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Ahern L, Timmons S, Lamb SE, McCullagh R. Behavioural change for Parkinson's Disease: A randomised controlled feasibility study to promote physical activity and exercise adherence among people with Parkinson's: study protocol. HRB Open Res 2024; 7:7. [PMID: 38784965 PMCID: PMC11109530 DOI: 10.12688/hrbopenres.13843.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2024] [Indexed: 05/25/2024] Open
Abstract
Background Parkinson's is a common progressive neurological condition characterized by motor and non-motor deficits. Physical activity and exercise can improve health, but many people with Parkinson's (PwP) have trouble reaching the recommended dosage. Our recent literature review found improvements in exercise adherence with behavioural change interventions, but it remains unclear which are most effective. Further qualitative research and patient and public involvement has informed a novel behavioural change intervention to be tested alongside an existing exercise program. Objective To examine the feasibility of behavioural change techniques delivered alongside an exercise programme to improve physical activity, function, and self-efficacy in PwP (and study procedures) to inform a future pilot RCT trial. Methods A parallel-arm single blinded randomised feasibility study. Twenty participants with Parkinson's (Hoehn and Yahr stage 1-3) will be recruited from a physiotherapy primary-care waiting list. Following written consent, and baseline assessment, the participants will be randomly allocated to the intervention (n=10) or the control group (n=10). Both groups will receive usual care, which includes a weekly program of a multidisciplinary education, a supervised exercise class and a prescribed home exercise program. The intervention group will receive additional behavioural change techniques, targeting behaviour regulation, belief about capabilities and social influences. Class and home exercise adherence, behavioural component uptake and adherence, and negative events will be recorded. Outcomes will include enrolment and maintenance rates, physical function, falls, physical activity, and exercise self-efficacy measured pre- and post- the 12-week program (in-person). Surveys will be used to compare experiences and satisfaction between groups. Exit interviews will be completed with the intervention group only, exploring their experience of the behavioural change techniques. Discussion The results will help inform a future pilot RCT, based on the intervention acceptability, consent rate, maintenance, and protocol integrity. Trial Registration ClincialTrials.gov NCT06192628.
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Affiliation(s)
- Leanne Ahern
- Discipline of Physiotherapy, School of Clinical Therapies, University College Cork, Cork, Ireland
| | - Suzanne Timmons
- Centre for Gerontology and Rehabilitation, School of Medicine, College of Medicine and Health, University College Cork, Cork, County Cork, Ireland
| | - Sarah E. Lamb
- Faculty of Health and Life Sciences, University of Exeter, Exeter, England, UK
| | - Ruth McCullagh
- Discipline of Physiotherapy, School of Clinical Therapies, University College Cork, Cork, Ireland
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Frau R, Devoto P, Aroni S, Saba P, Sagheddu C, Siddi C, Santoni M, Carli M, Gessa GL. The potent α 2-adrenoceptor antagonist RS 79948 also inhibits dopamine D 2 -receptors: Comparison with atipamezole and raclopride. Neuropharmacology 2022; 217:109192. [PMID: 35850212 DOI: 10.1016/j.neuropharm.2022.109192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 07/08/2022] [Accepted: 07/11/2022] [Indexed: 11/16/2022]
Abstract
Neurochemical, electrophysiological and behavioral evidence indicate that the potent α2-adrenoceptor antagonist RS 79948 is also a dopamine (DA) D2 receptor antagonist. Thus, results from ligand binding and adenylate cyclase activity indicate that RS 79948 binds to D2 receptors and antagonized D2 receptor-mediated inhibition of cAMP synthesis at nanomolar concentrations. RESULTS: from microdialysis indicated that RS 79948 shared with the selective α2-adrenergic antagonist atipamezole the ability to increase the co-release of DA and norepinephrine (NE) from noradrenergic terminals in the medial prefrontal cortex (mPFC), except that RS 79948-induced DA release persisted after noradrenergic denervation, unlike atipamezole effect, indicating that RS 79948 releases DA from dopaminergic terminals as well. Similarly to the D2 antagonist raclopride, but unlike atipamezole, RS 79948 increased extracellular DA and DOPAC in the caudate nucleus. Electrophysiological results indicate that RS 79948 shared with raclopride the ability to activate the firing of ventral tegmental area (VTA) DA neurons, while atipamezole was ineffective. RESULTS: from behavioral studies indicated that RS 79948 exerted effects mediated by independent, cooperative and contrasting inhibition of α2-and D2 receptors. Thus, RS 79948, but not atipamezole, prevented D2-autoreceptor mediated hypomotility produced by a small dose of quinpirole. RS 79948 potentiated, more effectively than atipamezole, quinpirole-induced motor stimulation. RS 79948 antagonized, less effectively than atipamezole, raclopride-induced catalepsy. Future studies should clarify if the dual α2-adrenoceptor- and D2-receptor antagonistic action might endow RS 79948 with potential therapeutic relevance in the treatment of schizophrenia, drug dependence, depression and Parkinson's disease.
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Affiliation(s)
- Roberto Frau
- Department of Biomedical Sciences, Section of Neurosciences and Clinical Pharmacology, University of Cagliari, Cittadella Universitaria, Monserrato, CA, Italy; The Guy Everett Laboratory for Neuroscience, University of Cagliari, Cittadella Universitaria, Monserrato, CA, Italy
| | - Paola Devoto
- Department of Biomedical Sciences, Section of Neurosciences and Clinical Pharmacology, University of Cagliari, Cittadella Universitaria, Monserrato, CA, Italy; The Guy Everett Laboratory for Neuroscience, University of Cagliari, Cittadella Universitaria, Monserrato, CA, Italy.
