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Carlisle TC, Fought AJ, Olson KE, Lopez-Esquibel N, Simpson A, Medina LD, Holden SK. Original research: longitudinal evaluation of cognitively demanding daily function using performance-based functional assessment highlights heterogeneous trajectories in cognitive and functional abilities in people with Parkinson's disease. Front Neurosci 2023; 17:1200347. [PMID: 37434765 PMCID: PMC10330725 DOI: 10.3389/fnins.2023.1200347] [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: 04/04/2023] [Accepted: 06/01/2023] [Indexed: 07/13/2023] Open
Abstract
Background Longitudinal assessment of functional abilities in Parkinson's disease (PD) is needed to determine the efficacy of cognitive interventions in providing meaningful improvements in daily life. Additionally, subtle changes in instrumental activities of daily living may precede a clinical diagnosis of dementia and could aid earlier detection of and intervention for cognitive decline. Objective The primary goal was to validate the longitudinal application of the University of California San Diego Performance-Based Skills Assessment (UPSA). An exploratory secondary goal was to determine whether UPSA may identify individuals at higher risk of cognitive decline in PD. Methods Seventy participants with PD completed the UPSA with at least one follow-up visit. Linear mixed effects modeling was used to identify associations between baseline UPSA score and cognitive composite score (CCS) over time. Descriptive analysis of four heterogeneous cognitive and functional trajectory groups and individual case examples was performed. Results Baseline UPSA score predicted CCS at each timepoint for functionally impaired and unimpaired groups (p < 0.01) but did not predict the rate change in CCS over time (p = 0.83). Participants displayed heterogenous trajectories in both UPSA and CCS during the follow-up period. Most participants maintained both cognitive and functional performance (n = 54), though some displayed cognitive and functional decline (n = 4), cognitive decline with functional maintenance (n = 4), and functional decline with cognitive maintenance (n = 8). Conclusion The UPSA is a valid measure of cognitive functional abilities over time in PD. Given the heterogeneity of functional and cognitive trajectories, this performance-based assessment did not predict cognitive decline with this relatively short follow-up. Further work is needed to understand longitudinal functional assessments in PD-associated cognitive impairment.
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Affiliation(s)
- Tara C. Carlisle
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
- Behavioral Neurology Section, Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
- University of Colorado Movement Disorders Center, Aurora, CO, United States
- University of Colorado Alzheimer’s and Cognition Center, Aurora, CO, United States
| | - Angela J. Fought
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, United States
| | - Kaitlin E. Olson
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, United States
| | | | - Abigail Simpson
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Luis D. Medina
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Samantha K. Holden
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
- Behavioral Neurology Section, Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
- University of Colorado Movement Disorders Center, Aurora, CO, United States
- University of Colorado Alzheimer’s and Cognition Center, Aurora, CO, United States
- Movement Disorders Section, Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
