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Ogbimi EM, Akemokwe FM, Ogunrin O. Frequency, pattern and predictors of cognitive impairments in patients with Parkinson's disease using the Community Screening Instrument for Dementia. Front Hum Neurosci 2023; 17:1126526. [PMID: 37441432 PMCID: PMC10333480 DOI: 10.3389/fnhum.2023.1126526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 05/31/2023] [Indexed: 07/15/2023] Open
Abstract
Background Parkinson's disease (PD) is a chronic neurodegenerative disorder complicated by cognitive dysfunctions which are associated with increased caregiver burden, pressure on community health facilities, and mortality in affected patients. Most of the data concerning cognitive dysfunctions in PD are from studies conducted in Europe and North America, but there is paucity of data from Sub-Saharan Africa. Objective The objective of this study is to determine the frequency, pattern and predictors of cognitive impairments amongst patients with Parkinson's disease. Materials and methods This was a cross sectional case control study carried out at a tertiary health facility in South-south Nigeria. Participants with PD were consecutively recruited from the neurology outpatient clinics. Demographic and disease-specific data were obtained with the use of a pre-tested questionnaire. Cognitive performance of thirty patients with PD were compared with thirty demographically matched controls using the Community Screening Instrument for Dementia (CSID). CSID was already validated among Nigerians. Results The frequency of cognitive impairment using the CSID was 50% for PD patients (3.3% for controls). Poor cognitive performance was observed across several cognitive domains including language, executive dysfunction, psychomotor speed, and constructional apraxia among PD patients. The independent predictors of the overall cognitive impairment in patients with PD determined by logistic regression analysis include recall deficiency (p = 0.007), impairment with naming (p = 0.044), apraxia (p = 0.003), Hoen&Yahr staging (p = 0.046), UPDRS score (p = 0.015) and age at presentation (p = 0.014). Conclusion Cognitive impairments occur more frequently in patients with PD compared to controls. This study also demonstrated the predictive role of severity of disease based on Hoehn &Yahr staging and UPDRS score, and presence of recall deficiency, poor naming ability and apraxia.
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Affiliation(s)
- Ewere Marie Ogbimi
- (formerly Neurology Unit, Department of Medicine, University of Benin Teaching Hospital, Benin City, Nigeria) Neurology Unit, Department of Medicine, Delta State University, Abraka, Nigeria
| | - Fatai Momodu Akemokwe
- (formerly Neurology Unit, Department of Medicine, University of Benin Teaching Hospital, Benin City, Nigeria) Department of Neurology, University of Kentucky, Lexington, KY, United States
| | - Olubunmi Ogunrin
- (formerly Neurology Unit, Department of Medicine, University of Benin, Benin City, Nigeria) Neurology Department, Neuroscience Directorate, Royal Stoke University Hospital, Stoke on Trent, United Kingdom
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Hamada T, Higashiyama Y, Saito A, Morihara K, Landin-Romero R, Okamoto M, Kimura K, Miyaji Y, Joki H, Kishida H, Doi H, Ueda N, Takeuchi H, Tanaka F. Qualitative Deficits in Verbal Fluency in Parkinson's Disease with Mild Cognitive Impairment: A Clinical and Neuroimaging Study. JOURNAL OF PARKINSONS DISEASE 2021; 11:2005-2016. [PMID: 34366367 DOI: 10.3233/jpd-202473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Mild cognitive impairment (MCI) in Parkinson's disease (PD) is considered a risk factor for PD with dementia (PDD). Verbal fluency tasks are widely used to assess executive function in PDD. However, in cases of PD with MCI (PD-MCI), the relative diagnostic accuracy of different qualitative verbal fluency measures and their related neural mechanisms remain unknown. OBJECTIVE This study aimed to investigate the relative diagnostic accuracy of qualitative (clustering and switching) verbal fluency strategies and their correlates with functional imaging in PD-MCI. METHODS Forty-five patients with PD (26 with MCI and 19 without MCI) and 25 healthy controls underwent comprehensive neurocognitive testing and resting-state functional magnetic resonance imaging. MCI in patients with PD was diagnosed according to established clinical criteria. The diagnostic accuracy of verbal fluency measures was determined via receiver operating characteristic analysis. Changes in brain functional connectivity between groups and across clinical measures were assessed using seed-to-voxel analyses. RESULTS Patients with PD-MCI generated fewer words and switched less frequently in semantic and phonemic fluency tasks compared to other groups. Switching in semantic fluency showed high diagnostic accuracy for PD-MCI and was associated with reduced functional connectivity in the salience network. CONCLUSION Our results indicate that reduced switching in semantic fluency tasks is a sensitive and specific marker for PD-MCI. Qualitative verbal fluency deficits and salience network dysfunction represent early clinical changes observed in PD-MCI.
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Affiliation(s)
- Tomoya Hamada
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan.,Department of Speech-Language-Hearing Therapy, Japan Welfare Education College, Shinjuku-ku, Tokyo, Japan
| | - Yuichi Higashiyama
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Asami Saito
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Keisuke Morihara
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Ramon Landin-Romero
- The University of Sydney, School of Psychology, Sydney, NSW, Australia.,The University of Sydney, Brain & Mind Centre, Sydney, NSW, Australia.,Australian Research Council Centre of Excellence in Cognition and its Disorders, Sydney, NSW, Australia
| | - Mitsuo Okamoto
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Katsuo Kimura
- Department of Neurology, Yokohama City University Medical Center Hospital, Yokohama, Kanagawa, Japan
| | - Yousuke Miyaji
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Hideto Joki
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Hitaru Kishida
- Department of Neurology, Yokohama City University Medical Center Hospital, Yokohama, Kanagawa, Japan
| | - Hiroshi Doi
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Naohisa Ueda
- Department of Neurology, Yokohama City University Medical Center Hospital, Yokohama, Kanagawa, Japan
| | - Hideyuki Takeuchi
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Fumiaki Tanaka
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
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Sanches C, Stengel C, Godard J, Mertz J, Teichmann M, Migliaccio R, Valero-Cabré A. Past, Present, and Future of Non-invasive Brain Stimulation Approaches to Treat Cognitive Impairment in Neurodegenerative Diseases: Time for a Comprehensive Critical Review. Front Aging Neurosci 2021; 12:578339. [PMID: 33551785 PMCID: PMC7854576 DOI: 10.3389/fnagi.2020.578339] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/07/2020] [Indexed: 12/14/2022] Open
Abstract
Low birth rates and increasing life expectancy experienced by developed societies have placed an unprecedented pressure on governments and the health system to deal effectively with the human, social and financial burden associated to aging-related diseases. At present, ∼24 million people worldwide suffer from cognitive neurodegenerative diseases, a prevalence that doubles every five years. Pharmacological therapies and cognitive training/rehabilitation have generated temporary hope and, occasionally, proof of mild relief. Nonetheless, these approaches are yet to demonstrate a meaningful therapeutic impact and changes in prognosis. We here review evidence gathered for nearly a decade on non-invasive brain stimulation (NIBS), a less known therapeutic strategy aiming to limit cognitive decline associated with neurodegenerative conditions. Transcranial Magnetic Stimulation and Transcranial Direct Current Stimulation, two of the most popular NIBS technologies, use electrical fields generated non-invasively in the brain to long-lastingly enhance the excitability/activity of key brain regions contributing to relevant cognitive processes. The current comprehensive critical review presents proof-of-concept evidence and meaningful cognitive outcomes of NIBS in eight of the most prevalent neurodegenerative pathologies affecting cognition: Alzheimer's Disease, Parkinson's Disease, Dementia with Lewy Bodies, Primary Progressive Aphasias (PPA), behavioral variant of Frontotemporal Dementia, Corticobasal Syndrome, Progressive Supranuclear Palsy, and Posterior Cortical Atrophy. We analyzed a total of 70 internationally published studies: 33 focusing on Alzheimer's disease, 19 on PPA and 18 on the remaining neurodegenerative pathologies. The therapeutic benefit and clinical significance of NIBS remains inconclusive, in particular given the lack of a sufficient number of double-blind placebo-controlled randomized clinical trials using multiday stimulation regimes, the heterogeneity of the protocols, and adequate behavioral and neuroimaging response biomarkers, able to show lasting effects and an impact on prognosis. The field remains promising but, to make further progress, research efforts need to take in account the latest evidence of the anatomical and neurophysiological features underlying cognitive deficits in these patient populations. Moreover, as the development of in vivo biomarkers are ongoing, allowing for an early diagnosis of these neuro-cognitive conditions, one could consider a scenario in which NIBS treatment will be personalized and made part of a cognitive rehabilitation program, or useful as a potential adjunct to drug therapies since the earliest stages of suh diseases. Research should also integrate novel knowledge on the mechanisms and constraints guiding the impact of electrical and magnetic fields on cerebral tissues and brain activity, and incorporate the principles of information-based neurostimulation.