| | - Sonia Aroni
- Department of Biomedical Sciences, Section of Neurosciences and Clinical Pharmacology, University of Cagliari, Cittadella Universitaria, Monserrato, CA, Italy
| | - Pierluigi Saba
- Department of Biomedical Sciences, Section of Neurosciences and Clinical Pharmacology, University of Cagliari, Cittadella Universitaria, Monserrato, CA, Italy
| | - Claudia Sagheddu
- Department of Biomedical Sciences, Section of Neurosciences and Clinical Pharmacology, University of Cagliari, Cittadella Universitaria, Monserrato, CA, Italy
| | - Carlotta Siddi
- Department of Biomedical Sciences, Section of Neurosciences and Clinical Pharmacology, University of Cagliari, Cittadella Universitaria, Monserrato, CA, Italy
| | - Michele Santoni
- Department of Biomedical Sciences, Section of Neurosciences and Clinical Pharmacology, University of Cagliari, Cittadella Universitaria, Monserrato, CA, Italy
| | - Marco Carli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Gian Luigi Gessa
- Department of Biomedical Sciences, Section of Neurosciences and Clinical Pharmacology, University of Cagliari, Cittadella Universitaria, Monserrato, CA, Italy; The Guy Everett Laboratory for Neuroscience, University of Cagliari, Cittadella Universitaria, Monserrato, CA, Italy
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Abstract
Neurodegenerative diseases are increasingly recognised to be an important cause of brain disorders, particularly in late age. Associated with a wide range of pathologies, they lead to progressive loss of neurons in different regions of the nervous system. Although anhedonia is common in a variety of neurodegenerative diseases, to date it has not been extensively studied in most of these conditions. Here we review the current literature on studies assessing the association between anhedonia and neurodegenerative diseases including Parkinson's Disease, Dementia with Lewy Bodies, Parkinson's Plus Syndromes, Alzheimer's Disease, Vascular Dementia, Frontotemporal Dementia, Amyotrophic Lateral Sclerosis and Huntington's Disease. Much of the research has been conducted in Parkinson's disease where it is evident that there are strong links between apathy (loss of motivation) and anhedonia, although the two syndromes can be dissociated. Intriguingly, drugs that improve apathy can also lead to amelioration of anhedonia in some cases. Overlaps between the two syndromes may also exist across other neurodegenerative conditions, including Frontotemporal Dementia in which imaging has revealed atrophy of both common brain regions associated with anhedonia and apathy, as well as a set of unique brain regions associated with anhedonia. A transdiagnostic perspective might be helpful to investigate whether a common network of brain regions is dysfunctional with anhedonia across neurodegenerative conditions.
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Affiliation(s)
- Vicky Turner
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Masud Husain
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
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Favier M, Carcenac C, Savasta M, Carnicella S. Dopamine D3 Receptors: A Potential Target to Treat Motivational Deficits in Parkinson's Disease. Curr Top Behav Neurosci 2022; 60:109-132. [PMID: 35469394 DOI: 10.1007/7854_2022_316] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Parkinson's disease (PD), which is traditionally viewed as a motor disorder involving the degeneration of dopaminergic (DA) neurons, has recently been identified as a quintessential neuropsychiatric condition. Indeed, a plethora of non-motor symptoms may occur in PD, including apathy. Apathy can be defined as a lack of motivation or a deficit of goal-directed behaviors and results in a pathological decrease of self-initiated voluntary behavior. Apathy in PD appears to fluctuate with the DA state of the patients, suggesting a critical role of DA neurotransmission in the pathophysiology of this neuropsychiatric syndrome. Using a lesion-based approach, we developed a rodent model which exhibits specific alteration in the preparatory component of motivational processes, reminiscent to apathy in PD. We found a selective decrease of DA D3 receptors (D3R) expression in the dorsal striatum of lesioned rats. Next, we showed that inhibition of D3R neurotransmission in non-lesioned animals was sufficient to reproduce the motivational deficit observed in our model. Interestingly, we also found that pharmacologically targeting D3R efficiently reversed the motivational deficit induced by the lesion. Our findings, among other recent data, suggest a critical role of D3R in parkinsonian apathy and highlight this receptor as a promising target for treating motivational deficits.
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Affiliation(s)
- Mathieu Favier
- Douglas Mental Health University Institute, McGill University, Verdun, QC, Canada
| | - Carole Carcenac
- Inserm, U1216, Univ. Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France
| | - Marc Savasta
- Inserm, Délégation régionale Provence-Alpes-Côte d'Azur et Corse, Marseille CEDEX 09, France
| | - Sebastien Carnicella
- Inserm, U1216, Univ. Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France.
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Foley JA, Cipolotti L. Apathy in Parkinson's Disease: A Retrospective Study of Its Prevalence and Relationship With Mood, Anxiety, and Cognitive Function. Front Psychol 2021; 12:749624. [PMID: 34880810 PMCID: PMC8645993 DOI: 10.3389/fpsyg.2021.749624] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/31/2021] [Indexed: 11/13/2022] Open
Abstract
Apathy is thought to be an important clinical feature of Parkinson's disease (PD). However, its prevalence ranges greatly across studies because of differing definitions, assessment tools, and patient inclusion criteria. Furthermore, it remains unclear how the presentation of apathy in PD is related to mood disorder and/or cognitive impairment. This study sought to examine the prevalence of a pure apathy syndrome in PD, distinct from both depression and anxiety, and reveal its associated cognitive profile. A retrospective study was performed on 177 PD patients who had completed measures of apathy [Apathy Evaluation Scale (AES)] and mood functioning [Hospital Anxiety and Depression Scale (HADS)] and had undergone extensive neuropsychological assessment, using measures of intellectual functioning, memory, executive function, attention, language, visual processing, and cognitive speed; 14.7% of the sample indicated clinically significant levels of apathy, but this nearly always co-presented with depression and/or anxiety, with cases of "pure" apathy very rare (2.8%). On extensive cognitive assessment, patients with mood disorder performed worse on a measure of non-verbal intellectual functioning, but patients with additional apathy or apathy only demonstrated no further losses. The syndrome of apathy in PD greatly overlaps with that of depression and anxiety, suggesting that apathy in PD may be in large an epiphenomenon of mood disorder, with no specific neuropsychological features.
