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Goal Setting for Cognitive Rehabilitation in Mild to Moderate Parkinson's Disease Dementia and Dementia with Lewy Bodies. PARKINSONS DISEASE 2016; 2016:8285041. [PMID: 27446628 PMCID: PMC4942668 DOI: 10.1155/2016/8285041] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/01/2016] [Indexed: 02/08/2023]
Abstract
Alongside the physical symptoms associated with Parkinson's disease dementia and dementia with Lewy bodies, health services must also address the cognitive impairments that accompany these conditions. There is growing interest in the use of nonpharmacological approaches to managing the consequences of cognitive disorder. Cognitive rehabilitation is a goal-orientated behavioural intervention which aims to enhance functional independence through the use of strategies specific to the individual's needs and abilities. Fundamental to this therapy is a person's capacity to set goals for rehabilitation. To date, no studies have assessed goal setting in early-stage Parkinson's disease dementia or dementia with Lewy bodies. Semistructured interviews were carried out with 29 participants from an ongoing trial of cognitive rehabilitation for people with these conditions. Here, we examined the goal statements provided by these participants using qualitative content analysis, exploring the types and nature of the goals set. Participants' goals reflected their motivations to learn new skills or improve performance in areas such as technology-use, self-management and orientation, medication management, and social and leisure activities. These results suggest that goal setting is achievable for these participants, provide insight into the everyday cognitive difficulties that they experience, and highlight possible domains as targets for intervention. The trial is registered with ISRCTN16584442 (DOI 10.1186/ISRCTN16584442 13/04/2015).
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Buhusi M, Olsen K, Yang BZ, Buhusi CV. Stress-Induced Executive Dysfunction in GDNF-Deficient Mice, A Mouse Model of Parkinsonism. Front Behav Neurosci 2016; 10:114. [PMID: 27445722 PMCID: PMC4914592 DOI: 10.3389/fnbeh.2016.00114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 05/24/2016] [Indexed: 12/22/2022] Open
Abstract
Maladaptive reactivity to stress is linked to improper decision making, impulsivity, and discounting of delayed rewards. Chronic unpredictable stress (CUS) alters dopaminergic function, re-shapes dopaminergic circuits in key areas involved in decision making, and impairs prefrontal-cortex dependent response inhibition and working memory. Glial-derived neurotrophic factor (GDNF) is essential for regulating dopamine (DA) release in the basal ganglia and for the survival of dopaminergic neurons; GDNF-deficient mice are considered an animal model for aging-related Parkinsonism. Recently, GDNF expression in the striatum has been linked to resilience to stress. Here we investigated the effects of CUS on decision making in GDNF-heterozygous (HET) mice and their wild-type littermate controls (WT). Before CUS no differences in temporal discounting (TD) were found between genotypes. However, following CUS GDNF HET mice, having a partial reduction of GDNF levels, showed increased impulsive choice indexed by a reduction in percent Larger-Later (LL) choices in the TD paradigm, and a reduction in area under the TD curve. Moreover, stressed GDNF HET mice, but not their WT controls, showed decreased neuronal activation (number of cFos positive neurons) in the orbitofrontal cortex (OFC), nucleus accumbens (NA) core, and NA shell, suggestive of a maladaptive response to stress. Interestingly, area under the TD curve positively correlated with cFos activation in the NA core, and NA shell, but not with orbitofrontal activity. These results provide further evidence of the differential involvement of the OFC, NA core, and NA shell in impulsive choice, and identify GDNF-deficient mice as a double-hit (gene × environment) model of stress-related executive dysfunction, particularly relevant to substance abuse and Parkinson’s disease (PD).
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Affiliation(s)
- Mona Buhusi
- Department of Psychology, Interdisciplinary Program in Neuroscience, Utah State University Logan, UT, USA
| | - Kaitlin Olsen
- Department of Psychology, Interdisciplinary Program in Neuroscience, Utah State University Logan, UT, USA
| | - Benjamin Z Yang
- Department of Psychology, Interdisciplinary Program in Neuroscience, Utah State University Logan, UT, USA
| | - Catalin V Buhusi
- Department of Psychology, Interdisciplinary Program in Neuroscience, Utah State University Logan, UT, USA
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Freitas ME, Fox SH. Nondopaminergic treatments for Parkinson's disease: current and future prospects. Neurodegener Dis Manag 2016; 6:249-68. [PMID: 27230697 PMCID: PMC4976881 DOI: 10.2217/nmt-2016-0005] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 04/18/2016] [Indexed: 12/21/2022] Open
Abstract
Parkinson's disease is primarily caused by dysfunction of dopaminergic neurons, however, nondopaminergic (ND) systems are also involved. ND targets are potentially useful to reduce doses of levodopa or to treat nonlevodopa-responsive symptoms. Recent studies have investigated the role of ND drugs for motor and nonmotor symptoms. Adenosine A2A receptor antagonists, mixed inhibitors of sodium/calcium channels and monoamine oxidase-B have recently been found to improve motor fluctuations. N-methyl-d-aspartate receptor antagonists and serotonin 5HT1B receptor agonists demonstrated benefit in levodopa-induced dyskinesia. Conversely, studies using antiepileptic drugs and adrenoreceptor antagonist had conflicting results. Moreover, metabotropic glutamate receptor antagonists also failed to improve symptoms. The current review summarizes the most recent findings on ND drugs over the last 2 years.
