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Mirabella G, Pilotto A, Rizzardi A, Montalti M, Olivola E, Zatti C, Di Caprio V, Ferrari E, Modugno N, Padovani A. Effects of dopaminergic treatment on inhibitory control differ across Hoehn and Yahr stages of Parkinson's disease. Brain Commun 2023; 6:fcad350. [PMID: 38162902 PMCID: PMC10757450 DOI: 10.1093/braincomms/fcad350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/23/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024] Open
Abstract
Motor inhibitory control, a core component of cognitive control, is impaired in Parkinson's disease, dramatically impacting patients' abilities to implement goal-oriented adaptive strategies. A progressive loss of the midbrain's dopamine neurons characterizes Parkinson's disease and causes motor features responsive to dopaminergic treatments. Although such treatments restore motor symptoms, their impact on response inhibition is controversial. Most studies failed to show any effect of dopaminergic medicaments, although three studies found that these drugs selectively improved inhibitory control in early-stage patients. Importantly, all previous studies assessed only one domain of motor inhibition, i.e. reactive inhibition (the ability to react to a stop signal). The other domain, i.e. proactive inhibition (the ability to modulate reactive inhibition pre-emptively according to the current context), was utterly neglected. To re-examine this issue, we recruited cognitively unimpaired Parkinson's patients under dopaminergic treatment in the early (Hoehn and Yahr, 1-1.5, n = 20), intermediate (Hoehn and Yahr 2, n = 20), and moderate/advanced (Hoehn and Yahr, 2.5-3, n = 20) stages of the disease. Using a cross-sectional study design, we compared their performance on a simple reaction-time task and a stop-signal task randomly performed twice on dopaminergic medication (ON) and after medication withdrawal (OFF). Normative data were collected on 30 healthy controls. Results suggest that medication effects are stage-dependent. In Hoehn and Yahr 1-1.5 patients, drugs selectively impair reactive inhibition, leaving proactive inhibition unaffected. In the ON state, Hoehn and Yahr two patients experienced impaired proactive inhibition, whereas reactive inhibition is no longer affected, as it deteriorates even during the OFF state. By contrast, Hoehn and Yahr 2.5-3 patients exhibited less efficient reactive and proactive inhibition in the OFF state, and medication slightly improved proactive inhibition. This evidence aligns with the dopamine overdose hypothesis, indicating that drug administration may overdose intact dopamine circuitry in the earliest stages, impairing associated cognitive functions. In later stages, the progressive degeneration of dopaminergic neurons prevents the overdose and can exert some beneficial effects. Thus, our findings suggest that inhibitory control assessment might help tailor pharmacological therapy across the disease stage to enhance Parkinson's disease patients' quality of life by minimizing the hampering of inhibitory control and maximizing the reduction of motor symptoms.
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Affiliation(s)
- Giovanni Mirabella
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, BS, Italy
- IRCCS Neuromed, 86077 Pozzilli, IS, Italy
| | - Andrea Pilotto
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, 25123 Brescia, BS, Italy
- Laboratory of Digital Neurology and Biosensors, University of Brescia, 25123 Brescia, BS, Italy
- Department of Continuity of Care and Frailty, Neurology Unit, ASST Spedali Civili Brescia Hospital, 25123 Brescia, BS, Italy
| | - Andrea Rizzardi
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, 25123 Brescia, BS, Italy
- Laboratory of Digital Neurology and Biosensors, University of Brescia, 25123 Brescia, BS, Italy
| | - Martina Montalti
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, BS, Italy
| | | | - Cinzia Zatti
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, 25123 Brescia, BS, Italy
- Laboratory of Digital Neurology and Biosensors, University of Brescia, 25123 Brescia, BS, Italy
- Department of Continuity of Care and Frailty, Neurology Unit, ASST Spedali Civili Brescia Hospital, 25123 Brescia, BS, Italy
| | | | - Elisabetta Ferrari
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, 25123 Brescia, BS, Italy
| | | | - Alessandro Padovani
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, 25123 Brescia, BS, Italy
- Laboratory of Digital Neurology and Biosensors, University of Brescia, 25123 Brescia, BS, Italy
- Department of Continuity of Care and Frailty, Neurology Unit, ASST Spedali Civili Brescia Hospital, 25123 Brescia, BS, Italy
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2
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Bhat SG, Shin AY, Kaufman KR. Upper extremity asymmetry due to nerve injuries or central neurologic conditions: a scoping review. J Neuroeng Rehabil 2023; 20:151. [PMID: 37940959 PMCID: PMC10634143 DOI: 10.1186/s12984-023-01277-7] [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: 10/21/2022] [Accepted: 11/01/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Peripheral nerve injuries and central neurologic conditions can result in extensive disabilities. In cases with unilateral impairment, assessing the asymmetry between the upper extremity has been used to assess outcomes of treatment and severity of injury. A wide variety of validated and novel tests and sensors have been utilized to determine the upper extremity asymmetry. The purpose of this article is to review the literature and define the current state of the art for describing upper extremity asymmetry in patients with peripheral nerve injuries or central neurologic conditions. METHOD An electronic literature search of PubMed, Scopus, Web of Science, OVID was performed for publications between 2000 to 2022. Eligibility criteria were subjects with neurological conditions/injuries who were analyzed for dissimilarities in use between the upper extremities. Data related to study population, target condition/injury, types of tests performed, sensors used, real-world data collection, outcome measures of interest, and results of the study were extracted. Sackett's Level of Evidence was used to judge the quality of the articles. RESULTS Of the 7281 unique articles, 112 articles met the inclusion criteria for the review. Eight target conditions/injuries were identified (Brachial Plexus Injury, Cerebral Palsy, Multiple Sclerosis, Parkinson's Disease, Peripheral Nerve Injury, Spinal Cord Injury, Schizophrenia, and stroke). The tests performed were classified into thirteen categories based on the nature of the test and data collected. The general results related to upper extremity asymmetry were listed for all the reviewed articles. Stroke was the most studied condition, followed by cerebral palsy, with kinematics and strength measurement tests being the most frequently used tests. Studies with a level of evidence level II and III increased between 2000 and 2021. The use of real-world evidence-based data, and objective data collection tests also increased in the same period. CONCLUSION Adequately powered randomized controlled trials should be used to study upper extremity asymmetry. Neurological conditions other than stroke should be studied further. Upper extremity asymmetry should be measured using objective outcome measures like motion tracking and activity monitoring in the patient's daily living environment.
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Affiliation(s)
- Sandesh G Bhat
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Alexander Y Shin
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Kenton R Kaufman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, 55905, USA.
- Motion Analysis Laboratory, Mayo Clinic, DAHLC 4-214A, 200 First Street SW, Rochester, MN, 55905, USA.
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Ye R, Hezemans FH, O'Callaghan C, Tsvetanov KA, Rua C, Jones PS, Holland N, Malpetti M, Murley AG, Barker RA, Williams-Gray CH, Robbins TW, Passamonti L, Rowe JB. Locus Coeruleus Integrity Is Linked to Response Inhibition Deficits in Parkinson's Disease and Progressive Supranuclear Palsy. J Neurosci 2023; 43:7028-7040. [PMID: 37669861 PMCID: PMC10586538 DOI: 10.1523/jneurosci.0289-22.2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 09/07/2023] Open
Abstract
Parkinson's disease (PD) and progressive supranuclear palsy (PSP) both impair response inhibition, exacerbating impulsivity. Inhibitory control deficits vary across individuals and are linked with worse prognosis, and lack improvement on dopaminergic therapy. Motor and cognitive control are associated with noradrenergic innervation of the cortex, arising from the locus coeruleus (LC) noradrenergic system. Here we test the hypothesis that structural variation of the LC explains response inhibition deficits in PSP and PD. Twenty-four people with idiopathic PD, 14 with PSP-Richardson's syndrome, and 24 age- and sex-matched controls undertook a stop-signal task and ultrahigh field 7T magnetization-transfer-weighted imaging of the LC. Parameters of "race models" of go- versus stop-decisions were estimated using hierarchical Bayesian methods to quantify the cognitive processes of response inhibition. We tested the multivariate relationship between LC integrity and model parameters using partial least squares. Both disorders impaired response inhibition at the group level. PSP caused a distinct pattern of abnormalities in inhibitory control with a paradoxically reduced threshold for go responses, but longer nondecision times, and more lapses of attention. The variation in response inhibition correlated with the variability of LC integrity across participants in both clinical groups. Structural imaging of the LC, coupled with behavioral modeling in parkinsonian disorders, confirms that LC integrity is associated with response inhibition and LC degeneration contributes to neurobehavioral changes. The noradrenergic system is therefore a promising target to treat impulsivity in these conditions. The optimization of noradrenergic treatment is likely to benefit from stratification according to LC integrity.SIGNIFICANCE STATEMENT Response inhibition deficits contribute to clinical symptoms and poor outcomes in people with Parkinson's disease and progressive supranuclear palsy. We used cognitive modeling of performance of a response inhibition task to identify disease-specific mechanisms of abnormal inhibitory control. Response inhibition in both patient groups was associated with the integrity of the noradrenergic locus coeruleus, which we measured in vivo using ultra-high field MRI. We propose that the imaging biomarker of locus coeruleus integrity provides a trans-diagnostic tool to explain individual differences in response inhibition ability beyond the classic nosological borders and diagnostic criteria. Our data suggest a potential new stratified treatment approach for Parkinson's disease and progressive supranuclear palsy.
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Affiliation(s)
- Rong Ye
- Research Center for Translational Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230032, China
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui, 230032, China
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, CB2 0SZ, United Kingdom
| | - Frank H Hezemans
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, CB2 0SZ, United Kingdom
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, CB2 7EF, United Kingdom
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6525 GD Nijmegen, The Netherlands
| | - Claire O'Callaghan
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, United Kingdom
- Brain and Mind Centre and School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Sydney 2050, New South Wales, Australia
| | - Kamen A Tsvetanov
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, CB2 7EF, United Kingdom
- Department of Psychology, University of Cambridge, Cambridge, CB2 3EA, United Kingdom
| | - Catarina Rua
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, CB2 0SZ, United Kingdom
| | - P Simon Jones
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, CB2 0SZ, United Kingdom
| | - Negin Holland
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, CB2 0SZ, United Kingdom
| | - Maura Malpetti
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, CB2 0SZ, United Kingdom
| | - Alexander G Murley
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, CB2 0SZ, United Kingdom
| | - Roger A Barker
- John van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0SZ, United Kingdom
- Wellcome-MRC Stem Cell Institute, University of Cambridge, Cambridge, CB2 0AW, United Kingdom
| | - Caroline H Williams-Gray
- John van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0SZ, United Kingdom
| | - Trevor W Robbins
- Department of Psychology, University of Cambridge, Cambridge, CB2 3EA, United Kingdom
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, CB2 3EA, United Kingdom
| | - Luca Passamonti
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, CB2 0SZ, United Kingdom
- Institute of Molecular Bioimaging and Physiology, National Research Council, 88100, Catanzaro, Italy
| | - James B Rowe
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, CB2 0SZ, United Kingdom
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, CB2 7EF, United Kingdom
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, CB2 3EA, United Kingdom
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Wessel JR, Diesburg DA, Chalkley NH, Greenlee JDW. A causal role for the human subthalamic nucleus in non-selective cortico-motor inhibition. Curr Biol 2022; 32:3785-3791.e3. [PMID: 35841891 PMCID: PMC9511894 DOI: 10.1016/j.cub.2022.06.067] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 06/07/2022] [Accepted: 06/22/2022] [Indexed: 11/22/2022]
Abstract
Common cortico-basal ganglia models of motor control suggest a key role for the subthalamic nucleus (STN) in motor inhibition.1-3 In particular, when already-initiated actions have to be suddenly stopped, the STN is purportedly recruited via a hyperdirect pathway to net inhibit the cortico-motor system in a broad, non-selective fashion.4 Indeed, the suppression of cortico-spinal excitability (CSE) during rapid action stopping extends beyond the stopped muscle and affects even task-irrelevant motor representations.5,6 Although such non-selective CSE suppression has long been attributed to the broad inhibitory influence of STN on the motor system, causal evidence for this association is hitherto lacking. Here, 20 Parkinson's disease patients treated with STN deep-brain stimulation (DBS) and 20 matched healthy controls performed a verbal stop-signal task while CSE was measured from a task-unrelated hand muscle. DBS allowed a causal manipulation of STN, while CSE was measured using transcranial magnetic stimulation (TMS) over primary motor cortex and concurrent electromyography. In patients OFF-DBS and controls, the CSE of the hand was non-selectively suppressed when the verbal response was successfully stopped. Crucially, this effect disappeared when STN was disrupted via DBS in the patient group. Using this unique combination of DBS and TMS during human behavior, the current study provides first causal evidence that STN is likely involved in non-selectively suppressing the physiological excitability of the cortico-motor system during action stopping. This confirms a core prediction of long-held cortico-basal ganglia circuit models of movement. The absence of cortico-motor inhibition during STN-DBS may also provide potential insights into the common side effects of STN-DBS, such as increased impulsivity.7-11.