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Affiliation(s)
- Jennifer A Foley
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, London, United Kingdom.,UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Lisa Cipolotti
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, London, United Kingdom.,UCL Queen Square Institute of Neurology, London, United Kingdom
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Mosley PE, Akram H. Neuropsychiatric effects of subthalamic deep brain stimulation. THE HUMAN HYPOTHALAMUS - MIDDLE AND POSTERIOR REGION 2021; 180:417-431. [DOI: 10.1016/b978-0-12-820107-7.00026-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
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Mosley PE, Robinson K, Coyne T, Silburn P, Barker MS, Breakspear M, Robinson GA, Perry A. Subthalamic deep brain stimulation identifies frontal networks supporting initiation, inhibition and strategy use in Parkinson's disease. Neuroimage 2020; 223:117352. [DOI: 10.1016/j.neuroimage.2020.117352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/22/2020] [Accepted: 09/04/2020] [Indexed: 12/13/2022] Open
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Spalletta G, Iorio M, Vecchio D, Piras F, Ciullo V, Banaj N, Sensi SL, Gianni W, Assogna F, Caltagirone C, Piras F. Subclinical Cognitive and Neuropsychiatric Correlates and Hippocampal Volume Features of Brain White Matter Hyperintensity in Healthy People. J Pers Med 2020; 10:jpm10040172. [PMID: 33076372 PMCID: PMC7712953 DOI: 10.3390/jpm10040172] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/28/2020] [Accepted: 10/12/2020] [Indexed: 12/11/2022] Open
Abstract
White matter hyperintensities (WMH) are associated with brain aging and behavioral symptoms as a possible consequence of disrupted white matter pathways. In this study, we investigated, in a cohort of asymptomatic subjects aged 50 to 80, the relationship between WMH, hippocampal atrophy, and subtle, preclinical cognitive and neuropsychiatric phenomenology. Thirty healthy subjects with WMH (WMH+) and thirty individuals without (WMH−) underwent comprehensive neuropsychological and neuropsychiatric evaluations and 3 Tesla Magnetic Resonance Imaging scan. The presence, degree of severity, and distribution of WMH were evaluated with a semi-automated algorithm. Volumetric analysis of hippocampal structure was performed through voxel-based morphometry. A multivariable logistic regression analysis indicated that phenomenology of subclinical apathy and anxiety was associated with the presence of WMH. ROI-based analyses showed a volume reduction in the right hippocampus of WMH+. In healthy individuals, WMH are associated with significant preclinical neuropsychiatric phenomenology, as well as hippocampal atrophy, which are considered as risk factors to develop cognitive impairment and dementia.
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Affiliation(s)
- Gianfranco Spalletta
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, 00179 Rome, Italy; (M.I.); (D.V.); (F.P.); (V.C.); (N.B.); (F.A.); (C.C.)
- Division of Neuropsychiatry, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA
- Correspondence: (G.S.); (F.P.); Tel.: +39-06-5150-1575; Fax: +39-06-5150-1575
| | - Mariangela Iorio
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, 00179 Rome, Italy; (M.I.); (D.V.); (F.P.); (V.C.); (N.B.); (F.A.); (C.C.)
- Molecular Neurology Unit, Center of Advanced Studies and Technology (CAST), G. d’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy;
| | - Daniela Vecchio
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, 00179 Rome, Italy; (M.I.); (D.V.); (F.P.); (V.C.); (N.B.); (F.A.); (C.C.)
- Department of Psychology, Sapienza University of Rome, Policlinico Umberto I, 00161 Rome, Italy
| | - Federica Piras
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, 00179 Rome, Italy; (M.I.); (D.V.); (F.P.); (V.C.); (N.B.); (F.A.); (C.C.)
| | - Valentina Ciullo
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, 00179 Rome, Italy; (M.I.); (D.V.); (F.P.); (V.C.); (N.B.); (F.A.); (C.C.)
| | - Nerisa Banaj
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, 00179 Rome, Italy; (M.I.); (D.V.); (F.P.); (V.C.); (N.B.); (F.A.); (C.C.)
| | - Stefano L. Sensi
- Molecular Neurology Unit, Center of Advanced Studies and Technology (CAST), G. d’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy;
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d’Annunzio of Chieti-Pescara, 66100 Chieti, Italy
- Institute for Mind Impairments and Neurological Disorders, University of California-Irvine, Irvine, CA 92697, USA
| | - Walter Gianni
- II Division of Internal Medicine and Geriatrics, Sapienza University of Rome, Policlinico Umberto I, 00161 Rome, Italy;
| | - Francesca Assogna
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, 00179 Rome, Italy; (M.I.); (D.V.); (F.P.); (V.C.); (N.B.); (F.A.); (C.C.)
| | - Carlo Caltagirone
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, 00179 Rome, Italy; (M.I.); (D.V.); (F.P.); (V.C.); (N.B.); (F.A.); (C.C.)
| | - Fabrizio Piras
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, 00179 Rome, Italy; (M.I.); (D.V.); (F.P.); (V.C.); (N.B.); (F.A.); (C.C.)