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Affiliation(s)
- Clara Sanches
- Cerebral Dynamics, Plasticity and Rehabilitation Group, FRONTLAB Team, CNRS UMR 7225, INSERM U 1127, Institut du Cerveau, Sorbonne Universités, Paris, France
| | - Chloé Stengel
- Cerebral Dynamics, Plasticity and Rehabilitation Group, FRONTLAB Team, CNRS UMR 7225, INSERM U 1127, Institut du Cerveau, Sorbonne Universités, Paris, France
| | - Juliette Godard
- Cerebral Dynamics, Plasticity and Rehabilitation Group, FRONTLAB Team, CNRS UMR 7225, INSERM U 1127, Institut du Cerveau, Sorbonne Universités, Paris, France
| | - Justine Mertz
- Cerebral Dynamics, Plasticity and Rehabilitation Group, FRONTLAB Team, CNRS UMR 7225, INSERM U 1127, Institut du Cerveau, Sorbonne Universités, Paris, France
| | - Marc Teichmann
- Cerebral Dynamics, Plasticity and Rehabilitation Group, FRONTLAB Team, CNRS UMR 7225, INSERM U 1127, Institut du Cerveau, Sorbonne Universités, Paris, France
- National Reference Center for Rare or Early Onset Dementias, Department of Neurology, Institute of Memory and Alzheimer’s Disease, Pitié-Salpêtrière Hospital, Assistance Publique -Hôpitaux de Paris, Paris, France
| | - Raffaella Migliaccio
- Cerebral Dynamics, Plasticity and Rehabilitation Group, FRONTLAB Team, CNRS UMR 7225, INSERM U 1127, Institut du Cerveau, Sorbonne Universités, Paris, France
- National Reference Center for Rare or Early Onset Dementias, Department of Neurology, Institute of Memory and Alzheimer’s Disease, Pitié-Salpêtrière Hospital, Assistance Publique -Hôpitaux de Paris, Paris, France
| | - Antoni Valero-Cabré
- Cerebral Dynamics, Plasticity and Rehabilitation Group, FRONTLAB Team, CNRS UMR 7225, INSERM U 1127, Institut du Cerveau, Sorbonne Universités, Paris, France
- Laboratory for Cerebral Dynamics Plasticity & Rehabilitation, Boston University School of Medicine, Boston, MA, United States
- Cognitive Neuroscience and Information Technology Research Program, Open University of Catalonia, Barcelona, Spain
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Roheger M, Kalbe E, Liepelt-Scarfone I. Progression of Cognitive Decline in Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2019; 8:183-193. [PMID: 29914040 PMCID: PMC6004891 DOI: 10.3233/jpd-181306] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background: Cognitive dysfunction is one of the most prevalent non-motor symptoms in Parkinson’s disease (PD), often experienced as more debilitating for patients and caregivers than motor problems. Therefore, a deeper understanding of the course of cognitive decline and the identification of valid progression markers for Parkinson’s disease dementia (PDD) is essential. Objective: This systematic review summarizes the current state of knowledge on cognitive decline over time by reporting effect sizes of cognitive changes in neuropsychological tests. METHODS: 1368 studies were identified by a PubMed database search and 25 studies by additionally scanning previous literature. After screening all records, including 69 full-text article reviews, 12 longitudinal studies on the progression of cognitive decline in PD met our criteria (e.g., sample size ≥50 patients). Results: Only a few studies monitored cognitive decline over a longer period (>4 years). Most studies focused on the evaluation of change in global cognitive state by use of the Mini-Mental State Examination, whereas the use of neuropsychological tests was highly heterogenic among studies. Only one study evaluated patients’ cognitive performance in all specified domains (executive function, attention & working memory, memory, language, and visual-spatial function) allowing for diagnosis of cognitive impairment according to consensus guidelines. Medium to strong effect sizes could only be observed in studies with follow-up intervals of four years or longer. Conclusions: The results emphasize the need for the assessment of larger PD cohorts over longer periods of follow-up with a comprehensive neuropsychological battery.
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Affiliation(s)
- Mandy Roheger
- Medical Psychology I Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), University Hospital Cologne, Köln, Germany
| | - Elke Kalbe
- Medical Psychology I Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), University Hospital Cologne, Köln, Germany
| | - Inga Liepelt-Scarfone
- German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany.,Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
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Transcranial direct current stimulation combined with cognitive training for the treatment of Parkinson Disease: A randomized, placebo-controlled study. Brain Stimul 2018; 11:1251-1262. [DOI: 10.1016/j.brs.2018.07.046] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 07/10/2018] [Accepted: 07/16/2018] [Indexed: 01/11/2023] Open
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6
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Lange F, Brückner C, Knebel A, Seer C, Kopp B. Executive dysfunction in Parkinson’s disease: A meta-analysis on the Wisconsin Card Sorting Test literature. Neurosci Biobehav Rev 2018; 93:38-56. [DOI: 10.1016/j.neubiorev.2018.06.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 06/14/2018] [Accepted: 06/15/2018] [Indexed: 12/13/2022]
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7
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Step length predicts executive dysfunction in Parkinson's disease: a 3-year prospective study. J Neurol 2018; 265:2211-2220. [PMID: 30014240 DOI: 10.1007/s00415-018-8973-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 07/07/2018] [Indexed: 01/28/2023]
Abstract
Cognition and gait appear to be closely related. The chronological interplay between cognitive decline and gait dysfunction is not fully understood. The aim of the present prospective study is investigating whether the dysfunction of specific gait parameters, during specific task and medication conditions, may predict subsequent cognitive impairment in Parkinson's disease (PD). We evaluated cognition and gait in 39 Parkinsonian patients at an initial assessment and after 3 years. Cognitive performance was evaluated with a neuropsychological battery designed to assess memory, executive/attention, and visuospatial domains. Gait was investigated using a gait analysis system during both the off and on states in the following conditions: (1) normal gait; (2) motor dual task; and (3) cognitive dual task. We used regression models to determine whether gait predicts subsequent cognitive dysfunction. Overall, the cognitive test scores were stable over time with the exception of the executive/attention scores, whereas all gait parameters declined. The step length during the cognitive dual task during the on state at the initial evaluation was the only significant predictor of executive/attention domain dysfunction at follow up. The results were confirmed when executive/attention dysfunction at the initial assessment evaluation was included in the regression model as a covariate. Our longitudinal study offers additional insight into the progression of gait dysfunction, and its chronological relationship with cognitive dysfunction in PD patients. In particular, the present study indicates that step length during a cognitive task when on medication is an independent predictor of future executive/attention decline.