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Affiliation(s)
- Jan R Wessel
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA; Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA 52245, USA; Cognitive Control Collaborative, University of Iowa, Iowa City, IA 52245, USA; Iowa Neuroscience Institute, University of Iowa, Iowa City, IA 52242, USA.
| | - Darcy A Diesburg
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA 52245, USA; Cognitive Control Collaborative, University of Iowa, Iowa City, IA 52245, USA
| | - Nathan H Chalkley
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA; Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA 52245, USA
| | - Jeremy D W Greenlee
- Iowa Neuroscience Institute, University of Iowa, Iowa City, IA 52242, USA; Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
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5
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Ye R, Mazibuko N, Teichert J, Regenthal R, Kehagia AA, Mehta MA. Mapping the effects of atomoxetine during response inhibition across cortical territories and the locus coeruleus. Psychopharmacology (Berl) 2022; 239:365-376. [PMID: 34693457 DOI: 10.1007/s00213-021-05998-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 10/04/2021] [Indexed: 10/20/2022]
Abstract
RATIONALE The effects of atomoxetine (ATO) on response inhibition have been typically examined using the stop signal task (SST) which is however confounded by attentional capture. The right inferior frontal cortex (rIFC) has been implicated in the modulation of ATO on inhibitory control, but a precise characterisation of its role is complicated by its functional inhomogeneity. OBJECTIVES The current study aimed to directly investigate the effect of ATO in the SST using the imaging contrast unconfounded by attentional capture, to test the specific drug actions in functionally dissociable rIFC subregions, and to explore the role of locus coeruleus (LC), the main source of cortical noradrenaline, in mediating the drug effects. METHODS This imaging study investigated the effect of ATO (40 mg) in 18 human participants during a modified SST that unconfounds attention from inhibition. Functional definitions for rIFC subdivisions were adopted in the analyses to isolate attention and inhibition during action cancellation. The LC integrity was measured in vivo using a neuromelanin-sensitive sequence. RESULTS We identified one mechanism of ATO modulation specific to inhibitory control: ATO enhanced activity in pre-supplementary area (pre-SMA) for motor inhibition, and the recruitment of temporoparietal junction (TPJ) and inferior frontal junction (IFJ) for functional integration during response inhibition. Moreover, drug-related behavioural and neural responses correlated with variations in LC integrity. CONCLUSIONS These findings provide a more nuanced and precise understanding of the effects of ATO on specific and domain general aspects of stopping.
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Affiliation(s)
- Rong Ye
- Department of Clinical Neurosciences and Cambridge University Hospital NHS Trust, University of Cambridge, Herchel Smith Building, Robinson Way, Cambridge, CB2 0SZ, UK. .,Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Ndabezinhle Mazibuko
- Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jens Teichert
- Division of Clinical Pharmacology, Rudolf-Boehm-Institute of Pharmacology and Toxicology, Leipzig University, Leipzig, Germany
| | - Ralf Regenthal
- Division of Clinical Pharmacology, Rudolf-Boehm-Institute of Pharmacology and Toxicology, Leipzig University, Leipzig, Germany
| | - Angie A Kehagia
- Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,University College Hospital, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mitul A Mehta
- Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Functional correlates of response inhibition in impulse control disorders in Parkinson's disease. Neuroimage Clin 2022; 32:102822. [PMID: 34536820 PMCID: PMC8449263 DOI: 10.1016/j.nicl.2021.102822] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/10/2021] [Accepted: 09/07/2021] [Indexed: 12/31/2022]
Abstract
PD patients with ICD behave like controls in proactive and reactive inhibition. PD patients with ICD recruit different mechanisms depending on the inhibition type. Proactive inhibition is executed hyperactivating the stopping network bilaterally. Restrained inhibition is accomplished with the coactivation of attentional areas. In restrained inhibition, connectivity between right STN and precuneus is reduced.
Impulse control disorder is a prevalent side-effect of Parkinson’s disease (PD) medication, with a strong negative impact on the quality of life of those affected. Although impulsivity has classically been associated with response inhibition deficits, previous evidence from PD patients with impulse control disorder (ICD) has not revealed behavioral dysfunction in response inhibition. In this study, 18 PD patients with ICD, 17 PD patients without this complication, and 15 healthy controls performed a version of the conditional Stop Signal Task during functional magnetic resonance imaging. Whole-brain contrasts, regions of interest, and functional connectivity analyses were conducted. Our aim was to investigate the neural underpinnings of two aspects of response inhibition: proactive inhibition, inhibition that has been prepared beforehand, and restrained inhibition, inhibition of an invalid inhibitory tendency. We observed that, in respect to the other two groups, PD patients with ICD exhibited hyperactivation of the stopping network bilaterally while performing proactive inhibition. When engaged in restrained inhibition, they showed hyperactivation of the left inferior frontal gyrus, an area linked to action monitoring. Restrained inhibition also resulted in changes to the functional co-activation between inhibitory regions and left inferior parietal cortex and right supramarginal gyrus. Our findings indicate that PD patients with ICD completed the inhibition task correctly, showing altered engagement of inhibitory and attentional areas. During proactive inhibition they showed bilateral hyperactivation of two inhibitory regions, while during restrained inhibition they showed additional involvement of attentional areas responsible for alerting and orienting.
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The motor inhibitory network in patients with asymmetrical Parkinson's disease: An fMRI study. Brain Imaging Behav 2022; 16:1349-1361. [PMID: 35020124 PMCID: PMC9107438 DOI: 10.1007/s11682-021-00587-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 12/28/2022]
Abstract
Recent imaging studies with the stop-signal task in healthy individuals indicate that the subthalamic nucleus, the pre-supplementary motor area and the inferior frontal gyrus are key components of the right hemisphere “inhibitory network”. Limited information is available regarding neural substrates of inhibitory processing in patients with asymmetric Parkinson’s disease. The aim of the current fMRI study was to identify the neural changes underlying deficient inhibitory processing on the stop-signal task in patients with predominantly left-sided Parkinson’s disease. Fourteen patients and 23 healthy controls performed a stop-signal task with the left and right hands. Behaviorally, patients showed delayed response inhibition with either hand compared to controls. We found small imaging differences for the right hand, however for the more affected left hand when behavior was successfully inhibited we found reduced activation of the inferior frontal gyrus bilaterally and the insula. Using the stop-signal delay as regressor, contralateral underactivation in the right dorsolateral prefrontal cortex, inferior frontal and anterior putamen were found in patients. This finding indicates dysfunction of the right inhibitory network in left-sided Parkinson’s disease. Functional connectivity analysis of the left subthalamic nucleus showed a significant increase of connectivity with bilateral insula. In contrast, the right subthalamic nucleus showed increased connectivity with visuomotor and sensorimotor regions of the cerebellum. We conclude that altered inhibitory control in left-sided Parkinson’s disease is associated with reduced activation in regions dedicated to inhibition in healthy controls, which requires engagement of additional regions, not observed in controls, to successfully stop ongoing actions.
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Caglayan A, Stumpenhorst K, Winter Y. The Stop Signal Task for Measuring Behavioral Inhibition in Mice With Increased Sensitivity and High-Throughput Operation. Front Behav Neurosci 2021; 15:777767. [PMID: 34955779 PMCID: PMC8696275 DOI: 10.3389/fnbeh.2021.777767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/03/2021] [Indexed: 11/14/2022] Open
Abstract
Ceasing an ongoing motor response requires action cancelation. This is impaired in many pathologies such as attention deficit disorder and schizophrenia. Action cancelation is measured by the stop signal task that estimates how quickly a motor response can be stopped when it is already being executed. Apart from human studies, the stop signal task has been used to investigate neurobiological mechanisms of action cancelation overwhelmingly in rats and only rarely in mice, despite the need for a genetic model approach. Contributing factors to the limited number of mice studies may be the long and laborious training that is necessary and the requirement for a very loud (100 dB) stop signal. We overcame these limitations by employing a fully automated home-cage-based setup. We connected a home-cage to the operant box via a gating mechanism, that allowed individual ID chipped mice to start sessions voluntarily. Furthermore, we added a negative reinforcement consisting of a mild air puff with escape option to the protocol. This specifically improved baseline inhibition to 94% (from 84% with the conventional approach). To measure baseline inhibition the stop is signaled immediately with trial onset thus measuring action restraint rather than action cancelation ability. A high baseline allowed us to measure action cancelation ability with higher sensitivity. Furthermore, our setup allowed us to reduce the intensity of the acoustic stop signal from 100 to 70 dB. We constructed inhibition curves from stop trials with daily adjusted delays to estimate stop signal reaction times (SSRTs). SSRTs (median 88 ms) were lower than reported previously, which we attribute to the observed high baseline inhibition. Our automated training protocol reduced training time by 17% while also promoting minimal experimenter involvement. This sensitive and labor efficient stop signal task procedure should therefore facilitate the investigation of action cancelation pathologies in genetic mouse models.
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Affiliation(s)
| | | | - York Winter
- Institute for Biology, Humboldt University, Berlin, Germany.,Excellenzcluster NeuroCure, Charité Universitätsmedizin Berlin, Berlin, Germany
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Waldthaler J, Stock L, Student J, Sommerkorn J, Dowiasch S, Timmermann L. Antisaccades in Parkinson's Disease: A Meta-Analysis. Neuropsychol Rev 2021; 31:628-642. [PMID: 33742354 PMCID: PMC8592977 DOI: 10.1007/s11065-021-09489-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 02/18/2021] [Indexed: 11/29/2022]
Abstract
The usefulness of eye-tracking tasks as potential biomarkers for motor or cognitive disease burden in Parkinson's disease (PD) has been subject of debate for many years. Several studies suggest that the performance in the antisaccade task may be altered in patients with PD and associated with motor disease severity or executive dysfunction. In this meta-analysis, random effects models were used to synthesize the existing evidence on antisaccade error rates and latency in PD. Furthermore, meta-regressions were performed to assess the role of motor and cognitive disease severity, dopaminergic medication and methodological factors. Additionally, the impact of acute levodopa administration and activation of deep brain stimulation was evaluated in two separate sub-analyses.This meta-analysis confirms that antisaccade latency and error rate are significantly increased in PD. Disease duration, Unified Parkinson's disease rating scale score and Hoehn and Yahr stage mediate the effect of PD on antisaccade latency with higher motor burden being associated with increased antisaccade latency.Acute administration of levodopa had no significant effects on antisaccade performance in a small number of eligible studies. Deep brain stimulation in the subthalamic nucleus, on the other hand, may alter the speed accuracy trade-off supporting an increase of impulsivity following deep brain stimulation in PD.According to the results of the meta-analysis, antisaccade latency may provide a potential marker for disease severity and progression in PD which needs further confirmation in longitudinal studies.
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Affiliation(s)
- Josefine Waldthaler
- Department of Neurology, University Hospital Marburg, 35033, Marburg, Germany.
- CMBB - Center for Mind, Brain and Behavior, Universities Gießen and Marburg, Marburg, Germany.
| | - Lena Stock
- Department of Neurology, University Hospital Marburg, 35033, Marburg, Germany
| | - Justus Student
- Department of Neurology, University Hospital Marburg, 35033, Marburg, Germany
| | - Johanna Sommerkorn
- Department of Neurology, University Hospital Marburg, 35033, Marburg, Germany
| | - Stefan Dowiasch
- CMBB - Center for Mind, Brain and Behavior, Universities Gießen and Marburg, Marburg, Germany
- Department of Neurophysics, University of Marburg, Marburg, Germany
- Thomas RECORDING GmbH, Giessen, Germany
| | - Lars Timmermann
- Department of Neurology, University Hospital Marburg, 35033, Marburg, Germany
- CMBB - Center for Mind, Brain and Behavior, Universities Gießen and Marburg, Marburg, Germany
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O’Callaghan C, Hezemans FH, Ye R, Rua C, Jones PS, Murley AG, Holland N, Regenthal R, Tsvetanov KA, Wolpe N, Barker RA, Williams-Gray CH, Robbins TW, Passamonti L, Rowe JB. Locus coeruleus integrity and the effect of atomoxetine on response inhibition in Parkinson's disease. Brain 2021; 144:2513-2526. [PMID: 33783470 PMCID: PMC7611672 DOI: 10.1093/brain/awab142] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 03/09/2021] [Accepted: 03/23/2021] [Indexed: 11/23/2022] Open
Abstract
Cognitive decline is a common feature of Parkinson's disease, and many of these cognitive deficits fail to respond to dopaminergic therapy. Therefore, targeting other neuromodulatory systems represents an important therapeutic strategy. Among these, the locus coeruleus-noradrenaline system has been extensively implicated in response inhibition deficits. Restoring noradrenaline levels using the noradrenergic reuptake inhibitor atomoxetine can improve response inhibition in some patients with Parkinson's disease, but there is considerable heterogeneity in treatment response. Accurately predicting the patients who would benefit from therapies targeting this neurotransmitter system remains a critical goal, in order to design the necessary clinical trials with stratified patient selection to establish the therapeutic potential of atomoxetine. Here, we test the hypothesis that integrity of the noradrenergic locus coeruleus explains the variation in improvement of response inhibition following atomoxetine. In a double-blind placebo-controlled randomized crossover design, 19 patients with Parkinson's disease completed an acute psychopharmacological challenge with 40 mg of oral atomoxetine or placebo. A stop-signal task was used to measure response inhibition, with stop-signal reaction times obtained through hierarchical Bayesian estimation of an ex-Gaussian race model. Twenty-six control subjects completed the same task without undergoing the drug manipulation. In a separate session, patients and controls underwent ultra-high field 7 T imaging of the locus coeruleus using a neuromelanin-sensitive magnetization transfer sequence. The principal result was that atomoxetine improved stop-signal reaction times in those patients with lower locus coeruleus integrity. This was in the context of a general impairment in response inhibition, as patients on placebo had longer stop-signal reaction times compared to controls. We also found that the caudal portion of the locus coeruleus showed the largest neuromelanin signal decrease in the patients compared to controls. Our results highlight a link between the integrity of the noradrenergic locus coeruleus and response inhibition in patients with Parkinson's disease. Furthermore, they demonstrate the importance of baseline noradrenergic state in determining the response to atomoxetine. We suggest that locus coeruleus neuromelanin imaging offers a marker of noradrenergic capacity that could be used to stratify patients in trials of noradrenergic therapy and to ultimately inform personalized treatment approaches.
