Mini mental Parkinson test: standardization and normative data on an Italian sample

Action observation treatment may improve daily living activities and verb recovery in Parkinson's disease-dementia: findings from a preliminary randomized controlled trial

Background and objectives

Action observation treatment (AOT) is a novel rehabilitation approach aimed to the recovery of both motor and linguistic deficits in subjects with brain lesions. The aim of the present randomized controlled study was to assess the benefits of AOT treatment in the activities of daily living (ADLs) and in the linguistic abilities of the patients with Parkinson's disease dementia (PDD) at mild-moderate stage (Hoehn & Yahr's stage scale: 2-3).

Methods

Twenty patients were enrolled and randomly assigned to an experimental group (submitted to AOT) or to a control group. The experimental group (AOT-group) underwent the vision of a video containing 6 complex ADLs, while the control group (C-group) was subjected to a video-clip regarding semantic information of a geographical-naturalistic type without motor content. The treatment duration was 4 weeks. All patients underwent assessment before and after the treatment by the following tools: Unified Parkinson's Disease Rating Scale Part III (UPDRS-Part III), Alzheimer's Disease Cooperative Study-Activities of Daily Living Scale (ADCS-ADL), Direct Assessment of Functional Status (DAFS) and subtest Verb Naming of Analysis of Aphasic Deficit Battery (BADA). Paired samples t test was performed to compare all the variables of interest in the time, dividing by groups. p-value<0.05 was considered significant in all analyses.

Results

AOT-group showed an improvement from baseline to the end of study in ADCS-ADL (p = 0.001), BADA (p = 0.011) and DAFS (p = 0.005), while C-group did not change significantly in the time.

Conclusion

These preliminary results suggest the potential efficacy of AOT in rehabilitation of ADLs and verb retrieval in people with PD. Further studies will be necessary to verify these findings.

The effectiveness of an immersive virtual reality and telemedicine-based cognitive intervention on prospective memory in Parkinson's disease patients with mild cognitive impairment and healthy aged individuals: design and preliminary baseline results of a placebo-controlled study

Introduction

Prospective memory (PM) impairments have been extensively documented in individuals with Parkinson's disease associated with mild cognitive impairment (PD-MCI) and in those with healthy aging. Considering how PM failure decreases individuals' quality of life and functional independence in the activities of daily living, training to enhance this ability could be a prior target of intervention.

Objective

Here, we aimed to present the study protocol and preliminary results of a novel immersive virtual reality (IVR) and telemedicine-based (TM) cognitive intervention focused on executive abilities (i.e., planning, shifting, and updating) to improve PM functioning in PD-MCI patients and healthy elderly individuals.

Methods

Outcome measures, collected before, immediately after and 2 months after the intervention, included: (1) pre-post training changes in objective cognitive functioning, evaluated with tests assessing executive functions and PM; (2) pre-post training changes in subjective perception of memory functioning, psychiatric symptoms, autonomy in daily living and quality of life, evaluated using the appropriate scales; (3) usability, feasibility and users' compliance with the proposed IVR and telemedicine program. The efficacy of this intervention compared to an active control condition is currently being evaluated in a randomized, double-blind controlled trial, which will be conducted on 30 eligible PD-MCI patients and 30 older adults.

Results

Preliminary results concerning between-group comparisons of demographic and neuropsychological screening data show a good balance among the intervention groups considered in this study. The results also suggest good levels of usability, feasibility and acceptability, thus supporting the notion that our intervention can be used to promote cognitive functioning, even in people with cognitive decline.

Conclusion

Considering the relatively low costs and easy accessibility to this program, it could prove valuable in primary prevention initiatives and early cognitive rehabilitation for dementia risk reduction.

Combined EEG and immersive virtual reality unveil dopaminergic modulation of error monitoring in Parkinson's Disease

Detecting errors in your own and others' actions is associated with discrepancies between intended and expected outcomes. The processing of salient events is associated with dopamine release, the balance of which is altered in Parkinson's disease (PD). Errors in observed actions trigger various electrocortical indices (e.g. mid-frontal theta, error-related delta, and error positivity [oPe]). However, the impact of dopamine depletion to observed errors in the same individual remains unclear. Healthy controls (HCs) and PD patients observed ecological reach-to-grasp-a-glass actions performed by a virtual arm from a first-person perspective. PD patients were tested under their dopaminergic medication (on-condition) and after dopaminergic withdrawal (off-condition). Analyses of oPe, delta, and theta-power increases indicate that while the formers were elicited after incorrect vs. correct actions in all groups, the latter were observed in on-condition but altered in off-condition PD. Therefore, different EEG error signatures may index the activity of distinct mechanisms, and error-related theta power is selectively modulated by dopamine depletion. Our findings may facilitate discovering dopamine-related biomarkers for error-monitoring dysfunctions that may have crucial theoretical and clinical implications.