- Correspondence: (G.S.); (F.P.); Tel.: +39-06-5150-1575; Fax: +39-06-5150-1575
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Krishnamurthi N, Fleury J, Belyea M, Shill HA, Abbas JJ. ReadySteady intervention to promote physical activity in older adults with Parkinson's disease: Study design and methods. Contemp Clin Trials Commun 2020; 17:100513. [PMID: 32211555 PMCID: PMC7083754 DOI: 10.1016/j.conctc.2019.100513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/16/2019] [Accepted: 12/30/2019] [Indexed: 02/02/2023] Open
Abstract
The main motor impairments of gait and balance experienced by people with Parkinson's disease (PD) contribute to a sedentary lifestyle, resulting in poor physical conditioning, loss of functional independence, and reduced quality of life. Despite the known benefits of physical activity in PD, the majority of older adults with PD are insufficiently active. Few studies incorporate behavioral change approaches to promoting physical activity in PD. The main goal of this research is to foster community mobility in older adults with PD by promoting physical activity and improving gait patterns using a theory-based behavioral change intervention. The ReadySteady intervention combines wellness motivation theory with polestriding physical activity, which has been shown to be beneficial for people with PD. The intervention will be tested using a randomized controlled design, including inactive older adults diagnosed with PD. Participants will be randomly assigned the 12-week ReadySteady intervention, 12-week polestriding, and education intervention, or 12-week education intervention. Thirty-six older adults with PD will participate in each of the interventions. Level of physical activity, clinical scores, quantitative measures of gait and balance control, and motivational variables for each intervention will be measured at three time points: pre-intervention, post-intervention (12 weeks), and follow-up (24 weeks). If the intervention is beneficial, it may serve as a sustainable addition to current practice in health promotion efforts serving the PD population.
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Affiliation(s)
- Narayanan Krishnamurthi
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, 85004, USA
| | - Julie Fleury
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, 85004, USA
| | - Michael Belyea
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, 85004, USA
| | - Holly A. Shill
- Muhammad Ali Parkinson Center, St. Joseph's Hospital and Medical Center, Phoenix, AZ, 85013, USA
| | - James J. Abbas
- Center for Adaptive Neural Systems, School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, 85287, USA
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Brown DS, Barrett MJ, Flanigan JL, Sperling SA. Clinical and demographic correlates of apathy in Parkinson's disease. J Neurol 2019; 266:507-514. [PMID: 30604055 DOI: 10.1007/s00415-018-9166-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 11/26/2018] [Accepted: 12/19/2018] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To better understand the demographic, neuropsychiatric, cognitive, and motor predictors of apathy in Parkinson's disease (PD). METHOD 112 participants (Mage = 68.53 years; Mdisease duration = 6.17 years) were administered the Apathy Scale (AS), Beck Depression Inventory-II (BDI-II), Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Trail Making Test (TMT), Wechsler Adult Intelligence Scale-IV Matrix Reasoning subtest, letter (F-A-S) and category (Animals) fluency, and Hopkins Verbal Learning Test-Revised. Psychosis was assessed. A stepwise logistic regression analysis was performed to investigate the ability of demographic factors and clinical assessments to predict nonapathetic (AS ≤ 13) versus apathetic (AS > 13) group membership. RESULTS The regression analysis yielded a robust model in which older age, less education, elevated BDI-II, current psychosis, higher MDS-UPDRS Part III (motor score), and slower TMT-B performance predicted membership in the apathetic group, with a correct classification rate of 77.5% (Nagelkerke R2 = 0.48, p < .001). Depression (OR = 9.20, p < .001) and education (OR = 0.66, p = 0.002) contributed significantly to the overall model. A linear regression with AS score as the outcome variable was similar, but TMT-B additionally contributed significantly (p = 0.02) to the overall model, F(6, 86) = 12.02, p < .001, adjusted R2 = 0.42. CONCLUSIONS Of the factors examined, depression, education, and executive functioning were the strongest correlates of apathy in PD. These results support the idea that common underlying frontosubcortical disruptions in this population contribute to apathy, depression, and executive dysfunction.
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Affiliation(s)
- Daniel S Brown
- Department of Neurology, University of Virginia, PO Box 800394, 22908-0394, Charlottesville, VA, USA
| | - Matthew J Barrett
- Department of Neurology, University of Virginia, PO Box 800394, 22908-0394, Charlottesville, VA, USA
| | - Joseph L Flanigan
- Department of Neurology, University of Virginia, PO Box 800394, 22908-0394, Charlottesville, VA, USA
| | - Scott A Sperling
- Department of Neurology, University of Virginia, PO Box 800394, 22908-0394, Charlottesville, VA, USA.
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Foley JA, Foltynie T, Limousin P, Cipolotti L. Standardised Neuropsychological Assessment for the Selection of Patients Undergoing DBS for Parkinson's Disease. PARKINSON'S DISEASE 2018; 2018:4328371. [PMID: 29971141 PMCID: PMC6009029 DOI: 10.1155/2018/4328371] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 03/23/2018] [Accepted: 04/30/2018] [Indexed: 11/17/2022]
Abstract
DBS is an increasingly offered advanced treatment for Parkinson's disease (PD). Neuropsychological assessment is considered to be an important part of the screening for selection of candidates for this treatment. However, no standardised screening procedure currently exists. In this study, we examined the use of our standardised neuropsychological assessment for the evaluation of surgical candidates and to identify risk factors for subsequent decline in cognition and mood. A total of 40 patients were assessed before and after DBS. Evaluation of mood and case notes review was also undertaken. Before DBS, patients with PD demonstrated frequent impairments in intellectual functioning, memory, attention, and executive function, as well as high rates of mood disorder. Post-DBS, there was a general decline in verbal fluency only, and in one patient, we documented an immediate and irreversible global cognitive decline, which was associated with older age and more encompassing cognitive deficits at baseline. Case note review revealed that a high proportion of patients developed mood disorder, which was associated with higher levels of depression at baseline and greater reduction in levodopa medication. We conclude that our neuropsychological assessment is suitable for the screening of candidates and can identify baseline risk factors, which requires careful consideration before and after surgery.