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Becker S, Bode M, Brockmann K, Gasser T, Michaelis K, Solbrig S, Nuerk HC, Schulte C, Maetzler W, Zimmermann M, Berg D, Liepelt-Scarfone I. Cognitive-Driven Activities of Daily Living Impairment as a Predictor for Dementia in Parkinson Disease: A Longitudinal Cohort Study. Neurology 2022; 99:e2548-e2560. [PMID: 36240089 PMCID: PMC9754648 DOI: 10.1212/wnl.0000000000201201] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 07/19/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES One-third of Parkinson disease (PD) patients with PD-mild cognitive impairment (PD-MCI) convert to dementia within a few years. Markers with a high prognostic value for dementia conversion are needed. Loss of everyday function primarily caused by cognitive dysfunction is the core criterion for the diagnosis of PD dementia, with an onset of more complex instrumental activities of daily living (IADL) dysfunction in the prodromal stage. This study evaluated the phenotype associated with cognitive IADL impairment and its predictive value for defining a high-risk group for PD dementia. METHODS An observational longitudinal study using cognitive and clinical scores in addition to genetic and CSF biomarkers was conducted. The Functional Activities Questionnaire quotient (cut-off ≥1), indicating more cognitive than motor-driven IADL impairment, defined cognitive IADL impairment status at baseline. Hazard ratios (HRs) were used to compare the impact of baseline classifications on dementia conversion. RESULTS Of 268 patients with PD assessed at baseline, 108 (40.3%) had PD-MCI. After a period of 3.78 ± 0.84 years, 164 (61.2%) patients were reassessed. At follow-up, 93 (56.7%) patients had no cognitive impairment, 54 (32.9%) fulfilled PD-MCI criteria, and 17 (10.4%) had developed dementia. The HR of baseline cognitive IADL impairment (n = 37) for dementia conversion was descriptively higher than for PD-MCI, but highest in patients with both markers (HR = 12.01, 95% CI 4.47-32.22, p < 0.001). In the follow-up sample, nearly half of the patients (n = 10, 47.6%) with baseline classification of cognitive IADL impairment and PD-MCI converted to dementia. Baseline status of cognitive IADL impairment was associated with higher nonmotor burden, worse cognitive performance, and more severe IADL progression over the study period. DISCUSSION The importance of differentiating between cognitive and motor aspects on ADL function in PD and monitoring cognitive ADL impairment in the prodromal stage of dementia is paramount. Patients with PD-MCI and cognitive IADL impairment may be a valuable target group for clinical trials aiming to slow down the development of dementia. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov NCT03687203. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that impairment of cognitive activities of daily living is associated with progression from MCI to dementia among patients with Parkinson disease.
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Affiliation(s)
- Sara Becker
- From the Hertie Institute for Clinical Brain Research (S.B., M.B., K.B., T.G., K.M., S.S., C.S., M.Z., D.B., I.L.-S.), Department of Neurodegenerative Diseases, University of Tübingen, Germany; Department of Psychology (S.B.), University of Calgary, AB, Canada; German Center for Neurodegenerative Diseases (DZNE) (M.B., K.B., T.G., K.M., S.S., C.S., M.Z., I.L.-S.), University of Tübingen; Diagnostics and Cognitive Neuropsychology (H.-C.N.), Department of Psychology, Eberhard Karls University Tübingen, Department of Neurology (W.M., D.B.), Christian-Albrechts-University, Kiel; and IB-Hochschule (I.L.-S.), Stuttgart, Germany
