1
|
Schejter‐Margalit T, Binyamin NB, Thaler A, Maidan I, Cedarbaum JM, Orr‐Urtreger A, Gana Weisz M, Goldstein O, Giladi N, Mirelman A, Kizony R. Validity of the Short Weekly Calendar Planning Activity in patients with Parkinson disease and nonmanifesting LRRK2 and GBA carriers. Eur J Neurol 2024; 31:e16327. [PMID: 38743695 PMCID: PMC11235808 DOI: 10.1111/ene.16327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 04/12/2024] [Accepted: 04/17/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND AND PURPOSE Subtle executive dysfunction is common in people newly diagnosed with Parkinson disease (PD), even when general cognitive abilities are intact. This study examined the Short Weekly Calendar Planning Activity (WCPA-10)'s known-group construct validity, comparing persons with PD to healthy controls (HCs) and nonmanifesting carriers of LRRK2 and GBA gene mutations to HCs. Additionally, convergent and ecological validity was examined. METHODS The study included 73 participants: 22 with idiopathic PD (iPD) who do not carry any of the founder GBA mutations or LRRK2-G2019S, 29 nonmanifesting carriers of the G2019S-LRRK2 (n = 14) and GBA (n = 15) mutations, and 22 HCs. Known-group validity was determined using the WCPA-10, convergent validity by also using the Montreal Cognitive Assessment (MoCA) and Color Trails Test (CTT), and ecological validity by using the WCPA-10, Schwab and England Activities of Daily Living Scale (SE ADL), and Physical Activity Scale for the Elderly (PASE). RESULTS Known-group validity of the WCPA-10 was established for the iPD group only; they followed fewer rules (p = 0.020), were slower (p = 0.003) and less efficient (p = 0.001), used more strategies (p = 0.017) on the WCPA-10, and achieved significantly lower CTT scores (p < 0.001) than the HCs. The nonmanifesting carriers and HCs were similar on all cognitive tests. Convergent and ecological validity of the WCPA-10 were partially established, with few correlations between WCPA-10 outcome measures and the MoCA (r = 0.50, r = 0.41), CTT-2 (r = 0.43), SE ADL (r = 0.41), and PASE (r = 0.54, r = 0.46, r = 0.31). CONCLUSIONS This study affirms the known-group validity for most (four) WCPA-10 scores and partially confirms its convergent and ecological validity for PD.
Collapse
Affiliation(s)
- Tamara Schejter‐Margalit
- Laboratory for Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition, and MobilityTel Aviv Sourasky Medical CenterTel AvivIsrael
- Occupational Therapy DepartmentUniversity of HaifaHaifaIsrael
| | | | - Avner Thaler
- Laboratory for Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition, and MobilityTel Aviv Sourasky Medical CenterTel AvivIsrael
- Faculty of Medicine and Sagol School of NeuroscienceTel Aviv UniversityTel AvivIsrael
| | - Inbal Maidan
- Laboratory for Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition, and MobilityTel Aviv Sourasky Medical CenterTel AvivIsrael
- Faculty of Medicine and Sagol School of NeuroscienceTel Aviv UniversityTel AvivIsrael
| | - Jesse M. Cedarbaum
- Yale University School of Medicine and Coeruleus Clinical SciencesWoodbridgeConnecticutUSA
| | - Avi Orr‐Urtreger
- Faculty of Medicine and Sagol School of NeuroscienceTel Aviv UniversityTel AvivIsrael
- Genomic Research Laboratory for NeurodegenerationTel Aviv Sourasky Medical CenterTel AvivIsrael
| | - Mali Gana Weisz
- Genomic Research Laboratory for NeurodegenerationTel Aviv Sourasky Medical CenterTel AvivIsrael
| | - Orly Goldstein
- Genomic Research Laboratory for NeurodegenerationTel Aviv Sourasky Medical CenterTel AvivIsrael
| | - Nir Giladi
- Laboratory for Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition, and MobilityTel Aviv Sourasky Medical CenterTel AvivIsrael
- Faculty of Medicine and Sagol School of NeuroscienceTel Aviv UniversityTel AvivIsrael
| | - Anat Mirelman
- Laboratory for Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition, and MobilityTel Aviv Sourasky Medical CenterTel AvivIsrael
- Faculty of Medicine and Sagol School of NeuroscienceTel Aviv UniversityTel AvivIsrael
| | - Rachel Kizony
- Occupational Therapy DepartmentUniversity of HaifaHaifaIsrael
- Occupational TherapySheba Medical CenterTel HashomerIsrael
| |
Collapse
|
2
|
Stamatelos P, Economou A, Yannis G, Stefanis L, Papageorgiou SG. Parkinson's Disease and Driving Fitness: A Systematic Review of the Existing Guidelines. Mov Disord Clin Pract 2024; 11:198-208. [PMID: 38164044 PMCID: PMC10928339 DOI: 10.1002/mdc3.13942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 09/21/2023] [Accepted: 11/05/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Motor/nonmotor symptomatology and antiparkinsonian drugs deteriorate the driving ability of Parkinson's disease (PD) patients. OBJECTIVES Treating neurologists are frequently asked to evaluate driving fitness of their patients and provide evidence-based consultation. Although several guidelines have been published, the exact procedure along with the neurologist's role in this procedure remains obscure. METHODS We systematically reviewed the existing guidelines, regarding driving fitness evaluation of PD patients. We searched MEDLINE and Google Scholar and identified 109 articles. After specified inclusion criteria were applied, 15 articles were included (nine national guidelines, five recommendation papers, and one consensus statement). RESULTS The treating physician is proposed as the initial evaluator in 8 of 15 articles (neurologist in 2 articles) and may refer patients for a second-line evaluation. The evaluation should include motor, cognitive, and visual assessment (proposed in 15, 13, and 8 articles, respectively). Specific motor tests are proposed in eight articles (cutoff values in four), whereas specific neuropsychological and visual tests are proposed in seven articles each (cutoff values in four and three articles, respectively). Conditional licenses are proposed in 11 of 15 articles, to facilitate driving for PD patients. We summarized our findings on a graphic of the procedure for driving fitness evaluation of PD patients. CONCLUSIONS Neurological aspects of driving fitness evaluation of PD patients are recognized in most of the guidelines. Motor, neuropsychological, visual, and sleep assessment and medication review are key components. Clear-cut instructions regarding motor, neuropsychological, and visual tests and relative cutoff values are lacking. Conditional licenses and periodical reevaluation of driving fitness are important safety measures.