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Thota N, Lenka A, George L, Hegde S, Arumugham SS, Prasad S, Stezin A, Kamble N, Yadav R, Pal PK. Impaired frontal lobe functions in patients with Parkinson's disease and psychosis. Asian J Psychiatr 2017; 30:192-195. [PMID: 29101795 DOI: 10.1016/j.ajp.2017.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 10/15/2017] [Accepted: 10/16/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Patients with Parkinson's disease (PD) may develop several non-motor symptoms (NMS). Psychosis is one of the debilitating NMS of PD. The neurobiology of psychosis is not fully understood. This study aims to compare the frontal lobe functions of PD patients with and without psychosis using the Frontal Assessment Battery (FAB). METHODOLOGY This study included 69 patients with PD; 34 with psychosis (PD-P) and 35 without psychosis (PD-NP). Mini Mental Status Examination (MMSE) was used to screen for cognitive impairment. Unified Parkinson's disease Rating scale part-III (UPDRS-III) was used to measure the severity and Hoehn and Yahr score (H&Y) was used to measure the stage of PD. Frontal lobe functions were assessed by FAB. RESULTS The PD-P and PD-NP groups were comparable for age (58.7±8.4 vs 55.7±8.2, p=0.14), age at onset of symptoms (51.4±8.1 vs 50.0±8.8, p=0.48), gender distribution (men: 88%vs 80%, p=0.51), MMSE (28.2±1.9 vs 28.7±1.2 p=0.12), levodopa equivalent dose/day (736.0±376.3 vs 625.2±332.2, p=0.19), UPDRS-III OFF-score (36.7±8.8 vs 35.4±13.2, p=0.64), UPDRS-III ON-score (13.2±5.4 vs 12.4±6.6, p=0.44) and H&Y stage (2.3±0.3 vs 2.3±0.3, p=0.07). PD-P group had lower total FAB score compared to PD-NP group (13.9±2.2 vs 16.5±1.8, p<0.01). On the FAB, PD-P group had lower scores compared to PD-NP in lexical fluency (FAB-2), programming (FAB-3), sensitivity to interference (FAB-4) and inhibitory control (FAB-5). CONCLUSION Patients with PD-P had significant frontal lobe dysfunction compared to PD-NP. FAB may be a simple and useful bedside tool to assess frontal dysfunction in patients with PD in a busy neurological set up.
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Affiliation(s)
- Naveen Thota
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Abhishek Lenka
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India; Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Lija George
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Shantala Hegde
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Shyam Sundar Arumugham
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Shweta Prasad
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India; Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Albert Stezin
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India; Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Nitish Kamble
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India.
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9
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Fields JA. Cognitive and Neuropsychiatric Features in Parkinson's and Lewy Body Dementias. Arch Clin Neuropsychol 2017; 32:786-801. [DOI: 10.1093/arclin/acx085] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 08/30/2017] [Indexed: 01/11/2023] Open
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Reynolds GO, Hanna KK, Neargarder S, Cronin-Golomb A. The relation of anxiety and cognition in Parkinson's disease. Neuropsychology 2017; 31:596-604. [PMID: 28425730 DOI: 10.1037/neu0000353] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE Parkinson's disease (PD) has long been conceptualized as a motor disorder, but nonmotor symptoms also manifest in the disease and significantly reduce quality of life. Anxiety and cognitive dysfunction are prevalent nonmotor symptoms, even in early disease stages, but the relation between these symptoms remains poorly understood. We examined self-reported anxiety and neurocognitive function, indexed by measures of executive function (set-shifting and phonemic fluency), categorical fluency, and attention/working memory. We hypothesized that anxiety would correlate with cognitive performance. METHOD The Beck Anxiety Inventory and cognitive tests (Trail Making, Verbal Fluency, Digit Span) were administered to 77 nondemented adults with mild to moderate idiopathic PD (39 men, 38 women; Mage = 62.9 years). RESULTS Higher anxiety was associated with more advanced disease stage and severity and with poorer set-shifting when using a derived metric to account for motoric slowing. Depression correlated with greater anxiety and disease severity, but not with cognitive performance. CONCLUSIONS Our findings support the association of anxiety with a specific domain of executive function, set-shifting, in nondemented individuals with mild to moderate PD, raising the possibility that treatment of anxiety may alleviate aspects of executive dysfunction in this population. (PsycINFO Database Record
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Affiliation(s)
| | - Kristine K Hanna
- Department of Psychological and Brain Sciences, Boston University
| | - Sandy Neargarder
- Department of Psychological and Brain Sciences, Boston University
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Turner TH, Renfroe JB, Elm J, Duppstadt-Delambo A, Hinson VK. Robustness of reliable change indices to variability in Parkinson’s disease with mild cognitive impairment. APPLIED NEUROPSYCHOLOGY-ADULT 2016; 23:399-402. [DOI: 10.1080/23279095.2016.1160907] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- T. H. Turner
- Mental Health Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - J. B. Renfroe
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA
| | - J. Elm
- Department of Public Health Science, Medical University of South Carolina, Charleston, SC, USA
| | - A. Duppstadt-Delambo
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA
| | - V. K. Hinson
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA
- Neurology Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
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Akhtar RS, Stern MB. New concepts in the early and preclinical detection of Parkinson’s disease: therapeutic implications. Expert Rev Neurother 2014; 12:1429-38. [DOI: 10.1586/ern.12.144] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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13
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Cognitive reserve in Parkinson's disease: A systematic review and meta-analysis. Parkinsonism Relat Disord 2014; 20:1-7. [DOI: 10.1016/j.parkreldis.2013.08.010] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 08/19/2013] [Accepted: 08/20/2013] [Indexed: 11/19/2022]
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Liepelt-Scarfone I, Fruhmann Berger M, Prakash D, Csoti I, Gräber S, Maetzler W, Berg D. Clinical characteristics with an impact on ADL functions of PD patients with cognitive impairment indicative of dementia. PLoS One 2013; 8:e82902. [PMID: 24349393 PMCID: PMC3857297 DOI: 10.1371/journal.pone.0082902] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 11/07/2013] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Dementia in Parkinson's disease (PD) is defined as cognitive decline severe enough to affect activities of daily living function (ADL). The aim of our exploratory study was to compare two groups of PD patients. Both groups had cognitive deficits severe enough to justify diagnosis of dementia, but they differed according to caregivers' rating on ADL dysfunction. Parameters which differed between the two groups were interpreted to affect the caregivers' perception of ADL dysfunction in PD patients with cognitive impairment indicative of Parkinson's disease dementia. METHODOLOGY/PRINCIPAL FINDINGS Thirty of 131 Parkinson's disease patients fulfilled the Movement Disorders Society Task Force - recommended, cognitive Level-I-criteria for dementia. According to standardized caregiver ratings, volunteers were grouped into 18 patients with (ADL-) and 12 without instrumental activities of daily living dysfunction (ADL+). Caregiver activities of daily living function ratings closely correlated with self-estimates of patients and those of physician (p<0.001). ADL- patients performed worse on tests assessing visual-construction (p<0.05) and attention (p=0.03) than ADL+ patients. Moreover, the postural instability and gait disorder subtype was more frequent in ADL- patients (p=0.009). ADL- patients tended to have more communication problems (p=0.05), more anxiety (p=0.05) and showed a tendency to be treated more often with neuroleptics (p=0.049) than ADL+. CONCLUSIONS/SIGNIFICANCE Results indicate that worse attention, visual-construction abilities, the postural instability and gait disorder subtype, communication problems, medication and presence of anxiety are related to activities of daily living dysfunctions in Parkinson's disease patients with cognitive decline indicative of dementia. Our data suggests that not only cognitive factors but also non-cognitive factors seem to be linked to the diagnosis of Parkinson's disease dementia associated with significant impact on instrumental activities of daily living function. Further studies with larger sample sizes are needed to verify our results.