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Affiliation(s)
- Claire O’Callaghan
- Brain and Mind Centre and School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Sydney 2050, Australia
- Department of Psychiatry, University of Cambridge, Cambridge CB2 0SZ, UK
| | - Frank H Hezemans
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0SZ, UK
| | - Rong Ye
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0SZ, UK
| | - Catarina Rua
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0SZ, UK
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge 04107, UK
| | - P Simon Jones
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0SZ, UK
| | - Alexander G Murley
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0SZ, UK
| | - Negin Holland
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0SZ, UK
| | - Ralf Regenthal
- Division of Clinical Pharmacology, Rudolf-Boehm-Institute for Pharmacology and Toxicology, University of Leipzig, Leipzig 69978, Germany
| | - Kamen A Tsvetanov
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0SZ, UK
| | - Noham Wolpe
- Department of Psychiatry, University of Cambridge, Cambridge CB2 0SZ, UK
- Department of Physical Therapy, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roger A Barker
- John van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0SZ, UK
- Wellcome Trust—Medical Research Council Stem Cell Institute, University of Cambridge, Cambridge CB2 0AW, UK
| | - Caroline H Williams-Gray
- John van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0SZ, UK
| | - Trevor W Robbins
- Department of Psychology, University of Cambridge, Cambridge CB2 3EA, UK
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge CB2 3EA, UK
| | - Luca Passamonti
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0SZ, UK
| | - James B Rowe
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0SZ, UK
- Cambridge University Hospitals NHS Trust, Cambridge, CB2 0QQ, UK
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11
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Eleni P, Georgia P, Constantine P, Efstratios K, Georgios V, Nikolaos K, Christoph K, Nikolaos S. Functional brain imaging of speeded decision processing in Parkinson's disease and comparison with Schizophrenia. Psychiatry Res Neuroimaging 2021; 314:111312. [PMID: 34111721 DOI: 10.1016/j.pscychresns.2021.111312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 05/23/2021] [Accepted: 05/25/2021] [Indexed: 10/21/2022]
Abstract
This study examined whether Parkinson's disease (PD1) and schizophrenia (SCZ2) share a hypo dopaminergic dysfunction of the prefrontal cortex leading to cognitive impairments in decision processing. 24 medicated PD patients and 28 matched controls performed the Eriksen flanker two-choice reaction time (RT3) task while brain activity was measured throughout, using functional Magnetic Resonance Imaging (fMRI4). Results were directly compared to those of 30 SCZ patients and 30 matched controls. Significant differences between SCZ and PD were found, through directly comparing the z-score deviations from healthy controls across all behavioral measures, where only SCZ patients showed deviances from controls. Similarly a direct comparison of z-score activation deviations from controls indicated significant differences in prefrontal and cingulate cortical activation between SCZ and PD, where only SCZ patients showed hypo-activation of these areas compared to controls. The hypo-activation of the dorsolateral prefrontal cortex was related to larger RT variability (ex-Gaussian tau) in SCZ but not PD patients. Overall, the concluding evidence does not support a shared neural substrate of cognitive dysfunction, since the deficit in speeded decision processing and the related cortical hypo-activation observed in SCZ were absent in PD.
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Affiliation(s)
- Pappa Eleni
- Laboratory of Cognitive Neuroscience, University Mental Health, Neurosciences and Precision Medicine Research Institute "COSTAS STEFANIS", Athens, Greece; 1st Department of Psychiatry, National and Kapodistrian University of Athens, School of Medicine, Eginition Hospital, Athens, Greece
| | - Panagiotaropoulou Georgia
- Laboratory of Cognitive Neuroscience, University Mental Health, Neurosciences and Precision Medicine Research Institute "COSTAS STEFANIS", Athens, Greece; 1st Department of Psychiatry, National and Kapodistrian University of Athens, School of Medicine, Eginition Hospital, Athens, Greece
| | - Potagas Constantine
- Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Eginition Hospital, Athens, Greece
| | - Karavasilis Efstratios
- Second Department of Radiology, National and Kapodistrian University of Athens, School of Medicine, University General Hospital 'Attikon', Athens, Greece
| | - Velonakis Georgios
- Second Department of Radiology, National and Kapodistrian University of Athens, School of Medicine, University General Hospital 'Attikon', Athens, Greece
| | - Kelekis Nikolaos
- Second Department of Radiology, National and Kapodistrian University of Athens, School of Medicine, University General Hospital 'Attikon', Athens, Greece
| | - Klein Christoph
- 1st Department of Psychiatry, National and Kapodistrian University of Athens, School of Medicine, Eginition Hospital, Athens, Greece; Department of Child and Adolescent Psychiatry, University of Freiburg, Freiburg, Germany; Department of Child and Adolescent Psychiatry, Medical Faculty, University of Cologne, Cologne, Germany
| | - Smyrnis Nikolaos
- Laboratory of Cognitive Neuroscience, University Mental Health, Neurosciences and Precision Medicine Research Institute "COSTAS STEFANIS", Athens, Greece; 2nd Department of Psychiatry, National and Kapodistrian University of Athens, School of Medicine, University General Hospital "Attikon", Athens, Greece..
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12
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Ruitenberg MFL, van Wouwe NC, Wylie SA, Abrahamse EL. The role of dopamine in action control: Insights from medication effects in Parkinson's disease. Neurosci Biobehav Rev 2021; 127:158-170. [PMID: 33905788 DOI: 10.1016/j.neubiorev.2021.04.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 02/26/2021] [Accepted: 04/18/2021] [Indexed: 01/14/2023]
Abstract
Parkinson's disease (PD) is a neurological disorder associated primarily with overt motor symptoms. Several studies show that PD is additionally accompanied by impairments in covert cognitive processes underlying goal-directed motor functioning (e.g., action planning, conflict adaptation, inhibition), and that dopaminergic medication may modulate these action control components. In this review we aim to leverage findings from studies in this domain to elucidate the role of dopamine (DA) in action control. A qualitative review of studies that investigated the effects of medication status (on vs. off) on action control in PD suggests a component-specific role for DA in action control, although the expression of medication effects depends on characteristics of both the patients and experimental tasks used to measure action control. We discuss these results in the light of findings from other research lines examining the role of DA in action control (e.g., animal research, pharmacology), and recommend that future studies use multi-method, within-subject approaches to model DA effects on action control across different components as well as underlying striatal pathways (ventral vs. dorsal).
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Affiliation(s)
- M F L Ruitenberg
- Department of Health, Medical and Neuropsychology, Leiden University, Leiden, the Netherlands; Leiden Institute for Brain and Cognition, Leiden, the Netherlands; Department of Experimental Psychology, Ghent University, Ghent, Belgium.
| | - N C van Wouwe
- Department of Neurological Surgery, University of Louisville, Louisville, KY, USA
| | - S A Wylie
- Department of Neurological Surgery, University of Louisville, Louisville, KY, USA
| | - E L Abrahamse
- Department of Communication and Cognition, Tilburg University, Tilburg, the Netherlands
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13
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van den Wildenberg WPM, van Wouwe NC, Ridderinkhof KR, Neimat JS, Elias WJ, Bashore TR, Wylie SA. Deep-brain stimulation of the subthalamic nucleus improves overriding motor actions in Parkinson's disease. Behav Brain Res 2021; 402:113124. [PMID: 33422595 DOI: 10.1016/j.bbr.2021.113124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 01/04/2021] [Accepted: 01/04/2021] [Indexed: 11/17/2022]
Abstract
Findings from previous research using the classic stop-signal task indicate that the subthalamic nucleus (STN) plays an important role in the ability to inhibit motor actions. Here we extend these findings using a stop-change task that requires voluntary action override to stop an ongoing motor response and change to an alternative response. Sixteen patients diagnosed with Parkinson's disease (PD) and 16 healthy control participants (HC) performed the stop-change task. PD patients completed the task when deep-brain stimulation (DBS) of the STN was turned on and when it was turned off. Behavioral results indicated that going, stopping, and changing latencies were shortened significantly among PD patients during STN DBS, the former two reductions replicating findings from previous DBS studies using the classic stop-signal task. The shortened go latencies observed among PD patients fell within the control range. In contrast, stopping latencies among PD patients, although reduced significantly, continued to be significantly longer than those of the HC. Like go latencies, stop-change latencies were reduced sufficiently among PD patients for them to fall within the control range, a novel finding. In conclusion, STN DBS produced a general, but differential, improvement in the ability of PD patients to override motor actions. Going, stopping, and stop-change latencies were all shortened, but only going and stop-change latencies were normalized.
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Affiliation(s)
- Wery P M van den Wildenberg
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Brain and Cognition (ABC), University of Amsterdam, Amsterdam, the Netherlands.
| | | | - K Richard Ridderinkhof
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Brain and Cognition (ABC), University of Amsterdam, Amsterdam, the Netherlands
| | - Joseph S Neimat
- Department of Neurosurgery, University of Louisville, Louisville, KY, USA
| | - W Jeffrey Elias
- Department of Neurosurgery, University of Virginia Health Systems, Charlottesville, VA, USA
| | - Theodore R Bashore
- Department of Neurosurgery, University of Louisville, Louisville, KY, USA; School of Psychological Sciences, University of Northern Colorado, Greeley, CO, USA
| | - Scott A Wylie
- Department of Neurosurgery, University of Louisville, Louisville, KY, USA
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14
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Chen W, de Hemptinne C, Miller AM, Leibbrand M, Little SJ, Lim DA, Larson PS, Starr PA. Prefrontal-Subthalamic Hyperdirect Pathway Modulates Movement Inhibition in Humans. Neuron 2020; 106:579-588.e3. [PMID: 32155442 PMCID: PMC7274135 DOI: 10.1016/j.neuron.2020.02.012] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 01/06/2020] [Accepted: 02/10/2020] [Indexed: 10/24/2022]
Abstract
The ability to dynamically change motor outputs, such as stopping an initiated response, is an important aspect of human behavior. A hyperdirect pathway between the inferior frontal gyrus and subthalamic nucleus is hypothesized to mediate movement inhibition, but there is limited evidence for this in humans. We recorded high spatial and temporal resolution field potentials from both the inferior frontal gyrus and subthalamic nucleus in 21 subjects. Cortical potentials evoked by subthalamic stimulation revealed short latency events indicative of monosynaptic connectivity between the inferior frontal gyrus and ventral subthalamic nucleus. During a stop signal task, stopping-related potentials in the cortex preceded stopping-related activity in the subthalamic nucleus, and synchronization between these task-evoked potentials predicted the stop signal reaction time. Thus, we show that a prefrontal-subthalamic hyperdirect pathway is present in humans and mediates rapid stopping. These findings may inform therapies to treat disorders featuring perturbed movement inhibition.
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Affiliation(s)
- Witney Chen
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA 94143, USA.
| | - Coralie de Hemptinne
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Andrew M Miller
- School of Medicine, University of Kansas, Kansas City, KS 66160, USA
| | | | - Simon J Little
- Department of Neurology, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Daniel A Lim
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA 94143, USA; San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA
| | - Paul S Larson
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA 94143, USA; San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA
| | - Philip A Starr
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA 94143, USA.
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15
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Hlavatá P, Linhartová P, Šumec R, Filip P, Světlák M, Baláž M, Kašpárek T, Bareš M. Behavioral and Neuroanatomical Account of Impulsivity in Parkinson's Disease. Front Neurol 2020; 10:1338. [PMID: 31998210 PMCID: PMC6965152 DOI: 10.3389/fneur.2019.01338] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 12/03/2019] [Indexed: 12/12/2022] Open
Abstract
Impulse control disorder (ICD) is a major non-motor complication of Parkinson's disease (PD) with often devastating consequences for patients' quality of life. In this study, we aimed to characterize the phenotype of impulsivity in PD and its neuroanatomical correlates. Methods: Thirty-seven PD patients (15 patients with ICD, 22 patients without ICD) and 36 healthy controls underwent a neuropsychological battery. The test battery consisted of anxiety and depression scales, self-report measures of impulsivity (Barratt scale and UPPS-P), behavioral measures of impulsive action (Go/No-Go task, Stop signal task) and impulsive choice (Delay discounting, Iowa gambling task), and measures of cognitive abilities (working memory, attention, executive function). Patients and controls underwent structural MRI scanning. Results: Patients with ICD had significantly higher levels of self-reported impulsivity (Barratt scale and Lack of perseverance from UPPS-P) in comparison with healthy controls and non-impulsive PD patients, but they performed similarly in behavioral tasks, except for the Iowa gambling task. In this task, patients with ICD made significantly less risky decisions than patients without ICD and healthy controls. Patients without ICD did not differ from healthy controls in self-reported impulsivity or behavioral measurements. Both patient groups were more anxious and depressive than healthy controls. MRI scanning revealed structural differences in cortical areas related to impulse control in both patient groups. Patients without ICD had lower volumes and cortical thickness of bilateral inferior frontal gyrus. Patients with ICD had higher volumes of right caudal anterior cingulate and rostral middle frontal cortex. Conclusions: Despite the presence of ICD as confirmed by both clinical follow-up and self-reported impulsivity scales and supported by structural differences in various neural nodes related to inhibitory control and reward processing, patients with ICD performed no worse than healthy controls in various behavioral tasks previously hypothesized as robust impulsivity measures. These results call for caution against impetuous interpretation of behavioral tests, since various factors may and will influence the ultimate outcomes, be it the lack of sensitivity in specific, limited ICD subtypes, excessive caution of ICD patients during testing due to previous negative experience rendering simplistic tasks insufficient, or other, as of now unknown aspects, calling for further research.
