Executive functions and disease characteristics in Parkinson's disease

Respiratory Responses to Two Voice Interventions for Parkinson's Disease

PURPOSE

The purpose of this study was to examine the respiratory strategies used by persons with Parkinson's disease (PD) to support louder speech in response to two voice interventions. Contrasting interventions were selected to investigate the role of internal and external cue strategies on treatment outcomes. LSVT LOUD, which uses an internal cueing framework, and the SpeechVive prosthesis, which employs an external noise cue to elicit louder speech, were studied.

METHOD

Thirty-four persons with hypophonia secondary to idiopathic PD were assigned to one of three groups: LSVT LOUD (n = 12), SpeechVive (n = 12), or a nontreatment clinical control (n = 10). The LSVT LOUD and SpeechVive participants received 8 weeks of voice intervention. Acoustic and respiratory kinematic data were simultaneously collected at pre-, mid- and posttreatment during a monologue speech sample. Intervention outcomes included sound pressure level (SPL), utterance length, lung volume initiation, lung volume termination, and lung volume excursion.

RESULTS

As compared to controls, the LSVT LOUD and SpeechVive participants significantly increased SPL at mid- and posttreatment, thus confirming a positive intervention effect. Treatment-related changes in speech breathing were further identified, including significantly longer utterance lengths (syllables per breath group) at mid- and posttreatment, as compared to pretreatment. The respiratory strategies used to support louder speech varied by group. The LSVT LOUD participants terminated lung volume at significantly lower levels at mid- and posttreatment, as compared to pretreatment. This finding suggests the use of greater expiratory muscle effort by the LSVT LOUD participants to support louder speech. Participants in the SpeechVive group did not significantly alter their respiratory strategies across the intervention period. Single-subject effect sizes highlight the variability in respiratory strategies used across speakers to support louder speech.

CONCLUSIONS

This study provides emerging evidence to suggest that the LSVT LOUD and SpeechVive therapies elicit different respiratory adjustments in persons with PD. The study highlights the need to consider respiratory function when addressing voice targets in persons with PD.

Cognitive Function and Postural Control Strategies in Relation to Disease Progression in Patients with Parkinson's Disease

AIM

This study assessed the influence of performing an additional cognitive task on center of pressure (COP) displacement in the early and advanced stages of patients with Parkinson's disease (PD) compared to age-matched healthy controls (HCs).

METHODS

The study included 40 HCs and 62 patients with PD: early PD (n = 38) and advanced PD (n = 24). COP parameters were determined by static posturography during quiet standing with open eyes (ST, single task) and simultaneous performance of a cognitive task (DT, dual task). Cognitive functioning was examined with a Mini Mental State Examination, number-counting-backward test, and number of enunciated words during DT.

RESULTS

In the advanced-PD group, DT significantly reduced the sway radius (p = 0.009), area of stabilogram (p = 0.034), medio-lateral length (p = 0.027), and velocity (p = 0.033) compared to ST. In HCs, DT showed a significant increase in the sway radius (p = 0.006), total length (p = 0.039), sway velocity (p = 0.037), anterior-posterior length, and sway velocity. Both PD groups showed worse cognitive performance compared to HCs.

CONCLUSIONS

Both early and advanced patients with PD showed significant delay in cognitive performance associated with executive function compared to the HCs. During additional cognitive tasks, patients with advanced stages of PD may reduce stabilographic parameters in medio-lateral direction, and this is probably an adaptive strategy to restore balance.

Normal aging and Parkinson's disease are associated with the functional decline of distinct frontal-striatal circuits

Impaired ability to shift attention between stimuli (i.e. shifting attentional ‘set’) is a well-established part of the dysexecutive syndrome in Parkinson's Disease (PD), nevertheless cognitive and neural bases of this deficit remain unclear. In this study, an fMRI-optimised variant of a classic paradigm for assessing attentional control (Hampshire and Owen 2006) was used to contrast activity in dissociable executive circuits in early-stage PD patients and controls. The results demonstrated that the neural basis of the executive performance impairments in PD is accompanied by hypoactivation within the striatum, anterior cingulate cortex (vACC), and inferior frontal sulcus (IFS) regions. By contrast, in aging it is associated with hypoactivation of the anterior insula/inferior frontal operculum (AI/FO) and the pre-supplementary motor area (preSMA). Between group behavioural differences were also observed; whereas normally aging individuals exhibited routine-problem solving deficits, PD patients demonstrated more global task learning deficits. These findings concur with recent research demonstrating model-based reinforcement learning deficits in PD and provide evidence that the AI/FO and IFS circuits are differentially impacted by PD and normal aging.

