1
|
Maier F, Greuel A, Hoock M, Kaur R, Tahmasian M, Schwartz F, Csoti I, Jessen F, Drzezga A, van Eimeren T, Timmermann L, Eggers C. Impaired self-awareness of cognitive deficits in Parkinson's disease relates to cingulate cortex dysfunction. Psychol Med 2023; 53:1244-1253. [PMID: 37010224 PMCID: PMC10009405 DOI: 10.1017/s0033291721002725] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 03/25/2021] [Accepted: 06/16/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Impaired self-awareness of cognitive deficits (ISAcog) has rarely been investigated in Parkinson's disease (PD). ISAcog is associated with poorer long-term outcome in other diseases. This study examines ISAcog in PD with and without mild cognitive impairment (PD-MCI), compared to healthy controls, and its clinical-behavioral and neuroimaging correlates. METHODS We examined 63 PD patients and 30 age- and education-matched healthy controls. Cognitive state was examined following the Movement Disorder Society Level II criteria. ISAcog was determined by subtracting z-scores (based on controls' scores) of objective tests and subjective questionnaires. Neural correlates were assessed by structural magnetic resonance imaging (MRI) and 2-[fluorine-18]fluoro-2-deoxy-d-glucose-positron emission tomography (FDG-PET) in 47 patients (43 with MRI) and 11 controls. We analyzed whole-brain glucose metabolism and cortical thickness in regions where FDG-uptake correlated with ISAcog. RESULTS PD-MCI patients (N = 23) showed significantly more ISAcog than controls and patients without MCI (N = 40). When all patients who underwent FDG-PET were examined, metabolism in the bilateral superior medial frontal gyrus, anterior and midcingulate cortex negatively correlated with ISAcog (FWE-corrected p < 0.001). In PD-MCI, ISAcog was related to decreased metabolism in the right superior temporal lobe and insula (N = 13; FWE-corrected p = 0.023) as well as the midcingulate cortex (FWE-corrected p = 0.002). Cortical thickness was not associated with ISAcog in these regions. No significant correlations were found between ISAcog and glucose metabolism in controls and patients without MCI. CONCLUSIONS Similar to Alzheimer's disease, the cingulate cortex seems to be relevant in ISAcog in PD. In PD-MCI patients, ISAcog might result from a disrupted network that regulates awareness of cognition and error processes.
Collapse
Affiliation(s)
- Franziska Maier
- Department of Psychiatry and Psychotherapy, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Andrea Greuel
- Department of Neurology, University Hospital Giessen and Marburg, Marburg, Germany
| | - Marius Hoock
- Department of Neurology, University Hospital Giessen and Marburg, Marburg, Germany
| | - Rajbir Kaur
- Department of Neurology, University Hospital Giessen and Marburg, Marburg, Germany
| | - Masoud Tahmasian
- Institute of Medical Science and Technology, Shahid Beheshti University, Tehran, Iran
| | - Frank Schwartz
- Department of Neurology, Hospital of the Brothers of Mercy, Trier, Germany
| | - Ilona Csoti
- Gertrudis Clinic, Parkinson-Center, Leun-Biskirchen, Germany
| | - Frank Jessen
- Department of Psychiatry and Psychotherapy, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
- German Center for Neurodegenerative Disorders (DZNE), Bonn, Germany
| | - Alexander Drzezga
- German Center for Neurodegenerative Disorders (DZNE), Bonn, Germany
- Department of Nuclear Medicine, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-2), Research Center Jülich, Jülich, Germany
| | - Thilo van Eimeren
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-2), Research Center Jülich, Jülich, Germany
- Department of Neurology, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Jülich, Germany
| | - Lars Timmermann
- Department of Neurology, University Hospital Giessen and Marburg, Marburg, Germany
| | - Carsten Eggers
- Department of Neurology, University Hospital Giessen and Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), Universities of Marburg and Giessen, Giessen and Marburg, Germany
| |
Collapse
|
2
|
