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Parkinson’s Disease
Volume 2016 (2016), Article ID 4058580, 9 pages
http://dx.doi.org/10.1155/2016/4058580
Research Article

Abnormal Echogenicity of the Substantia Nigra, Raphe Nuclei, and Third-Ventricle Width as Markers of Cognitive Impairment in Parkinsonian Disorders: A Cross-Sectional Study

1Department of Neurology, Reinier de Graaf Gasthuis, Reinier de Graafweg 5, 2625 AD Delft, Netherlands
2Department of Psychiatry, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, Netherlands
3Department of Clinical Neurophysiology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, Netherlands
4Department of Neurology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, Netherlands

Received 14 September 2015; Revised 4 December 2015; Accepted 9 December 2015

Academic Editor: Yong-An Chung

Copyright © 2016 Angela E. P. Bouwmans et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. Patients with Parkinson’s disease (PD) have a high risk of cognitive problems. Objective. This study assesses whether abnormal echogenicity of the substantia nigra (SN) and raphe nuclei (RN) and the diameter of third ventricle are markers of cognitive impairment in patients with PD and other forms of parkinsonism. Methods. 126 outpatients with early signs of parkinsonism underwent transcranial sonography (TCS). The scales for the outcome of Parkinson’s disease cognition (SCOPA-COG) were used as cognitive measure. Definite neurological diagnosis was established after two-year follow-up. Results. One-third of the patients with PD and half of those with APS had signs of cognitive impairment. The echogenicity of the SN was not related to cognitive impairment. The diameter of the third ventricle was significantly larger in PD patients with cognitive impairment compared to those without. In patients with APS we found a significantly higher frequency of hypoechogenic RN in patients with cognitive problems. Conclusions. Cognitive impairment is already present in a substantial proportion of patients with PD and APS at first referral. In patients with APS the frequency of hypoechogenic RN points to the direction of other pathophysiology with more emphasis on deficits in the serotonergic neurotransmitter system. The larger diameter of the third ventricle in PD patients with cognitive impairment may reflect Alzheimer like brain atrophy, as has been reported in earlier studies.