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Affiliation(s)
- Jennifer A. Foley
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- UCL Institute of Neurology, Queen Square, London, UK
| | - Tom Foltynie
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- UCL Institute of Neurology, Queen Square, London, UK
| | - Patricia Limousin
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- UCL Institute of Neurology, Queen Square, London, UK
| | - Lisa Cipolotti
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Dipartimento di Scienze Psicologiche, Pedagogiche e della Formazione, Università degli Studi di Palermo, Palermo, Italy
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12
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Argaud S, Vérin M, Sauleau P, Grandjean D. Facial emotion recognition in Parkinson's disease: A review and new hypotheses. Mov Disord 2018; 33:554-567. [PMID: 29473661 PMCID: PMC5900878 DOI: 10.1002/mds.27305] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 12/21/2017] [Accepted: 12/22/2017] [Indexed: 02/02/2023] Open
Abstract
Parkinson's disease is a neurodegenerative disorder classically characterized by motor symptoms. Among them, hypomimia affects facial expressiveness and social communication and has a highly negative impact on patients' and relatives' quality of life. Patients also frequently experience nonmotor symptoms, including emotional-processing impairments, leading to difficulty in recognizing emotions from faces. Aside from its theoretical importance, understanding the disruption of facial emotion recognition in PD is crucial for improving quality of life for both patients and caregivers, as this impairment is associated with heightened interpersonal difficulties. However, studies assessing abilities in recognizing facial emotions in PD still report contradictory outcomes. The origins of this inconsistency are unclear, and several questions (regarding the role of dopamine replacement therapy or the possible consequences of hypomimia) remain unanswered. We therefore undertook a fresh review of relevant articles focusing on facial emotion recognition in PD to deepen current understanding of this nonmotor feature, exploring multiple significant potential confounding factors, both clinical and methodological, and discussing probable pathophysiological mechanisms. This led us to examine recent proposals about the role of basal ganglia-based circuits in emotion and to consider the involvement of facial mimicry in this deficit from the perspective of embodied simulation theory. We believe our findings will inform clinical practice and increase fundamental knowledge, particularly in relation to potential embodied emotion impairment in PD. © 2018 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Soizic Argaud
- Behavior and Basal Ganglia Research Unit (EA4712)University of Rennes 1RennesFrance
- Neuroscience of Emotion and Affective Dynamics laboratory, Department of Psychology and Educational SciencesUniversity of GenevaGenevaSwitzerland
| | - Marc Vérin
- Behavior and Basal Ganglia Research Unit (EA4712)University of Rennes 1RennesFrance
- Department of NeurologyRennes University HospitalRennesFrance
| | - Paul Sauleau
- Behavior and Basal Ganglia Research Unit (EA4712)University of Rennes 1RennesFrance
- Department of NeurophysiologyRennes University HospitalRennesFrance
| | - Didier Grandjean
- Neuroscience of Emotion and Affective Dynamics laboratory, Department of Psychology and Educational SciencesUniversity of GenevaGenevaSwitzerland
- Swiss Center for Affective SciencesCampus BiotechGenevaSwitzerland
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Chagraoui A, Boukhzar L, Thibaut F, Anouar Y, Maltête D. The pathophysiological mechanisms of motivational deficits in Parkinson's disease. Prog Neuropsychopharmacol Biol Psychiatry 2018; 81:138-152. [PMID: 29097256 DOI: 10.1016/j.pnpbp.2017.10.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 09/21/2017] [Accepted: 10/30/2017] [Indexed: 12/23/2022]
Abstract
Parkinson's disease (PD) is a progressive degenerative disorder that leads to disabling motor symptoms and a wide variety of neuropsychiatric symptoms. Apathy is the most common psychiatric disorder in the early stages of untreated PD and can be defined as a hypodopaminergic syndrome, which also includes anxiety and depression. Apathy is also considered the core feature of the parkinsonian triad (apathy, anxiety and depression) of behavioural non-motor signs, including a motivational deficit. Moreover, apathy is recognised as a distinct chronic neuropsychiatric behavioural disorder based on specific diagnostic criteria. Given the prevalence of apathy in approximately 40% of the general Parkinson's disease population, this appears to be a contributing factor to dementia in PD; also, apathy symptoms are factors that potentially contribute to morbidity, leading to a major impairment of health-related quality of life, thus stressing the importance of understanding the pathophysiology of this disease. Several studies have clearly established a prominent role for DA-mediated signals in PD apathy. However, synergistic interaction between dopaminergic impairment resulting from the neurodegenerative process and deep brain stimulation of the subthalamic nucleus may cause or exacerbate apathy. Furthermore, serotoninergic mechanism signalling is also likely to be of importance in this pathophysiology.
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Affiliation(s)
- A Chagraoui
- Normandie Univ, UNIROUEN, INSERM, U1239, CHU Rouen, Neuronal and Neuroendocrine Differentiation and Communication Laboratory, Institute for Research and Innovation in Biomedicine of Normandy (IRIB), Rouen, France.; Department of Medical Biochemistry, Rouen University Hospital, Rouen, France.
| | - L Boukhzar
- Normandie Univ, UNIROUEN, INSERM, U1239, CHU Rouen, Neuronal and Neuroendocrine Differentiation and Communication Laboratory, Institute for Research and Innovation in Biomedicine of Normandy (IRIB), Rouen, France
| | - F Thibaut
- Department of Psychiatry, University Hospital Cochin (site Tarnier), University of Paris-Descartes and INSERM U 894 Laboratory of Psychiatry and Neurosciences, Paris, France
| | - Y Anouar
- Normandie Univ, UNIROUEN, INSERM, U1239, CHU Rouen, Neuronal and Neuroendocrine Differentiation and Communication Laboratory, Institute for Research and Innovation in Biomedicine of Normandy (IRIB), Rouen, France
| | - D Maltête
- Department of Neurology, Rouen University Hospital, Rouen, France
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14
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Garlovsky JK, Overton PG, Simpson J. Psychological Predictors of Anxiety and Depression in Parkinson's Disease: A Systematic Review. J Clin Psychol 2016; 72:979-98. [PMID: 27062284 DOI: 10.1002/jclp.22308] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 01/01/2016] [Accepted: 02/23/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Parkinson's disease (PD) is a neurodegenerative disorder, affecting the motor system with psychological difficulties also frequently reported. While explanations for psychological difficulties are historically situated within a biomedical framework, more recently the relevance of psychological determinants has become a research focus. This review therefore examines this relationship with the two most commonly reported psychological difficulties (anxiety and depression) in people with PD. METHOD Databases were systematically searched up to December 17, 2013, identifying 24 studies meeting inclusion criteria. RESULTS Significant predictors of heightened anxiety and depression included increased emotion-focused coping; less problem-focused coping; lower perceived control; more dominant beliefs about PD as part of a person's identity and influence on life; less social support and more avoidant personality types. CONCLUSIONS Relationships between some specific psychological predictors and depression and anxiety seem well supported. The complexity of relationships between these psychological determinants should be taken into consideration when delivering psychological interventions.