Neuroimaging studies of striatum in cognition part II: Parkinson's disease

In recent years a gradual shift in the definition of Parkinson's disease (PD) has been established, from a classical akinetic-rigid movement disorder to a multi-system neurodegenerative disease. While the pathophysiology of PD is complex and goes much beyond the nigro-striatal degeneration, the striatum has been shown to be responsible for many cognitive functions. Patients with PD develop impairments in multiple cognitive domains and the PD model is probably the most extensively studied regarding striatum dysfunction and its influence on cognition. Up to 40% of PD patients present cognitive impairment even in the early stages of disease development. Thus, understanding the key patterns of striatum and connecting regions' influence on cognition will help develop more specific approaches to alleviate cognitive impairment and slow down its decline. This review focuses on the contribution of neuroimaging studies in understanding how striatum impairment affects cognition in PD.

Executive dysfunction in Parkinson's disease and timing deficits

Patients with Parkinson’s disease (PD) have deficits in perceptual timing, or the perception and estimation of time. PD patients can also have cognitive symptoms, including deficits in executive functions such as working memory, planning, and visuospatial attention. Here, we discuss how PD-related cognitive symptoms contribute to timing deficits. Timing is influenced by signaling of the neurotransmitter dopamine in the striatum. Timing also involves the frontal cortex, which is dysfunctional in PD. Frontal cortex impairments in PD may influence memory subsystems as well as decision processes during timing tasks. These data suggest that timing may be a type of executive function. As such, timing can be used to study the neural circuitry of cognitive symptoms of PD as they can be studied in animal models. Performance of timing tasks also maybe a useful clinical biomarker of frontal as well as striatal dysfunction in PD.

Prefrontal dopamine signaling and cognitive symptoms of Parkinson's disease

Cognitive dysfunction is a common symptom of Parkinson's disease (PD) that causes significant morbidity and mortality. The severity of these symptoms ranges from minor executive symptoms to frank dementia involving multiple domains. In the present review, we will concentrate on the aspects of cognitive impairment associated with prefrontal dopaminergic dysfunction, seen in non-demented patients with PD. These symptoms include executive dysfunction and disorders of thought, such as hallucinations and psychosis. Such symptoms may go on to predict dementia related to PD, which involves amnestic dysfunction and is typically seen later in the disease. Cognitive symptoms are associated with dysfunction in cholinergic circuits, in addition to the abnormalities in the prefrontal dopaminergic system. These circuits can be carefully studied and evaluated in PD, and could be leveraged to treat difficult clinical problems related to cognitive symptoms of PD.

Dual task performance in Parkinson's disease: a sensitive predictor of impairment and disability

BACKGROUND

Dual task (DT) performance assesses the ability to perform two tasks simultaneously. Difficulty with DT performance may be a sensitive indicator of early Parkinson's disease (PD) impairment. The objective of this study was to assess what elements of a DT performance (cognition or gait) are most associated with impairment and disability in PD.

METHODS

Performance in single and DT conditions was examined in 154 PD patients. The single task assessments included the time required to walk 50 feet (gait speed) and the number of words generated in a verbal fluency task (word generation). The DT comprised simultaneous performance of the single tasks. Impairment and disability were measured with the Unified Parkinson's Disease Rating Scale, Hoehn &Yahr, Berg Balance Scale, and Older Americans Resource and Services Scale. Age, education, and gender were control variables. Standardized residuals from regressions of DT upon single task performance were computed separately for word and gait, indicating the extent that the individual performed proportionally better/worse than predicted in DT considering their single task performance.

RESULTS

Multiple regressions revealed that individuals who performed worse than expected in DT-word had greater impairment and disability. Dual task-gait was not significant in any model. Verbal fluency during DT performance is more closely associated with PD-related impairment and disability than gait speed during DT.

CONCLUSION

This suggests that subjects prioritize gait performance at the expense of cognitive performance, and that DT word generation may be a sensitive indicator of early PD impairment and disability.