Collapse
Affiliation(s)
- Petros Stamatelos
- 1st Department of NeurologyMedical School, National and Kapodistrian University of Athens, Eginition HospitalAthensGreece
| | - Alexandra Economou
- Department of PsychologyNational and Kapodistrian University of AthensAthensGreece
| | - George Yannis
- Department of Transportation Planning and EngineeringSchool of Civil Engineering, National Technical University of AthensAthensGreece
| | - Leonidas Stefanis
- 1st Department of NeurologyMedical School, National and Kapodistrian University of Athens, Eginition HospitalAthensGreece
| | - Sokratis G. Papageorgiou
- 1st Department of NeurologyMedical School, National and Kapodistrian University of Athens, Eginition HospitalAthensGreece
| |
Collapse
|
3
|
Makhoul K, Jankovic J. Driving Impairment in Movement Disorders. Mov Disord Clin Pract 2023; 10:369-381. [PMID: 36949799 PMCID: PMC10026316 DOI: 10.1002/mdc3.13676] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 12/22/2022] [Accepted: 12/29/2022] [Indexed: 01/29/2023] Open
Abstract
Background Driving may be adversely affected by any movement disorder, but has been mostly studied in Parkinson's disease (PD). Few studies have addressed driving impairment in patients with Huntington's disease (HD); driving in other movement disorders such as dystonia, blepharospasm and Tourette syndrome (TS) has not been adequately evaluated. Objectives The aim of this review is to summarize the findings of driving impairment in movement disorders and evaluate the usefulness of clinical tools in guiding clinicians whether to refer patients for driving assessment. Methods A review of literature was performed on PubMed and articles on driving and movement disorders were identified using a Boolean phrase. Results We were able to identify 66 articles that fulfilled the target subject: impairment of driving in PD, cervical dystonia, blepharospasm, HD and TS. We also included articles discussing the role of driving rehabilitation in patients with movement disorders. Conclusions Driving is often impaired in patients with PD and other movement disorders not only due to motor symptoms but also because of cognitive and behavioral co-morbidities. Certain screening tools may be helpful in guiding the clinician in referring the patients for driving assessment.
Collapse
Affiliation(s)
- Karim Makhoul
- Parkinson's Disease Center and Movement Disorders Clinic, Department of NeurologyBaylor College of MedicineHoustonTexasUSA
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of NeurologyBaylor College of MedicineHoustonTexasUSA
| |
Collapse
|
4
|
Beavan A, Spielmann J, Ehmann P, Mayer J. The Development of Executive Functions in High-Level Female Soccer Players. Percept Mot Skills 2022; 129:1036-1052. [PMID: 35521695 DOI: 10.1177/00315125221096989] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Executive functions (EFs) are higher-level cognitive functions that help keep an individual's goal-oriented thoughts and actions aligned. While many studies have shown the importance of EFs in sport, a limitation in this literature is that female participants have been underrepresented. In this mixed-longitudinal study, we examined the development of EFs in a cohort of high performing female athletes. We collected data over five seasons in a large sample of 175 female soccer players (aged 12-29 years old) from the U14 - senior age groups of a professional German soccer club. Players undertook a large battery of cognitive tasks aimed at measuring higher-level cognitive functioning: a sustained attention task, a stop-signal task, a Go-No-go test, an N-Back Test, and both a 180°- and 360°-multiple-object tracking task. We used linear and non-linear mixed effect regressions to examine the relationship between age and EFs. Second order polynomial curves explained many of these relationships between age and EFs compared to their linear relationships. Negatively accelerated curves reveal that these players' cognitive abilities mainly developed before players reached early adulthood, with a performance plateau evident at around 21 years of age. Age explained low to moderate proportions of the variance in EFs (<1-50%), while cognitive development across playing positions was not a strong contributor to this variance (M = 2.1, SD = 2.1%). We concluded that age has a negatively accelerated relationship with EFs in female soccer players that does not differ between playing positions. These data support the idea that athletes require only a reasonable level of EF ability to perform at the highest level of their sport. Our research raises new questions regarding the validity of current EF measurement methods for inferring information about in-game use of these cognitive abilities.
Collapse
Affiliation(s)
| | - Jan Spielmann
- TSG ResearchLab gGmbH, Zuzenhausen, Germany.,Institute of Sports Science, Saarland University, Saarbrücken, Germany
| | - Paul Ehmann
- TSG ResearchLab gGmbH, Zuzenhausen, Germany.,153707Institute of Psychology, Goethe University Frankfurt, Frankfurt, Germany
| | - Jan Mayer
- TSG ResearchLab gGmbH, Zuzenhausen, Germany.,Institute of Sports Science, Saarland University, Saarbrücken, Germany
| |
Collapse
|
5
|
Kay KR, Uc EY. Real-life consequences of cognitive dysfunction in Parkinson's disease. PROGRESS IN BRAIN RESEARCH 2022; 269:113-136. [DOI: 10.1016/bs.pbr.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
6
|
Paire-Ficout L, Lafont S, Hay M, Coquillat A, Fabrigoule C, Chavoix C. Relationships Between Cognitive and Driving Self-awareness in Older Drivers. J Gerontol B Psychol Sci Soc Sci 2021; 76:1077-1085. [PMID: 33315101 DOI: 10.1093/geronb/gbaa224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Many older drivers incorrectly estimate their driving ability. The present study aimed to determine whether, and if so, to what extent unawareness of cognitive abilities affects self-awareness of driving ability. METHOD Two successive studies were conducted in older drivers. A cohort study investigated cognitive self-awareness and an experimental study examined driving self-awareness. In each one, self-awareness was assessed by cross-analyzing objective (respectively Trail-Making Tests A and B and the Digit Symbol Substitution Test and driving performance of on-road assessment) and subjective data (responses about everyday cognitive skills and driving ability). Older drivers were then classified as being over-, correct, or underestimators. The 3 cognitive and driving self-awareness profiles were then cross-analyzed. RESULTS In the cohort study, 1,190 drivers aged 70 years or older were included. The results showed that 42.7% of older drivers overestimated their cognitive ability, 42.2% estimated it correctly, and 15.1% underestimated it. The experimental study included 145 participants from the cohort. The results showed that 34% of participants overestimated, 45% correctly estimated, and 21% underestimated their driving ability. There was a significant relationship between cognitive and driving self-awareness profiles (p = .02). This overlap was more marked in overestimators. DISCUSSION Significant overlap between cognitive and driving self-awareness provides useful and new knowledge about driving in the aging population. Misestimation of cognitive ability could hamper self-awareness of driving ability, and consequently self-regulation of driving. It is now crucial to develop measures that promote self-awareness of ability.