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15
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Magnard R, Vachez Y, Carcenac C, Krack P, David O, Savasta M, Boulet S, Carnicella S. What can rodent models tell us about apathy and associated neuropsychiatric symptoms in Parkinson's disease? Transl Psychiatry 2016; 6:e753. [PMID: 26954980 PMCID: PMC4872443 DOI: 10.1038/tp.2016.17] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 01/11/2016] [Accepted: 01/19/2016] [Indexed: 12/19/2022] Open
Abstract
In addition to classical motor symptoms, Parkinson's disease (PD) patients display incapacitating neuropsychiatric manifestations, such as apathy, anhedonia, depression and anxiety. These hitherto generally neglected non-motor symptoms, have gained increasing interest in medical and scientific communities over the last decade because of the extent of their negative impact on PD patients' quality of life. Although recent clinical and functional imaging studies have provided useful information, the pathophysiology of apathy and associated affective impairments remains elusive. Our aim in this review is to summarize and discuss recent advances in the development of rodent models of PD-related neuropsychiatric symptoms using neurotoxin lesion-based approaches. The data collected suggest that bilateral and partial lesions of the nigrostriatal system aimed at inducing reliable neuropsychiatric-like deficits while avoiding severe motor impairments that may interfere with behavioral evaluation, is a more selective and efficient strategy than medial forebrain bundle lesions. Moreover, of all the different classes of pharmacological agents, D2/D3 receptor agonists such as pramipexole appear to be the most efficient treatment for the wide range of behavioral deficits induced by dopaminergic lesions. Lesion-based rodent models, therefore, appear to be relevant tools for studying the pathophysiology of the non-motor symptoms of PD. Data accumulated so far confirm the causative role of dopaminergic depletion, especially in the nigrostriatal system, in the development of behavioral impairments related to apathy, depression and anxiety. They also put forward D2/D3 receptors as potential targets for the treatment of such neuropsychiatric symptoms in PD.
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Affiliation(s)
- R Magnard
- Inserm U1216, Grenoble, France,Université Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble, France
| | - Y Vachez
- Inserm U1216, Grenoble, France,Université Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble, France
| | - C Carcenac
- Inserm U1216, Grenoble, France,Université Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble, France
| | - P Krack
- Inserm U1216, Grenoble, France,Université Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble, France,Movement Disorder Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Grenoble, France
| | - O David
- Inserm U1216, Grenoble, France,Université Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble, France
| | - M Savasta
- Inserm U1216, Grenoble, France,Université Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble, France
| | - S Boulet
- Inserm U1216, Grenoble, France,Université Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble, France
| | - S Carnicella
- Inserm U1216, Grenoble, France,Université Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble, France,Inserm U1216, Grenoble Institute of Neuroscience, Site Santé La Tronche - BP 170, 38042 Grenoble, France. E-mail:
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16
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Rana AQ, Ahmed US, Chaudry ZM, Vasan S. Parkinson's disease: a review of non-motor symptoms. Expert Rev Neurother 2016; 15:549-62. [PMID: 25936847 DOI: 10.1586/14737175.2015.1038244] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder resulting from degeneration of the substantia nigra and the dopaminergic nigrostriatal pathway. Most treatments are geared toward the management and relief of motor symptoms in Parkinson's patients; however, as the disease progresses, various complications can be observed. Non-motor symptoms (NMS) may arise simply from the disease itself and are highly destructive to quality of life. These symptoms include mood disorders, cognitive dysfunction, pain, sensory dysfunction, and dysautonomia. Though it is undisputed that many NMS may appear years or even decades prior to the clinical diagnosis of PD, the focus of this review will be the overt motor phase of the condition. As such, the focus of this paper is to review the major NMS found in PD patients status post-diagnosis, their etiology, as well as treatment options available for the individual NMS.
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Affiliation(s)
- Abdul Qayyum Rana
- Parkinson's Clinic of Eastern Toronto & Movement Disorders Centre, Toronto, Ontario, Canada
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17
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Skorvanek M, Gdovinova Z, Rosenberger J, Ghorbani Saeedian R, Nagyova I, Groothoff JW, van Dijk JP. The associations between fatigue, apathy, and depression in Parkinson's disease. Acta Neurol Scand 2015; 131:80-7. [PMID: 25288130 DOI: 10.1111/ane.12282] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2014] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Fatigue and apathy are two of the most common and most disabling non-motor symptoms of Parkinson's disease (PD). They have a high coincidence and can often be confused; moreover, their relationship is not fully understood. The aim of our study was to describe the coincidence of apathy with different fatigue domains in the presence/absence of depression and to separately describe the associations of different aspects of primary and secondary fatigue with apathy and other clinical and disease-related factors. MATERIALS AND METHODS A total of 151 non-demented patients with PD were examined using the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Starkstein Apathy Scale, Multidimensional Fatigue Inventory (MFI), Beck Depression Inventory-II, and Epworth Sleepiness Scale. RESULTS The prevalence and severity of fatigue and apathy were significantly higher in depressed PD patients. However, our results show that depression, fatigue, and apathy can be clearly distinguished in PD. Apathy was associated with the MFI's-reduced motivation domain in both depressed and non-depressed patients. However, apathy was associated with mental fatigue aspects only in non-depressed patients, and it was not related to the physical aspects of fatigue in any of the studied groups. CONCLUSIONS Although the pathophysiology of fatigue and apathy in PD is clearly multifactorial, in a proportion of PD patients, these symptoms are associated with depression, dopaminergic depletion in the mesocorticolimbic structures, and disruption of the prefrontal cortex-basal ganglia axis. Therefore, in some PD patients, adequate management of depression and optimal dopaminergic medication may improve both fatigue and apathy.