The role of the basal ganglia in learning and memory: neuropsychological studies

In recent years, a common approach to understanding how the basal ganglia contribute to learning and memory in humans has been to study the deficits that occur in patients with basal ganglia pathology, such as Parkinson's disease and Huntington's disease. Pharmacological manipulations in patients and in healthy volunteers have also been conducted to investigate the role of dopamine, a neurotransmitter that is crucial for normal striatal functioning. When combined with powerful functional neuroimaging methods such as positron emission tomography and functional magnetic resonance imaging, such studies can provide important new insights into striatal function and dysfunction in humans. In this review, we consider this broad literature in an attempt to define a specific role for the caudate nucleus in learning and memory, and in particular, how this role may differ from that of the putamen. We conclude that the caudate nucleus contributes to learning and memory through the excitation of correct action schemas and the selection of appropriate sub-goals based on an evaluation of action-outcomes; both processes that are fundamental to all tasks involve goal-directed action.

Memory impairment induced by low doses of reserpine in rats: possible relationship with emotional processing deficits in Parkinson disease

We have recently verified that the monoamine-depleting drug reserpine--at doses that do not modify motor function--impairs memory in a rodent model of aversive discrimination. In this study, the effects of reserpine (0.1-0.5 mg/kg) on the performance of rats in object recognition, spatial working memory (spontaneous alternation) and emotional memory (contextual freezing conditioning) tasks were investigated. While object recognition and spontaneous alternation behavior were not affected by reserpine treatment, contextual fear conditioning was impaired. Together with previous studies, these results suggest that low doses of reserpine would preferentially induce deficits in tasks involved with emotional contexts. Possible relationships with cognitive and emotional processing deficits in Parkinson disease are discussed.

Cognitive and behavioural impairment in Parkinson's disease

Although Parkinson's disease (PD) has been considered to primarily affect motor abilities, increasing emphasis is being placed on cognitive and behavioural impairment in this disorder. Depression, dementia, psychosis and impulse control disorders have a major impact on quality of life for both patients and families. This article reviews cognitive and behavioural disturbances in PD and their relation to affective and motor symptoms, treatment of dementia associated with PD, and treatment approaches to psychosis in PD. We also discuss similarities between the dementia of PD and dementia with Lewy bodies.

The role of learned irrelevance in attentional set-shifting impairments in Parkinson's disease

In this study, the cognitive and neurochemical factors underlying learned irrelevance, one of the mechanisms thought to be responsible for attentional set-shifting deficits in Parkinson's disease (PD), were investigated. In a visual discrimination learning task, the extent to which a target dimension was irrelevant prior to an extra-dimensional shift was varied. Twenty patients with PD and 22 healthy participants performed the task twice, with patients tested on and off L-dopa. The patients made more errors than control participants in the condition in which the target dimension was completely irrelevant prior to the extradimensional shift, but not when it was partially reinforced. Moreover, L-dopa had no effect on the patients' task performance, despite improving their working memory. These results confirm that learned irrelevance is a significant factor in accounting for attentional set-shifting deficits in patients with PD, although unlike other executive impairments in this group, the phenomenon appears to be unrelated to their central dopaminergic deficit.

Theta and alpha oscillations reflect differences in memory strategy and visual discrimination performance in patients with Parkinson's disease

The aim of the present study was to investigate alterations in brain oscillatory activity during transient intentional encoding of abstract novel shapes in patients with Parkinson's disease (PD). Combined time-frequency analyses of alpha and theta power revealed a clear dissociation between PD patients (N=10) and age-matched healthy controls (N=10). PD patients used sub-optimal stimulus encoding strategies for subsequent maintenance and recall, whereas the controls mainly used categorization processes. In contrast to controls, PD patients showed significantly less theta increase and upper alpha suppression at frontal locations and significant laterality of early posterior theta and lower-2 alpha oscillations at right posterior locations. These findings suggest that the fronto-striatal circuits participate in visual categorization processes. Furthermore, theta and alpha oscillations appear to be involved in mediating the integration processes in mnemonic networks underlying visual categorization.

Force control and disease severity in Parkinson's disease

Several measures of isometric contractions reflect motor impairments in subjects with Parkinson's disease (PD), including long relaxation times and greater power in the 5 to 15 Hz electromyographic (EMG) bandwidth during the holding phase of contractions compared to those measures in healthy subjects. We sought to determine whether the impairments observed in subjects with PD in the performance of isometric contractions reflect disease severity. Twenty-eight subjects with PD performed isometric contractions at a torque level equal to 50% of the torque generated during a maximum voluntary contraction while off medication. Subjects were instructed to reach the target torque as fast as possible upon hearing the auditory "go" signal and to relax their muscles when a second auditory cue signaled the end of the hold phase. There was a significant positive correlation between torque relaxation time and Unified Parkinson's Disease Rating Scale (UPDRS)-Motor score. A significant positive correlation was also observed between the proportion of power in the 5 to 15 Hz frequency bin of the agonist EMG signal and UPDRS-Motor score, and a significant negative correlation between the proportion of power in the 15 to 30 Hz frequency bin and UPDRS-Motor score. These measures provide objective quantification of the severity of motor impairment that can be used to investigate the efficacy of different interventions in individuals with PD.