Collapse
Affiliation(s)
| | - Sylviane Lafont
- Université de Lyon, University Gustave Eiffel, UMRESTTE, UMR_T9405, Bron, France
| | - Marion Hay
- Normandie Université, UNICAEN, INSERM, COMETE, Caen, France
| | - Amandine Coquillat
- Université de Lyon, University Gustave Eiffel, UMRESTTE, UMR_T9405, Bron, France
| | | | | |
Collapse
|
7
|
Abstract
Driving is impaired in most patients with Parkinson disease because of motor, cognitive, and visual dysfunction. Driving impairments in Parkinson disease may increase the risk of crashes and result in early driving cessation with loss of independence. Drivers with Parkinson disease should undergo comprehensive evaluations to determine fitness to drive with periodic follow-up evaluations as needed. Research in rehabilitation of driving and automation to maintain independence of patients with Parkinson disease is in progress.
Collapse
Affiliation(s)
- Maud Ranchet
- Laboratoire Ergonomie Sciences Cognitives pour les Transports (LESCOT), IFSTTAR (Institut Français des Sciences et Technologies des Transports, de l'Aménagement et des Réseaux), 25, Avenue François Mitterrand, Case 24, Cité des Mobilités, Lyon, Bron F-69675, France
| | - Hannes Devos
- Department of Physical Therapy and Rehabilitation Science, Kansas University, KU Medical Center, 3901 Rainbow Boulevard/MS2002, Kansas City, KS 66160, USA
| | - Ergun Y Uc
- Department of Neurology, University of Iowa, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA; Neurology Service, Veterans Affairs Medical Center, 601 Highway 6 W, Iowa City, IA 52246, USA.
| |
Collapse
|
8
|
Ando R, Iwaki H, Tsujii T, Nagai M, Nishikawa N, Yabe H, Aiba I, Hasegawa K, Tsuboi Y, Aoki M, Nakashima K, Nomoto M. The Clinical Findings Useful for Driving Safety Advice for Parkinson's Disease Patients. Intern Med 2018; 57:1977-1982. [PMID: 29491315 PMCID: PMC6096020 DOI: 10.2169/internalmedicine.9653-17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective We conducted a study to obtain information that could be used to provide Parkinson's disease (PD) patients with appropriate advice on safe driving. Methods Consecutive PD patients who visited our office were studied. Among these patients, those who had experienced driving after being diagnosed with PD were interviewed by neurologists and a trained nurse to investigate their previous car accidents, motor function, cognitive function, sleepiness, levodopa equivalent dose (LED), and emotional dysregulation. The rates of major car accidents before and after the onset of PD were compared. Results Fifteen patients had experienced a major car accident resulting in human injury or serious property damage since the onset of PD. When the rates of major car accidents before and after the onset of PD were compared, the ratio was 4.3 [95% confidence interval (CI) 1.9-9.7]. The incidence of accidents after the onset of PD was correlated with age, disease duration, LED, the cognitive function Mini-Mental Scale Examination (MMSE), Japanese translation of the Montreal Cognitive Assessment (MoCA-J), but not the motor symptom score [Unified Pankinson's disease rating scale (UPDRS) part III at the time of the study]. The Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease (QUIP) score was also higher in patients with major car accidents. Conclusion The severity of symptoms (Hoehn-Yahr classification), cognitive function, and disease duration were expected to be risk factors for car accidents. However, the motor symptom score (UPDRS part III) was not associated with the incidence of major car accidents. In addition to a low cognitive function and the severity of symptoms, the QUIP score might be an independent factor that can be referenced when advising PD patients to refrain from driving.