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Affiliation(s)
- Pavlína Hlavatá
- Department of Psychiatry, Faculty of Medicine, Masaryk University Brno and University Hospital, Brno, Czechia.,Behavioral and Social Neuroscience Research Group, CEITEC-Central European Institute of Technology, Masaryk University, Brno, Czechia
| | - Pavla Linhartová
- Department of Psychiatry, Faculty of Medicine, Masaryk University Brno and University Hospital, Brno, Czechia
| | - Rastislav Šumec
- First Department of Neurology, Faculty of Medicine, Masaryk University and St. Anne's University Hospital, Brno, Czechia
| | - Pavel Filip
- First Department of Neurology, Faculty of Medicine, Masaryk University and St. Anne's University Hospital, Brno, Czechia
| | - Miroslav Světlák
- Faculty of Medicine, Institute of Psychology and Psychosomatics, Masaryk University Brno and University Hospital, Brno, Czechia
| | - Marek Baláž
- First Department of Neurology, Faculty of Medicine, Masaryk University and St. Anne's University Hospital, Brno, Czechia
| | - Tomáš Kašpárek
- Department of Psychiatry, Faculty of Medicine, Masaryk University Brno and University Hospital, Brno, Czechia
| | - Martin Bareš
- First Department of Neurology, Faculty of Medicine, Masaryk University and St. Anne's University Hospital, Brno, Czechia.,Department of Neurology, School of Medicine, University of Minnesota, Minneapolis, MN, United States
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16
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Slowed Movement Stopping in Parkinson's Disease and Focal Dystonia is Improved by Standard Treatment. Sci Rep 2019; 9:19504. [PMID: 31862983 PMCID: PMC6925208 DOI: 10.1038/s41598-019-55321-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 11/26/2019] [Indexed: 11/29/2022] Open
Abstract
Patients with Parkinson’s disease and focal dystonia have difficulty in generating and preventing movement. Reaction time (RT) and stop signal reaction time (SSRT) measure the speed to initiate and stop a movement respectively. We developed a portable device to assess RT and SSRT. This incorporated a novel analysis to measure SSRT more efficiently (optimal combination SSRT, ocSSRT). After validation ocSSRT was measured in Parkinson’s disease patients without dyskinesia (PD), cervical dystonia (CD) and writer’s cramp. We also assessed how ocSSRT responded to L-dopa in PD patients and botulinum toxin injections in CD patients. Participants were instructed to release a button following a green LED flash on the device. On 25% of trials, a red LED flashed 5–195 ms after the green LED; participations were instructed to abort the button release on these trials. ocSSRT and RT were significantly prolonged in patients with Parkinson’s disease and focal dystonia (one-way ANOVA p < 0.001). Administration of L-dopa significantly improved ocSSRT and RT in PD patients (p < 0.001). Administration of botulinum toxin significantly improved ocSSRT, but not RT, in CD patients (p < 0.05). ocSSRT is an easily-administered bedside neuro-physiological tool; significantly prolonged ocSSRT is associated with PD and focal dystonia.
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17
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Di Caprio V, Modugno N, Mancini C, Olivola E, Mirabella G. Early‐Stage Parkinson's Patients Show Selective Impairment in Reactive But Not Proactive Inhibition. Mov Disord 2019; 35:409-418. [DOI: 10.1002/mds.27920] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 09/27/2019] [Accepted: 10/23/2019] [Indexed: 11/08/2022] Open
Affiliation(s)
- Veronica Di Caprio
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Pozzilli (IS) Italy
| | - Nicola Modugno
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Pozzilli (IS) Italy
| | - Christian Mancini
- Department of Anatomy, Histology, Forensic Medicine & OrthopedicsSapienza University Rome Italy
| | - Enrica Olivola
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Pozzilli (IS) Italy
| | - Giovanni Mirabella
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Pozzilli (IS) Italy
- Department of Anatomy, Histology, Forensic Medicine & OrthopedicsSapienza University Rome Italy
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18
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Aponte EA, Schöbi D, Stephan KE, Heinzle J. Computational Dissociation of Dopaminergic and Cholinergic Effects on Action Selection and Inhibitory Control. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2019; 5:364-372. [PMID: 31952937 DOI: 10.1016/j.bpsc.2019.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 10/06/2019] [Accepted: 10/28/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Patients with schizophrenia make more errors than healthy subjects in the antisaccade task. In this paradigm, participants are required to inhibit a reflexive saccade to a target and to select the correct action (a saccade in the opposite direction). While the precise origin of this deficit is not clear, it has been connected to aberrant dopaminergic and cholinergic neuromodulation. METHODS To study the impact of dopamine and acetylcholine on inhibitory control and action selection, we administered two selective drugs (levodopa 200 mg/galantamine 8 mg) to healthy volunteers (N = 100) performing the antisaccade task. The computational model SERIA (stochastic early reaction, inhibition, and late action) was employed to separate the contribution of inhibitory control and action selection to empirical reaction times and error rates. RESULTS Modeling suggested that levodopa improved action selection (at the cost of increased reaction times) but did not have a significant effect on inhibitory control. By contrast, according to our model, galantamine affected inhibitory control in a dose-dependent fashion, reducing inhibition failures at low doses and increasing them at higher levels. These effects were sufficiently specific that the computational analysis allowed for identifying the drug administered to an individual with 70% accuracy. CONCLUSIONS Our results do not support the hypothesis that elevated tonic dopamine strongly impairs inhibitory control. Rather, levodopa improved the ability to select correct actions. However, inhibitory control was modulated by cholinergic drugs. This approach may provide a starting point for future computational assays that differentiate neuromodulatory abnormalities in heterogeneous diseases like schizophrenia.
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Affiliation(s)
- Eduardo A Aponte
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland.
| | - Dario Schöbi
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Klaas E Stephan
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland; Wellcome Centre for Human Neuroimaging, University College London, London, United Kingdom; Max Planck Institute for Metabolism Research, Cologne, Germany
| | - Jakob Heinzle
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland.
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19
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Spay C, Meyer G, Lio G, Pezzoli G, Ballanger B, Cilia R, Boulinguez P. Resting state oscillations suggest a motor component of Parkinson's Impulse Control Disorders. Clin Neurophysiol 2019; 130:2065-2075. [PMID: 31541984 DOI: 10.1016/j.clinph.2019.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 07/02/2019] [Accepted: 08/14/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Impulse control disorders (ICDs) in Parkinson's disease (PD) have been associated with cognitive impulsivity and dopaminergic dysfunction and treatment. The present study tests the neglected hypothesis that the neurofunctional networks involved in motor impulsivity might also be dysfunctional in PD-ICDs. METHODS We performed blind spectral analyses of resting state electroencephalographic (EEG) data in PD patients with and without ICDs to probe the functional integrity of all cortical networks. Analyses were performed directly at the source level after blind source separation. Discrete differences between groups were tested by comparing patients with and without ICDs. Gradual dysfunctions were assessed by means of correlations between power changes and clinical scores reflecting ICD severity (QUIP score). RESULTS Spectral signatures of ICDs were found in the medial prefrontal cortex, the dorsal anterior cingulate and the supplementary motor area, in the beta and gamma bands. Beta power changes in the supplementary motor area were found to predict ICDs severity. CONCLUSION ICDs are associated with abnormal activity within frequency bands and cortical circuits supporting the control of motor response inhibition. SIGNIFICANCE These results bring to the forefront the need to consider, in addition to the classical interpretation based on aberrant mesocorticolimbic reward processing, the issue of motor impulsivity in PD-ICDs and its potential implications for PD therapy.
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Affiliation(s)
- Charlotte Spay
- Université de Lyon, 92 rue Pasteur, 69007 Lyon, France; Université Lyon 1, 43 boulevard du 11 novembre 1918, 69622 Villeurbanne, France; INSERM, U 1028, Lyon Neuroscience Research Center, 95 boulevard Pinel, 69500 Bron, France; CNRS, UMR 5292, Lyon Neuroscience Research Center, 95 boulevard Pinel, 69500 Bron, France
| | - Garance Meyer
- Université de Lyon, 92 rue Pasteur, 69007 Lyon, France; Université Lyon 1, 43 boulevard du 11 novembre 1918, 69622 Villeurbanne, France; INSERM, U 1028, Lyon Neuroscience Research Center, 95 boulevard Pinel, 69500 Bron, France; CNRS, UMR 5292, Lyon Neuroscience Research Center, 95 boulevard Pinel, 69500 Bron, France
| | - Guillaume Lio
- Centre de Neuroscience Cognitive, UMR 5229, 67 boulevard Pinel, 69675 Bron, France
| | - Gianni Pezzoli
- Parkinson Institute, ASST Gaetano Pini-CTO, Via bignami 1, 20126 Milan, Italy
| | - Bénédicte Ballanger
- Université de Lyon, 92 rue Pasteur, 69007 Lyon, France; Université Lyon 1, 43 boulevard du 11 novembre 1918, 69622 Villeurbanne, France; INSERM, U 1028, Lyon Neuroscience Research Center, 95 boulevard Pinel, 69500 Bron, France; CNRS, UMR 5292, Lyon Neuroscience Research Center, 95 boulevard Pinel, 69500 Bron, France
| | - Roberto Cilia
- Parkinson Institute, ASST Gaetano Pini-CTO, Via bignami 1, 20126 Milan, Italy
| | - Philippe Boulinguez
- Université de Lyon, 92 rue Pasteur, 69007 Lyon, France; Université Lyon 1, 43 boulevard du 11 novembre 1918, 69622 Villeurbanne, France; INSERM, U 1028, Lyon Neuroscience Research Center, 95 boulevard Pinel, 69500 Bron, France; CNRS, UMR 5292, Lyon Neuroscience Research Center, 95 boulevard Pinel, 69500 Bron, France.
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Meder D, Herz DM, Rowe JB, Lehéricy S, Siebner HR. The role of dopamine in the brain - lessons learned from Parkinson's disease. Neuroimage 2019; 190:79-93. [DOI: 10.1016/j.neuroimage.2018.11.021] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 10/25/2018] [Accepted: 11/16/2018] [Indexed: 11/30/2022] Open
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Canário N, Sousa M, Moreira F, Duarte IC, Oliveira F, Januário C, Castelo-Branco M. Impulsivity across reactive, proactive and cognitive domains in Parkinson's disease on dopaminergic medication: Evidence for multiple domain impairment. PLoS One 2019; 14:e0210880. [PMID: 30759108 PMCID: PMC6373905 DOI: 10.1371/journal.pone.0210880] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 01/03/2019] [Indexed: 11/24/2022] Open
Abstract
Impulse control disorders (ICD) may occur in Parkinson’s disease (PD) although it remains to be understood if such deficits may occur even in the absence of a formal ICD diagnosis. Moreover, studies addressing simultaneously distinct neurobehavioral domains, such as cognitive, proactive and reactive motor impulsivity, are still lacking. Here, we aimed to investigate if reactive, proactive and cognitive impulsivity involving risk taking are concomitantly affected in medicated PD patients, and whether deficits were dependent on response strategies, such as speed accuracy tradeoffs, or the proportion of omission vs. commission errors. We assessed three different impulsivity domains in a sample of 21 PD patients and 13 matched controls. We found impaired impulsivity in both reactive (p = 0.042) and cognitive domains (p = 0.015) for the PD patients, irrespective of response strategy. For the latter, effect sizes were larger for the actions related with reward processing (p = 0.017, dCohen = 0.9). In the proactive impulsivity task, PD patients showed significantly increased number of omissions (p = 0.041), a response strategy which was associated with preserved number of commission errors. Moreover, the number of premature and proactive response errors were correlated with disease stage. Our findings suggest that PD ON medication is characterized compared to healthy controls by impairment across several impulsivity domains, which is moderated in the proactive domain by the response strategy.