Buchwitz TM, Ruppert-Junck MC, Greuel A, Maier F, Thieken F, Jakobs V, Eggers C. Exploring impaired self-awareness of motor symptoms in Parkinson's disease: Resting-state fMRI correlates and the connection to mindfulness. PLoS One 2023; 18:e0279722. [PMID: 36827321 PMCID: PMC9955618 DOI: 10.1371/journal.pone.0279722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 12/13/2022] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVE To further explore the phenomenon of impaired self-awareness of motor symptoms in patients with Parkinson's Disease by using an evaluated measurement approach applied in previous studies, while also examining its connection with dispositional mindfulness and possible correlates of functional connectivity. BACKGROUND Recently, the phenomenon of impaired self-awareness has been studied more intensively by applying different measurement and imaging methods. Existing literature also points towards a possible connection with mindfulness, which has not been examined in a cross-sectional study. There is no data available concerning correlates of functional connectivity. METHODS Non-demented patients with idiopathic Parkinson's Disease without severe depression were tested for impaired self-awareness for motor symptoms following a psychometrically evaluated approach. Mindfulness was measured by applying the German version of the Five Facet Mindfulness Questionnaire. A subset of eligible patients underwent functional MRI scanning. Spearman correlation analyses were performed to examine clinical data. Whole-brain voxelwise regressions between seed-based connectivity and behavioral measures were calculated to identify functional connectivity correlates of impaired self-awareness scores. RESULTS A total of 41 patients with Parkinson's Disease were included. 15 patients successfully underwent resting-state fMRI scanning. Up to 88% of patients showed signs of impaired self-awareness. Awareness for hypokinetic movements correlated with total mindfulness values and three facets, while awareness for dyskinetic movements did not. Three significant clusters between scores of impaired self-awareness in general and for dyskinetic movements were identified linking behavioral measures with the functional connectivity of the inferior frontal gyrus, the right insular cortex, the supplementary motor area, and the precentral gyrus among others. Impaired self-awareness for hypokinetic movements did not have any neural correlate. CONCLUSIONS Clinical data is comparable with results from previous studies applying the same structured approach to measure impaired self-awareness in Parkinson's Disease. Functional connectivity analyses were conducted for the first time to evaluate neural correlates thereof. This data does not support a connection between impaired self-awareness of motor symptoms and dispositional mindfulness.
Collapse
Affiliation(s)
| | - Marina Christine Ruppert-Junck
- Department of Neurology, University Hospital Marburg, Marburg, Germany
- Center for Mind, Brain, and Behavior (CMBB), Universities Marburg and Gießen, Marburg, Germany
| | - Andrea Greuel
- Department of Neurology, University Hospital Marburg, Marburg, Germany
| | - Franziska Maier
- Department of Psychiatry, University Hospital Cologne, Medical Faculty, Cologne, Germany
| | - Franziska Thieken
- Department of Neurology, University Hospital Marburg, Marburg, Germany
| | - Viktoria Jakobs
- Department of Neurology, University Hospital Marburg, Marburg, Germany
| | - Carsten Eggers
- Department of Neurology, University Hospital Marburg, Marburg, Germany
- Center for Mind, Brain, and Behavior (CMBB), Universities Marburg and Gießen, Marburg, Germany
- Department of Neurology, Knappschaftskrankenhaus Bottrop GmbH, Bottrop, Germany
| |
Collapse
|
3
|
Stanziano M, Golfrè Andreasi N, Messina G, Rinaldo S, Palermo S, Verri M, Demichelis G, Medina JP, Ghielmetti F, Bonvegna S, Nigri A, Frazzetta G, D'Incerti L, Tringali G, DiMeco F, Eleopra R, Bruzzone MG. Resting State Functional Connectivity Signatures of MRgFUS Vim Thalamotomy in Parkinson's Disease: A Preliminary Study. Front Neurol 2022; 12:786734. [PMID: 35095731 PMCID: PMC8791196 DOI: 10.3389/fneur.2021.786734] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/02/2021] [Indexed: 12/03/2022] Open
Abstract
Magnetic Resonance-guided high-intensity Focused Ultrasound (MRgFUS) of the thalamic ventral intermediate nucleus (Vim) for tremor has increasingly gained interest as a new non-invasive alternative to standard neurosurgery. Resting state functional connectivity (rs-FC) correlates of MRgFUS have not been extensively investigated yet. A region of interest (ROI)-to-ROI rs-FC MRI “connectomic” analysis focusing on brain regions relevant for tremor was conducted on 15 tremor-dominant patients with Parkinson's disease who underwent MRgFUS. We tested whether rs-FC between tremor-related areas was modulated by MRgFUS at 1 and 3 months post-operatively, and whether such changes correlated with individual clinical outcomes assessed by the MDS-UPDRS-III sub items for tremor. Significant increase in FC was detected within bilateral primary motor (M1) cortices, as well as between bilateral M1 and crossed primary somatosensory cortices, and also between pallidum and the dentate nucleus of the untreated hemisphere. Correlation between disease duration and FC increase at 3 months was found between