Factors Related with Frontal Dysfunction in Early Stages of Parkinson Disease

Parkinson Disease (PD) was described for first time in 1817 by James Parkinson in their monograph of 66 pages An Essay on the shaking palsy [1]. PD kept as the second degenerative disorder of the central nervous system after Alzheimer disease [2-4]. Although was initially described as a disease with motor disorder has been demonstrated that the cognitive disorders in the form of disejecutive syndrome are frequent in PD worsening with the evolution [5-13]. The patients have difficulty in maintaining adaptive responses with visuospatials and visuoperceptuals deficits, who leads to alteration of the memory of work and attentional deficits [14]. Has been demonstrated that the signs of frontal disease are well represented in subcortical pattern dementias, whose prototype can be PD [15-20]. With the present article we intended to characterize the frontal dysfunction in patients with PD and to determine the factors related with frontal dysfunction in early stages of PD.

Procedure the study was carried out in two phases

Frontal Assessment Battery (FAB)

Cognitive deterioration

Statistical analysis

In table 1 we found the onset age 62.6±10.5 years old and the current age 68.1±8.6 years old, remain as well as the world average in the sixth decade of life, prevailing the form of beginning tremoric, in addition the time of evolution mean was of 5.6±4.3 years in spite of being in the first motor stages of the DP, with a mean of the motor UPDRS in On and Off that does not arrive at the 20 points.

The majority of the patients (71.4%) presented frontal lobe dysfunction (Graph 1).

Table 1: Relation of the clinical variables of the sample.

Graph 1: Distribution of the patients according to the frontal activity.

With regard to the variables related to the frontal dysfunction (Table 2) we found that the patients who presented frontal dysfunction had an average of age higher than those which remained with the adequate frontal functions (p=0.02), occurring the same with the variables that measure global cognitive alteration basically the MoCA where its values differ between groups presenting a mean of 16.9±4.3 (p<0.0001).The MMSE also showed a relevant difference between groups with an statistical significance (p=0.01). 

Table 2: Relationship between the mean±SD of clinical/demographic variables and the presence of frontal dysfunction.

In table 3 we found that the average of the FAB was lower in the patients with rural origin (p<0.001), those which attended only up to the second level of teaching (10.9±3.9; p=0.003), onset age and current age older than 60 years with a significance of 0.02 and 0.025 respectively. Not occurring statistical significance among the stages I and II of Hoehn and Yahr although showed mean of the FAB lower in the stage I.

Table 3: Relation of the mean±SD of the FAB and clinical/demographic variables according to t student.

Upon establishing the correlation among the clinical and demographic variables with the values of the FAB (Table 4) we find that the age (R=-0.45; p<0.001) and onset age (R=-0.33; p=0.002) showed an inversely proportional correlation in relation with regard to the values of the FAB. The schooling showed gave directly proportional values (R=0.43; p=0.001), that is to lower values of the schooling lower values of the FAB. The rest of the clinical variables did not show statistical significance including the evolution time.

Table 4: Correlation of demographic and motor variables with the FAB’s scoring.

** The correlation is significant at level 0.01 (bilateral).
(a) Mean of the FAB ± Standard deviation.

In the graph 2 can see as the means items of the FAB, in all study’s pacients, that presented lower values were the fluidity and motor series, occurring the opposite with the behavior of compenzación with an almost equal average value to 3.00, that is maximum value.

Graph 2: More affected frontal functions in early stage of Parkinson's disease (according to FAB).

The present study emphasizes us that the frontal affectations are presented at onset of the PD.

Analyzing the demographic variables these do not differ from the reviewed studies that have dealt with widely this subject, being noteworthy that the majority of the patients present a schooling that does not surpass the secondary teaching bearing no relation this with the origin that presents both similar percentages for those which are of rural origin and urban [24].

The age is kept as one of the principal variables related to the frontal dysfunction, being able to be in relation this with which as advances the age occur cognitive alterations, although the average for this of our study was of 68.1 years, being noteworthy that the motor scales of the PD did not show a statistically significant relation, occurring the opposite with the neuropsychological scales that demonstrate the presence of global cognitive alteration, represented by the association of frontal dysfunction with the MoCA and MMSE what translates that in the beginning of the EP not only are affected prefrontal cortical areas, but also parietal areas and rising subcorticales systems, that they utilize other neurotransmitters; in addition to parts of the striate one as putamen, caudate or nucleus accumbens that is associated with the implicit learning of habits or of incentive response and sensoriomotor coordination, most adequate planifcación of each incentive [25,26].

Furthermore find that both the age and the onset age present an inversely proportional correlation, which is to greater age and greater onset age smaller scoring of the FAB and greater frontal dysfunction, with a greater significance for a point of cut off greater than 60 year [27,28].

With the results of this study is shown that the affectation in the frontal lobes comes together with the onset of the disease, then seem to be affected different cortico-subcortical circuits that act parallels and similar with regard to their structure and organization, affecting in this form the closed circuit that is originated in a private area of the frontal córtex that transmits the information through the basal nodes and returns to the place of departure in the lobe frontal.

Furthermore occurs specific disorder: In the motor circuits that leads to the classical acinesia or bradycinesia, the dorsolateral frontal circuit that is translated into a disejecutive syndrome with disability for the mental flexibility and the change of criteria, in planning and generation of strategy, in the organization of the actions, in the utilization of the experience and in the production of a spontaneous activity, in addition to the previous cingular circuit by the presence of the reduction of the initiative and the maintenance of the attention.

The present study demonstrates that already in early stages of PD occurs degeneration in different frontal cortical regions as the motor cortex, premotor, dorsolateral and cingular area. With variables that are related to the frontal dysfunction as the age and onset age above 60 years, the lower schooling than second level of teaching as well as the presence of generalized cognitive affectation.

None.

The author declares there is no conflict of interest.

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