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Affiliation(s)
- Nádia Canário
- Coimbra Institute for Biomedical Imaging and Translational Research (CiBit), ICNAS—Institute for Nuclear Sciences Applied to Health, Brain Imaging Network of Portugal, Coimbra, Portugal
- Laboratory of Biostatistics and Medical Informatics, Institute for Biomedical Imaging and Life Sciences (CNC.IBILI), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Mário Sousa
- Division of Movement Disorders, Department of Neurology, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Fradique Moreira
- Division of Movement Disorders, Department of Neurology, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Isabel Catarina Duarte
- Coimbra Institute for Biomedical Imaging and Translational Research (CiBit), ICNAS—Institute for Nuclear Sciences Applied to Health, Brain Imaging Network of Portugal, Coimbra, Portugal
- Laboratory of Biostatistics and Medical Informatics, Institute for Biomedical Imaging and Life Sciences (CNC.IBILI), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Francisco Oliveira
- Coimbra Institute for Biomedical Imaging and Translational Research (CiBit), ICNAS—Institute for Nuclear Sciences Applied to Health, Brain Imaging Network of Portugal, Coimbra, Portugal
| | - Cristina Januário
- Division of Movement Disorders, Department of Neurology, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Miguel Castelo-Branco
- Coimbra Institute for Biomedical Imaging and Translational Research (CiBit), ICNAS—Institute for Nuclear Sciences Applied to Health, Brain Imaging Network of Portugal, Coimbra, Portugal
- Laboratory of Biostatistics and Medical Informatics, Institute for Biomedical Imaging and Life Sciences (CNC.IBILI), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- * E-mail:
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Atkinson-Clement C, Cavazzini É, Zénon A, Witjas T, Fluchère F, Azulay JP, Baunez C, Eusebio A. Effects of subthalamic nucleus stimulation and levodopa on decision-making in Parkinson's disease. Mov Disord 2019; 34:377-385. [PMID: 30681186 DOI: 10.1002/mds.27625] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 10/26/2018] [Accepted: 11/30/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Parkinson's disease (PD) is frequently associated with behavioral disorders, particularly within the spectrum of motivated behaviors such as apathy or impulsivity. Both pharmacological and neurosurgical treatments have an impact on these impairments. However, there still is controversy as to whether subthalamic nucleus deep brain stimulation (STN-DBS) can cause or reduce impulsive behaviors. OBJECTIVES We aimed to identify the influence of functional surgery on decision-making processes in PD. METHODS We studied 13 PD patients and 13 healthy controls. The experimental task involved squeezing a dynamometer with variable force to obtain rewards of various values under four conditions: without treatment, with l-dopa or subthalamic stimulation alone, and with both l-dopa and subthalamic stimulation. Statistical analyses consisted of generalized linear mixed models including treatment condition, reward value, level of effort, and their interactions. We analyzed acceptance rate (the percentage of accepted trials), decision time, and force applied. RESULTS Comparatively to controls, patients without treatment exhibited lower acceptance rate and force applied. Patients under l-dopa alone did not exhibit increased acceptance rate. With subthalamic stimulation, either with or without added l-dopa, all measures were improved so that patients' behaviors were undistinguishable from healthy controls'. CONCLUSIONS Our study shows that l-dopa administration does not fully restore cost-benefit decision-making processes, whereas STN-DBS fully normalizes patients' behaviors. These findings suggest that dopamine is partly involved in cost-benefit valuation, and that STN-DBS can have a beneficial effect on motivated behaviors in PD and may improve certain forms of impulsive behaviors. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Cyril Atkinson-Clement
- Aix Marseille Université, CNRS, LPL, Aix-en-Provence, France.,Aix Marseille Université, CNRS, INT, Inst Neurosci Timone, Marseille, France
| | | | - Alexandre Zénon
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium.,INCIA, Université de Bordeaux, CNRS UMR5287, Bordeaux, France
| | - Tatiana Witjas
- Aix Marseille Université, CNRS, INT, Inst Neurosci Timone, Marseille, France.,Aix Marseille Université, APHM, CHU Timone, Department of Neurology and Movement Disorders, Marseille, France
| | - Frédérique Fluchère
- Aix Marseille Université, APHM, CHU Timone, Department of Neurology and Movement Disorders, Marseille, France.,Aix Marseille Université, CNRS, LNC, Marseille, France
| | - Jean-Philippe Azulay
- Aix Marseille Université, CNRS, INT, Inst Neurosci Timone, Marseille, France.,Aix Marseille Université, APHM, CHU Timone, Department of Neurology and Movement Disorders, Marseille, France
| | - Christelle Baunez
- Aix Marseille Université, CNRS, INT, Inst Neurosci Timone, Marseille, France
| | - Alexandre Eusebio
- Aix Marseille Université, CNRS, INT, Inst Neurosci Timone, Marseille, France.,Aix Marseille Université, APHM, CHU Timone, Department of Neurology and Movement Disorders, Marseille, France
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Harrington DL, Shen Q, Theilmann RJ, Castillo GN, Litvan I, Filoteo JV, Huang M, Lee RR. Altered Functional Interactions of Inhibition Regions in Cognitively Normal Parkinson's Disease. Front Aging Neurosci 2018; 10:331. [PMID: 30405399 PMCID: PMC6206214 DOI: 10.3389/fnagi.2018.00331] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 10/01/2018] [Indexed: 11/24/2022] Open
Abstract
Deficient inhibitory control in Parkinson's disease (PD) is often observed in situations requiring inhibition of impulsive or prepotent behaviors. Although activation of the right-hemisphere frontal-basal ganglia response inhibition network is partly altered in PD, disturbances in interactions of these regions are poorly understood, especially in patients without cognitive impairment. The present study investigated context-dependent connectivity of response inhibition regions in PD patients with normal cognition and control participants who underwent fMRI while performing a stop signal task. PD participants were tested off antiparkinsonian medication. To determine if functional disturbances depended on underlying brain structure, aberrant connectivity was correlated with brain volume and white-matter tissue diffusivity. We found no group differences in response inhibition proficiency. Yet the PD group showed functional reorganization in the long-range connectivity of inhibition regions, despite preserved within network connectivity. Successful inhibition in PD differed from the controls by strengthened connectivity of cortical regions, namely the right dorsolateral prefrontal cortex, pre-supplementary motor area and right caudal inferior frontal gyrus, largely with ventral and dorsal attention regions, but also the substantia nigra and default mode network regions. Successful inhibition in controls was distinguished by strengthened connectivity of the right rostral inferior frontal gyrus and subcortical inhibition nodes (right caudate, substantia nigra, and subthalamic nucleus). In both groups, the strength of context-dependent connectivity correlated with various indices of response inhibition performance. Mechanisms that may underlie aberrantly stronger context-specific connectivity include reduced coherence within reorganized systems, compensatory mechanisms, and/or the reorganization of intrinsic networks. In PD, but not controls, abnormally strengthened connectivity was linked to individual differences in underlying brain volumes and tissue diffusivity, despite no group differences in structural variables. The pattern of structural-functional associations suggested that subtle decreases in tissue diffusivity of underlying tracts and posterior cortical volumes may undermine the enhancement of normal cortical-striatal connectivity or cause strengthening in cortical-cortical connectivity. These novel findings demonstrate that functionally reorganized interactions of inhibition regions predates the development of inhibition deficits and clinically significant cognitive impairment in PD. We speculate that altered interactions of inhibition regions with attention-related networks and the dopaminergic system may presage future decline in inhibitory control.
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Affiliation(s)
- Deborah L. Harrington
- Cognitive Neuroimaging Laboratory, Research Service, VA San Diego Healthcare System, San Diego, CA, United States
- Department of Radiology, University of California, San Diego, La Jolla, CA, United States
| | - Qian Shen
- Cognitive Neuroimaging Laboratory, Research Service, VA San Diego Healthcare System, San Diego, CA, United States
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, United States
| | - Rebecca J. Theilmann
- Department of Radiology, University of California, San Diego, La Jolla, CA, United States
| | - Gabriel N. Castillo
- Cognitive Neuroimaging Laboratory, Research Service, VA San Diego Healthcare System, San Diego, CA, United States
- Department of Radiology, University of California, San Diego, La Jolla, CA, United States
| | - Irene Litvan
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, United States
| | - J. Vincent Filoteo
- Psychology Service, VA San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Mingxiong Huang
- Department of Radiology, University of California, San Diego, La Jolla, CA, United States
- Department of Radiology, VA San Diego Healthcare System, San Diego, CA, United States
| | - Roland R. Lee
- Department of Radiology, University of California, San Diego, La Jolla, CA, United States
- Department of Radiology, VA San Diego Healthcare System, San Diego, CA, United States
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Picazio S, Ponzo V, Caltagirone C, Brusa L, Koch G. Dysfunctional inhibitory control in Parkinson’s disease patients with levodopa-induced dyskinesias. J Neurol 2018; 265:2088-2096. [DOI: 10.1007/s00415-018-8945-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/28/2018] [Accepted: 06/18/2018] [Indexed: 10/28/2022]
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25
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Manza P, Schwartz G, Masson M, Kann S, Volkow ND, Li CSR, Leung HC. Levodopa improves response inhibition and enhances striatal activation in early-stage Parkinson's disease. Neurobiol Aging 2018; 66:12-22. [PMID: 29501966 DOI: 10.1016/j.neurobiolaging.2018.02.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 01/31/2018] [Accepted: 02/04/2018] [Indexed: 11/26/2022]
Abstract
Dopaminergic medications improve the motor symptoms of Parkinson's disease (PD), but their effect on response inhibition, a critical executive function, remains unclear. Previous studies primarily enrolled patients in more advanced stages of PD, when dopaminergic medication loses efficacy, and patients were typically on multiple medications. Here, we recruited 21 patients in early-stage PD on levodopa monotherapy and 37 age-matched controls to perform the stop-signal task during functional magnetic resonance imaging. In contrast to previous studies reporting null effects in more advanced PD, levodopa significantly improved response inhibition performance in our sample. No significant group differences were found in brain activations to pure motor inhibition or error processing (stop success vs. error trials). However, relative to controls, the PD group showed weaker striatal activations to salient events (infrequent vs. frequent events: stop vs. go trials) and fronto-striatal task-residual functional connectivity; both were restored with levodopa. Thus, levodopa appears to improve an important executive function in early-stage PD via enhanced salient signal processing, shedding new light on the role of dopaminergic signaling in response inhibition.
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Affiliation(s)
- Peter Manza
- Department of Psychology, Integrative Neuroscience Program, Stony Brook University, Stony Brook, NY, USA.
| | - Guy Schwartz
- Department of Neurology, Stony Brook University, Stony Brook, NY, USA
| | - Mala Masson
- Department of Psychology, Integrative Neuroscience Program, Stony Brook University, Stony Brook, NY, USA
| | - Sarah Kann
- Department of Psychology, Integrative Neuroscience Program, Stony Brook University, Stony Brook, NY, USA
| | - Nora D Volkow
- National Institute on Alcoholism and Alcohol Abuse, National Institutes of Health, Bethesda, MD, USA; National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA
| | - Chiang-Shan R Li
- Department of Psychiatry, Yale University, New Haven, CT, USA; Department of Neuroscience, Yale University, New Haven, CT, USA; Interdepartmental Neuroscience Program, Yale University, New Haven, CT, USA; Beijing Huilongguan Hospital, Beijing, China
| | - Hoi-Chung Leung
- Department of Psychology, Integrative Neuroscience Program, Stony Brook University, Stony Brook, NY, USA.
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26
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Abstract
OBJECTIVES We investigated how broad motivational tendencies are related to the expression and suppression of action impulses in Parkinson's disease (PD). METHODS Sixty-nine participants with PD completed a Simon response conflict task and Behavioral Inhibition System (BIS) and Behavioral Activation System (BAS) scales based on Gray's (1987) reinforcement sensitivity theory. Analyses determined relationships between BIS, BAS, and the susceptibility to making impulsive action errors and the proficiency of inhibiting interference from action impulses. RESULTS BIS scores correlated positively with rates of impulsive action errors, indicating that participants endorsing low BIS tendencies were much more susceptible to acting on strong motor impulses. Analyses of subgroups with high versus low BIS scores confirmed this pattern and ruled out alternative explanations in terms of group differences in speed-accuracy tradeoffs. None of the scores on the BIS or BAS scales correlated with reactive inhibitory control. CONCLUSIONS PD participants who endorse diminished predilection toward monitoring and avoiding aversive experiences (low BIS) show much greater difficulty restraining fast, impulsive motor errors. Establishing relationships between motivational sensitivities and cognitive control processes may have important implications for treatment strategies and positive health outcomes in participants with PD, particularly those at risk for falling and driving difficulties related to impulsive reactions. (JINS, 2018, 24, 128-138).
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The neurobiology of impulse control disorders in Parkinson's disease: from neurotransmitters to neural networks. Cell Tissue Res 2018; 373:327-336. [PMID: 29383446 PMCID: PMC6015621 DOI: 10.1007/s00441-017-2771-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 12/14/2017] [Indexed: 01/08/2023]
Abstract
Impulse control disorders (ICD) are common neuropsychiatric disorders that can arise in Parkinson’s disease (PD) patients after commencing dopamine replacement therapy. Approximately 15% of all patients develop these disorders and many more exhibit subclinical symptoms of impulsivity. ICD is thought to develop due to an interaction between the use of dopaminergic medication and an as yet unknown neurobiological vulnerability that either pre-existed before PD onset (possibly genetic) or is associated with neural alterations due to the PD pathology. This review discusses genes, neurotransmitters and neural networks that have been implicated in the pathophysiology of ICD in PD. Although dopamine and the related reward system have been the main focus of research, recently, studies have started to look beyond those systems to find new clues to the neurobiological underpinnings of ICD and come up with possible new targets for treatment. Studies on the whole-brain connectome to investigate the global alterations due to ICD development are currently lacking. In addition, there is a dire need for longitudinal studies that are able to disentangle the contributions of individual (genetic) traits and secondary effects of the PD pathology and chronic dopamine replacement therapy to the development of ICD in PD.