the putamen of both cerebral hemispheres and the Lobe VI of both cerebellar hemispheres, as well as between the Lobe VI of untreated cerebellar hemisphere with bilateral supplementary motor area (SMA). Drop-points value of MDS-UPDRS at 3 months correlated with post-treatment decrease in FC, between the anterior cingulate cortex and bilateral SMA, as well as between the Lobe VI of treated cerebellar hemisphere and the interpositus nucleus of untreated cerebellum. Tremor improvement at 3 months, expressed as percentage of intra-subject MDS-UPDRS changes, correlated with FC decrease between bilateral occipital fusiform gyrus and crossed Lobe VI and Vermis VI. Good responders (≥50% of baseline tremor improvement) showed reduced FC between bilateral SMA, between the interpositus nucleus of untreated cerebellum and the Lobe VI of treated cerebellum, as well as between the untreated SMA and the contralateral putamen. Good responders were characterized at baseline by crossed hypoconnectivity between bilateral putamen and M1, as well as between the putamen of the treated hemisphere and the contralateral SMA. We conclude that MRgFUS can effectively modulate brain FC within the tremor network. Such changes are associated with clinical outcome. The shifting mode of integration among the constituents of this network is, therefore, susceptible to external redirection despite the chronic nature of PD.
Collapse
Affiliation(s)
- Mario Stanziano
- Neuroradiology Unit, Diagnostic and Technology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy.,Neurosciences Department "Rita Levi Montalcini, " University of Turin, Turin, Italy
| | - Nico Golfrè Andreasi
- Parkinson and Movement Disorders Unit, Clinical Neurosciences Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giuseppe Messina
- Functional Neurosurgery Unit, Neurosurgery Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Sara Rinaldo
- Parkinson and Movement Disorders Unit, Clinical Neurosciences Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Sara Palermo
- Neuroradiology Unit, Diagnostic and Technology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy.,European Innovation Partnership on Active and Healthy Ageing, Brussels, Belgium
| | - Mattia Verri
- Neuroradiology Unit, Diagnostic and Technology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Greta Demichelis
- Neuroradiology Unit, Diagnostic and Technology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Jean Paul Medina
- Neuroradiology Unit, Diagnostic and Technology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco Ghielmetti
- Health Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Salvatore Bonvegna
- Parkinson and Movement Disorders Unit, Clinical Neurosciences Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Anna Nigri
- Neuroradiology Unit, Diagnostic and Technology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Ludovico D'Incerti
- Neuroradiology Unit, Diagnostic and Technology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giovanni Tringali
- Functional Neurosurgery Unit, Neurosurgery Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco DiMeco
- Neurosurgery Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy.,Pathophysiology and Transplantation Department, University of Milan, Milan, Italy.,Neurological Surgery Department, Johns Hopkins Medical School, Baltimore, MD, United States
| | - Roberto Eleopra
- Parkinson and Movement Disorders Unit, Clinical Neurosciences Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Maria Grazia Bruzzone
- Neuroradiology Unit, Diagnostic and Technology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| |
Collapse
|
4
|
Amanzio M, Palermo S, Stanziano M, D'Agata F, Galati A, Gentile S, Castellano G, Bartoli M, Cipriani GE, Rubino E, Fonio P, Rainero I. Investigating Neuroimaging Correlates of Early Frailty in Patients With Behavioral Variant Frontotemporal Dementia: A MRI and FDG-PET Study. Front Aging Neurosci 2021; 13:637796. [PMID: 33935684 PMCID: PMC8079404 DOI: 10.3389/fnagi.2021.637796] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 02/19/2021] [Indexed: 01/20/2023] Open
Abstract