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Affiliation(s)
- Inga Liepelt-Scarfone
- German Center of Neurodegenerative Diseases (DZNE), Tuebingen, Germany
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Monika Fruhmann Berger
- German Center of Neurodegenerative Diseases (DZNE), Tuebingen, Germany
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Deborah Prakash
- German Center of Neurodegenerative Diseases (DZNE), Tuebingen, Germany
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Ilona Csoti
- Department of Neurology, Gertrudis Hospital, Leun-Biskirchen, Germany
| | - Susanne Gräber
- German Center of Neurodegenerative Diseases (DZNE), Tuebingen, Germany
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Walter Maetzler
- German Center of Neurodegenerative Diseases (DZNE), Tuebingen, Germany
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Daniela Berg
- German Center of Neurodegenerative Diseases (DZNE), Tuebingen, Germany
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
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Predictors of cognitive decline in the early stages of Parkinson's disease: a brief cognitive assessment longitudinal study. PARKINSONS DISEASE 2013; 2013:912037. [PMID: 24303226 PMCID: PMC3835472 DOI: 10.1155/2013/912037] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 09/09/2013] [Accepted: 09/13/2013] [Indexed: 11/18/2022]
Abstract
Our objectives were to perform a longitudinal assessment of mental status in early stage Parkinson's disease (PD) patients, with brief neuropsychological tests, in order to find predictive factors for cognitive decline. Sixty-one, early stage, and nondemented patients were assessed twice, over a 2-year interval, with a global cognitive test (mini-mental state examination (MMSE)) and a frontal function test (frontal assessment battery (FAB)) and motor function scales. Dementia and hallucinations were diagnosed according to the DSM-IV criteria. Cognitive function scores did not decrease significantly, except for FAB lexical fluency score. Four patients presented with dementia at followup. The MMSE score below cut-off, worse gait dysfunction, the nontremor motor subtype, and hallucinations were significantly related to dementia. Rigidity and speech dysfunction were related to dementia and a decrease in FAB scores. We can conclude that decline in the MMSE and FAB scores is small and heterogeneous in the early stages of PD. Scores below cut-off in the MMSE could be helpful to predict dementia. Nontremor motor deficits could be predictive factors for frontal cognitive decline and dementia.
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Lima MMS. Sleep disturbances in Parkinson's disease: the contribution of dopamine in REM sleep regulation. Sleep Med Rev 2013; 17:367-75. [PMID: 23481545 DOI: 10.1016/j.smrv.2012.10.006] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 09/14/2012] [Accepted: 10/29/2012] [Indexed: 11/29/2022]
Abstract
Nearly all patients with Parkinson's disease (PD) have sleep disturbances. While it has been suggested that these disturbances involve a dopaminergic component, the specific mechanisms that contribute to this behavior are far from being fully understood. In this article, we have reviewed the current understanding of the linkage between sleep and PD, focusing on the participation of the dopaminergic system in the regulation of rapid eye movement (REM) sleep. The presence of an REM sleep behavior disorder in patients with PD might reflect the early involvement of dopaminergic neurotransmission in REM sleep-related structures. Therefore, it has been suggested that these structures are affected by an imbalance of dopamine levels. Several studies have demonstrated that neurons in the substantia nigra pars compacta (SNpc) and in the ventral tegmental area (VTA) are active during REM sleep and that sleep-related disturbances may result when these neurons are targeted by neurotoxins. We discuss current evidence suggesting the presence of a putative reciprocal connectivity between the SNpc, VTA, the pedunculopontine tegmental nucleus and reticular formation, which may exert an important influence on the REM sleep mechanism. This review provides a comprehensive overview of the literature that addresses this challenging and unrecognized component of PD.
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Affiliation(s)
- Marcelo M S Lima
- Laboratório de Neurofisiologia, Departamento de Fisiologia, Universidade Federal do Paraná, Curitiba, Paraná, Brasil.
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Abstract
Letter fluency deficits are commonly detected in non-demented Parkinson's disease (PD) patients but the underlying cause remains uncertain. We investigated the role of slowed processing speed and executive dysfunction. Eighteen nondemented PD participants and nineteen controls were compared on letter fluency using a fluency index (Fi); the average time to "think" of each word, a measure independent of motor speed. Video analyses produced thinking times to switch between word clusters and generate a word within a cluster. Correlational and regression analyses were undertaken with tests of processing speed and executive functioning. The PD group exhibited significantly longer fluency indices than controls across all components. Performance on tests of executive functioning explained a significant proportion of variance whereas performance in processing speed tests did not. Moreover, PD participants with an executive functioning impairment showed significantly worse switching fluency indices only compared with Controls and PD participants without executive dysfunction. PD participants with executive dysfunction exhibited a disproportionate impairment in the time taken to switch between clusters than to think of words within clusters. Executive functioning contributed to fluency performance more than processing speed. Cognitive heterogeneity and motor slowing, may mask the profile of cognitive dysfunction in neurodegenerative disease.
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Pontone GM, Palanci J, Williams JR, Bassett SS. Screening for DSM-IV-TR cognitive disorder NOS in Parkinson's disease using the Mattis Dementia Rating Scale. Int J Geriatr Psychiatry 2013; 28:364-71. [PMID: 22628158 PMCID: PMC3449223 DOI: 10.1002/gps.3833] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 04/24/2012] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study explores the utility of the Mattis Dementia Rating Scale (MDRS) as a screening tool for the Diagnostic and Statistical Manual for Mental Disorders 4th edition (DSM-IV-TR) diagnosis cognitive disorder not otherwise specified (NOS) in Parkinson's disease (PD). METHODS A total of 125 individuals with PD were diagnosed using DSM-IV-TR criteria for cognitive disorder NOS and dementia. Receiver operating characteristics (ROC) tested the discriminant validity of the MDRS, with the clinician's diagnosis serving as the gold standard. RESULTS The MDRS ROC curve to discriminate subjects with cognitive disorder NOS from non-demented subjects had an area under the curve of 0.59 (standard error = 0.08, 95% CI: 0.43-0.74). CONCLUSIONS The MDRS is not effective for identifying PD patients with cognitive disorder NOS without dementia.
