OBJECTIVE: To compare the scores of patients with idiopathic Parkinson's Disease using the Montreal Cognitive Assessment and Mini-Mental State Examination in a tertiary hospital
BACKGROUND: Parkinson's Disease (PD) is a neurodegenerative disorder diagnosed clinically based on the signs of resting tremor bradykinesia, rigidity and loss of postural reflexes. According to Bassett et al, 20% to 40% of PD patients ultimately become demented with an incidence of 10% per year. Cognitive decline is an impotant predictor of dementia in PD. Almost all patients with PD suffer from selective cognitive impairments including difficulties with attention, concentration, planning, sequencing, concept formation, problem solving, set-shifting and memory which are thought ro reflect dysfunction of cortical circuits subserving frontal brain regions. Identification of cognitive impairment in PD is crucial. It predicts future cognitive decline and may eventually be a target for pharmacologic intervention to prevent or delay the development of dementia.
METHODS: A descriptive study. A convenience sampling of 95 patients with idiopathic Patkinson's disease were screened for cognitive impairment.
RESULTS: Mean MMSE and MoCA scores were 26.1 (SD 2.9) and 19.8 (SD 4.28). Based on the published cutoff scores for cognitive impairment for Parkinson's Disease, 72% of the participants scored 26/30 and below on MoCA whereas only 42% scored 26/30 and below on the MMSE. Impairments were seen in numerous cognitive domains including executive function, language, recent semantic memory, visuo-spatial processing and constructional praxis. Predictors of cognitive impairment on the MoCA include low level of education and older age.
CONCLUSIONS: MoCA was able to detect more cognitive impairments in patients with Parkinson's disease than MMSE. Therefore, MoCA is a better screening tool to detect cognitive impairments in PD patients.

Human ; Male ; Female ; Attention ; Brain ; Cognition ; Cognition Disorders ; Cognitive Dysfunction ; Dementia ; Hypokinesia ; Muscle Rigidity ; Neuropsychological Tests ; Parkinson Disease ; Tremor

INTRODUCTION: Simultaneous bilateral angle-closure glaucoma is a potentially blinding disease. From 2001 to 2007, over 100 cases of Topiramate-associated bilateral acute angle glaucoma (TA-ACG) were reported. We report the first known case in the Philippines.

CASE REPORT: A 42-year old Filipino woman diagnosed with migraine presented with the sudden blurring of vision, with generalized headache after her second dose of 25mg Topiramate. Visual acuity was decreased to 20/200 in each eye. Intraocular pressures  (IOP) were elevated to OD 50mmHg and OS 55mmHg with shallow anterior chambers and 360 degree angle closure on gonioscopy. Stat doses of mannitol, acetazolamide, brimonidine, and latanoprost were given. Topiramate was discontinued. Laser iridotomy was performed with note of an immediate drop in IOP to OD 24mmHg and OS 18 mmHg. On the day of discharge, the patient's third day of admission, IOP had returned to 12 mmHg OU and best-corrected vision had improved to 20/20 in both eyes. B-scan ultrasonography confirmed choroidal thickening in both eyes.

DISCUSSION: Topiramate associated acute angle closure glaucoma (TA-AACG) as an idiosyncratic adverse effect was first reported by Banta et al in July 20018 with shallow anterior chambers, relative lens thickening, and 360° ciliochoroidal detachments in both eyes on A- and B-scan ultrasonography. Angle-closure was believed to result from the anterior rotation of the ciliary process and not from pupillary block, rendering laser iridotomy ineffective. Signiñicant lens thickening has been shown in TA-AACG. It is thought to result in part from relaxation of the zonules due to anterior ciliary rotation and ciliary edema, and from a direct drug effect. Myopia resulting from this is characteristic of TA-AACG and may persist from days to weeks after discontinuation of topiramate. The management of TAAACG requires stopping the drug. As TA-AACG and transient myopia usually resolves within days to weeks after stopping Topiramate, medical treatment with topical cycloplegic agents, topical beta-blockers and oral pressure-lowering agents often suffice as an interim measure. However, more invasive options such as laser iridotomy should be considered when significant pupillary block angle closure is present.

SUMMARY: Topiramate may be associated with acute angle-closure glaucoma wherein, in the Filipino patient, pupillary block may be present and should be addressed by laser iridotomy when possible.

Human ; Female ; Glaucoma, Angle-closure ; Latanoprost ; Mydriatics ; Acetazolamide ; Intraocular Pressure ; Gonioscopy ; Topiramate ; Brimonidine Tartrate ; Mannitol ; Rotation ; Philippines ; Acceleratory Factor From Growth Hormone ; Prostaglandins F, Synthetic ; Fructose ; Migraine Disorders ; Visual Acuity ; Myopia ; Headache ; Ultrasonography ; Edema ; Anterior Chamber