Frailty is a dynamic clinical condition characterized by the reduction of interconnections among different psychobiological domains, which leads to a homeostatic vulnerability. The association between physical frailty and cognitive dysfunctions is a possible predictor of poor prognosis in patients with neurodegenerative disorders. However, this construct has not been fully analyzed by a multidimensional neuropsychogeriatric assessment matched with multimodal neuroimaging methods in patients with behavioral variant frontotemporal dementia (bvFTD). We have investigated cognitive dysfunctions and frailty status, assessed by both a neuropsychological evaluation and the Multidimensional Prognostic Index (MPI), in a sample of 18 bvFTD patients and compared to matched healthy controls. Gray matter (GM) volume (as assessed by voxel-based morphometry) and metabolism (on 18fluorodeoxyglucose positron emission tomography) were first separately compared between groups, then voxelwise compared and correlated to each other within patients. Linear regression of the MPI was performed on those voxels presenting a significant correlation between altered GM volume and metabolism. The neuropsychological assessment reflected the diagnoses and the functional-anatomical alterations documented by neuroimaging analyses. In particular, the majority of patients presented significant executive dysfunction and mood changes in terms of apathy, depression, and anxiety. In the overall MPI score, the patients fell in the lower range (indicating an early frailty status). On imaging, they exhibited a bilateral decrease of GM density and hypometabolism involving the frontal pole, the anterior opercular region, and the anterior cingulate cortex. Greater atrophy than hypometabolism was observed in the bilateral orbitofrontal cortex, the triangular part of the inferior frontal gyrus, and the ventral striatum, whereas the contrary was detected in the bilateral dorsal anterior cingulate cortex and pre-supplementary motor area. MPI scores significantly correlated only with the co-occurrence of a decrease of GM density and hypometabolism in the right anterior insular cortex, but not with the separate pathological phenomena. Our results show a correlation between a specific pattern of co-occurring GM atrophy and hypometabolism with early frailty in bvFTD patients. These aspects, combined with executive dysfunction and mood changes, may lead to an increased risk of poor prognosis, highlighting a potentially critical and precocious role of the insula in the pathogenesis of frailty.
Collapse
Affiliation(s)
- Martina Amanzio
- Department of Psychology, University of Turin, Turin, Italy
- European Innovation Partnership on Active and Healthy Ageing (EIP-AHA), Brussels, Belgium
- Centro Interdipartimentale di Studi Avanzati in Neuroscienze - National Institute of Turin (NIT), Orbassano, Italy
| | - Sara Palermo
- Department of Psychology, University of Turin, Turin, Italy
- European Innovation Partnership on Active and Healthy Ageing (EIP-AHA), Brussels, Belgium
| | - Mario Stanziano
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico “Carlo Besta,”Milan, Italy
- Department of Neuroscience “Rita Levi Montalcini,” University of Turin, Turin, Italy
| | - Federico D'Agata
- Neuroradiology Unit, Department of Neuroscience “Rita Levi Montalcini,” University of Turin, Turin, Italy
| | - Antonello Galati
- Nuclear Medicine, Azienda Ospedaliera Universitaria “Città della Salute e della Scienza di Torino,”Turin, Italy
| | - Salvatore Gentile
- Aging Brain and Memory Clinic, Neurology I, Department of Neuroscience “Rita Levi Montalcini,” University of Turin, Turin, Italy
| | - Giancarlo Castellano
- Neuroradiology Unit, Department of Neuroscience “Rita Levi Montalcini,” University of Turin, Turin, Italy
| | | | | | - Elisa Rubino
- Aging Brain and Memory Clinic, Neurology I, Department of Neuroscience “Rita Levi Montalcini,” University of Turin, Turin, Italy
| | - Paolo Fonio
- Department of Diagnostic Imaging and Radiotherapy, Radiology Institute, Azienda Ospedaliera Universitaria “Città della Salute e della Scienza di Torino,” University of Turin, Turin, Italy
| | - Innocenzo Rainero
- Centro Interdipartimentale di Studi Avanzati in Neuroscienze - National Institute of Turin (NIT), Orbassano, Italy
- Aging Brain and Memory Clinic, Neurology I, Department of Neuroscience “Rita Levi Montalcini,” University of Turin, Turin, Italy
| |
Collapse
|
5
|
Amanzio M, Palermo S. Editorial: Unawareness of Illness in Neurological Disorders: A Focussed Neurocognitive Approach Shedding Light on Neuropsychological Deficits and Neural Underpinnings Potential Association. Front Psychol 2020; 11:622576. [PMID: 33365009 PMCID: PMC7750403 DOI: 10.3389/fpsyg.2020.622576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 11/10/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Martina Amanzio
- Department of Psychology, University of Turin, Turin, Italy.,Department of Neuroscience, Center for the Study of Movement Disorders, University of Turin, Turin, Italy
| | - Sara Palermo
- Department of Neuroscience, Center for the Study of Movement Disorders, University of Turin, Turin, Italy.,European Innovation Partnership on Active and Healthy Aging, Brussels, Belgium
| |
Collapse
|
6
|