Collapse
Affiliation(s)
- Rina Ando
- Department of Neurology and Clinical Pharmacology, Ehime University Graduate School of Medicine, Japan
| | - Hirotaka Iwaki
- Department of Neurology and Clinical Pharmacology, Ehime University Graduate School of Medicine, Japan
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, USA
| | - Tomoaki Tsujii
- Department of Neurology and Clinical Pharmacology, Ehime University Graduate School of Medicine, Japan
| | - Masahiro Nagai
- Department of Neurology and Clinical Pharmacology, Ehime University Graduate School of Medicine, Japan
| | - Noriko Nishikawa
- Department of Neurology and Clinical Pharmacology, Ehime University Graduate School of Medicine, Japan
| | - Hayato Yabe
- Department of Neurology and Clinical Pharmacology, Ehime University Graduate School of Medicine, Japan
| | - Ikuko Aiba
- Department of Neurology, Higashi Nagoya Hospital, Japan
| | - Kazuko Hasegawa
- Department of Neurology, Sagamihara National Hospital, Japan
| | | | - Masashi Aoki
- Department of Neurology, Tohoku University School of Medicine, Japan
| | - Kenji Nakashima
- Department of Neurology, Tottori University Faculty of Medicine, Japan
| | - Masahiro Nomoto
- Department of Neurology and Clinical Pharmacology, Ehime University Graduate School of Medicine, Japan
| |
Collapse
|
9
|
Hird MA, Vesely KA, Tasneem T, Saposnik G, Macdonald RL, Schweizer TA. A Case-Control Study Investigating Simulated Driving Errors in Ischemic Stroke and Subarachnoid Hemorrhage. Front Neurol 2018; 9:54. [PMID: 29487561 PMCID: PMC5816745 DOI: 10.3389/fneur.2018.00054] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 01/22/2018] [Indexed: 01/13/2023] Open
Abstract
Background Stroke can affect a variety of cognitive, perceptual, and motor abilities that are important for safe driving. Results of studies assessing post-stroke driving ability are quite variable in the areas and degree of driving impairment among patients. This highlights the need to consider clinical characteristics, including stroke subtype, when assessing driving performance. Methods We compared the simulated driving performance of 30 chronic stroke patients (>3 months), including 15 patients with ischemic stroke (IS) and 15 patients with subarachnoid hemorrhage (SAH), and 20 age-matched controls. A preliminary analysis was performed, subdividing IS patients into right (n = 8) and left (n = 6) hemispheric lesions and SAH patients into middle cerebral artery (MCA, n = 5) and anterior communicating artery (n = 6) territory. A secondary analysis was conducted to investigate the cognitive correlates of driving. Results Nine patients (30%) exhibited impaired simulated driving performance, including four patients with IS (26.7%) and five patients with SAH (33.3%). Both patients with IS (2.3 vs. 0.3, U = 76, p < 0.05) and SAH (1.5 vs. 0.3, U = 45, p < 0.001) exhibited difficulty with lane maintenance (% distance out of lane) compared to controls. In addition, patients with IS exhibited difficulty with speed maintenance (% distance over speed limit; 8.9 vs. 4.1, U = 81, p < 0.05), whereas SAH patients exhibited difficulty with turning performance (total turning errors; 5.4 vs. 1.6, U = 39.5, p < 0.001). The Trail Making Test (TMT) and Useful Field of View test were significantly associated with lane maintenance among patients with IS (rs > 0.6, p < 0.05). No cognitive tests showed utility among patients with SAH. Conclusion Both IS and SAH exhibited difficulty with lane maintenance. Patients with IS additionally exhibited difficulty with speed maintenance, whereas SAH patients exhibited difficulty with turning performance. Current results support the importance of differentiating between stroke subtypes and considering other important clinical characteristics (e.g., side of lesion, vascular territory) when assessing driving performance and reinforce the importance of physicians discussing driving safety with patients after stroke.
Collapse
Affiliation(s)
- Megan A Hird
- Neuroscience Research Program, Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | - Kristin A Vesely
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada
| | - Tahira Tasneem
- Neuroscience Research Program, Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | - Gustavo Saposnik
- Neuroscience Research Program, Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada.,Stroke Research Unit, Mobility Program, St. Michael's Hospital, Toronto, ON, Canada.,Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - R Loch Macdonald
- Neuroscience Research Program, Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada.,Department of Surgery, Neurosurgery Division, University of Toronto, Toronto, ON, Canada
| | - Tom A Schweizer
- Neuroscience Research Program, Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada.,Department of Surgery, Neurosurgery Division, University of Toronto, Toronto, ON, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
10
|
Uc EY, Rizzo M, O'Shea AMJ, Anderson SW, Dawson JD. Longitudinal decline of driving safety in Parkinson disease. Neurology 2017; 89:1951-1958. [PMID: 29021353 DOI: 10.1212/wnl.0000000000004629] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 08/23/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To longitudinally assess and predict on-road driving safety in Parkinson disease (PD). METHODS Drivers with PD (n = 67) and healthy controls (n = 110) drove a standardized route in an instrumented vehicle and were invited to return 2 years later. A professional driving expert reviewed drive data and videos to score safety errors. RESULTS At baseline, drivers with PD performed worse on visual, cognitive, and motor tests, and committed more road safety errors compared to controls (median PD 38.0 vs controls 30.5; p < 0.001). A smaller proportion of drivers with PD returned for repeat testing (42.8% vs 62.7%; p < 0.01). At baseline, returnees with PD made fewer errors than nonreturnees with PD (median 34.5 vs 40.0; p < 0.05) and performed similar to control returnees (median 33). Baseline global cognitive performance of returnees with PD was better than that of nonreturnees with PD, but worse than for control returnees (p < 0.05). After 2 years, returnees with PD showed greater cognitive decline and larger increase in error counts than control returnees (median increase PD 13.5 vs controls 3.0; p < 0.001). Driving error count increase in the returnees with PD was predicted by greater error count and worse visual acuity at baseline, and by greater interval worsening of global cognition, Unified Parkinson's Disease Rating Scale activities of daily living score, executive functions, visual processing speed, and attention. CONCLUSIONS Despite drop out of the more impaired drivers within the PD cohort, returning drivers with PD, who drove like controls without PD at baseline, showed many more driving safety errors than controls after 2 years. Driving decline in PD was predicted by baseline driving performance and deterioration of cognitive, visual, and functional abnormalities on follow-up.
Collapse
Affiliation(s)
- Ergun Y Uc
- From the Departments of Neurology (E.Y.U., M.R., S.W.A.) and Biostatistics (A.M.J.O., J.D.D.), University of Iowa; Neurology Service (E.Y.U.) and Comprehensive Access and Delivery Research & Evaluation (A.M.J.O.), Veterans Affairs Medical Center, Iowa City, IA; and Department of Neurology (M.R.), University of Nebraska, Omaha.