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Affiliation(s)
- Gregory M. Pontone
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD,Morris K. Udall Parkinson’s Disease Research Center of Excellence at Johns Hopkins,Correspondence to: Greg Pontone, MD, Johns Hopkins University School of Medicine, 600 N. Wolfe Street - Phipps 300, Baltimore, MD 21287, , o:(410) 502-0477/f:(410)614-3676
| | - Justin Palanci
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD,Morris K. Udall Parkinson’s Disease Research Center of Excellence at Johns Hopkins
| | - James R. Williams
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD,Biogen Idec, Cambridge, MA
| | - Susan Spear Bassett
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD,Morris K. Udall Parkinson’s Disease Research Center of Excellence at Johns Hopkins
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Roca M, Manes F, Chade A, Gleichgerrcht E, Gershanik O, Arévalo GG, Torralva T, Duncan J. The relationship between executive functions and fluid intelligence in Parkinson's disease. Psychol Med 2012; 42:2445-52. [PMID: 22440401 PMCID: PMC3466050 DOI: 10.1017/s0033291712000451] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Revised: 02/22/2012] [Accepted: 02/22/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND We recently demonstrated that decline in fluid intelligence is a substantial contributor to frontal deficits. For some classical 'executive' tasks, such as the Wisconsin Card Sorting Test (WCST) and Verbal Fluency, frontal deficits were entirely explained by fluid intelligence. However, on a second set of frontal tasks, deficits remained even after statistically controlling for this factor. These tasks included tests of theory of mind and multitasking. As frontal dysfunction is the most frequent cognitive deficit observed in early Parkinson's disease (PD), the present study aimed to determine the role of fluid intelligence in such deficits. METHOD We assessed patients with PD (n=32) and control subjects (n=22) with the aforementioned frontal tests and with a test of fluid intelligence. Group performance was compared and fluid intelligence was introduced as a covariate to determine its role in frontal deficits shown by PD patients. RESULTS In line with our previous results, scores on the WCST and Verbal Fluency were closely linked to fluid intelligence. Significant patient-control differences were eliminated or at least substantially reduced once fluid intelligence was introduced as a covariate. However, for tasks of theory of mind and multitasking, deficits remained even after fluid intelligence was statistically controlled. CONCLUSIONS The present results suggest that clinical assessment of neuropsychological deficits in PD should include tests of fluid intelligence, together with one or more specific tasks that allow for the assessment of residual frontal deficits associated with theory of mind and multitasking.
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Affiliation(s)
- M. Roca
- Institute of Cognitive Neurology (INECO), Buenos Aires, Argentina
- Laboratory of Neuroscience, Universidad Diego Portales, Chile
- Institute of Neurosciences Favaloro University, Buenos Aires, Argentina
| | - F. Manes
- Institute of Cognitive Neurology (INECO), Buenos Aires, Argentina
- Laboratory of Neuroscience, Universidad Diego Portales, Chile
| | - A. Chade
- Institute of Cognitive Neurology (INECO), Buenos Aires, Argentina
- Laboratory of Neuroscience, Universidad Diego Portales, Chile
| | - E. Gleichgerrcht
- Institute of Cognitive Neurology (INECO), Buenos Aires, Argentina
| | - O. Gershanik
- Laboratory of Neuroscience, Universidad Diego Portales, Chile
| | - G. G. Arévalo
- Institute of Cognitive Neurology (INECO), Buenos Aires, Argentina
- Laboratory of Neuroscience, Universidad Diego Portales, Chile
| | - T. Torralva
- Institute of Cognitive Neurology (INECO), Buenos Aires, Argentina
- Laboratory of Neuroscience, Universidad Diego Portales, Chile
| | - J. Duncan
- MRC Cognition and Brain Sciences Unit, Cambridge, UK
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Cognitive profiles in Parkinson's disease and their relation to dementia: a data-driven approach. Int J Alzheimers Dis 2012; 2012:910757. [PMID: 23119224 PMCID: PMC3483831 DOI: 10.1155/2012/910757] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 08/01/2012] [Indexed: 01/30/2023] Open
Abstract
Parkinson's disease is characterized by a substantial cognitive heterogeneity, which is apparent in different profiles and levels of severity. To date, a distinct clinical profile for patients with a potential risk of developing dementia still has to be identified. We introduce a data-driven approach to detect different cognitive profiles and stages. Comprehensive neuropsychological data sets from a cohort of 121 Parkinson's disease patients with and without dementia were explored by a factor analysis to characterize different cognitive domains. Based on the factor scores that represent individual performance in each domain, hierarchical cluster analyses determined whether subgroups of Parkinson's disease patients show varying cognitive profiles. A six-factor solution accounting for 65.2% of total variance fitted best to our data and revealed high internal consistencies (Cronbach's alpha coefficients >0.6). The cluster analyses suggested two independent patient clusters with different cognitive profiles. They differed only in severity of cognitive impairment and self-reported limitation of activities of daily living function but not in motor performance, disease duration, or dopaminergic medication.
Based on a data-driven approach, divers cognitive profiles were identified, which separated early and more advanced stages of cognitive impairment in Parkinson's disease without dementia. Importantly, these profiles were independent of motor progression.
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Pagonabarraga J, Kulisevsky J. Cognitive impairment and dementia in Parkinson's disease. Neurobiol Dis 2012; 46:590-6. [PMID: 22484304 DOI: 10.1016/j.nbd.2012.03.029] [Citation(s) in RCA: 154] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 03/09/2012] [Accepted: 03/21/2012] [Indexed: 02/01/2023] Open
Abstract
Relatively subtle cognitive disturbances may be present from the initial stages of Parkinson's disease (PD) that progress in many patients to a more severe cognitive impairment and dementia. Several of the initial deficits are ascribed to failure in the frontal-striatal basal ganglia circuits and involve executive defects in planning, initiation, monitoring of goal-directed behaviors and working-memory. Other non-demented PD patients also exhibit visuospatial and memory deficits more representative of posterior cortical functioning and fail performing naming or copying tasks. Major differences in the overall rate of cognitive decline among PD patients support the co-existence of at least two patterns of involution, differentiating a relatively slow decline of fronto-striatal deficits from a more rapid decline of posterior-cortical deficits, with different pathophysiological substrates, genetics, prognosis and response to drugs used to treat the motor symptoms of PD.
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Affiliation(s)
- Javier Pagonabarraga
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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22
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Schoenberg MR, Rinehardt E, Duff K, Mattingly M, Bharucha KJ, Scott JG. Assessing reliable change using the repeatable battery for the assessment of neuropsychological status (RBANS) for patients with Parkinson's Disease undergoing deep brain stimulation (DBS) surgery. Clin Neuropsychol 2012; 26:255-70. [PMID: 22332733 DOI: 10.1080/13854046.2011.653587] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Parkinson's disease (PD) is progressive neurological disease characterized by resting tremor, rigidity, akinesia, postural instability and cognitive changes. The symptoms of PD are debilitating and often become unsatisfactorily treated by medication. Deep brain stimulation (DBS) is an effective treatment to significantly reduce the cardinal motor symptoms of PD. However, the neuropsychological effects of this treatment are less clear. This study examined pre- to post-DBS scores on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) using Reliable Change Indices (RCIs) derived from 20 patients with PD who were medically managed, and then compared to 20 patients with PD treated with DBS and medication. When using group statistical analyses and false discovery rate correction, no significant differences between or within groups were evident at baseline or at follow-up. However, when using the RCIs more patients in the DBS group exhibited reliable change in RBANS scores than did the Med Tx group. Although preliminary, these RCIs provide clinicians and researchers a foundational tool for assessing the effects of interventions (e.g., DBS) independent of the effects of PD and measurement error when using the RBANS.