Bartoli M, Palermo S, Stanziano M, Cipriani GE, Leotta D, Valentini MC, Amanzio M. Reduced Self-Awareness Following a Combined Polar and Paramedian Bilateral Thalamic Infarction. A Possible Relationship With SARS-CoV-2 Risk of Contagion? Front Psychol 2020; 11:570160. [PMID: 33132979 PMCID: PMC7566041 DOI: 10.3389/fpsyg.2020.570160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 09/04/2020] [Indexed: 01/07/2023] Open
Abstract
Reduced self-awareness is a well-known phenomenon investigated in patients with vascular disease; however, its impact on neuropsychological functions remains to be clarified. Importantly, selective vascular lesions provide an opportunity to investigate the key neuropsychological features of reduced self-awareness in neurocognitive disorders. Because of its rarity, we present an unusual case of a woman affected by a combined polar and paramedian bilateral thalamic infarction. The patient underwent an extensive neuropsychological evaluation to assess cognitive, behavioral, and functional domains, with a focus on executive functions. She was assessed clinically in the acute phase and after 6 months from the stroke, both clinically and by magnetic resonance imaging. The patient developed a cognitive impairment, characterised by prevalent executive dysfunction associated with reduced self-awareness and mood changes, in terms of apathy and depression. Such condition persisted after 6 months. In May 2020, the patient underwent the serology test in chemiluminescence to detect IgG antibodies against SARS-CoV-2. The result of the quantitative test highlighted a high probability of previous contact with the virus. We suggest that reduced self-awareness related to executive dysfunction and behavioral changes may be due to combined polar and paramedian bilateral thalamic lesion. Metacognitive–executive dysfunction affecting the instrumental abilities of everyday life might make people less able to take appropriate precautions, facilitating the risk of SARS-CoV-2 contagion.
Collapse
Affiliation(s)
| | - Sara Palermo
- Department of Psychology, University of Turin, Turin, Italy.,European Innovation Partnership on Active and Healthy Ageing, Brussels, Belgium
| | - Mario Stanziano
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milan, Italy.,Postgraduate School of Radiodiagnostics, University of Milan, Milan, Italy
| | | | | | - Maria C Valentini
- Neuroradiology Unit, Azienda Ospedaliera Universitaria "Città della Salute e della Scienza di Torino", Turin, Italy
| | - Martina Amanzio
- Department of Psychology, University of Turin, Turin, Italy.,European Innovation Partnership on Active and Healthy Ageing, Brussels, Belgium
| |
Collapse
|
7
|
Pennington C, Duncan G, Ritchie C. Altered awareness of motor symptoms in Parkinson's disease and Dementia with Lewy Bodies: A systematic review. Int J Geriatr Psychiatry 2020; 35:972-981. [PMID: 32525228 DOI: 10.1002/gps.5362] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 06/01/2020] [Accepted: 06/03/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Altered awareness of motor symptoms is reported in people with Parkinson's disease and Dementia with Lewy Bodies, and may adversely affect quality of life and medication concordance. How symptom awareness is influenced by motor and cognitive disease severity, age and medication use is not fully understood. We carried out a systematic review of the literature on motor symptom awareness in Parkinson's disease and Dementia with Lewy Bodies. METHODS Pubmed and Wed of Science were searched for relevant articles published in or prior to March 2019. Data regarding participant demographics, diagnosis, cognitive status, method of assessing awareness and study findings were extracted from relevant publications. RESULTS Sixteen relevant publications were identified. Motor symptom awareness appears to decline over the course of Parkinson's disease. Imaging studies implicate the prefrontal cortex, with different mechanisms involved in hypokinesia and dyskinesia awareness. The hypothesis that people with right hemisphere based disease would have more severely reduced awareness is only weakly supported. Most studies focused on cognitively intact individuals, and on awareness of dyskinesia rather than hypokinesia. CONCLUSIONS Whilst reduced awareness of dyskinesia and to a lesser extent hypokinesia is common, there is a lack of longitudinal data on how awareness changes over time, and how it interacts with global cognitive changes. Motor symptom awareness in Dementia with Lewy Bodies is understudied. Future studies of symptom awareness should include robust assessment of overall cognitive functioning, and use a longitudinal design to elucidate how awareness changes over time. J Am Geriatr Soc 68:-, 2020.
