoogle Scholar
  40. Hoff P, Hippius H (1989) Alois Alzheimer 1864–1915. Nervenarzt 60: 332–337PubMedGoogle Scholar
  41. Huber SJ, Shuttleworth EC, Paulson GW, et al (1986) Cortical vs subcortical dementia/ Neuropsychological differences. Arch Neurol 43: 392–394PubMedCrossRefGoogle Scholar
  42. Huber SJ, Shulman HG, Paulson GW, Shuttleworth EC (1989) Dose-dependent memory impairment in Parkinson’s disease. Neurology 39: 438–440PubMedGoogle Scholar
  43. Javoy-Agid F, Agid Y (1980) Is the mesocortical dopaminergic system involved in Parkinson disease? Neurology 30: 1326–1330PubMedGoogle Scholar
  44. Kish SJ, Chang LJ, Mirchandani L, et al (1985) Progressive supranuclear palsy: relationship between extrapyramidal disturbances, and brain neurotransmitter markers. Ann Neurol 18: 530–536PubMedCrossRefGoogle Scholar
  45. Lauter H, Kurz A, Zimmer R (1986) Klinische Probleme bei der Diagnostik von Demenzprozessen im Alter. Act Neurol 13: 11–18Google Scholar
  46. Lees AJ (1989) Neuropsychologische Störungen beim Morbus Parkinson. Nervenarzt 60: 71–79PubMedGoogle Scholar
  47. Lees AJ, Smith E (1983) Cognitive deficits in the early stages of Parkinson’s disease. Brain 106: 257–270PubMedCrossRefGoogle Scholar
  48. Leverenz J, Sumi SM (1986) Parkinson’s disease in patients with Alzheimer’s disease. Arch Neurol 43: 662–664PubMedCrossRefGoogle Scholar
  49. Levin BE, Llabre MM, Weiner WJ (1989) Cognitive impairments associated with early Parkinson’s disease. Neurology 39: 557–561PubMedGoogle Scholar
  50. Lewin R (1985) Parkinson’s disease: an environmental cause? Science 229: 257–258PubMedCrossRefGoogle Scholar
  51. Liebermann A, Dziatolowski M, Kupersmith M, et al (1979) Dementia in Parkinson’s disease. Ann Neurol 6: 355–359CrossRefGoogle Scholar
  52. Loranger AW, Goodell H, McDowell FH (1972) Intellectual impairment in Parkinson’s disease. Brain 95: 405–412PubMedCrossRefGoogle Scholar
  53. Mann JJ, Stanley M, Kaplan RD, et al (1983) Central catecholamine metabolism in vivo and in cognitive and motor deficits in Parkinson’s disease. J Neurol Neurosurg Psychiatry 46: 905–910PubMedCrossRefGoogle Scholar
  54. Martin WE, Loewenson RB, Resch JA, Baker AB (1973) Parkinson’s disease. Clinical analysis of 100 patients. Neurology 23: 783–790PubMedGoogle Scholar
  55. Matthews ChG, Haaland KY (1979) The effect of symptom duration on cognitive and motor performance in parkinsonism. Neurology 29: 951–956PubMedGoogle Scholar
  56. Mayeux R, Stern Y, Rosen J, Leventhal J (1981) Depression, intellectual impairment, and Parkinson disease. Neurology 31: 645–650PubMedGoogle Scholar
  57. Mayeux R, Stern Y, Spanton S (1985) Heterogeneity in dementia of the Alzheimer type: evidence of subgroups. Neurology 35: 453–461PubMedGoogle Scholar
  58. Mayeux R, Stern Y, Rosen J, Benson DF (1983) Is “Subcortical dementia” a recognizable clinical entity? Ann Neurol 14: 278–283PubMedCrossRefGoogle Scholar
  59. Mayeux R, Stern Y, Rosen J, Benson DF (1981) Subcortical dementia: a recognizable clinical entity. Ann Neurol 10: 100–101Google Scholar
  60. Mindham RHS, Ahmed SAW, Clongh C (1982) A controlled study of dementia in Parkinson’s disease. J Neurol Neurosurg Psychiatry 45: 969–974PubMedCrossRefGoogle Scholar
  61. Mindham RHS (1970) Psychiatric symptoms in Parkinsonism. J Neurol Neurosurg Psychiatry 33: 188–191PubMedCrossRefGoogle Scholar
  62. Mohr E, Fabbrini G, Williams J, et al (1989) Dopamine and memory function in Parkinson’s disease. Movement Dis 4: 113–120PubMedCrossRefGoogle Scholar
  63. Monte SM, Wells SE, Hedley-Whyte ET, Growdon JH (1989) Neuropathological distinction between Parkinson’s dementia and Parkinson’s plus Alzheimer’s disease. Ann Neurol 26: 309–320PubMedCrossRefGoogle Scholar