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Silveira CRA, Roy EA, Intzandt BN, Almeida QJ. Aerobic exercise is more effective than goal-based exercise for the treatment of cognition in Parkinson's disease. Brain Cogn 2018; 122:1-8. [PMID: 29331916 DOI: 10.1016/j.bandc.2018.01.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 12/11/2017] [Accepted: 01/02/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Little is known about how different exercise modalities influence cognition in Parkinson's disease (PD). Moreover, the focus of previous investigations on examining the effects of exercise mainly on executive functions and the exclusion of individuals with cognitive impairment may limit the potential to define exercise as a treatment for cognitive decline in PD. OBJECTIVE The aim of this study was to compare the effects of aerobic and goal-based exercise on five cognitive domains in cognitively normal and impaired individuals with PD. METHODS Seventy-six individuals with PD were randomly allocated into three groups: Aerobic, Goal-based, and Control. Participants in the exercise groups attended 1-h sessions 3x/week for 12 weeks, while those in the Control group carried on with their regular activities. Changes in cognitive domains were assessed using paper-based neuropsychological tests. RESULTS Inhibitory control improved only in the Aerobic group (p = .04), irrespective of participants cognitive status at baseline. Moreover, participants with cognitive impairment in Aerobic group maintained their set-shifting ability, whereas those in the Control group were worse at post-test (p = .014). CONCLUSION This is the first study to show that aerobic exercise is more effective than goal-based exercise for the treatment of cognition in PD with and without cognitive impairment.
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Affiliation(s)
- Carolina R A Silveira
- Movement Disorders Research and Rehabilitation Centre, Wilfrid Laurier University, 75 University Avenue West, Waterloo, Ontario N2L 3C5, Canada; Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada.
| | - Eric A Roy
- Movement Disorders Research and Rehabilitation Centre, Wilfrid Laurier University, 75 University Avenue West, Waterloo, Ontario N2L 3C5, Canada; Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada.
| | - Brittany N Intzandt
- Movement Disorders Research and Rehabilitation Centre, Wilfrid Laurier University, 75 University Avenue West, Waterloo, Ontario N2L 3C5, Canada.
| | - Quincy J Almeida
- Movement Disorders Research and Rehabilitation Centre, Wilfrid Laurier University, 75 University Avenue West, Waterloo, Ontario N2L 3C5, Canada.
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Dopaminergic medication shifts the balance between going and stopping in Parkinson's disease. Neuropsychologia 2018; 109:262-269. [DOI: 10.1016/j.neuropsychologia.2017.12.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 12/12/2017] [Accepted: 12/17/2017] [Indexed: 11/17/2022]
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30
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Gazzellini S, Napolitano A, Bauleo G, Bisozzi E, Lispi ML, Ardu E, Castelli E, Benso F. Time-frequency analyses of reaction times and theta/beta EEG ratio in pediatric patients with traumatic brain injury: A preliminary study. Dev Neurorehabil 2017; 20:393-407. [PMID: 27629793 DOI: 10.1080/17518423.2016.1216470] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE The literature on patients with attention deficit reports peculiar reaction time (RT) oscillation at very low frequencies (VLFO=0.06-0.2 Hz). The data were explained as default mode network (DMN) intrusion in goal-oriented activity. The present study investigates whether a pattern of recurrent lapses in attention can be detected in TBI patients and whether VLFO can be generalized to the sustained attention deficit, regardless of etiology. METHODS Groups of pediatric TBIs and healthy controls performed four attentional tasks. RT and theta/beta timeseries were subjected to wavelet analyses. RESULTS Significant high-power VLFOs were recorded in patient group performances but not in those of controls, both for RTs and theta/beta in all the tasks. CONCLUSION This preliminary study suggests that central-midline theta/beta ratio could be considered a neurophysiological correlate of RT variability and that the general continuous goal-oriented activity can be cross-etiologically affected by recurrent lapses in attention regardless of the specific cognitive component involved.
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Affiliation(s)
- Simone Gazzellini
- a Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital IRCCS , Rome , Italy
| | - Antonio Napolitano
- b Clinical Technology Innovations Research Area, Bambino Gesù Children's Hospital IRCCS , Rome , Italy
| | - Graziella Bauleo
- c "Il filo dalla Torre" Centre for Education, Autism and Disability , Rome , Italy
| | - Eleonora Bisozzi
- a Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital IRCCS , Rome , Italy
| | - Maria Luisa Lispi
- a Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital IRCCS , Rome , Italy
| | | | - Enrico Castelli
- a Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital IRCCS , Rome , Italy
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Parkinson's Disease Subtypes Show Distinct Tradeoffs Between Response Initiation and Inhibition Latencies. J Int Neuropsychol Soc 2017; 23:665-674. [PMID: 28850018 DOI: 10.1017/s1355617717000467] [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] [Indexed: 11/07/2022]
Abstract
OBJECTIVES In unpredictable situations, individuals often show tradeoffs between response initiation and inhibition speeds. We tested the hypothesis that Parkinson's disease (PD) motor subtypes differentially impact tradeoffs between these two action-oriented processes. We predicted that, compared to tremor dominant (TD) patients, predominant postural instability and gait dysfunction (PIGD) patients would show exacerbated tradeoffs between response initiation and inhibition in situations requiring the sudden potential need to interrupt an action. METHODS Fifty-one PD patients (subdivided into PIGD [n=27] and TD [n=24]) and 21 healthy controls (HCs) completed a choice reaction task to establish baseline response initiation speed between groups. Subsequently, participants completed a stop-signal task which introduced an occasional, unpredictable stop stimulus. We measured changes in initiation speed in preparation of an unpredictable stop (i.e., proactive slowing) and inhibition latency (i.e., stop-signal reaction time). RESULTS Compared to HCs, PD patients showed slower response initiation speeds in the choice reaction task. All groups showed proactive slowing in the stop-signal task but the magnitude was considerably larger in PIGD patients, almost twice as large as TD patients. PD patients, irrespective of motor subtype, showed longer inhibition latencies than HCs. CONCLUSIONS PIGD and TD subtypes both showed exacerbated response inhibition deficits. However, PIGD patients showed much more pronounced proactive slowing in situations with an expected yet unpredictable need to stop action abruptly. This suggests that PIGD is accompanied by exaggerated tradeoffs between response initiation and inhibition processes to meet situational action demands. We discuss putative neural mechanisms and clinical implications of these findings. (JINS, 2017, 23, 665-674).
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On the Globality of Motor Suppression: Unexpected Events and Their Influence on Behavior and Cognition. Neuron 2017; 93:259-280. [PMID: 28103476 DOI: 10.1016/j.neuron.2016.12.013] [Citation(s) in RCA: 250] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 11/21/2016] [Accepted: 12/05/2016] [Indexed: 02/08/2023]
Abstract
Unexpected events are part of everyday experience. They come in several varieties-action errors, unexpected action outcomes, and unexpected perceptual events-and they lead to motor slowing and cognitive distraction. While different varieties of unexpected events have been studied largely independently, and many different mechanisms are thought to explain their effects on action and cognition, we suggest a unifying theory. We propose that unexpected events recruit a fronto-basal-ganglia network for stopping. This network includes specific prefrontal cortical nodes and is posited to project to the subthalamic nucleus, with a putative global suppressive effect on basal-ganglia output. We argue that unexpected events interrupt action and impact cognition, partly at least, by recruiting this global suppressive network. This provides a common mechanistic basis for different types of unexpected events; links the literatures on motor inhibition, performance monitoring, attention, and working memory; and is relevant for understanding clinical symptoms of distractibility and mental inflexibility.
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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.
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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
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Acting without being in control: Exploring volition in Parkinson's disease with impulsive compulsive behaviours. Parkinsonism Relat Disord 2017; 40:51-57. [DOI: 10.1016/j.parkreldis.2017.04.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 03/14/2017] [Accepted: 04/18/2017] [Indexed: 11/23/2022]
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35
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Mirabella G, Fragola M, Giannini G, Modugno N, Lakens D. Inhibitory control is not lateralized in Parkinson's patients. Neuropsychologia 2017. [DOI: 10.1016/j.neuropsychologia.2017.06.025] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Fjodorova M, Torres EM, Dunnett SB. Transplantation site influences the phenotypic differentiation of dopamine neurons in ventral mesencephalic grafts in Parkinsonian rats. Exp Neurol 2017; 291:8-19. [PMID: 28131726 PMCID: PMC5354310 DOI: 10.1016/j.expneurol.2017.01.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 01/17/2017] [Accepted: 01/24/2017] [Indexed: 01/26/2023]
Abstract
Foetal midbrain progenitors have been shown to survive, give rise to different classes of dopamine neurons and integrate into the host brain alleviating Parkinsonian symptoms following transplantation in patients and animal models of the disease. Dopamine neuron subpopulations in the midbrain, namely A9 and A10, can be identified anatomically based on cell morphology and ascending axonal projections. G protein-gated inwardly rectifying potassium channel Girk2 and the calcium binding protein Calbindin are the two best available histochemical markers currently used to label (with some overlap) A9- and A10-like dopamine neuron subtypes, respectively, in tyrosine hydroxylase expressing neurons both in the midbrain and grafts. Both classes of dopamine neurons survive in grafts in the striatum and extend axonal projections to their normal dorsal and ventral striatal targets depending on phenotype. Nevertheless, grafts transplanted into the dorsal striatum, which is an A9 input nucleus, are enriched for dopamine neurons that express Girk2. It remains to be elucidated whether different transplantation sites favour the differential survival and/or development of concordant dopamine neuron subtypes within the grafts. Here we used rat foetal midbrain progenitors at two developmental stages corresponding to a peak in either A9 or A10 neurogenesis and examined their commitment to respective dopaminergic phenotypes by grafting cells into different forebrain regions that contain targets of either nigral A9 dopamine innervation (dorsal striatum), ventral tegmental area A10 dopamine innervation (nucleus accumbens and prefrontal cortex), or only sparse dopamine but rich noradrenaline innervation (hippocampus). We demonstrate that young (embryonic day, E12), but not older (E14), mesencephalic tissue and the transplant environment influence survival and functional integration of specific subtypes of dopamine neurons into the host brain. We also show that irrespective of donor age A9-like, Girk2-expressing neurons are more responsive to environmental cues in adopting a dopaminergic phenotype during differentiation post-grafting. These novel findings suggest that dopamine progenitors use targets of A9/A10 innervation in the transplantation site to complete maturation and the efficacy of foetal cell replacement therapy in patients may be improved by deriving midbrain tissue at earlier developmental stages than in current practice.
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Affiliation(s)
- Marija Fjodorova
- Brain Repair Group, School of Biosciences, Cardiff University, Museum Avenue, Cardiff, Wales CF10 3AX, UK.
| | - Eduardo M Torres
- Brain Repair Group, School of Biosciences, Cardiff University, Museum Avenue, Cardiff, Wales CF10 3AX, UK
| | - Stephen B Dunnett
- Brain Repair Group, School of Biosciences, Cardiff University, Museum Avenue, Cardiff, Wales CF10 3AX, UK
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Kehagia AA. A neurological perspective on the enhancement debate: Lessons learned from Parkinson's disease. J Psychopharmacol 2016; 30:957-66. [PMID: 27604630 DOI: 10.1177/0269881116665328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Cognitive enhancement is signified by adaptive behavioural change following an intervention that targets the brain. Although much of the discussion and research into cognitive enhancement focuses on the effects of neural interventions in healthy individuals, it is useful to consider evidence from clinical populations. Diseases of the central nervous system represent the primary and richest source of evidence on the effects of brain manipulations, which are in the first instance therapeutic. Parkinson's disease (PD) is used as a model for understanding the effects of pharmacological agents that target systems with a central role in cognition. The mixed outcomes of deep brain stimulation on cognition will also be discussed. By illustrating the psychopharmacological principle of diverse and malleable neurochemical optima for different cognitive functions, and the role of individual differences, it will be argued that the entire spectrum of cognitive effects in any one individual following any given manipulation, such as the administration of a drug, often includes enhancement as well as impairment. Predicting these effects represents a complex multivariate problem, and the accuracy of this predictive effort, as well as the harm prevention it connotes, is determined by our evolving understanding of the brain and cognition. A manipulation can be said to confer cognitive enhancement; however, it is argued that using the global term cognitive enhancer to refer to such a manipulation without qualification is of limited utility.
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Affiliation(s)
- Angie A Kehagia
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Response inhibition rapidly increases single-neuron responses in the subthalamic nucleus of patients with Parkinson's disease. Cortex 2016; 84:111-123. [PMID: 27745848 DOI: 10.1016/j.cortex.2016.09.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 07/12/2016] [Accepted: 09/12/2016] [Indexed: 11/22/2022]
Abstract
The subthalamic nucleus (STN) plays a critical role during action inhibition, perhaps by acting like a fast brake on the motor system when inappropriate responses have to be rapidly suppressed. However, the mechanisms involving the STN during motor inhibition are still unclear, particularly because of a relative lack of single-cell responses reported in this structure in humans. In this study, we used extracellular microelectrode recordings during deep brain stimulation surgery in patients with Parkinson's disease (PD) to study STN neurophysiological correlates of inhibitory control during a stop signal task. We found two neuronal subpopulations responding either during motor execution (GO units) or during motor inhibition (STOP units). GO units fired selectively before patients' motor responses whereas STOP units fired selectively when patients successfully withheld their move at a latency preceding the duration of the inhibition process. These results provide electrophysiological evidence for the hypothesized role of the STN in current models of response inhibition.