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Affiliation(s)
- Mike R Schoenberg
- Department of Psychiatry and Neurosciences, University of South Florida College of Medicine, Florida, USA.
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23
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McKinlay A, Grace RC. Characteristic of Cognitive Decline in Parkinson's Disease: A 1-Year Follow-Up. ACTA ACUST UNITED AC 2011; 18:269-77. [DOI: 10.1080/09084282.2011.595453] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Annanmaki T, Pohja M, Parviainen T, Hakkinen P, Murros K. Uric acid and cognition in Parkinson’s disease: A follow-up study. Parkinsonism Relat Disord 2011; 17:333-7. [DOI: 10.1016/j.parkreldis.2011.01.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Revised: 01/20/2011] [Accepted: 01/23/2011] [Indexed: 10/18/2022]
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Dalrymple-Alford JC, Livingston L, MacAskill MR, Graham C, Melzer TR, Porter RJ, Watts R, Anderson TJ. Characterizing mild cognitive impairment in Parkinson's disease. Mov Disord 2011; 26:629-36. [DOI: 10.1002/mds.23592] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Revised: 10/26/2010] [Accepted: 11/22/2010] [Indexed: 11/11/2022] Open
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Rinehardt E, Duff K, Schoenberg M, Mattingly M, Bharucha K, Scott J. Cognitive change on the repeatable battery of neuropsychological status (RBANS) in parkinson's disease with and without bilateral subthalamic nucleus deep brain stimulation surgery. Clin Neuropsychol 2010; 24:1339-54. [DOI: 10.1080/13854046.2010.521770] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Fine EM, Delis DC, Paul BM, Filoteo JV. Reduced verbal fluency for proper names in nondemented patients with Parkinson's disease: a quantitative and qualitative analysis. J Clin Exp Neuropsychol 2010; 33:226-33. [PMID: 20936559 DOI: 10.1080/13803395.2010.507185] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
There has been an increasing interest within neuropsychology in comparing verbal fluency for different grammatical classes (e.g., verb generation vs. noun generation) in neurological populations, including Parkinson's disease (PD). However, to our knowledge, few studies have compared verbal fluency for common nouns and proper names in PD. Common nouns and proper names differ in terms of their semantic characteristics, as categories of common nouns are organized hierarchically based on semantics, while categories of proper nouns lack a well-defined semantic organization. In addition, there is accumulating evidence that the retrieval of these distinct grammatical classes are subserved by somewhat distinct neural systems. Given that verbal fluency deficits are among the first impairments to emerge in PD, and that such deficits are predictors of future cognitive decline, it is important to examine all aspects of verbal fluency in this population. For the current study, we compared the performance of a group of 32 nondemented PD patients with 32 healthy participants (HP) on verbal fluency tasks for common nouns (animals) and proper names (boys' first names). A significant interaction between verbal fluency task and diagnostic status emerged, as the PD group performed significantly worse on only the proper name fluency task. This finding may reflect the absence of well-defined semantic organization that structures the verbal search for first names, thus placing a greater onus on strategic or "executive" verbal retrieval processes.
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Affiliation(s)
- Eric M Fine
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.
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Abstract
The most extensively described pathological abnormality in Parkinson's disease (PD) is loss of dopaminergic neurons in the substantia nigra pars compacta and the ventral tegmental area, with degeneration of their striatal terminals. Because of the intimate connections between the striatum and the frontal lobes, individuals with PD often demonstrate impairments on those tasks relying on the prefrontal cortex (e.g., tests of executive functioning). Source memory, or memory for context, is believed to rely on the prefrontal cortex and has been previously associated with executive functioning performance, although it has received little attention in the PD literature. Executive functioning and source memory were measured in a group of nondemented PD patients and healthy control participants. Within the PD group, an anti-Parkinson's medication withdrawal manipulation was used to examine whether source memory was affected by phasic changes in dopamine levels. Compared to healthy control participants, PD patients were impaired in source memory (both on- and off-medication) and on a composite measure of executive functioning. Within the PD group, medication administration improved motor performance but did not have a significant effect on source memory.
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Kandiah N, Narasimhalu K, Lau PN, Seah SH, Au WL, Tan LC. Cognitive decline in early Parkinson's disease. Mov Disord 2009; 24:605-8. [DOI: 10.1002/mds.22384] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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30
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van Stockum S, MacAskill M, Anderson T, Dalrymple-Alford J. Don’t look now or look away: Two sources of saccadic disinhibition in Parkinson's disease? Neuropsychologia 2008; 46:3108-15. [PMID: 18674551 DOI: 10.1016/j.neuropsychologia.2008.07.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2008] [Revised: 07/04/2008] [Accepted: 07/05/2008] [Indexed: 11/29/2022]
Affiliation(s)
- Saskia van Stockum
- Van der Veer Institute for Parkinson's & Brain Research, Christchurch, New Zealand.
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31
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Drago V, Foster PS, Skidmore FM, Heilman KM. Creativity in Parkinson's disease as a function of right versus left hemibody onset. J Neurol Sci 2008; 276:179-83. [PMID: 18952243 DOI: 10.1016/j.jns.2008.09.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Revised: 09/19/2008] [Accepted: 09/23/2008] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Creativity is heavily dependent on divergent thinking and divergent thinking appears to be strongly dependent on fontal lobe function. Since patients with Parkinson's disease (PD) often have evidence of frontal lobe dysfunction we wanted to learn if these patients have a reduction of creativity, as well as learning if the side of onset (right versus left) influences the type (verbal versus visuospatial) of decrement in creativity. DESIGN Participants of this study were patients with right (RHO) or left (LHO) onset PD as well as matched controls. All subjects were given the Abbreviated Torrance Test of Creative Thinking for Adults (ATTA), a widely used test to assess creativity that examines Fluency, Originality, Flexibility and Elaboration. Subjects were also assessed with the Controlled Word Association Test (COWAT). RESULTS/CONCLUSIONS When compared to controls the patients with RHO, but not LHO, had a decrease of verbal creative fluency. Patients with PD often have a decrease on the COWAT, but performance on the COWAT did not differ between the RHO and the LHO patients. This suggests that patients with PD who have RHO have a decrease in verbal creativity and this decrement does not appear to be related to decreased fluency.
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Affiliation(s)
- V Drago
- University of Florida, Department of Neurology, and Center for Neuropsychological Studies, Gainesville, FL 32610-0236, USA.