| | - Matthew Rizzo
- From the Departments of Neurology (E.Y.U., M.R., S.W.A.) and Biostatistics (A.M.J.O., J.D.D.), University of Iowa; Neurology Service (E.Y.U.) and Comprehensive Access and Delivery Research & Evaluation (A.M.J.O.), Veterans Affairs Medical Center, Iowa City, IA; and Department of Neurology (M.R.), University of Nebraska, Omaha
| | - Amy M J O'Shea
- From the Departments of Neurology (E.Y.U., M.R., S.W.A.) and Biostatistics (A.M.J.O., J.D.D.), University of Iowa; Neurology Service (E.Y.U.) and Comprehensive Access and Delivery Research & Evaluation (A.M.J.O.), Veterans Affairs Medical Center, Iowa City, IA; and Department of Neurology (M.R.), University of Nebraska, Omaha
| | - Steven W Anderson
- From the Departments of Neurology (E.Y.U., M.R., S.W.A.) and Biostatistics (A.M.J.O., J.D.D.), University of Iowa; Neurology Service (E.Y.U.) and Comprehensive Access and Delivery Research & Evaluation (A.M.J.O.), Veterans Affairs Medical Center, Iowa City, IA; and Department of Neurology (M.R.), University of Nebraska, Omaha
| | - Jeffrey D Dawson
- From the Departments of Neurology (E.Y.U., M.R., S.W.A.) and Biostatistics (A.M.J.O., J.D.D.), University of Iowa; Neurology Service (E.Y.U.) and Comprehensive Access and Delivery Research & Evaluation (A.M.J.O.), Veterans Affairs Medical Center, Iowa City, IA; and Department of Neurology (M.R.), University of Nebraska, Omaha
| |
Collapse
|
11
|
Jacobs M, Hart EP, Roos RAC. Driving with a neurodegenerative disorder: an overview of the current literature. J Neurol 2017; 264:1678-1696. [PMID: 28424901 PMCID: PMC5533843 DOI: 10.1007/s00415-017-8489-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 04/06/2017] [Accepted: 04/06/2017] [Indexed: 11/06/2022]
Abstract
Driving is important for employment, social activities, and for the feeling of independence. The decision to cease driving affects the quality of life and has been associated with reduced mobility, social isolation, and sadness. Patients with neurodegenerative disorders can experience difficulties while driving due to their cognitive, motor, and behavioral impairments. The aim of this review is to summarize the available literature on changes in driving competence and behavior in patients with neurodegenerative disorders, with a particular focus on Huntington's (HD), Parkinson's (PD), and Alzheimer's disease (AD). A systematic literature search was conducted in the PubMed/Medline database. Studies using on-road or simulated driving assessments were examined in this review. In addition, studies investigating the association between cognitive functioning and driving were included. The review identified 70 studies. Only a few publications were available on HD (n = 7) compared to PD (n = 32) and AD (n = 31). This review revealed that driving is impaired in patients with neurodegenerative disorders on all levels of driving competence. The errors most commonly committed were on the tactical level including lane maintenance and lane changing. Deficits in executive functioning, attention, and visuospatial abilities can partially predict driving competence, and the performance on neuropsychological tests might be useful when discussing potential driving cessation. Currently, there is no gold standard to assess driving ability using clinical measures such as neuropsychological assessments, so more studies are necessary to detect valid screening tools and develop useful and reliable evidence-based guidelines.
Collapse
Affiliation(s)
- Milou Jacobs
- Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Ellen P Hart
- Center for Human Drug Research, Leiden, The Netherlands
| | - Raymund A C Roos
- Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| |
Collapse
|
12
|
Manza P, Amandola M, Tatineni V, Li CSR, Leung HC. Response inhibition in Parkinson's disease: a meta-analysis of dopaminergic medication and disease duration effects. NPJ Parkinsons Dis 2017; 3:23. [PMID: 28702504 PMCID: PMC5501877 DOI: 10.1038/s41531-017-0024-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 06/07/2017] [Accepted: 06/16/2017] [Indexed: 12/24/2022] Open
Abstract
Parkinson's disease is a neurodegenerative disorder involving the basal ganglia that results in a host of motor and cognitive deficits. Dopamine-replacement therapy ameliorates some of the hallmark motor symptoms of Parkinson's disease, but whether these medications improve deficits in response inhibition, a critical executive function for behavioral control, has been questioned. Several studies of Parkinson's disease patients "on" and "off" (12-h withdrawal) dopaminergic medications suggested that dopamine-replacement therapy did not provide significant response inhibition benefits. However, these studies tended to include patients with moderate-to-advanced Parkinson's disease, when the efficacy of dopaminergic drugs is reduced compared to early-stage Parkinson's disease. In contrast, a few recent studies in early-stage Parkinson's disease report that dopaminergic drugs do improve response inhibition deficits. Based on these findings, we hypothesized that Parkinson's disease duration interacts with medication status to produce changes in cognitive function. To investigate this issue, we conducted a meta-analysis of studies comparing patients with Parkinson's disease and healthy controls on tests of response inhibition (50 comparisons from 42 studies). The findings supported the hypothesis; medication benefited response inhibition in patients with shorter disease duration, whereas "off" medication, moderate deficits were present that were relatively unaffected by disease duration. These findings support the role of dopamine in response inhibition and suggest the need to consider disease duration in research of the efficacy of dopamine-replacement therapy on cognitive function in Parkinson's disease.
Collapse
Affiliation(s)
- Peter Manza
- Department of Psychology, Stony Brook University, Stony Brook, NY 11790 USA
| | - Matthew Amandola
- Department of Psychology, Stony Brook University, Stony Brook, NY 11790 USA
| | | | - Chiang-shan R. Li
- Department of Psychiatry, Yale University, New Haven, CT 06519 USA
- Department of Neuroscience, Yale University, New Haven, CT 06520 USA
- Interdepartmental Neuroscience Program, Yale University, New Haven, CT 06520 USA
- Beijing Huilongguan Hospital, Beijing, China
| | - Hoi-Chung Leung
- Department of Psychology, Stony Brook University, Stony Brook, NY 11790 USA
| |
Collapse
|
13
|
Ranchet M, Orlosky J, Morgan J, Qadir S, Akinwuntan AE, Devos H. Pupillary response to cognitive workload during saccadic tasks in Parkinson's disease. Behav Brain Res 2017; 327:162-166. [PMID: 28366772 DOI: 10.1016/j.bbr.2017.03.043] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 03/24/2017] [Accepted: 03/27/2017] [Indexed: 11/17/2022]
Abstract
The relationship between cognitive workload and cognitive impairments in Parkinson's disease (PD) is currently not well known. This study compared cognitive workload during saccadic tasks between patients with PD and controls. Sixteen controls, 11 patients with no obvious cognitive impairment (PD-NCI) (MOCA score≥26), and 10 PD patients with cognitive impairment (PD-CI) (MOCA score<26) performed prosaccade and antisaccade tasks. Cognitive workload, extracted via pupil recording, and other eye metrics were compared between the three groups. PD-NCI patients exhibited greater cognitive workload than controls in the prosaccade task. PD-CI patients also showed more cognitive workload in the prosaccade task than PD-NCI patients and controls. No other differences in eye metrics were found between the three groups. Cognitive workload could be used to differentiate between different cognitive states in PD. The causal relationship between increased cognitive workload and cognitive decline in PD-NCI should be the focus of future studies.