Striatal dopamine and learning strategy-an (123)I-FP-CIT SPECT study

Patients with Parkinson's disease (PD) have difficulty in processing learning tasks that lack external guidelines and, consequently, necessitate the subjects to generate their own problem-solving strategy. While the contribution of striatal dopaminergic deficiency to PD-specific motor symptoms is well established, its role in the PD-characteristic deviant learning style remains unclear. The aim of this study was to assess the relation between striatal dopamine activity as revealed by single photon emission computed tomography (SPECT) with (123)I-FP-CIT, a ligand for the dopamine transporter (DaT), and type of learning strategy, as identified by the California Verbal Learning Task (CVLT) in 19 patients with probable PD. The results showed a robust inverse correlation between striatal dopamine DaT binding and the externally guided, serial learning strategy: the lower the DaT in caudate nucleus as well as in putamen, the more the patient group appeared to rely on externally structured learning. Additionally, a significant positive correlation was found between caudatal DaT activity and the internally generated, semantic learning strategy. Unlike these strategic learning characteristics, IQ equivalent and recall total score appeared to vary independently from striatal DaT availability.

CONCLUSION

our findings provide direct evidence that striatal dopaminergic activity is specifically involved in the regulation of strategic learning processes.

Verbal fluency deficits in Parkinson's disease: a meta-analysis

A meta-analysis of 68 studies with a total of 4644 participants was conducted to investigate the sensitivity of tests of verbal fluency to the presence of Parkinson's disease (PD) relative to healthy controls. Both phonemic and semantic fluency were moderately impaired but neither deficit qualified as a differential deficit relative to verbal intelligence or psychomotor speed. However, PD patients were significantly more impaired on semantic relative to phonemic fluency (rs =.37 vs.33, respectively), and confrontation naming, a test of semantic memory that imposes only minimal demands upon cognitive speed and effortful retrieval, was associated with a deficit that was of a comparable magnitude to the deficits upon each of these types of fluency. Thus, the disorder appears to be associated with particular problems with semantic memory. Tests that impose heavy demands upon switching may also be disproportionately affected. Demented and non-demented PD patients differ quantitatively but not qualitatively in terms of the relative prominence of deficits on tests of phonemic and semantic fluency. However, patients with dementia of the Alzheimer's type and demented PD patients can be differentiated from one another by the relative magnitude of deficits upon these two measures.

A review of the cognitive and behavioral sequelae of Parkinson's disease: relationship to frontostriatal circuitry

BACKGROUND

Parkinson's disease is a neurodegenerative hypokinetic movement disorder presenting with subcortical pathology and characterized by motor deficits. However, as is frequently reported in the literature, patients with Parkinson's disease can also exhibit cognitive and behavioral impairments. These impairments may be attributed to dysfunction of multiple systems associated with the disease process in Parkinson's disease that are not necessarily related to motor symptoms. In recent years, considerable attention has addressed the circuits connecting the frontal cortical regions and the basal ganglia (i.e., frontostriatal circuits) and how they mediate cognition and behavior in humans. It has been suggested that these same circuits are disrupted in Parkinson's disease and may be responsible for the frontal/executive deficits predominantly reported in this patient population.

OBJECTIVE

The current survey of the literature provides a critique and analysis of the neuropsychological profile of Parkinson's disease, including cognitive impairments, behavioral alterations, and emotional processing deficits. A special feature of this paper is to ascertain how frontostriatal circuitry might provide the substrate for the neuropsychological impairments exhibited in Parkinson's disease. In so doing, studies involving nonhuman subjects, neurologically healthy adults, brain-lesioned individuals, and patients with Parkinson's disease are reviewed to provide a novel perspective in conceptualizing and categorizing the cognitive and behavioral sequelae concomitant to specific frontostriatal circuit dysfunction in Parkinson's disease.

CONCLUSIONS

The current review suggests that the neuropsychological profile of Parkinson's disease, which predominantly reflects frontal/executive dysfunction, may be attributed to disruption of the frontostriatal circuitry. The information generated from this review can serve as a guide in the assessment of frontal/executive dysfunction in Parkinson's disease with suggestions for a clinical neuropsychological test battery.