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Affiliation(s)
- Maria Eliza Freitas
- Movement Disorders Clinic, Division of Neurology, University of Toronto, Toronto Western Hospital, 399 Bathurst Street MCL7-412, Toronto, ON M5T 2S8, Canada
| | - Susan H Fox
- Movement Disorders Clinic, Division of Neurology, University of Toronto, Toronto Western Hospital, 399 Bathurst Street MCL7-412, Toronto, ON M5T 2S8, Canada
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Besser LM, Litvan I, Monsell SE, Mock C, Weintraub S, Zhou XH, Kukull W. Mild cognitive impairment in Parkinson's disease versus Alzheimer's disease. Parkinsonism Relat Disord 2016; 27:54-60. [PMID: 27089852 DOI: 10.1016/j.parkreldis.2016.04.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 03/28/2016] [Accepted: 04/08/2016] [Indexed: 12/15/2022]
Abstract
INTRODUCTION No known studies have compared longitudinal characteristics between individuals with incident mild cognitive impairment due to Parkinson's disease (PD-MCI) versus Alzheimer's Disease (AD-MCI). METHODS We used longitudinal data from the National Alzheimer's Coordinating Center's Uniform Data Set to compare 41 PD-MCI and 191 AD-MCI participants according to their demographics, presence of ≥1 APOE e4 allele, and baseline and change over time in clinical characteristics, neuropsychological test scores, and Clinical Dementia Rating sum of boxes (CDR-SB). Multivariable linear regression models with generalized estimating equations were used to account for clustered data and to test for baseline and longitudinal differences in neuropsychological test scores. RESULTS PD-MCI and AD-MCI participants differed by many demographic and clinical characteristics. Significantly fewer PD-MCI participants developed dementia over one year. Compared to AD-MCI participants, PD-MCI participants performed better at baseline and over time on a global measure of cognition (Mini Mental State Exam), memory measures (immediate and delayed Logical Memory), and a language measure (Boston Naming Test), and additionally performed better over time on an attention measure (Digit Span Forward), a language measure (Vegetable List), a processing speed measure (Digit Symbol), and an overall measure of memory and functional impairment (CDR-SB). CONCLUSION Our study provides further evidence that PD-MCI is clinically distinct from AD-MCI and requires different tools for diagnosis and monitoring clinical progression. More importantly, this study suggests that PD-MCI takes longer to convert into dementia than AD-MCI, findings that require replication by other studies.
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Affiliation(s)
- Lilah M Besser
- National Alzheimer's Coordinating Center, University of Washington, 4311 11th Ave NE, Suite 300, Seattle, WA, 98105, USA.
| | - Irene Litvan
- University of California San Diego, Department of Neurosciences, National Parkinson Foundation Movement Disorder Center of Excellence, 8950 Villa La Jolla Drive, Suite C112, La Jolla, CA, 92037, USA.
| | - Sarah E Monsell
- National Alzheimer's Coordinating Center, University of Washington, 4311 11th Ave NE, Suite 300, Seattle, WA, 98105, USA.
| | - Charles Mock
- National Alzheimer's Coordinating Center, University of Washington, 4311 11th Ave NE, Suite 300, Seattle, WA, 98105, USA.
| | - Sandra Weintraub
- Cognitive Neurology and Alzheimer's Disease Center, and Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 320 E Superior, Searle 11-467, Chicago, IL, 60611, USA.
| | - Xiao-Hua Zhou
- National Alzheimer's Coordinating Center, University of Washington, 4311 11th Ave NE, Suite 300, Seattle, WA, 98105, USA.
| | - Walter Kukull
- National Alzheimer's Coordinating Center, University of Washington, 4311 11th Ave NE, Suite 300, Seattle, WA, 98105, USA.
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Weintraub D, Hauser RA, Elm JJ, Pagan F, Davis MD, Choudhry A. Rasagiline for mild cognitive impairment in Parkinson's disease: A placebo-controlled trial. Mov Disord 2016; 31:709-14. [PMID: 27030249 DOI: 10.1002/mds.26617] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 02/12/2016] [Accepted: 02/19/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND This study's aims were to determine the efficacy and tolerability of rasagiline, a selective monoamine oxidase inhibitor B, for PD patients with mild cognitive impairment. METHODS Patients on stable dopaminergic therapy were randomized to adjunct rasagiline 1 mg/day or placebo in this 24-week, double-blind, placebo-controlled, multisite study. The primary endpoint was mean change from baseline to week 24 on the Scales for Outcomes of Parkinson's Disease-Cognition total score. Key secondary measures included changes in cognition, activities of daily living, motor scores, and Clinical Global Impression of Change, as well as safety and tolerability measures. RESULTS Of the 170 patients randomized, 151 (88.2%) completed the study. Change in Scales for Outcomes of Parkinson's Disease-Cognition scores were not significantly different in the rasagiline and placebo groups (adjusted mean: 1.6 [standard error {SE} = 0.5] vs. 0.8 [SE = 0.5] points; LS means difference = 0.8; 95% confidence interval: -0.48, 2.05; P = 0.22). There were no between-group differences in change in the MoCA (p=0.84) or Penn Daily Activities Questionnaire (P = 0.48) scores or in the distribution of Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change modified for mild cognitive impairment (P = 0.1). Changes in motor (UPDRS part III; P = 0.02) and activities of daily living (UPDRS part II; P < 0.001) scores favored rasagiline. Rasagiline was well tolerated; the most common adverse events in both groups were falls and dizziness. CONCLUSIONS Rasagiline treatment in PD patients with mild cognitive impairment was not associated with cognitive improvement. Rasagiline did not worsen cognition, improved motor symptoms and activities of daily living, and was well tolerated in elderly cognitively impaired patients. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Daniel Weintraub
- Departments of Psychiatry and Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Jordan J Elm
- Department of Public Health Science, Medical University of South Carolina, Charleston, South Carolina, USA
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