Collapse
Affiliation(s)
- M Ranchet
- Department of Physical Therapy, College of Allied Health Sciences, Augusta University, Augusta, GA, USA; University of Lyon, F-69000 Lyon, France; French Institute of Science and Technology for Transport, Development and Networks (IFSTTAR), TS2, LESCOT, F-69500 Bron, France.
| | - J Orlosky
- Cybermedia Center, Toyonaka Educational Research Center 5F, Osaka University, 1-32 Machikaneyama, Toyonaka, Osaka 560-0043, Japan
| | - J Morgan
- Movement and Cognitive Disorders Center, Department of Neurology, Augusta University, GA, USA
| | - S Qadir
- Medical College of Georgia, Augusta University, GA, USA
| | - A E Akinwuntan
- Department of Physical Therapy, College of Allied Health Sciences, Augusta University, Augusta, GA, USA; Dean's Office, School of Health Professions, The University of Kansas Medical Center, Kansas City, KS, USA
| | - H Devos
- Department of Physical Therapy, College of Allied Health Sciences, Augusta University, Augusta, GA, USA; Department of Physical Therapy and Rehabilitation Science, School of Health Professions, The University of Kansas Medical Center, Kansas City, KS, USA
| |
Collapse
|
14
|
Paire-Ficout L, Marin-Lamellet C, Lafont S, Thomas-Antérion C, Laurent B. The role of navigation instruction at intersections for older drivers and those with early Alzheimer's disease. ACCIDENT; ANALYSIS AND PREVENTION 2016; 96:249-254. [PMID: 27552136 DOI: 10.1016/j.aap.2016.08.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 07/06/2016] [Accepted: 08/11/2016] [Indexed: 06/06/2023]
Abstract
AIMS Our purpose was to explore the effect of navigation instruction on older drivers' driving performance at left turn intersections. Left turns at intersections are particularly complex because they require many perceptive and cognitive abilities under considerable time pressure. METHODS Fifty-four participants were recruited: 18 drivers with early-stage Alzheimer's disease (AD), 18 neurologically healthy older drivers and 18 younger individuals. Various cognitive processes were measured, and 9 left turn maneuvers with or without navigation instruction were evaluated during an in-traffic road test. The psychomotor, planning and decision-making components involved in left turn were also analyzed closely. RESULTS Only older drivers (both healthy drivers and those with AD) were negatively affected by navigation instruction during the maneuver. The planning and decision-making components were more likely to be affected by the navigation instruction. CONCLUSION This finding highlights the importance of carefully considering the use of navigation instructions when developing navigation systems. Adapting this instruction is necessary to simplify our understanding of the real-world driving environment and to avoid increasing the cognitive load of older drivers.
Collapse
|
15
|
Jitkritsadakul O, Bhidayasiri R. Physicians' role in the determination of fitness to drive in patients with Parkinson's disease: systematic review of the assessment tools and a call for national guidelines. JOURNAL OF CLINICAL MOVEMENT DISORDERS 2016; 3:14. [PMID: 27729986 PMCID: PMC5048693 DOI: 10.1186/s40734-016-0043-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 09/06/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Physicians are usually at the forefront when the issue of driving ability is raised by Parkinson's disease (PD) patients or their family members, even though few have been formally trained in this area. OBJECTIVES AND METHODS To identify relevant literature on driving assessment tools in patients with PD by performing a systematic review on this subject in order to provide background information for physicians on what types of driving assessment are available, and to delineate the role of physicians in providing fitness to drive recommendations. RESULTS Of 1,490 abstracts screened, 55 articles fulfilled the selection criteria that investigated assessment of driving ability in PD patients with questionnaires, off-road testing battery, driving simulators, and driving skill tests (on-road tests and naturalistic driving test). Despite different methodology across studies, PD patients were observed to commit more driving errors than controls. Poor driving performance correlated with motor, visual, and cognitive severity. Excessive daytime somnolence was common in PD drivers and the presence of falling asleep while driving was identified to be a significant predictor of car accidents. CONCLUSION Although the evidence indicated more driving errors among PD drivers as identified by various assessment tools, the extent on how physicians should be involved in the evaluation process and make related recommendations remain unclear. Driving safety is an important public health issue in PD that needs better-defined specific legal and medical guidelines. National guidelines that establish risk assessment protocols involving multidisciplinary assessments are needed to assist physicians in making appropriate referrals for additional evaluations and recommendations when patients are deemed to be unsafe drivers.