Differential executive control impairments in early Parkinson’s disease

Investigations concerning cognitive functions in early PD have revealed memory and executive function deficits related to dysfunction of fronto-striatal circuitry. Despite the range of data base, many previous investigations are limited because of methodological questions and inconsistencies. Thus the pattern of executive function impairments in early PD is far from being established. In the present investigation, twenty PD patients in early stages of the disease were compared to control subjects on a comprehensive neuropsychological test battery, aiming to explore their cognitive profile across a range of executive subcomponents. Results revealed impairments with respect to initiation, reasoning and planning. In summary, the present investigation shows that PD is associated with a differential executive impairment pattern which is (partly) related to disease characteristics and affective variables.

Self-Awareness of Deficits in Parkinson Disease

Anosognosia is an unawareness or denial of deficits. While it has mainly been associated with damage to cortical brain regions, anosognosia has also been reported in patients with subcortical brain disease. The present study investigated whether anosognosia is a feature of Parkinson disease. Forty-eight Parkinson disease patients with predominantly left- (N = 16) or right-sided (N = 32) motor symptoms who eventually underwent right or left pallidotomies, and 48 individuals identified as caregivers completed questionnaires rating severity of PD. There was no discrepancy in report between patients and caregivers as a function of pallidotomy side. However, as a group, patients rated themselves as significantly less impaired on 2 measures of activities of daily living, indicating that basal ganglia dysfunction may alter insight into severity of illness. Patients and caregivers in the left-symptom PD group differed significantly on selected measures of functional independence. This suggests the potential interaction of laterality and handedness. The importance of future investigations in PD patients with more severe cognitive impairment is stressed.

Substantia nigra pars reticulata neurons code initiation of a serial pattern: implications for natural action sequences and sequential disorders

Sequences of movements are initiated abnormally in neurological disorders involving basal ganglia dysfunction, such as Parkinson's disease or Tourette's syndrome. The substantia nigra pars reticulata (SNpr) is one of the two primary output structures of the basal ganglia. However, little is known about how substantia nigra mediates the initiation of normal movement sequences. We studied its role in coding initiation of a sequentially stereotyped but natural movement sequence by recording neuronal activity in SNpr during behavioural performance of 'syntactic grooming chains'. These are rule-governed sequences of up to 25 grooming movements emitted in four predictable (syntactic) phases, which occur spontaneously during grooming behaviour by rats and other rodents. Our results show that neuronal activation in central SNpr codes the onset of this entire rule-governed sequential pattern of grooming actions, not elemental grooming movements. We conclude that the context of sequential pattern may be more important than the elemental motor parameters in determining SNpr neuronal activation.

Mental and motor switching in Parkinson's disease

Switching difficulties in Parkinson's disease (PD) are expressed in both mental and motor tasks. The authors of the present study investigated whether those deficits coexist in the same patient and are positively correlated. They tested 8 nondemented PD patients and 6 age-matched control participants by using the modified Wisconsin Card Sorting Test and a motor switching paradigm that is based on the task of reaching toward visual targets, the location of which could unexpectedly be altered within the reaction time. In both mental and motor tasks, patients performed significantly worse than controls. There were no significant correlations between the two types of pathology in individual patients. Mental and motor switching deteriorate in PD patients, but the deficits are not necessarily of parallel severity.

Quantitative und qualitative Analysen von verbalen Flüssigkeitsaufgaben bei Parkinsonpatienten

Zusammenfassung: Bei nicht dementen Patienten mit Morbus Parkinson (PK) mehren sich die Hinweise auf spezifische neuropsychologische Funktionseinbußen. Insbesondere bei Wortflüssigkeitsaufgaben wird kontrovers diskutiert, ob und bei welchem Aufgabentypus PK-Patienten Minderleistungen erbringen. In der vorliegenden Studie wurden die Leistungen von 26 nicht dementen PK-Patienten bei semantischen und formallexikalischen Wortflüssigkeitsaufgaben sowie einer Generierungsaufgabe nach Wortarten (Adjektive) untersucht und denen einer Kontrollgruppe (KG) von 24 hirngesunden Personen gegenübergestellt. Während die PK-Patienten bei sämtlichen Aufgaben signifikant niedrigere Wortraten erbrachten, ergab die qualitative Untersuchung der Nennungen keine Gruppenunterschiede bezüglich Clusterbildung, kategorialer Verteilung und Variationsbreite der Nennungen. Semantische Wortflüssigkeitsaufgaben erwiesen sich als besonders sensible Indikatoren für neuropsychologische Funktionseinbußen bei nicht dementen PK-Patienten.