| | - Merle Bode
- From the Hertie Institute for Clinical Brain Research (S.B., M.B., K.B., T.G., K.M., S.S., C.S., M.Z., D.B., I.L.-S.), Department of Neurodegenerative Diseases, University of Tübingen, Germany; Department of Psychology (S.B.), University of Calgary, AB, Canada; German Center for Neurodegenerative Diseases (DZNE) (M.B., K.B., T.G., K.M., S.S., C.S., M.Z., I.L.-S.), University of Tübingen; Diagnostics and Cognitive Neuropsychology (H.-C.N.), Department of Psychology, Eberhard Karls University Tübingen, Department of Neurology (W.M., D.B.), Christian-Albrechts-University, Kiel; and IB-Hochschule (I.L.-S.), Stuttgart, Germany
| | - Kathrin Brockmann
- From the Hertie Institute for Clinical Brain Research (S.B., M.B., K.B., T.G., K.M., S.S., C.S., M.Z., D.B., I.L.-S.), Department of Neurodegenerative Diseases, University of Tübingen, Germany; Department of Psychology (S.B.), University of Calgary, AB, Canada; German Center for Neurodegenerative Diseases (DZNE) (M.B., K.B., T.G., K.M., S.S., C.S., M.Z., I.L.-S.), University of Tübingen; Diagnostics and Cognitive Neuropsychology (H.-C.N.), Department of Psychology, Eberhard Karls University Tübingen, Department of Neurology (W.M., D.B.), Christian-Albrechts-University, Kiel; and IB-Hochschule (I.L.-S.), Stuttgart, Germany
| | - Thomas Gasser
- From the Hertie Institute for Clinical Brain Research (S.B., M.B., K.B., T.G., K.M., S.S., C.S., M.Z., D.B., I.L.-S.), Department of Neurodegenerative Diseases, University of Tübingen, Germany; Department of Psychology (S.B.), University of Calgary, AB, Canada; German Center for Neurodegenerative Diseases (DZNE) (M.B., K.B., T.G., K.M., S.S., C.S., M.Z., I.L.-S.), University of Tübingen; Diagnostics and Cognitive Neuropsychology (H.-C.N.), Department of Psychology, Eberhard Karls University Tübingen, Department of Neurology (W.M., D.B.), Christian-Albrechts-University, Kiel; and IB-Hochschule (I.L.-S.), Stuttgart, Germany
| | - Katja Michaelis
- From the Hertie Institute for Clinical Brain Research (S.B., M.B., K.B., T.G., K.M., S.S., C.S., M.Z., D.B., I.L.-S.), Department of Neurodegenerative Diseases, University of Tübingen, Germany; Department of Psychology (S.B.), University of Calgary, AB, Canada; German Center for Neurodegenerative Diseases (DZNE) (M.B., K.B., T.G., K.M., S.S., C.S., M.Z., I.L.-S.), University of Tübingen; Diagnostics and Cognitive Neuropsychology (H.-C.N.), Department of Psychology, Eberhard Karls University Tübingen, Department of Neurology (W.M., D.B.), Christian-Albrechts-University, Kiel; and IB-Hochschule (I.L.-S.), Stuttgart, Germany
| | - Susanne Solbrig
- From the Hertie Institute for Clinical Brain Research (S.B., M.B., K.B., T.G., K.M., S.S., C.S., M.Z., D.B., I.L.-S.), Department of Neurodegenerative Diseases, University of Tübingen, Germany; Department of Psychology (S.B.), University of Calgary, AB, Canada; German Center for Neurodegenerative Diseases (DZNE) (M.B., K.B., T.G., K.M., S.S., C.S., M.Z., I.L.-S.), University of Tübingen; Diagnostics and Cognitive Neuropsychology (H.-C.N.), Department of Psychology, Eberhard Karls University Tübingen, Department of Neurology (W.M., D.B.), Christian-Albrechts-University, Kiel; and IB-Hochschule (I.L.-S.), Stuttgart, Germany
| | - Hans-Christoph Nuerk