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Dobkin RD, Menza M, Bienfait KL. CBT for the treatment of depression in Parkinson's disease: a promising nonpharmacological approach. Expert Rev Neurother 2008; 8:27-35. [PMID: 18088199 DOI: 10.1586/14737175.8.1.27] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Depression is very common in Parkinson's disease (PD) and linked with a faster progression of physical symptoms, greater cognitive decline and poorer quality of life. Nonpharmacological approaches, such as cognitive-behavioral therapy (CBT), for the treatment of depression in PD (dPD) have received little experimental attention despite strong demonstrated efficacy in other geriatric and medical populations. Depressed PD patients often differ from the depressed non-PD elderly in that they present with increased rates of both executive dysfunction and comorbid psychiatric diagnoses, may differ in their depressive symptom presentation and typically have caregivers who are highly involved in their treatment. Therefore, it is not possible to conclude that empirically validated treatments in the depressed aged will generalize to those with PD. In order to be most effective for PD patients, CBT should be tailored to their unique needs. Additional controlled research is needed to further explore the efficacy of CBT for dPD.
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Affiliation(s)
- Roseanne DeFronzo Dobkin
- Department of Psychiatry, UMDNJ/Robert Wood Johnson Medical School, 675 Hoes Lane, Room D-317, Piscataway, NJ 08854, USA.
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Amboni M, Cozzolino A, Longo K, Picillo M, Barone P. Freezing of gait and executive functions in patients with Parkinson's disease. Mov Disord 2007; 23:395-400. [DOI: 10.1002/mds.21850] [Citation(s) in RCA: 236] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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34
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Dobkin RD, Allen LA, Menza M. Cognitive-behavioral therapy for depression in Parkinson's disease: a pilot study. Mov Disord 2007; 22:946-52. [PMID: 17377926 DOI: 10.1002/mds.21455] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The present study was conducted to examine the feasibility and effect of an individual cognitive-behavioral treatment (CBT) for depression that was modified to meet the unique needs of the PD patient and incorporated a separate social support intervention for caregivers. Fifteen PD patients with Major Depressive Disorder participated in the study with a caregiver. Patients received 10-14 sessions of modified individual CBT. Caregivers attended 3-4 psychoeducational sessions, occurring separately from the patients treatment sessions, which focused on strategies for offering appropriate support, and ways to respond to the patients' negative thoughts in a targeted manner. Patients experienced a significant reduction in depressive symptoms and negative cognitions, and an increased perception of social support over the course of treatment. Gains were maintained at 1-month follow-up. In conclusion, individual CBT, when modified appropriately, may be a feasible and effective option for PD depression. Larger, randomized controlled trials are needed to further evaluate the efficacy of this intervention and to identify specific mechanisms of change.
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Affiliation(s)
- Roseanne DeFronzo Dobkin
- Department of Psychiatry, UMDNJ-Robert Wood Johnson Medical School, Piscataway, New Jersey 08854, USA.
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35
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Martin SC, Wolters PL, Toledo-Tamula MA, Zeichner SL, Hazra R, Civitello L. Cognitive functioning in school-aged children with vertically acquired HIV infection being treated with highly active antiretroviral therapy (HAART). Dev Neuropsychol 2006; 30:633-57. [PMID: 16995830 DOI: 10.1207/s15326942dn3002_1] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
In today's era of highly active antiretroviral therapy (HAART), few children with HIV-1 infection experience severe central nervous system (CNS) manifestations indicative of encephalopathy. However, little is known about the neurocognitive strengths and weaknesses of HIV-infected children treated with HAART. This cross-sectional study is the first to systematically investigate the relation between cognitive functioning and medical markers in HIV-infected children and adolescents treated with HAART with varying levels of computed tomography (CT) brain scan abnormalities. The Wechsler Intelligence Scale for Children-Third Edition was administered to 41 vertically infected children (mean age = 11.2 years) treated with HAART for at least 1 year. Other procedures at the time of testing included CT brain scans and collection of CD4 cell counts and plasma HIV1 RNA PCR. Although global cognitive functioning among participants was in the Average range, children with minimal to moderate CT brain scan abnormalities scored significantly lower than children with normal scans on composite measures of cognitive functioning and five specific subtests, especially tasks involving executive functions. Furthermore, children with worse immune status (CD4+ counts < or = 500) scored lower on subtests measuring processing speed. Viral load was unrelated to cognitive test scores. Thus, children with HIV being treated with HAART remain at risk for developing CNS disease. Findings emphasize the importance of conducting neuropsychological assessments in this population, particularly for children with cortical atrophy and absolute CD4+ cell counts < or = 500.
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Affiliation(s)
- Staci C Martin
- HIV and AIDS Malignancy Branch, National Cancer Institute, 9030 Old Georgetown Road, Bethesda, MD 20814, USA.
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Abstract
Sequence learning, a cognitive task linked to cortico-striatal function, is impaired in Parkinson's disease (PD). We chose this task as a behavioral paradigm to study the functional architecture of PD in treated and untreated conditions. In our studies, participants were scanned with H(2)(15)O while performing a kinematically controlled motor sequence learning task and a matching motor baseline task. Experiments revealed that a specific sequence learning network predicts learning in normal subjects, and in independent cohorts of early and advanced PD patients. The analysis of the relationship of network activity to learning performance revealed diverging influences of dopaminergic therapy and deep brain stimulation (DBS). DBS of the internal GP and of STN increased network activity and task performance, while levodopa decreased both measures. In separate studies, we investigated the role of dopaminergic modulation on brain activation during sequence learning. In healthy subjects dopamine transporter (DAT) binding correlated with learning-related brain activation in prefrontal, premotor and cingulate cortices, and in the thalamus. By contrast, in PD most of these regional relationships were lost. Only ventral and dorsolateral prefrontal cortex activation correlated with caudate dopaminergic input. In a final set of studies, we found a significant decline in learning performance in early stage PD patients followed over the course of 2 years. Longitudinal declines in learning-related activation were found in parietal areas, while concomitant increases were localized to the left hippocampus. These observations support hypotheses on disease-stage and task-specific effects within the different cortico-striato-pallido-thalamocortical loops and the mesocortical system in PD.
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Affiliation(s)
- Maren Carbon
- Center for Neurosciences, Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY 11030, USA.
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Dobkin RD, Allen LA, Menza M. A Cognitive-Behavioral Treatment Package for Depression in Parkinson's Disease. PSYCHOSOMATICS 2006; 47:259-63. [PMID: 16684945 DOI: 10.1176/appi.psy.47.3.259] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Roseanne DeFronzo Dobkin
- Department of Psychiatry, UMDNJ-Robert Wood Johnson Medical School, 675 Hoes Lane, Rm. D-317, Piscataway NJ 08855, USA.
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Riepe MW, Kassubek J, Tracik F, Ebersbach G. Screening for cognitive impairment in Parkinson's disease--which marker relates to disease severity? J Neural Transm (Vienna) 2006; 113:1463-8. [PMID: 16604308 DOI: 10.1007/s00702-006-0433-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2005] [Accepted: 01/22/2006] [Indexed: 10/24/2022]
Abstract
The frequency and pattern of cognitive deficits in Parkinson's disease (PD) is under discussion. We assessed 157 consecutive subjects with PD (66.4 +/- 8.9 years (mean +/- standard deviation); average duration of disease 3.5 +/- 1.3 years; average Hoehn and Yahr stage 2.4 +/- 0.9) diagnosed in centers specialized for the diagnosis and treatment of PD with brief tests for memory (Memory Impairment Screen), attention (Letter Sorting Test) and semantic fluency (category animals). Impaired memory was observed in about one half of the subjects regardless of severity of disease as assessed by staging according to Hoehn and Yahr. With greater severity, free recall was impaired and subjects required the cues to recall the items. Performance in the Letter Sorting Test and the semantic fluency task declined with increasing Hoehn and Yahr stage, also. We conclude that cognitive deficits are frequent in PD. Further analyses reveal that even in selected screening tests (e.g. semantic fluency) a significant impairment with increasing disease severity (Hoehn and Yahr stage) as opposed to disease duration alone can be demonstrated.