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Affiliation(s)
- M. Skorvanek
- Department of Neurology; Safarik University; Kosice Slovak Republic
- Department of Neurology; L. Pasteur University Hospital; Kosice Slovak Republic
- Graduate School Kosice Institute for Society and Health; Safarik University; Kosice Slovak Republic
| | - Z. Gdovinova
- Department of Neurology; Safarik University; Kosice Slovak Republic
- Department of Neurology; L. Pasteur University Hospital; Kosice Slovak Republic
| | - J. Rosenberger
- Graduate School Kosice Institute for Society and Health; Safarik University; Kosice Slovak Republic
| | - R. Ghorbani Saeedian
- Graduate School Kosice Institute for Society and Health; Safarik University; Kosice Slovak Republic
- Department of Social Medicine; Institute of Public Health; Safarik University; Kosice Slovak Republic
| | - I. Nagyova
- Graduate School Kosice Institute for Society and Health; Safarik University; Kosice Slovak Republic
- Department of Social Medicine; Institute of Public Health; Safarik University; Kosice Slovak Republic
| | - J. W. Groothoff
- Department of Community and Occupational Health; University Medical Center Groningen; Groningen The Netherlands
| | - J. P. van Dijk
- Graduate School Kosice Institute for Society and Health; Safarik University; Kosice Slovak Republic
- Department of Community and Occupational Health; University Medical Center Groningen; Groningen The Netherlands
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18
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Katz AC, Sarapas C, Bishop JR, Patel SR, Shankman SA. The mediating effect of prefrontal asymmetry on the relationship between the COMT Val(158)Met SNP and trait consummatory positive affect. Cogn Emot 2014; 29:867-81. [PMID: 25195915 DOI: 10.1080/02699931.2014.951030] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The Val(158)Met rs4680 polymorphism in the COMT gene regulates dopamine catabolism in the prefrontal cortex (PFC). Dopamine's involvement in reward experience suggests those with the methionine (Met) variant may exhibit trait-level sensitivity to reward due to more post-synaptic dopamine in the PFC. A physiological mediator of this association may be greater relative left asymmetry in the PFC, a putative biomarker for trait positive emotionality. Electroencephalograms of 120 participants were measured during a task that assesses two aspects of reward processing: pre-reward anticipation and post-reward consummatory affect. Participants provided genetics samples and completed the Temporal Experience of Pleasure Scale (TEPS), which assesses trait-level anticipatory and consummatory positive affect. Met carriers had higher TEPS-Consummatory scores. This effect was mediated by greater relative left activation in the post-reward phase of the task. No effects were observed for the pre-reward phase. Results suggest that frontal asymmetry is an endophenotype between COMT genotype and trait reward responsivity.
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Affiliation(s)
- Andrea C Katz
- a Department of Psychology , University of Illinois at Chicago , Chicago , IL , USA
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19
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Skorvanek M, Rosenberger J, Gdovinova Z, Nagyova I, Saeedian RG, Groothoff JW, Dijk JP. Apathy in elderly nondemented patients with Parkinson's disease: clinical determinants and relationship to quality of life. J Geriatr Psychiatry Neurol 2013; 26:237-43. [PMID: 23970460 DOI: 10.1177/0891988713500587] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To describe the prevalence and clinical determinants of apathy in elderly nondemented patients with Parkinson's disease (PD) and their relationship to quality of life (QoL). METHODS A total of 106 nondemented elderly patients with PD were examined using the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Starkstein Apathy Scale, Hospital Anxiety and Depression Scale, Beck Depression Inventory-II, and 39-item Parkinson's disease quality of life questionnaire. RESULTS Apathy was present in 54% of the studied population. Factors associated with apathy were higher depression scores and a lower daily levodopa equivalent dose. Longer disease duration, higher motor MDS-UPDRS subscore, and higher depression and anxiety scores, but not apathy, were found to be associated with worse QoL. CONCLUSIONS Although apathy does not seem to be an independent predictor of worse QoL specifically in elderly patients with PD, it remains very relevant, as its presence increases caregiver burden. Both depression and potential dopaminergic treatment underdosing can be properly managed, thus potentially reducing the prevalence and severity of apathy in a proportion of the apathetic patients with PD.
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Affiliation(s)
- Matej Skorvanek
- Department of Neurology, Faculty of Medicine, Safarik University and L. Pasteur University Hospital, Kosice, Slovak Republic
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20
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Shapiro ME, Mahoney JR, Zingman BS, Pogge DL, Verghese J. Apathy correlates with cognitive performance, functional disability, and HIV RNA plasma levels in HIV-positive individuals. J Clin Exp Neuropsychol 2013; 35:934-45. [PMID: 24090038 DOI: 10.1080/13803395.2013.838941] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We examined the relationship of apathy with neurocognitive performance, age, disease markers, and functional disability in 116 HIV-infected individuals. Apathy was assessed with the Apathy Evaluation Scale and was significantly associated with highest HIV plasma level, functional disability, and neurocognitive performance. Individuals with higher apathy levels demonstrated a stronger association between age and processing speed performance. Our findings suggest that apathy is related to poor neuropsychological functioning, HIV plasma levels, and increased functional disability in individuals with HIV. Additionally, to our knowledge, this is the first study to demonstrate an interactive effect of age and apathy on neuropsychological performance in HIV.