- From the Hertie Institute for Clinical Brain Research (S.B., M.B., K.B., T.G., K.M., S.S., C.S., M.Z., D.B., I.L.-S.), Department of Neurodegenerative Diseases, University of Tübingen, Germany; Department of Psychology (S.B.), University of Calgary, AB, Canada; German Center for Neurodegenerative Diseases (DZNE) (M.B., K.B., T.G., K.M., S.S., C.S., M.Z., I.L.-S.), University of Tübingen; Diagnostics and Cognitive Neuropsychology (H.-C.N.), Department of Psychology, Eberhard Karls University Tübingen, Department of Neurology (W.M., D.B.), Christian-Albrechts-University, Kiel; and IB-Hochschule (I.L.-S.), Stuttgart, Germany
| | - Claudia Schulte
- From the Hertie Institute for Clinical Brain Research (S.B., M.B., K.B., T.G., K.M., S.S., C.S., M.Z., D.B., I.L.-S.), Department of Neurodegenerative Diseases, University of Tübingen, Germany; Department of Psychology (S.B.), University of Calgary, AB, Canada; German Center for Neurodegenerative Diseases (DZNE) (M.B., K.B., T.G., K.M., S.S., C.S., M.Z., I.L.-S.), University of Tübingen; Diagnostics and Cognitive Neuropsychology (H.-C.N.), Department of Psychology, Eberhard Karls University Tübingen, Department of Neurology (W.M., D.B.), Christian-Albrechts-University, Kiel; and IB-Hochschule (I.L.-S.), Stuttgart, Germany
| | - Walter Maetzler
- From the Hertie Institute for Clinical Brain Research (S.B., M.B., K.B., T.G., K.M., S.S., C.S., M.Z., D.B., I.L.-S.), Department of Neurodegenerative Diseases, University of Tübingen, Germany; Department of Psychology (S.B.), University of Calgary, AB, Canada; German Center for Neurodegenerative Diseases (DZNE) (M.B., K.B., T.G., K.M., S.S., C.S., M.Z., I.L.-S.), University of Tübingen; Diagnostics and Cognitive Neuropsychology (H.-C.N.), Department of Psychology, Eberhard Karls University Tübingen, Department of Neurology (W.M., D.B.), Christian-Albrechts-University, Kiel; and IB-Hochschule (I.L.-S.), Stuttgart, Germany
| | - Milan Zimmermann
- From the Hertie Institute for Clinical Brain Research (S.B., M.B., K.B., T.G., K.M., S.S., C.S., M.Z., D.B., I.L.-S.), Department of Neurodegenerative Diseases, University of Tübingen, Germany; Department of Psychology (S.B.), University of Calgary, AB, Canada; German Center for Neurodegenerative Diseases (DZNE) (M.B., K.B., T.G., K.M., S.S., C.S., M.Z., I.L.-S.), University of Tübingen; Diagnostics and Cognitive Neuropsychology (H.-C.N.), Department of Psychology, Eberhard Karls University Tübingen, Department of Neurology (W.M., D.B.), Christian-Albrechts-University, Kiel; and IB-Hochschule (I.L.-S.), Stuttgart, Germany
| | - Daniela Berg
- From the Hertie Institute for Clinical Brain Research (S.B., M.B., K.B., T.G., K.M., S.S., C.S., M.Z., D.B., I.L.-S.), Department of Neurodegenerative Diseases, University of Tübingen, Germany; Department of Psychology (S.B.), University of Calgary, AB, Canada; German Center for Neurodegenerative Diseases (DZNE) (M.B., K.B., T.G., K.M., S.S., C.S., M.Z., I.L.-S.), University of Tübingen; Diagnostics and Cognitive Neuropsychology (H.-C.N.), Department of Psychology, Eberhard Karls University Tübingen, Department of Neurology (W.M., D.B.), Christian-Albrechts-University, Kiel; and IB-Hochschule (I.L.-S.), Stuttgart, Germany
| | - Inga Liepelt-Scarfone
- From the Hertie Institute for Clinical Brain Research (S.B., M.B., K.B., T.G., K.M., S.S., C.S., M.Z., D.B., I.L.-S.), Department of Neurodegenerative Diseases, University of Tübingen, Germany; Department of Psychology (S.B.), University of Calgary, AB, Canada; German Center for Neurodegenerative Diseases (DZNE) (M.B., K.B., T.G., K.M., S.S., C.S., M.Z., I.L.-S.), University of Tübingen; Diagnostics and Cognitive Neuropsychology (H.-C.N.), Department of Psychology, Eberhard Karls University Tübingen, Department of Neurology (W.M., D.B.), Christian-Albrechts-University, Kiel; and IB-Hochschule (I.L.-S.), Stuttgart, Germany.