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Affiliation(s)
- M W Riepe
- Department of Psychiatry, Charité Universitätsmedizin, Berlin, Germany.
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Sabbagh MN, Silverberg N, Bircea S, Majeed B, Samant S, Caviness JN, Reisberg B, Adler CH. Is the functional decline of Parkinson's disease similar to the functional decline of Alzheimer's disease? Parkinsonism Relat Disord 2005; 11:311-5. [PMID: 15886042 DOI: 10.1016/j.parkreldis.2005.02.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2004] [Revised: 01/26/2005] [Accepted: 02/04/2005] [Indexed: 11/17/2022]
Abstract
Since many Parkinson's disease (PD) subjects develop dementia, we determined whether the correlation between functional and cognitive decline seen in Alzheimer's disease (AD) is seen in PD. Seventy-five PD subjects with and without dementia and 103 AD/MCI subjects underwent the Functional Assessment Staging (FAST), the Global Deterioration Scale (GDS), the UPDRS motor portion, and the MMSE. In AD/MCI subjects, changes in FAST and GDS scores correlated with MMSE (rho=-0.814, P<0.001; rho=-0.840, P<0.001, respectively). In PD subjects, the FAST and GDS also correlated with MMSE (rho=-0.675, P<0.001; rho=-0.647, P<0.001, respectively). The UPDRS correlated with the GDS and FAST more closely in PD than in AD. Similar to AD, functional declines in PD correlates with cognitive decline and may be influenced by motor disability in PD.
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Affiliation(s)
- M N Sabbagh
- The Cleo Roberts Center for Clinical Research, Sun Health Research Institute, 10515 West Santa Fe Drive, Sun City, AZ 85351, USA.
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Grossi D, Trojano L, Pellecchia MT, Amboni M, Fragassi NA, Barone P. Frontal dysfunction contributes to the genesis of hallucinations in non-demented Parkinsonian patients. Int J Geriatr Psychiatry 2005; 20:668-73. [PMID: 16021658 DOI: 10.1002/gps.1339] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Hallucinations occur in patients with Parkinson's disease (PD) with reported prevalence ranging from 8% to 40%. Hallucinations are significantly associated with dementia in PD, but little is known about possible distinctive cognitive features of non-demented PD patients who develop hallucinations. OBJECTIVE The aim of the study was to assess selected cognitive abilities in non-demented PD patients with and without hallucinations in order to identify specific neuropsychological correlates of such phenomena. METHODS Forty-eight consecutive patients with PD and Mini Mental State Examination (MMSE) > or = 23 were examined for the presence of hallucinations and assessed on standardized neuropsychological tasks for semantic and phonological fluency, verbal learning and logical abstract thinking; disease severity was staged according to Hoehn and Yahr scale. RESULTS Fourteen (29.2%) of 48 patients experienced hallucinations. There was no difference between hallucinators and non-hallucinators on demographic variables, disease severity and dose of any pharmacological treatment. Disease duration was significantly longer in hallucinator vs non-hallucinator patients (p = 0.02). Patients with hallucinations scored significantly lower than patients without hallucinations only on verbal learning-immediate recall task (p = 0.0324), and semantic and phonological fluency tasks (p = 0.0005 and p = 0.0036, respectively). CONCLUSIONS Our results suggest that PD patients with hallucinations show reduced performance on tasks that explore executive functioning as compared with non-hallucinators. Therefore, executive dysfunction may be considered as a risk factor for the development of hallucinations in non-demented PD patients.
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Affiliation(s)
- Dario Grossi
- Department of Psychology, Second University, Naples, Italy
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Brotherton SS, Williams HG, Gossard JL, Hussey JR, McClenaghan BA, Eleazer P. Are Measures Employed in the Assessment of Balance Useful for Detecting Differences among Groups that Vary by Age and Disease State? J Geriatr Phys Ther 2005; 28:14-9. [PMID: 16236223 DOI: 10.1519/00139143-200504000-00003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE This study explored the usefulness of measures commonly employed in the examination of persons with balance impairment to discriminate between performances of young and older adults and older adults with and without neurological disease. METHODS Eighteen young adults, 22 healthy older adults, 12 individuals with Parkinson disease, and 20 older adults with peripheral neuropathy were recruited from the community.Performances on the following measures were compared: Mini Mental State Exam, grip strength, timed chair rise, semitandem and tandem stance, Timed Up and Go (TUG), and Berg Balance Scale (BBS). Survival analysis was used to analyze semitandem and tandem stance. Grip strength and other tests were analyzed using analysis of variance. Tukey multiple comparison procedure was employed to assess differences in performance among groups. RESULTS Significant differences in performance were found for all measures. Grip and timed chair rise discriminated young and older adult groups. Timed chair rise, tandem stance, TUG, and BBS detected differences between healthy individuals and those with disease. Semitandem stance and BBS discriminated between individuals with disease conditions. CONCLUSIONS When examining individuals with balance difficulty, combinations of measures are needed to discriminate between clinically distinct groups.
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Affiliation(s)
- Sandra S Brotherton
- Physical Therapy Education Program, Department of Rehabilitation Sciences, Medical University of South Carolina, PO Box 250700, Charleston, SC 29425, USA.
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Braak H, Ghebremedhin E, Rüb U, Bratzke H, Del Tredici K. Stages in the development of Parkinson's disease-related pathology. Cell Tissue Res 2004; 318:121-34. [PMID: 15338272 DOI: 10.1007/s00441-004-0956-9] [Citation(s) in RCA: 1780] [Impact Index Per Article: 89.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2004] [Accepted: 07/13/2004] [Indexed: 01/16/2023]
Abstract
The synucleinopathy, idiopathic Parkinson's disease, is a multisystem disorder that involves only a few predisposed nerve cell types in specific regions of the human nervous system. The intracerebral formation of abnormal proteinaceous Lewy bodies and Lewy neurites begins at defined induction sites and advances in a topographically predictable sequence. As the disease progresses, components of the autonomic, limbic, and somatomotor systems become particularly badly damaged. During presymptomatic stages 1-2, inclusion body pathology is confined to the medulla oblongata/pontine tegmentum and olfactory bulb/anterior olfactory nucleus. In stages 3-4, the substantia nigra and other nuclear grays of the midbrain and forebrain become the focus of initially slight and, then, severe pathological changes. At this point, most individuals probably cross the threshold to the symptomatic phase of the illness. In the end-stages 5-6, the process enters the mature neocortex, and the disease manifests itself in all of its clinical dimensions.
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Affiliation(s)
- Heiko Braak
- Institute for Clinical Neuroanatomy, J.W. Goethe University, Theodor Stern Kai 7, 60590 Frankfurt/Main, Germany.
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