  64. Mortimer JA, Pirozzolo FJ, Hausch EC, Webster DD (1982) Relationship of motor symptoms to intellectual deficits in Parkinson disease. Neurology 32: 133–137PubMedGoogle Scholar
  65. Mortimer JA, Hausch EC, Pirozzolo FJ, Webster DD (1982) Continuum of intellectual deficit in Parkinson disease. Ann Neurol 12: 402–403PubMedCrossRefGoogle Scholar
  66. Mortimer JA, Christensen KJ, Webster DD (1985) Parkinsonian dementia. Handbook Clin Neurol 46: 371–384Google Scholar
  67. Oyebode JR, Barker WA, Blessed J, et al (1986) Cognitive functioning in Parkinson’s disease in relationship to prevalence of dementia and psychiatric diagnose. Br J Psychiatry 149: 720–725PubMedCrossRefGoogle Scholar
  68. Pearce J (1974) The extrapyramidal disorder of Alzheimer’s disease. Eur Neurol 12: 94–103PubMedCrossRefGoogle Scholar
  69. Perry EK, Curtis M, Dick DJ, et al (1985) Cholinergic correlates of cognitive impairment in Parkinson’s disease: comparison with Alzheimer’s disease. J Neurol Neurosurg Psychiatry 48: 413–421PubMedCrossRefGoogle Scholar
  70. Phelps EM, Mazziotta JC, Schelbert HR (1986) PET and autoradiography. Principles and applications for the brain and heart. Raven Press, New YorkGoogle Scholar
  71. Piccirilli M, Piccinin GI, Agostini L (1984) Characteristic clinical aspects of parkinson patients with intellectual impairment. Eur Neurol 23: 44–50PubMedCrossRefGoogle Scholar
  72. Pillon B, Dubois B, Lhermitte F, Agid Y (1986) Heterogeneity of cognitive impairment in progressive supranuclear palsy. Neurology 36: 1179–1185PubMedGoogle Scholar
  73. Pillon B, Dubois B, Cusimano G, et al (1989) Does cognitive impairment in Parkinson’s disease result from non-dopaminergic lesion. J Neurol Neurosurg Psychiatry 52: 201–206PubMedCrossRefGoogle Scholar
  74. Pollock M, Hornabrook RW (1966) The prevalence, natural history and dementia of Parkinson’s disease. Brain 89: 429–448PubMedCrossRefGoogle Scholar
  75. Portin R, Rinne UK (1984) Predictive factors for dementia in Parkinson’s disease. Acta Neurol Scand 69: 57–58CrossRefGoogle Scholar
  76. Rafal RD, Posner MJ, Walker JA, Friedrich FJ (1984) Cognition and the basal ganglia. Brain 107: 1083–1094PubMedCrossRefGoogle Scholar
  77. Rapcsak SZ, Croswell SC, Rubens AB (1989) Apraxia in Alzheimer’s disease. Neurology 39: 664–668PubMedGoogle Scholar
  78. Rinne UK, Laakso K, Mölsä P, et al (1984) Relationship between Parkinson’s and Alzheimer’s disease. Involvement of extrapyramidal, dopaminergic, cholinergic and somatostatin mechanism in relation to dementia. Acta Neurol Scand 69: 59–60Google Scholar
  79. Rogers D, Lees AJ, Smith E, et al (1987) Bradyphrenia in Parkinson’s disease and psychomotor retardation in depressive illness. Brain 110: 761–776PubMedCrossRefGoogle Scholar
  80. Rosenberg RN, Green JB, White ChL, et al (1989) Dominantly inherited dementia and parkinsonism, with non-Alzheimer amyloid plaques: a new neurogenetic disorder. Ann Neurol 25: 152–158PubMedCrossRefGoogle Scholar
  81. Sala S, Lorenzo G, Giordano A, Spinnler H (1986) Is there a specific visuo-spatial impairment in Parkinsonians? J Neurol Neurosurg Psychiatry 49: 1258–1265PubMedCrossRefGoogle Scholar
  82. Scatton B, Rouquier L, Javoy-Agid F, Agid Y (1982) Dopamine deficiency in the cerebral cortex in Parkinson’s disease. Neurology 32: 1039–1040PubMedGoogle Scholar
  83. Shankar SK, Yanagihara R, Garruto RM, et al (1989) Immuncytochemical characterisation of neurofibrillary tangles in amyotrophic lateral sclerosis and parkinsonism-dementia of Guam. Ann Neurol 25: 146–151PubMedCrossRefGoogle Scholar
  84. Smet Y, Ruberg M, Serdaru M, et al (1982) Confusion, dementia, and anticholinergics in Parkinson’s disease. J Neurol Neurosurg Psychiatry 45: 1161–1164PubMedCrossRefGoogle Scholar