Psychometrics and diagnostics of Italian cognitive screening tests: a systematic review

BACKGROUND

Cognitive screening tests (CSTs) are crucial to neuropsychological diagnostics, and thus need to be featured by robust psychometric and diagnostic properties. However, CSTs happen not to meet desirable statistical standards, negatively affecting their level of recommendations and applicability. This study aimed at (a) providing an up-to-date compendium of available CSTs in Italy, (b) report their psychometric and diagnostic properties, and (c) address related limitations.

METHODS

This review was implemented by consulting Preferred Reporting Items for Systematic Reviews and Meta-Analyses and pre-registered on the International Prospective Register of Systematic Reviews. Standardization and usability studies focusing on norms, validity, reliability, or sensitivity/specificity (and derived metrics) in adults were considered for eligibility. Quality assessment was performed by means of an ad hoc checklist collecting information on sampling, psychometrics/diagnostics, norming, and feasibility.

RESULTS

Sixty studies were included out of an initial N = 683. Identified CSTs (N = 40) were classified into general, domain-, and disease-specific (N = 17, 7, and 16, respectively), the latter being less statistically robust than remaining categories. Validity and reliability evidence was provided for 29 and 26 CSTs, respectively, sensitivity/specificity for 20 and norms for 33. Prevalence- and post-test-based diagnostic metrics were seldomly represented; factorial structures, ceiling/floor effects, and acceptability rarely investigated; content, face, and ecological validity never assessed.

DISCUSSION

Although available Italian CSTs overall met basic psychometric/diagnostic requirements, their statistical profile often proved to be poor on several properties that are desirable for clinical applications, with a few exceptions among general and domain-specific ones.

Transcranial direct current stimulation enhances theory of mind in Parkinson's disease patients with mild cognitive impairment: a randomized, double-blind, sham-controlled study

Background

Parkinson’s Disease (PD) with mild cognitive impairment (MCI) (PD-MCI) represents one of the most dreaded complications for patients with PD and is associated with a higher risk of developing dementia. Although transcranial direct current stimulation (tDCS) has been demonstrated to improve motor and non-motor symptoms in PD, to date, no study has investigated the effects of tDCS on Theory of Mind (ToM), i.e., the ability to understand and predict other people’s behaviours, in PD-MCI.

Methods

In this randomized, double-blind, sham-controlled study, we applied active tDCS over the medial frontal cortex (MFC) to modulate ToM performance in twenty patients with PD-MCI. Twenty matched healthy controls (HC) were also enrolled and were asked to perform the ToM task without receiving tDCS.

Results

In the patients with PD-MCI, i) ToM performance was worse than that in the HC, ii) ToM abilities were poorer in those with fronto-executive difficulties, and iii) tDCS over the MFC led to significant shortening of latency for ToM tasks.

Conclusions

We show for the first time that active tDCS over the MFC enhances ToM in patients with PD-MCI, and suggest that non-invasive brain stimulation could be used to ameliorate ToM deficits observed in these patients.

Ein kurzer Leistungstest zur Erfassung von Störungen des Gedächtnisses und der Aufmerksamkeit

Zusammenfassung. Der SKT nach Hellmut Erzigkeit ist ein kurzer Leistungstest zur Erfassung von Störungen des Gedächtnisses und der Aufmerksamkeit. Er wurde mithilfe eines regressionsbasierten Ansatzes nach Zachary und Gorsuch (1985) neunormiert (SKT Edition Manual 2015). Dieses war notwendig geworden, weil zum einen die letzte Normierung leicht veraltet ist, und zum anderen weil Berichte aus der Praxis vermehrt gezeigt haben, dass die alte Normierung im Bereich der beginnenden kognitiven Veränderungen zu ungenau ausfiel. Für die Neunormierung wurden 2 Datensätze verwendet (eine Stichprobe von N = 1 053 gesunden Menschen und eine klinische Stichprobe N = 930 inklusive Demenzdiagnosen). Die Stichprobe gesunder älterer Menschen diente der Berechnung von Soll-Leistungen in den Subtests. Subtrahiert man die gemessene Ist-Leistung einer neuen Testperson von deren Soll-Leistung und teilt diese Differenz durch den Standardfehler der Leistungen einer neuen Testperson (siehe Crawford & Garthwaite, 2006 ), dann entsteht eine t-Verteilung. Diese t-Verteilung ist symmetrisch um den Wert 0 verteilt; die oberen Prozentränge repräsentieren mehr Soll- als Ist-Leistungen (positive Werte für die Differenz). Die unteren Prozentränge repräsentieren schlechte Leistungen, da hier die Ist-Leistung geringer ausfällt als die Soll-Leistung (d. h. es entstehen hier negative Werte für die Differenz zwischen Ist- und Soll-Leistungen). Große negative Differenzen zwischen Ist- und Soll-Leistungen werden mit Abweichungspunkten bewertet und über alle 9 Subtests zu einem SKT-Gesamtwert aufsummiert. Die klinische Stichprobe diente der Ermittlung von Cut-Offs im Rahmen des SKT-Gesamtwertes. Der regressionsbasierte Normierungsansatz wird ausführlich beschrieben und als nützliche Alternative zum klassischen Normierungsansatz dargestellt.