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Rae CL, Nombela C, Rodríguez PV, Ye Z, Hughes LE, Jones PS, Ham T, Rittman T, Coyle-Gilchrist I, Regenthal R, Sahakian BJ, Barker RA, Robbins TW, Rowe JB. Atomoxetine restores the response inhibition network in Parkinson's disease. Brain 2016; 139:2235-48. [PMID: 27343257 PMCID: PMC4958901 DOI: 10.1093/brain/aww138] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 05/03/2016] [Accepted: 05/06/2016] [Indexed: 01/03/2023] Open
Abstract
Parkinson's disease impairs the inhibition of responses, and whilst impulsivity is mild for some patients, severe impulse control disorders affect ∼10% of cases. Based on preclinical models we proposed that noradrenergic denervation contributes to the impairment of response inhibition, via changes in the prefrontal cortex and its subcortical connections. Previous work in Parkinson's disease found that the selective noradrenaline reuptake inhibitor atomoxetine could improve response inhibition, gambling decisions and reflection impulsivity. Here we tested the hypotheses that atomoxetine can restore functional brain networks for response inhibition in Parkinson's disease, and that both structural and functional connectivity determine the behavioural effect. In a randomized, double-blind placebo-controlled crossover study, 19 patients with mild-to-moderate idiopathic Parkinson's disease underwent functional magnetic resonance imaging during a stop-signal task, while on their usual dopaminergic therapy. Patients received 40 mg atomoxetine or placebo, orally. This regimen anticipates that noradrenergic therapies for behavioural symptoms would be adjunctive to, not a replacement for, dopaminergic therapy. Twenty matched control participants provided normative data. Arterial spin labelling identified no significant changes in regional perfusion. We assessed functional interactions between key frontal and subcortical brain areas for response inhibition, by comparing 20 dynamic causal models of the response inhibition network, inverted to the functional magnetic resonance imaging data and compared using random effects model selection. We found that the normal interaction between pre-supplementary motor cortex and the inferior frontal gyrus was absent in Parkinson's disease patients on placebo (despite dopaminergic therapy), but this connection was restored by atomoxetine. The behavioural change in response inhibition (improvement indicated by reduced stop-signal reaction time) following atomoxetine correlated with structural connectivity as measured by the fractional anisotropy in the white matter underlying the inferior frontal gyrus. Using multiple regression models, we examined the factors that influenced the individual differences in the response to atomoxetine: the reduction in stop-signal reaction time correlated with structural connectivity and baseline performance, while disease severity and drug plasma level predicted the change in fronto-striatal effective connectivity following atomoxetine. These results suggest that (i) atomoxetine increases sensitivity of the inferior frontal gyrus to afferent inputs from the pre-supplementary motor cortex; (ii) atomoxetine can enhance downstream modulation of frontal-subcortical connections for response inhibition; and (iii) the behavioural consequences of treatment are dependent on fronto-striatal structural connections. The individual differences in behavioural responses to atomoxetine highlight the need for patient stratification in future clinical trials of noradrenergic therapies for Parkinson's disease.
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Affiliation(s)
- Charlotte L Rae
- 1 Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0SZ, UK 2 Medical Research Council Cognition and Brain Sciences Unit, Cambridge, CB2 7EF, UK
| | - Cristina Nombela
- 1 Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0SZ, UK
| | | | - Zheng Ye
- 1 Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0SZ, UK
| | - Laura E Hughes
- 1 Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0SZ, UK 2 Medical Research Council Cognition and Brain Sciences Unit, Cambridge, CB2 7EF, UK
| | - P Simon Jones
- 1 Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0SZ, UK
| | - Timothy Ham
- 1 Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0SZ, UK
| | - Timothy Rittman
- 1 Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0SZ, UK
| | - Ian Coyle-Gilchrist
- 1 Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0SZ, UK
| | - Ralf Regenthal
- 3 Division of Clinical Pharmacology, Rudolf-Boehm-Institute of Pharmacology and Toxicology, University of Leipzig, Leipzig, 04107, Germany
| | - Barbara J Sahakian
- 4 Behavioural and Clinical Neuroscience Institute, Cambridge, CB2 3EB, UK 5 Department of Psychiatry, University of Cambridge, CB2 0SZ, Cambridge, UK
| | - Roger A Barker
- 1 Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0SZ, UK
| | - Trevor W Robbins
- 4 Behavioural and Clinical Neuroscience Institute, Cambridge, CB2 3EB, UK 6 Department of Experimental Psychology, University of Cambridge, CB2 3EB, Cambridge, UK
| | - James B Rowe
- 1 Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0SZ, UK 2 Medical Research Council Cognition and Brain Sciences Unit, Cambridge, CB2 7EF, UK 4 Behavioural and Clinical Neuroscience Institute, Cambridge, CB2 3EB, UK
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Lelos MJ, Morgan RJ, Kelly CM, Torres EM, Rosser AE, Dunnett SB. Amelioration of non-motor dysfunctions after transplantation of human dopamine neurons in a model of Parkinson's disease. Exp Neurol 2016; 278:54-61. [PMID: 26851542 PMCID: PMC4801014 DOI: 10.1016/j.expneurol.2016.02.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 01/25/2016] [Accepted: 02/02/2016] [Indexed: 11/29/2022]
Abstract
Background Patients suffering from Parkinson's disease (PD) display cognitive and neuropsychiatric dysfunctions, especially with disease progression. Although these impairments have been reported to impact more heavily upon a patient's quality of life than any motor dysfunctions, there are currently no interventions capable of adequately targeting these non-motor deficits. Objectives Utilizing a rodent model of PD, we investigated whether cell replacement therapy, using intrastriatal transplants of human-derived ventral mesencephalic (hVM) grafts, could alleviate cognitive and neuropsychiatric, as well as motor, dysfunctions. Methods Rats with unilateral 6-hydroxydopamine lesions to the medial forebrain bundle were tested on a complex operant task that dissociates motivational, visuospatial and motor impairments sensitive to the loss of dopamine. A subset of lesioned rats received intrastriatal hVM grafts of ~ 9 weeks gestation. Post-graft, rats underwent repeated drug-induced rotation tests and were tested on two versions of the complex operant task, before post-mortem analysis of the hVM tissue grafts. Results Post-graft behavioural testing revealed that hVM grafts improved non-motor aspects of task performance, specifically visuospatial function and motivational processing, as well as alleviating motor dysfunctions. Conclusions We report the first evidence of human VM cell grafts alleviating both non-motor and motor dysfunctions in an animal model of PD. This intervention, therefore, is the first to improve cognitive and neuropsychiatric symptoms long-term in a model of PD. Non-motor dysfunctions affect quality of life in Parkinson's disease. We tested whether human-derived foetal dopamine cells could improve these deficits. Human dopamine cells improved rotational bias and movement impairments in a rat model. Non-motor dysfunctions, specifically visuospatial and motivational deficits, improved. This is the first evidence of improved non-motor deficits from human dopamine cells.
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Affiliation(s)
- M J Lelos
- Brain Repair Group, School of Biosciences, Cardiff University, Cardiff, Wales CF10 3AX, UK.
| | - R J Morgan
- Brain Repair Group, School of Biosciences, Cardiff University, Cardiff, Wales CF10 3AX, UK
| | - C M Kelly
- Brain Repair Group, School of Biosciences, Cardiff University, Cardiff, Wales CF10 3AX, UK
| | - E M Torres
- Brain Repair Group, School of Biosciences, Cardiff University, Cardiff, Wales CF10 3AX, UK
| | - A E Rosser
- Brain Repair Group, School of Biosciences, Cardiff University, Cardiff, Wales CF10 3AX, UK
| | - S B Dunnett
- Brain Repair Group, School of Biosciences, Cardiff University, Cardiff, Wales CF10 3AX, UK
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Ye Z, Rae CL, Nombela C, Ham T, Rittman T, Jones PS, Rodríguez PV, Coyle-Gilchrist I, Regenthal R, Altena E, Housden CR, Maxwell H, Sahakian BJ, Barker RA, Robbins TW, Rowe JB. Predicting beneficial effects of atomoxetine and citalopram on response inhibition in Parkinson's disease with clinical and neuroimaging measures. Hum Brain Mapp 2016; 37:1026-37. [PMID: 26757216 PMCID: PMC4819701 DOI: 10.1002/hbm.23087] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 11/10/2015] [Accepted: 12/01/2015] [Indexed: 12/25/2022] Open
Abstract
Recent studies indicate that selective noradrenergic (atomoxetine) and serotonergic (citalopram) reuptake inhibitors may improve response inhibition in selected patients with Parkinson's disease, restoring behavioral performance and brain activity. We reassessed the behavioral efficacy of these drugs in a larger cohort and developed predictive models to identify patient responders. We used a double‐blind randomized three‐way crossover design to investigate stopping efficiency in 34 patients with idiopathic Parkinson's disease after 40 mg atomoxetine, 30 mg citalopram, or placebo. Diffusion‐weighted and functional imaging measured microstructural properties and regional brain activations, respectively. We confirmed that Parkinson's disease impairs response inhibition. Overall, drug effects on response inhibition varied substantially across patients at both behavioral and brain activity levels. We therefore built binary classifiers with leave‐one‐out cross‐validation (LOOCV) to predict patients’ responses in terms of improved stopping efficiency. We identified two optimal models: (1) a “clinical” model that predicted the response of an individual patient with 77–79% accuracy for atomoxetine and citalopram, using clinically available information including age, cognitive status, and levodopa equivalent dose, and a simple diffusion‐weighted imaging scan; and (2) a “mechanistic” model that explained the behavioral response with 85% accuracy for each drug, using drug‐induced changes of brain activations in the striatum and presupplementary motor area from functional imaging. These data support growing evidence for the role of noradrenaline and serotonin in inhibitory control. Although noradrenergic and serotonergic drugs have highly variable effects in patients with Parkinson's disease, the individual patient's response to each drug can be predicted using a pattern of clinical and neuroimaging features. Hum Brain Mapp 37:1026–1037, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Zheng Ye
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom.,Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Charlotte L Rae
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom.,Medical Research Council Cognition and Brain Sciences Unit, Cambridge, United Kingdom
| | - Cristina Nombela
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Timothy Ham
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Timothy Rittman
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Peter Simon Jones
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | | | - Ian Coyle-Gilchrist
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Ralf Regenthal
- Division of Clinical Pharmacology, Rudolf-Boehm-Institute of Pharmacology and Toxicology, University of Leipzig, Leipzig, Germany
| | - Ellemarije Altena
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Charlotte R Housden
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Helen Maxwell
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Barbara J Sahakian
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.,Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom
| | - Roger A Barker
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Trevor W Robbins
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom.,Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom
| | - James B Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom.,Medical Research Council Cognition and Brain Sciences Unit, Cambridge, United Kingdom.,Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom
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St George RJ, Carlson-Kuhta P, King LA, Burchiel KJ, Horak FB. Compensatory stepping in Parkinson's disease is still a problem after deep brain stimulation randomized to STN or GPi. J Neurophysiol 2015; 114:1417-23. [PMID: 26108960 DOI: 10.1152/jn.01052.2014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 06/19/2015] [Indexed: 11/22/2022] Open
Abstract
The effects of deep brain stimulation (DBS) on balance in people with Parkinson's disease (PD) are not well established. This study examined whether DBS randomized to the subthalamic nucleus (STN; n = 11) or globus pallidus interna (GPi; n = 10) improved compensatory stepping to recover balance after a perturbation. The standing surface translated backward, forcing subjects to take compensatory steps forward. Kinematic and kinetic responses were recorded. PD-DBS subjects were tested off and on their levodopa medication before bilateral DBS surgery and retested 6 mo later off and on DBS, combined with off and on levodopa medication. Responses were compared with PD-control subjects (n = 8) tested over the same timescale and 17 healthy control subjects. Neither DBS nor levodopa improved the stepping response. Compensatory stepping in the best-treated state after surgery (DBS+DOPA) was similar to the best-treated state before surgery (DOPA) for the PD-GPi group and the PD-control group. For the PD-STN group, there were more lateral weight shifts, a delayed foot-off, and a greater number of steps required to recover balance in DBS+DOPA after surgery compared with DOPA before surgery. Within the STN group five subjects who did not fall during the experiment before surgery fell at least once after surgery, whereas the number of falls in the GPi and PD-control groups were unchanged. DBS did not improve the compensatory step response needed to recover from balance perturbations in the GPi group and caused delays in the preparation phase of the step in the STN group.
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Affiliation(s)
- R J St George
- Department of Neurology, Oregon Health and Science University, Beaverton, Oregon; Human Motor Control Laboratory, School of Medicine, University of Tasmania, Hobart, Australia
| | - P Carlson-Kuhta
- Department of Neurology, Oregon Health and Science University, Beaverton, Oregon
| | - L A King
- Department of Neurology, Oregon Health and Science University, Beaverton, Oregon
| | - K J Burchiel
- Department of Neurosurgery, Oregon Health and Science University, Beaverton, Oregon
| | - F B Horak
- Department of Neurology, Oregon Health and Science University, Beaverton, Oregon; Department of Veterans Affairs Portland Health Care System, Portland, Oregon; and
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Fluchère F, Deveaux M, Burle B, Vidal F, van den Wildenberg WPM, Witjas T, Eusebio A, Azulay JP, Hasbroucq T. Dopa therapy and action impulsivity: subthreshold error activation and suppression in Parkinson's disease. Psychopharmacology (Berl) 2015; 232:1735-46. [PMID: 25510855 DOI: 10.1007/s00213-014-3805-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 11/06/2014] [Indexed: 11/28/2022]
Abstract
RATIONALE Impulsive actions entail (1) capture of the motor system by an action impulse, which is an urge to act and (2) failed suppression of that impulse in order to prevent a response error. Several studies indicate that dopaminergic treatment can induce action impulsivity in patients diagnosed with Parkinson's disease (PD). Whether this effect is due to increased impulse expression or to decreased impulse suppression remains to be deciphered. METHOD We used a novel approach based on electromyographic (EMG) analyses to decipher the effects of the patient's usual dopaminergic therapy on the expression and suppression of subliminal erroneous impulses. To this end, we used a within-subject design and took advantage of the Simon task, that elicits prepotent response tendencies. The patients (N = 15) performed the task on their usual dopaminergic medication and after complete medication withdrawal (for at least 12 h). RESULTS The correction rate that measures the ability to suppress subthreshold impulsive muscle activity was lower when the patients were on medication as compared to their off medication state (p < 0.05). The incorrect activation rate that measures the capture of the motor system by action impulses was unaffected by medication. CONCLUSIONS Dopa therapy affected action impulsivity. Although medication did not influence the incidence of fast action impulses, it significantly reduced patients' ability to abort and suppress muscle activation related to the incorrect response alternative.