  85. Sroka H, Elizan MD, Yahr MD, et al (1981) Organic mental syndrome and confusional states in Parkinson’s disease. Arch Neurol 38: 339–342PubMedCrossRefGoogle Scholar
  86. Starkstein S, Leignarda R, Gershanik O, Berthier M (1987) Neuropsychological disturbances in hemiparkinson’s disease. Neurology 37: 1762–1764PubMedGoogle Scholar
  87. Stern Y, Langston JW (1985) Intellectual changes in patients with MPTP-induced parkinsonism. Neurology 35: 1506–1509PubMedGoogle Scholar
  88. Summers WK, Viesselman JO (1981) Use of THA in treatment of Alzheimer-like dementia: pilot study in 12 patients. Biol Psychiatry 16: 145–153PubMedGoogle Scholar
  89. Sweet RD, McDowell FH, Feigenson JS, et al (1976) Mental symptoms in Parkinson’s disease during chronic treatment with levodopa. Neurology 26: 305–310PubMedGoogle Scholar
  90. Talland GA (1962) Cognitive function in Parkinson’s disease. J Nery Ment Dis 135:196–197Google Scholar
  91. Taylor AE, Saint-cyr JA, Lang AE (1986) Frontal lobe dysfunction in Parkinson’s disease. Brain 109: 845–883PubMedCrossRefGoogle Scholar
  92. Torack RM, Morris JC (1986) Mesolimbocortical dementia. A clinicopathologic case study of a putative disorder. Arch Neurol 43: 1074–1078Google Scholar
  93. Villardita C, Smirni P, Pira F, et al (1982) Mental deterioration, visuoperceptive disabilities and constructional apraxia in Parkinson’s disease. Acta Neurol Scand 66: 112–120PubMedCrossRefGoogle Scholar
  94. Wetterling T (1989) Alzheimersche Krankheit: Überblick über den aktuellen Stand der Forschung. Fortschr Neurol Psychiat 57: 1–13PubMedCrossRefGoogle Scholar
  95. Whitehouse PJ (1986) The concept of subcortical and cortical dementia: another look. Ann Neurol 19: 1–6PubMedCrossRefGoogle Scholar
  96. Whitehouse PJ (1986) From: Alzheimer’s and Parkinson’s diseases. Plenum Publishing Corporation, pp 85–94Google Scholar
  97. Whitehouse PJ (1989) Parkinson’s disease and Alzheimer’s disease: new neurochemical parallels. Movement Dis 4: 57–62CrossRefGoogle Scholar
  98. Whitehouse PJ, Unnerstall JR (1988) Neurochemistry of dementia. Eur Neurol 28: 36–41PubMedGoogle Scholar
  99. Whitehouse PJ, Price DL, Clark AW, et al (1981) Alzheimer’s disease: evidence for selective loss of cholinergic neurons in the nucleus basalis. Ann Neurol 10: 122–126PubMedCrossRefGoogle Scholar
  100. Whitehouse PJ, Hedreen JC, White ChL, Price DL (1983) Basal forebrain neurons in the dementia of Parkinson’s disease. Ann Neurol 13: 243–248PubMedCrossRefGoogle Scholar
  101. Whitehouse PJ, Vale WW, Zweig RM, et al (1987) Reduction in corticotropin releasing factor-like immunoreactivity in cerebral cortex in Alzheimer’s disease, Parkinson’s disease, and progressive supranuclear palsy. Neurology 37: 905–909Google Scholar
  102. Whitehouse PJ, Martino AM, Wagster MV, et al (1988) Reduction in [3H] nicotinic acetylcholine bindings in Alzheimer’s disease and Parkinson’s disease: an auto-radiographic study. Neurology 38: 720–723PubMedGoogle Scholar
  103. Yoshimura M (1983) Cortical changes in the parkinsonian brain: a contribution to the delineation of “diffuse Lewy body disease”. J Neurol 229: 17–32PubMedCrossRefGoogle Scholar
  104. Zweig RM, Shegg KM, Peacock JH, Melarkey D (1989) A case of Alzheimer’s disease and hippocampal sclerosis with normal cholinergic activity in the basal forebrain, neocortex, and hippocampus. Neurology 39: 288–290PubMedGoogle Scholar

Copyright information

© Springer-Verlag 1991

Authors and Affiliations

  • I. Marschall
    • 1
  • P. Dal-Bianco
    • 2
  • J. Maly
    • 2
  • E. Auff
    • 2
  • J. Hufgard
    • 2
  • M. Mraz
    • 2
  • L. Deecke
    • 2
  1. 1.Neurological University ClinicViennaAustria
  2. 2.Neurological University ClinicViennaAustria

Personalised recommendations