Collapse
Affiliation(s)
- Onanong Jitkritsadakul
- Chulalongkorn Center of Excellence for Parkinson Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama 4 Road, Bangkok, 10330 Thailand
| | - Roongroj Bhidayasiri
- Chulalongkorn Center of Excellence for Parkinson Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama 4 Road, Bangkok, 10330 Thailand
- Department of Rehabilitation Medicine, Juntendo University, Tokyo, Japan
| |
Collapse
|
16
|
Devos H, Ranchet M, Emmanuel Akinwuntan A, Uc EY. Establishing an evidence-base framework for driving rehabilitation in Parkinson's disease: A systematic review of on-road driving studies. NeuroRehabilitation 2016; 37:35-52. [PMID: 26409692 DOI: 10.3233/nre-151239] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Individuals with Parkinson's disease (PD) experience problems with on-road driving that can be targeted in driving rehabilitation programs. OBJECTIVE To provide a framework for driving rehabilitation in PD by identifying the critical on-road driving impairments and their associated visual, cognitive, and motor deficits. METHODS We conducted a systematic review of the literature on on-road driving and naturalistic driving practices in PD. Relevant databases including Pubmed, Medline, PsychINFO, ISI Web of Science, Cochrane library, and ClinicalTrials.gov, were reviewed using the key words Parkinson's disease, on-road driving, naturalistic driving, and their related entry words. On-road driving skills were mapped onto an existing theoretic model of operational, tactical, and strategic levels. The on-road and off-road cognitive, motor, and visual predictors of global on-road driving were summarized. RESULTS Twenty-seven studies were included. All but one study were prospective and Class II studies according to the American Academy of Neurology Classification Criteria. Participants were on average 68 years old and in the mild to moderate stages of PD. Drivers with PD were more likely to fail a driving assessment compared to age- and gender-matched controls. Compared with controls, drivers with PD experienced difficulties on all levels of driving skill. However, the compensation strategies on the strategic level showed that drivers with PD were aware of their diminished driving skills on the operational and strategic levels. Operational and tactical on-road driving skills best predicted global on-road driving. A combination of visual, cognitive, and motor deficits underlie impaired on-road driving performance in PD. CONCLUSION Driving rehabilitation strategies for individuals with PD should include training of operational and tactical driving skills or indirect comprehensive training program of visual, cognitive, and motor skills.
Collapse
Affiliation(s)
- Hannes Devos
- Department of Physical Therapy, College of Allied Health Sciences, Georgia Regents University, Augusta, GA, USA
| | - Maud Ranchet
- Department of Physical Therapy, College of Allied Health Sciences, Georgia Regents University, Augusta, GA, USA
| | - Abiodun Emmanuel Akinwuntan
- Department of Physical Therapy, College of Allied Health Sciences, Georgia Regents University, Augusta, GA, USA
| | - Ergun Y Uc
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.,Neurology Service, Veterans Affairs Medical Center, Iowa City, IA, USA
| |
Collapse
|
17
|
Vardaki S, Devos H, Beratis I, Yannis G, Papageorgiou SG. Exploring the association between working memory and driving performance in Parkinson's disease. TRAFFIC INJURY PREVENTION 2016; 17:359-366. [PMID: 26376369 DOI: 10.1080/15389588.2015.1091926] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The aim of this study was to explore whether varying levels of operational and tactical driving task demand differentially affect drivers with Parkinson's disease (PD) and control drivers in their sign recall. METHODS Study participants aged between 50 and 70 years included a group of drivers with PD (n = 10) and a group of age- and sex-matched control drivers (n = 10). Their performance in a sign recall task was measured using a driving simulator. RESULTS Drivers in the control group performed better than drivers with PD in a sign recall task, but this trend was not statistically significant (P =.43). In addition, regardless of group membership, subjects' performance differed according to varying levels of task demand. Performance in the sign recall task was more likely to drop with increasing task demand (P =.03). This difference was significant when the variation in task demand was associated with a cognitive task; that is, when drivers were required to apply the instructions from working memory. CONCLUSIONS Although the conclusions drawn from this study are tentative, the evidence presented here is encouraging with regard to the use of a driving simulator to examine isolated cognitive functions underlying driving performance in PD. With an understanding of its limitations, such driving simulation in combination with functional assessment batteries measuring physical, visual, and cognitive abilities could comprise one component of a multitiered system to evaluate medical fitness to drive.
Collapse
Affiliation(s)
- Sophia Vardaki
- a Department of Transportation Planning and Engineering , School of Civil Engineering, National Technical University of Athens , Athens , Greece
| | - Hannes Devos
- b Department of Physical Therapy , Georgia Regents University , Augusta , Georgia
| | - Ion Beratis
- c Department of Neurology , ATTIKON General University Hospital, Medical School, University of Athens , Athens , Greece
| | - George Yannis
- a Department of Transportation Planning and Engineering , School of Civil Engineering, National Technical University of Athens , Athens , Greece
| | - Sokratis G Papageorgiou
- c Department of Neurology , ATTIKON General University Hospital, Medical School, University of Athens , Athens , Greece
| |
Collapse
|
18
|
Ranchet M, Tant M, Akinwuntan AE, Neal E, Devos H. Comorbidity in Drivers with Parkinson's Disease. J Am Geriatr Soc 2016; 64:342-6. [DOI: 10.1111/jgs.13942] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Maud Ranchet
- Department of Physical Therapy; College of Allied Health Sciences; Augusta University; Augusta Georgia
| | - Mark Tant
- Center for Evaluation of Fitness to Drive and Car Adaptations; Belgian Road Safety Institute; Brussels Belgium
| | - Abiodun Emmanuel Akinwuntan
- Department of Physical Therapy; College of Allied Health Sciences; Augusta University; Augusta Georgia
- Dean's Office; College of Allied Health Sciences; Augusta University; Augusta Georgia
| | - Erin Neal
- Department of Physical Therapy; College of Allied Health Sciences; Augusta University; Augusta Georgia
| | - Hannes Devos
- Department of Physical Therapy; College of Allied Health Sciences; Augusta University; Augusta Georgia
| |
Collapse
|
19
|
Preliminary Investigation on the Association between Depressive Symptoms and Driving Performance in Heart Failure. Geriatrics (Basel) 2015; 1:geriatrics1010002. [PMID: 31022798 PMCID: PMC6371127 DOI: 10.3390/geriatrics1010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 12/03/2015] [Accepted: 12/07/2015] [Indexed: 11/17/2022] Open
Abstract
Heart failure (HF) patients commit many errors on driving simulation tasks and cognitive dysfunction appears to be one important contributor to impaired driving in HF. Clinical modifiers of cognition may also play a key role. In particular, depression is common in HF patients, linked with cognitive dysfunction, and contributes to reduced driving fitness in non-HF samples. However, the associations among depressive symptoms, cognition, and driving in HF are unclear. Eighteen HF patients completed a validated simulated driving scenario, the Beck Depression Inventory-II (BDI-II), and a cognitive test battery. Partial correlations controlling for demographic and medical confounds showed higher BDI-II score correlated with greater number of collisions, centerline crossings, and % time out of lane. Increased depressive symptoms correlated with lower attention/executive function, and reduced performance in this domain was associated with a greater number of collisions, centerline crossing, and % time out of lane. Depressive symptoms may be related to poorer driving performance in HF, perhaps through association with cognitive dysfunction. However, larger studies with on-road testing are needed to replicate our preliminary findings before recommendations for clinical practice can be made.