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Affiliation(s)
- Frédérique Fluchère
- Laboratoire de Neurosciences Cognitives, Fédération de Recherche Comportement-Cerveau-Cognition, Aix-Marseille Université, CNRS, Marseille, France,
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Failure of stop and go in de novo Parkinson's disease—a functional magnetic resonance imaging study. Neurobiol Aging 2015; 36:470-5. [DOI: 10.1016/j.neurobiolaging.2014.07.031] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 07/22/2014] [Accepted: 07/23/2014] [Indexed: 01/23/2023]
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Claassen DO, van den Wildenberg WPM, Harrison MB, van Wouwe NC, Kanoff K, Neimat JS, Wylie SA. Proficient motor impulse control in Parkinson disease patients with impulsive and compulsive behaviors. Pharmacol Biochem Behav 2014; 129:19-25. [PMID: 25459105 DOI: 10.1016/j.pbb.2014.11.017] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 11/16/2014] [Accepted: 11/22/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Parkinson disease (PD) patients treated with dopamine agonist therapy can develop maladaptive reward-driven behaviors, known as impulse control disorder (ICD). In this study, we assessed if ICD patients have evidence of motor-impulsivity. METHODS We used the stop-signal task in a cohort of patients with and without active symptoms of ICD to evaluate motor-impulsivity. Of those with PD, 12 were diagnosed with ICD symptoms (PD-ICD) and were assessed before clinical reduction of dopamine agonist medication; 12 were without symptoms of ICD [PD-control] and taking equivalent dosages of dopamine agonist. Levodopa, if present, was maintained in both settings. Groups were similar in age, duration, and severity of motor symptoms, levodopa co-therapy, and total levodopa daily dose. All were tested in the dopamine agonist medicated and acutely withdrawn (24 h) state, in a counterbalanced manner. Primary outcome measures were mean reaction time to correct go trials (go reaction time), and mean stop-signal reaction time (SSRT). RESULTS ICD patients produce faster SSRT than both Healthy Controls, and PD-Controls. Faster SSRT in ICD patients is apparent in both dopamine agonist medication states. Also, we show unique dopamine medication effects on Go Reaction time (GoRT). In dopamine agonist monotherapy patients, dopamine agonist administration speeds GoRT. Conversely, in those with levodopa co-therapy, dopamine agonist administration slows. DISCUSSION PD patients with active ICD symptoms are significantly faster at stopping initiated motor actions, and this is not altered by acute dopamine agonist withdrawal. In addition, the effect of dopamine agonist on GoRT is strongly influenced by the presence or absence of levodopa, even though levodopa co-therapy does not appear to influence SSRT. We discuss these findings as they pertain to the multifaceted definition of 'impulsivity,' the lack of evidence for motor-impulsivity in PD-ICD, and dopamine effects on motor-control in PD.
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Affiliation(s)
- Daniel O Claassen
- Department of Neurology, Vanderbilt University, Nashville, TN, United States.
| | | | - Madaline B Harrison
- Department of Neurology, University of Virginia, Charlottesville, VA, United States
| | - Nelleke C van Wouwe
- Department of Neurology, Vanderbilt University, Nashville, TN, United States
| | - Kristen Kanoff
- Department of Neurology, Vanderbilt University, Nashville, TN, United States
| | - Joseph S Neimat
- Department of Neurosurgery, Vanderbilt University, Nashville, TN, United States
| | - Scott A Wylie
- Department of Neurology, Vanderbilt University, Nashville, TN, United States
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Jahanshahi M, Obeso I, Baunez C, Alegre M, Krack P. Parkinson's Disease, the Subthalamic Nucleus, Inhibition, and Impulsivity. Mov Disord 2014; 30:128-40. [DOI: 10.1002/mds.26049] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 08/21/2014] [Accepted: 09/07/2014] [Indexed: 12/14/2022] Open
Affiliation(s)
- Marjan Jahanshahi
- Cognitive Motor Neuroscience Group and Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology; London United Kingdom
| | - Ignacio Obeso
- CINAC, HM-Puerta del Sur, Hospitales de Madrid; CEU-San Pablo University, Móstoles; Madrid Spain
| | - Christelle Baunez
- Basal Ganglia, Motivation and Reward' (BAGAMORE), Institut de Neurosciences de la Timone, UMR7289 CNRS and AMU (Aix Marseille Universite); Marseille France
| | - Manuel Alegre
- Neurophysiology Laboratory, Neuroscience Area, CIMA, University of Navarra; Pamplona Spain
| | - Paul Krack
- INSERM U836, F-38000 Grenoble, France; University Grenoble Alpes, GIN, Grenoble, France, and CHU de Grenoble, Movement Disorder Unit; Grenoble France
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Dirnberger G, Jahanshahi M. Executive dysfunction in Parkinson's disease: a review. J Neuropsychol 2014; 7:193-224. [PMID: 24007368 DOI: 10.1111/jnp.12028] [Citation(s) in RCA: 324] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 06/30/2013] [Indexed: 12/17/2022]
Abstract
Executive dysfunction can be present from the early stages of Parkinson's disease (PD). It is characterized by deficits in internal control of attention, set shifting, planning, inhibitory control, dual task performance, and on a range of decision-making and social cognition tasks. Treatment with dopaminergic medication has variable effects on executive deficits, improving some, leaving some unchanged, and worsening others. In this review, we start by defining the specific nature of executive dysfunction in PD and describe suitable neuropsychological tests. We then discuss how executive deficits relate to pathology in specific territories of the basal ganglia, consider the impact of dopaminergic treatment on executive function (EF) in this context, and review the changes in EFs with disease progression. In later sections, we summarize correlates of executive dysfunction in PD with motor performance (e.g., postural instability, freezing of gait) and a variety of psychiatric (e.g., depression, apathy) and other clinical symptoms, and finally discuss the implications of these for the patients' daily life.
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Affiliation(s)
- Georg Dirnberger
- Department of Clinical Neuroscience and Preventive Medicine, Danube University, Krems, Austria.
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48
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Kehagia AA, Housden CR, Regenthal R, Barker RA, Müller U, Rowe J, Sahakian BJ, Robbins TW. Targeting impulsivity in Parkinson's disease using atomoxetine. ACTA ACUST UNITED AC 2014; 137:1986-97. [PMID: 24893708 PMCID: PMC4065022 DOI: 10.1093/brain/awu117] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Noradrenergic dysfunction may play a significant role in cognition in Parkinson's disease due to the early degeneration of the locus coeruleus. Converging evidence from patient and animal studies points to the role of noradrenaline in dopaminergically insensitive aspects of the parkinsonian dysexecutive syndrome, yet the direct effects of noradrenergic enhancement have not to date been addressed. Our aim was to directly investigate these, focusing on impulsivity during response inhibition and decision making. To this end, we administered 40 mg atomoxetine, a selective noradrenaline re-uptake inhibitor to 25 patients with Parkinson's disease (12 female /13 male; 64.4 ± 6.9 years old) in a double blind, randomized, placebo controlled design. Patients completed an extensive battery of neuropsychological tests addressing response inhibition, decision-making, attention, planning and verbal short term memory. Atomoxetine improved stopping accuracy on the Stop Signal Task [F(1,19) = 4.51, P = 0.047] and reduced reflection impulsivity [F(1,9) = 7.86, P = 0.02] and risk taking [F(1,9) = 9.2, P = 0.01] in the context of gambling. The drug also conferred effects on performance as a function of its measured blood plasma concentration: it reduced reflection impulsivity during information sampling [adjusted R(2) = 0.23, F(1,16) = 5.83, P = 0.03] and improved problem solving on the One Touch Stockings of Cambridge [adjusted R(2) = 0.29, F(1,17) = 8.34, P = 0.01]. It also enhanced target sensitivity during sustained attention [F(1,9) = 5.33, P = 0.046]. The results of this exploratory study represent the basis of specific predictions in future investigations on the effects of atomoxetine in Parkinson's disease and support the hypothesis that targeting noradrenergic dysfunction may represent a new parallel avenue of therapy in some of the cognitive and behavioural deficits seen in the disorder.
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Affiliation(s)
- Angie A Kehagia
- 1 Department of Neuroimaging, Institute of Psychiatry, King's College London, London SE5 8AF, UK
| | - Charlotte R Housden
- 2 Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK3 Cambridge Cognition Limited, Cambridge, UK4 Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Ralf Regenthal
- 5 Division of Clinical Pharmacology, Rudolf-Boehm-Institute of Pharmacology and Toxicology, University of Leipzig, Germany
| | - Roger A Barker
- 6 Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Ulrich Müller
- 2 Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK4 Department of Psychiatry, University of Cambridge, Cambridge, UK7 Adult ADHD Service, Cambridgeshire and Peterborough NHS Foundation Trust, UK
| | - James Rowe
- 2 Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK6 Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK8 MRC Cognition and Brain Sciences Unit, Cambridge, UK
| | - Barbara J Sahakian
- 2 Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK4 Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Trevor W Robbins
- 2 Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK9 Department of Psychology, University of Cambridge, Cambridge, UK
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Obeso I, Wilkinson L, Casabona E, Speekenbrink M, Luisa Bringas M, Álvarez M, Álvarez L, Pavón N, Rodríguez-Oroz MC, Macías R, Obeso JA, Jahanshahi M. The subthalamic nucleus and inhibitory control: impact of subthalamotomy in Parkinson's disease. ACTA ACUST UNITED AC 2014; 137:1470-80. [PMID: 24657985 DOI: 10.1093/brain/awu058] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of our study was to investigate two inter-related hypotheses about the role of the subthalamic nucleus. First that the subthalamic nucleus plays a role in adjusting response thresholds and speed-accuracy trade-offs and second that it is involved in reactive and proactive inhibition and conflict resolution. These were addressed by comparing the performance of 10 patients with Parkinson's disease treated with right subthalamotomy and 12 patients with left subthalamotomy, to 14 unoperated patients with Parkinson's disease and 23 age-matched healthy control participants on a conditional stop signal task and applying the drift diffusion model. Unilateral subthalamotomy significantly improved Parkinson's disease motor signs. Patients with right subthalamotomy had significantly faster Go reaction times with their contra-lesional hand than the unoperated patients and did not differ from the control participants, indicating their speed of response initiation was 'normalized'. However, operated patients made significantly more discrimination errors than unoperated patients and controls, suggesting that subthalamotomy influenced speed-accuracy trade-offs. This was confirmed by the drift diffusion model, revealing that while the unoperated patients had significantly lower drift rate and higher response thresholds than the control participants, the response thresholds for the operated groups did not differ from the controls and the patients with right subthalamotomy had a significantly higher drift rate than unoperated patients and similar to that of controls. The drift diffusion model further established that unlike the control participants, operated patients failed to show context-dependent strategic modulation of response thresholds. The patients with right subthalamotomy could not engage in late phase, fast inhibition of the response and showed minimal proactive inhibition when tested with the contra-lesional hand. These results provide strong evidence that the subthalamic nucleus is involved in response inhibition, in modulating the rate of information accumulation and the response threshold and influencing the balance between speed and accuracy of performance. Accordingly, the subthalamic nucleus can be considered a key component of the cerebral inhibitory network.
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Affiliation(s)
- Ignacio Obeso
- 1 Cognitive-Motor Neuroscience Group and the Functional Neurosurgery Unit, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, WC1N 3BG, UK
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Jahanshahi M. Effects of deep brain stimulation of the subthalamic nucleus on inhibitory and executive control over prepotent responses in Parkinson's disease. Front Syst Neurosci 2013; 7:118. [PMID: 24399941 PMCID: PMC3872293 DOI: 10.3389/fnsys.2013.00118] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 12/06/2013] [Indexed: 12/19/2022] Open
Abstract
Inhibition of inappropriate, habitual or prepotent responses is an essential component of executive control and a cornerstone of self-control. Via the hyperdirect pathway, the subthalamic nucleus (STN) receives inputs from frontal areas involved in inhibition and executive control. Evidence is reviewed from our own work and the literature suggesting that in Parkinson's disease (PD), deep brain stimulation (DBS) of the STN has an impact on executive control during attention-demanding tasks or in situations of conflict when habitual or prepotent responses have to be inhibited. These results support a role for the STN in an inter-related set of processes: switching from automatic to controlled processing, inhibitory and executive control, adjusting response thresholds and influencing speed-accuracy trade-offs. Such STN DBS-induced deficits in inhibitory and executive control may contribute to some of the psychiatric problems experienced by a proportion of operated cases after STN DBS surgery in PD. However, as no direct evidence for such a link is currently available, there is a need to provide direct evidence for such a link between STN DBS-induced deficits in inhibitory and executive control and post-surgical psychiatric complications experienced by operated patients.
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Affiliation(s)
- Marjan Jahanshahi
- Cognitive Motor Neuroscience Group and Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, The National Hospital for Neurology and Neurosurgery London, UK
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