Impaired perception of vocal emotions in Parkinson's disease: influence of speech time processing and executive functioning

Little is known about the underlying dimensions of impaired recognition of emotional prosody that is frequently observed in patients with Parkinson's disease (PD). Because patients with PD also suffer from working memory deficits and impaired time perception, the present study examined the contribution of (a) working memory (frontal executive functioning) and (b) processing of the acoustic parameter speech rate to the perception of emotional prosody in PD. Two acoustic parameters known to be important for emotional classifications (speech duration and pitch variability) were systematically varied in prosodic utterances. Twenty patients with PD and 16 healthy controls (matched for age, sex, and IQ) participated in the study. The findings imply that (1) working memory dysfunctions and perception of emotional prosody are not independent in PD, (2) PD and healthy control subjects perceived vocal emotions categorically along two acoustic manipulation continua, and (3) patients with PD show impairments in processing of speech rate information.

Cognitive processes involved in delayed non-matching-to-sample performance in Parkinson's disease

Visual recognition memory was assessed in terms of delay duration, memory load and amount of interference(s) in non-demented patients with Parkinson's disease (PD) using an automated delayed non-matching-to-sample (DNMS) task with trial-unique stimuli. Special attention was focused on the different cognitive functions engaged by these patients in solving this recognition memory task. Thirteen patients with PD, carefully selected according to their stable regimen and anticholinergic medication, were compared to 12 controls matched by age and educational level. Besides the DNMS task, a neuropsychological battery that included tasks carefully selected according to processes potentially required to perform the DNMS task (e.g. attention, executive functions, visual discrimination and motor speed) was administered to the subjects. As compared with controls, patients with PD showed a deficit on most DNMS subscores, except those requiring the least cognitive load. The correlative analysis between the DNMS and other neuropsychological tasks suggests involvement of long-term memory mainly in the DNMS performance for the control group, contrasting with a major involvement of executive functions for the patients with PD. These data indicate that visual recognition memory impairment in non-demented patients with PD is largely due to an executive dysfunction, notably in working memory. Several hypotheses are proposed concerning the neuronal substrates underlying the impairment on the visual DNMS task in PD.

Dopamine and the origins of human intelligence

A general theory is proposed that attributes the origins of human intelligence to an expansion of dopaminergic systems in human cognition. Dopamine is postulated to be the key neurotransmitter regulating six predominantly left-hemispheric cognitive skills critical to human language and thought: motor planning, working memory, cognitive flexibility, abstract reasoning, temporal analysis/sequencing, and generativity. A dopaminergic expansion during early hominid evolution could have enabled successful chase-hunting in the savannas of sub-Saharan Africa, given the critical role of dopamine in counteracting hyperthermia during endurance activity. In turn, changes in physical activity and diet may have further increased cortical dopamine levels by augmenting tyrosine and its conversion to dopamine in the central nervous system (CNS). By means of the regulatory action of dopamine and other substances, the physiological and dietary changes may have contributed to the vertical elongation of the body, increased brain size, and increased cortical convolutedness that occurred during human evolution. Finally, emphasizing the role of dopamine in human intelligence may offer a new perspective on the advanced cognitive reasoning skills in nonprimate lineages such as cetaceans and avians, whose cortical anatomy differs radically from that of primates.

Selective attention is impaired in amyotrophic lateral sclerosis--a study of event-related EEG potentials

In humans, selective attention is assumed to be under control of the frontal lobe. A significant proportion of patients with amyotrophic lateral sclerosis (ALS) shows impairments in various tasks touching frontal lobe function. We, therefore, undertook a study of event-related EEG potentials (ERPs) in eight non-demented ALS patients in order to investigate a possible deficit of auditory selective attention: tones were presented in random sequence to the left or right ear, one of which was to be attended. The negative shift of the ERPs evoked by attended tones in relation to unattended tones ('processing negativity': PN) was smaller in ALS patients than in age-matched healthy control persons. This was true for Fz and Cz and for both a slow and a fast presentation rate of the tones. In the patients, reduced PN amplitude correlated with functional motor impairment. The utility of ERP testing to assess impaired frontal lobe function is shown for the first time in ALS patients. The results of our study fit to recent positron emission tomography (PET) and fMRI data.