Collapse
|
20
|
Thaler A, Helmich RC, Or-Borichev A, van Nuenen BFL, Shapira-Lichter I, Gurevich T, Orr-Urtreger A, Marder K, Bressman S, Bloem BR, Giladi N, Hendler T, Mirelman A. Intact working memory in non-manifesting LRRK2 carriers--an fMRI study. Eur J Neurosci 2015; 43:106-12. [PMID: 26536050 DOI: 10.1111/ejn.13120] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 10/28/2015] [Accepted: 10/29/2015] [Indexed: 01/26/2023]
Abstract
Cognitive impairments are prevalent in patients with Parkinson's disease. Mutations in the leucine-rich repeat kinase 2 (LRRK2) gene are the most common cause of genetic Parkinsonism. Non-manifesting carriers of the G2019S mutation in the LRRK2 gene were found to have lower executive functions as measured by the Stroop task. This exploratory study aimed to assess whether the cognitive impairment in non-manifesting carriers is specific for executive functions or includes other cognitive domains such as working memory. We recruited 77 non-manifesting first-degree relatives of Parkinson's disease patients (38 carriers). A block-design fMRI N-back task, with 0-back, 2-back and 3-back conditions, was used in order to assess working memory. Participants were well matched on the Montreal Cognitive Assessment, University of Pennsylvania Smell Identification Test, Unified Parkinson's Disease Rating Scale part III, digit span, age, gender and Beck Depression Inventory. The task achieved the overall expected effect in both groups with longer reaction times and lower accuracy rates with increasing task demands. However, no whole-brain or region-of-interest between-groups differences were found on any of the task conditions. These results indicate that non-manifesting carriers of the G2019S mutation in the LRRK2 gene have a specific cognitive profile with executive functions, as assessed by the Stroop task, demonstrating significant impairment but with working memory, as assessed with the N-back task, remaining relatively intact. These finding shed light on the pre-motor cognitive changes in this unique 'at risk' population and should enable more focused cognitive assessments of these cohorts.
Collapse
Affiliation(s)
- Avner Thaler
- Movement Disorders Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv, 64239, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Functional Brain Center, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Rick C Helmich
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ayelet Or-Borichev
- Functional Brain Center, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Irit Shapira-Lichter
- Functional Brain Center, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Tanya Gurevich
- Movement Disorders Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv, 64239, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avi Orr-Urtreger
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Genetic Institute, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Karen Marder
- Columbia University Medical Center, Columbia University, New-York, NY, USA
| | | | - Bastiaan R Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Nir Giladi
- Movement Disorders Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv, 64239, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sieratzki Chair in Neurology, Tel Aviv University, Tel Aviv, Israel
| | - Talma Hendler
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Functional Brain Center, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sagol School for Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Anat Mirelman
- Movement Disorders Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv, 64239, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | |
Collapse
|
21
|
Emre M, Ford PJ, Bilgiç B, Uç EY. Cognitive impairment and dementia in Parkinson's disease: practical issues and management. Mov Disord 2014; 29:663-72. [PMID: 24757114 DOI: 10.1002/mds.25870] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 02/17/2014] [Accepted: 02/24/2014] [Indexed: 11/11/2022] Open
Abstract
Cognitive impairment and dementia pose particular challenges in the management of patients with Parkinson's disease (PD). Decision-making capacity can render patients vulnerable in a way that requires careful ethical considerations by clinicians with respect to medical decision making, research participation, and public safety. Clinicians should discuss how future decisions will be made as early in the disease course as possible. Because of cognitive, visual, and motor impairments, PD may be associated with unsafe driving, leading to early driving cessation in many. DBS of the STN and, to a lesser degree, globus pallidus interna (GPi) has consistently been associated with decreased verbal fluency, but significant global cognitive decline is usually not observed in patients who undergo rigorous selection. There are some observations suggesting lesser cognitive decline in GPi DBS than STN DBS, but further research is required. Management of PD dementia (PDD) patients involves both pharmacological and nonpharmacological measures. Patients with PDD should be offered treatment with a cholinesterase inhibitor taking into account expected benefits and potential risks. Treatment with neuroleptics may be necessary to treat psychosis; classical neuroleptics, as well as risperidone and olanzapine, should be avoided. Quetiapine might be considered first-line treatment because it does not need special monitoring, although the strongest evidence for efficacy exists for clozapine. Evidence from randomized, controlled studies in the PDD population is lacking; selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors may be used to treat depressive features. Clonazepam or melatonin may be useful in the treatment of rapid eye movement behavior disorder.
Collapse
Affiliation(s)
- Murat Emre
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Behavioral Neurology and Movement Disorders Unit, Istanbul, Turkey
| | | | | | | |
Collapse
|
22
|
The tools of the trade: A state of the art “How to Assess Cognition” in the patient with Parkinson's disease. Mov Disord 2014; 29:584-96. [DOI: 10.1002/mds.25874] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 02/07/2014] [Accepted: 02/27/2014] [Indexed: 01/08/2023] Open
|
23
|
Classen S, Holmes J. Executive functions and driving in people with Parkinson's disease. Mov Disord 2013; 28:1909-11. [PMID: 24151241 DOI: 10.1002/mds.25727] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 10/06/2013] [Indexed: 11/08/2022] Open
|