Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Neuropsychiatry

Background: Parkinson{u2019}s disease (PD) is a common, disabling, neurodegenerative disorder. In addition to classical motor symptoms, non-motor features are now widely accepted as part of the clinical picture, and cognitive decline is a very important aspect of the disease. However, at present, the pathophysiology and clinical management of these symptoms are poorly understood. Objectives: The present study aimed to investigate the association between serum TNF-Ü level and cognition in PD patients, and to examine their relation to clinical presentation and disease severity. Methods: Thirty diagnosed PD patients and thirty healthy controls were included in this study. Patients were subjected to complete clinical assessment and Unified Parkinson Disease Rating Scale (UPDRS) was done to evaluate severity of PD. Cognitive assessment using Addenbrooke{u2019}s Cognitive Examination (ACE-III) and trail making B test and measurement of serum levels of TNF-Ü were done for both patients and controls. Results: The patients showed significant worse performance than controls in the cognitive assessment scales except for language subset of ACE score.Mean serum TNF-Ü level was significantly higher in PD patients compared to controls.TNF-Ü serum level was significantly negatively correlated with ACE language but not with age, age at onset, duration of the disease, UPDRS and H&Y scores. Sensitivity and specificity of TNF-Ü to detect cognitive impairment in PD using ACE III and trail making B were (73.1, 75%), (57.1, 56.2 %) respectively .Whereas, sensitivity and specificity of TNF-Ü to detect severity of PD using H&Y staging in PD were 50%. Conclusion: cognitive impairment is commonly encountered in PD patients. Elevated serum levels of TNF-Ü in PD patients implicate this proinflammatory cytokine in the pathophysiology of the disease

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