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Affiliation(s)
- Miriam E Shapiro
- a Department of Psychology , Fairleigh Dickinson University , Teaneck , NJ , USA
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21
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Shapiro ME, Mahoney JR, Peyser D, Zingman BS, Verghese J. Cognitive reserve protects against apathy in individuals with human immunodeficiency virus. Arch Clin Neuropsychol 2013; 29:110-20. [PMID: 24021844 DOI: 10.1093/arclin/act071] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Apathy is associated with impaired neuropsychological functioning in individuals with HIV. While cognitive reserve (CR) delays neurocognitive decline, CR's relationship with apathy has never been studied. We examined CR's association with apathy in 116 HIV-positive individuals recruited from an urban AIDS center and assessed whether this relationship is moderated by age and/or disease severity. Participants completed the Wechsler Test of Adult Reading and Apathy Evaluation Scale. A CR-composite, combining years of education and word-reading ability, significantly predicted apathy (t = -2.37, p = .02). CR's relationship with apathy was not moderated by age, but participants with nadir CD4 levels ≤ 200 demonstrated a stronger association (t = -3.25, p = .002) than those with nadir CD4 levels > 200 (t = -0.61, p = .55). These findings suggest a protective effect of CR against apathy in HIV-infected individuals across the age span, particularly after a certain threshold of disease severity.
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Affiliation(s)
- Miriam E Shapiro
- Department of Psychology, Fairleigh Dickinson University, Teaneck, NJ, USA
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22
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Drye LT, Scherer RW, Lanctôt KL, Rosenberg PB, Herrmann N, Bachman D, Mintzer JE. Designing a trial to evaluate potential treatments for apathy in dementia: the apathy in dementia methylphenidate trial (ADMET). Am J Geriatr Psychiatry 2013; 21:549-59. [PMID: 23567407 PMCID: PMC3402588 DOI: 10.1016/j.jagp.2012.12.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 11/03/2011] [Accepted: 11/30/2011] [Indexed: 12/12/2022]
Abstract
BACKGROUND Research on efficacious treatments for apathy in Alzheimer disease has been hindered by a lack of consensus diagnosis, difficulties in measurement, and studies with small sample sizes. METHODS In designing the Apathy in Dementia Methylphenidate Trial (ADMET), a trial to evaluate the efficacy and safety of methylphenidate for the treatment of apathy in Alzheimer disease, we encountered the following issues: defining and measuring apathy, distinguishing apathy and depression, determining an appropriate test treatment, selecting relevant secondary outcomes, recruiting participants, and deciding on a suitable method for treatment unmasking. ADMET is a 6-week randomized, double-masked, placebo-controlled multicenter clinical trial with two parallel treatment groups assigned in a 1:1 ratio with randomization stratified by clinical center. The recruitment goal is 60 randomized participants over 2 years. The primary outcomes are change in apathy severity as measured by the Apathy Evaluation Scale and the Alzheimer Disease Cooperative Study-Clinical Global Impression of Change. CONCLUSION The design decisions made for ADMET are important elements to be considered in trials assessing the safety and efficacy of medications for clinically significant apathy in Alzheimer disease.
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Affiliation(s)
- Lea T. Drye
- Johns Hopkins Bloomberg School of Public Health,Corresponding author: 615 North Wolfe Street, W5010, Baltimore, MD 21205, Phone (443) 287-3170, Fax (443) 287-5797,
| | | | | | - Paul B. Rosenberg
- Johns Hopkins School of Medicine and Johns Hopkins Bayview Medical Center
| | | | - David Bachman
- Medical University of South Carolina and Ralph H Johnson VA Medical Center
| | - Jacobo E. Mintzer
- Medical University of South Carolina and Ralph H Johnson VA Medical Center
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Predictors of discrepancies in Parkinson's disease patient and caregiver ratings of apathy, disinhibition, and executive dysfunction before and after diagnosis. J Int Neuropsychol Soc 2013; 19:295-304. [PMID: 23351239 DOI: 10.1017/s1355617712001385] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Parkinson’s disease (PD) patient and caregiver reports of patient functioning are often used interchangeably in clinical and research settings; however, the consistency of these reports is largely unknown. This study aimed to investigate the consistency and predictors of discrepancy between self- and caregiver reports of patient apathy, disinhibition, and executive dysfunction. Fifty-one pairs of nondemented PD patients and their caregivers completed the frontal systems behavior scale (FrSBe). Patients were administered a neuropsychological battery, and mood and burden were assessed in a subset of caregivers. Patients and caregivers significantly differed in their ratings of all retrospective prediagnosis behaviors and current levels of disinhibition. Current levodopa equivalent dosages predicted patient-caregiver rating differences in prediagnosis and current apathy and current executive dysfunction, while patient motor function, cognition, and mood failed to predict any disparities in ratings. Caregiver burden and depression were associated with apathy rating discrepancies, while burden was associated with discrepancies in ratings of disinhibition. These results suggest that consistency of patient and caregiver behavioral ratings may vary depending on the behavior assessed; and underscore the importance of considering the reporter when using subjective measures, as discrepancies in behavioral reports may be influenced by specific patient and/or caregiver symptoms or factors.
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Péron J, Frühholz S, Vérin M, Grandjean D. Subthalamic nucleus: a key structure for emotional component synchronization in humans. Neurosci Biobehav Rev 2013; 37:358-73. [PMID: 23318227 DOI: 10.1016/j.neubiorev.2013.01.001] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Revised: 12/12/2012] [Accepted: 01/03/2013] [Indexed: 11/28/2022]
Abstract
Affective neuroscience is concerned with identifying the neural bases of emotion. For historical and methodological reasons, models describing the brain architecture that supports emotional processes in humans have tended to neglect the basal ganglia, focusing instead on cortical and amygdalar mechanisms. Now, however, deep brain stimulation (DBS) of the subthalamic nucleus (STN), a neurosurgical treatment for Parkinson's disease and obsessive-compulsive disorder, is helping researchers explore the possible functional role of this particular basal ganglion in emotional processes. After reviewing studies that have used DBS in this way, we propose a model in which the STN plays a crucial role in producing temporally organized neural co-activation patterns at the cortical and subcortical levels that are essential for generating emotions and related feelings.
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Affiliation(s)
- Julie Péron
- Swiss Center for Affective Sciences, 7 rue des Battoirs, 1205 Geneva, Switzerland.
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