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6
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Becker S, Solbrig S, Michaelis K, Faust B, Brockmann K, Liepelt-Scarfone I. Divergence Between Informant and Self-Ratings of Activities of Daily Living Impairments in Parkinson’s Disease. Front Aging Neurosci 2022; 14:838674. [PMID: 35222002 PMCID: PMC8874137 DOI: 10.3389/fnagi.2022.838674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 01/21/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo examine the agreement between self- and informant-reported activities of daily living (ADL) deficits in Parkinson’s Disease (PD) patients, and to examine factors influencing ADL ratings.BackgroundIn PD, the loss of functional independence is an important outcome of disease progression. The valid assessment of ADL function in PD is essential, but it is unclear to what extent informants’ and patients’ perceptions of their daily functions concur, and how other factors may influence both ratings.MethodsData of 150 PD patients who underwent cognitive and motor testing, as well as their informants were analyzed. The 10-item Functional Activities Questionnaire (FAQ), completed separately by patients (FAQ-S) and their informants (FAQ-I), assessed ADL function. Weighted κ statistics summarized level of agreement, and a discrepancy score (FAQ-I – FAQ-S) quantified agreement. Correlation analyses between FAQ total scores, patient and informant characteristics, and cognitive scores were conducted, with post hoc regressions to determine the associations between both FAQ scores and cognition, independent of patient characteristics.ResultsThe sample included 87 patients with normal cognition, 50 with mild cognitive impairment, and 13 with dementia. Overall, there was fair to moderate agreement between patients and informants on individual FAQ items (0.27 ≤ κ ≤ 0.61, p < 0.004), with greater discrepancies with increasing cognitive impairment. Patients’ age, motor severity, non-motor burden, and depression also affected both ratings (0.27 ≤ r ≤ 0.50, p < 0.001), with motor severity showing the greatest influence on both ratings. Both the FAQ-I and FAQ-S were correlated with almost all cognitive domains. Post hoc regression analyses controlling for patient characteristics showed that the attention domain was a significant predictor of both the FAQ-S and FAQ-I scores, and memory was also a significant predictor of the FAQ-I score. Only 29.3% of patients agreed perfectly with informants on the FAQ total score, with informants most commonly rating ADL impairments as more severe than patients.ConclusionsPatient and informant ratings of ADL function using FAQ items showed moderate agreement, with only few items reaching substantial agreement. Ratings of both were associated with patient cognitive status, but also other characteristics. In addition to patient and informant reports, objective measures are needed to accurately classify ADL deficits in PD.
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Affiliation(s)
- Sara Becker
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- Department of Psychology, Faculty of Arts, University of Calgary, Calgary, AB, Canada
| | - Susanne Solbrig
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - Katja Michaelis
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - Bettina Faust
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - Kathrin Brockmann
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - Inga Liepelt-Scarfone
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
- Studienzentrum Stuttgart, IB Hochschule für Gesundheit und Soziales, Stuttgart, Germany
- *Correspondence: Inga Liepelt-Scarfone,
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8
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Pourzinal D, Yang JHJ, Bakker A, McMahon KL, Byrne GJ, Pontone GM, Mari Z, Dissanayaka NN. Hippocampal correlates of episodic memory in Parkinson's disease: A systematic review of magnetic resonance imaging studies. J Neurosci Res 2021; 99:2097-2116. [PMID: 34075634 DOI: 10.1002/jnr.24863] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/09/2021] [Accepted: 05/11/2021] [Indexed: 12/15/2022]
Abstract
The present review asks whether magnetic resonance imaging (MRI) studies are able to define neural correlates of episodic memory within the hippocampus in Parkinson's disease (PD). Systematic searches were performed in PubMed, Web of Science, Medline, CINAHL, and EMBASE using search terms related to structural and functional MRI (fMRI), the hippocampus, episodic memory, and PD. Risk of bias was assessed for each study using the Newtown-Ottawa Scale. Thirty-nine studies met inclusion criteria; eight fMRI, seven diffusion MRI (dMRI), and 24 structural MRI (14 exploring whole hippocampus and 10 exploring hippocampal subfields). Critical analysis of the literature revealed mixed evidence from functional and dMRI, but stronger evidence from sMRI of the hippocampus as a biomarker for episodic memory impairment in PD. Hippocampal subfield studies most often implicated CA1, CA3/4, and subiculum volume in episodic memory and cognitive decline in PD. Despite differences in imaging methodology, study design, and sample characteristics, MRI studies have helped elucidate an important neural correlate of episodic memory impairment in PD with both clinical and theoretical implications. Natural progression of this work encourages future research on hippocampal subfield function as a potential biomarker of, or therapeutic target for, episodic memory dysfunction in PD.
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Affiliation(s)
- Dana Pourzinal
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia
| | - Ji Hyun J Yang
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia
| | - Arnold Bakker
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA.,Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Katie L McMahon
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Gerard J Byrne
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia.,Mental Health Service, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia
| | - Gregory M Pontone
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA.,Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Zoltan Mari
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Nadeeka N Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia.,Department of Neurology, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia.,School of Psychology, The University of Queensland, Brisbane, QLD, Australia
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