Collapse
Affiliation(s)
- Catherine Pennington
- Edinburgh Dementia Prevention, University of Edinburgh, Edinburgh, UK.,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Gordon Duncan
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Craig Ritchie
- Edinburgh Dementia Prevention, University of Edinburgh, Edinburgh, UK.,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
8
|
Morese R, Palermo S. Altruistic Punishment and Impulsivity in Parkinson's Disease: A Social Neuroscience Perspective. Front Behav Neurosci 2020; 14:102. [PMID: 32792921 PMCID: PMC7385270 DOI: 10.3389/fnbeh.2020.00102] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/25/2020] [Indexed: 12/28/2022] Open
Abstract
Non-motor symptoms of Parkinson's disease (PD) are of increasing interest in clinical and psychological research. Disinhibition-the inability to inhibit inappropriate behavior-leads to social and emotional impairments, including impulsive behavior and disregard for social conventions and decision-making behavior. In recent years, the latter has been investigated using economic exchanges during social interactions. Altruistic punishment-to punish someone who violates group norms even if it foresees a personal cost-is one of the most useful and fruitful paradigms; it allows to maintain a cooperation system within social groups. Alterations of this cognitive ability negatively impact the quality of life of the individual and social stability. Social neuroscience has suggested association between impulsive behaviors and altruistic punishment. Neuroimaging research aimed at exploring functional networks and intrinsic functional connectivity went in this direction. To date, little is known about these issues in neurodegenerative diseases such as PD. Dopamine replacement treatment and dopamine-agonists have been associated with impulse-control disorder and impulsive-compulsive behavior able to affect social decision-making. Frontal-executive dysfunction determines an alteration of social functioning through a mechanism of subversion of online action-monitoring, which associates disinhibition with volition. Genetic polymorphisms, alterations of the nigro-striatal substance, and impairment in the medial prefrontal cortex and in the Default mode network (DMN) seem to be able to explain these mechanisms. This theoretical perspective article aims to present these topics in order to encourage an interdisciplinary discussion capable of generating new research and developing rehabilitative intervention to improve social decision-making in PD patients.
Collapse
Affiliation(s)
- Rosalba Morese
- Institute of Public Health, Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland.,Faculty of Communication, Culture and Society, Università della Svizzera italiana, Lugano, Switzerland
| | - Sara Palermo
- Center for the Study of Movement Disorders, Department of Neuroscience, University of Turin, Turin, Italy.,European Innovation Partnership on Active and Healthy Ageing, Brussels, Belgium
| |
Collapse
|
9
|
Palermo S, Morese R, Zibetti M, Romagnolo A, Carlotti EG, Zardi A, Valentini MC, Pontremoli A, Lopiano L. What Happens When I Watch a Ballet and I Am Dyskinetic? A fMRI Case Report in Parkinson Disease. Front Psychol 2020; 11:1999. [PMID: 32849162 PMCID: PMC7426453 DOI: 10.3389/fpsyg.2020.01999] [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: 01/22/2020] [Accepted: 07/20/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The identical sets of neurons - the mirror neuron system (MNS) - can be activated by simply observing specific, specific movements, decoded behaviors and even facial expressions performed by other people. The same neurons activated during observation are those recruited during the same movements and actions. Hence the mirror system plays a central role in observing and executing movements. Little is known about MNS in a neurodegenerative motor disorder, such as Parkinson's Disease (PD) is. METHODS We explored the neural correlates potentially involved in empathy and embodiment in PD through complex action observation of complex behaviors like the choreutical arts. An integrated multidisciplinary assessment (neurological, neuropsychiatric, and neuropsychological) was used for the selection of the PD candidate for the neuroimaging experimental acquisition. For the first time in literature the famous Calvo-Merino's paradigm was administered to a PD subject. KEY POINTS Functional magnetic resonance imaging (fMRI) exploratory analysis shows the recruitment of the left thalamus, the right dorsolateral prefrontal cortex, and the bilateral superior precentral gyrus (one of the main hubs of the MNS). If the observed choreic movement becomes part of the observer's motor repertoire experience, mirror neurons might activate stimulating affective empathy and making the understanding of movement an own proper body experience (cognitive embodiment). MAIN LESSONS Our study sheds light on a possible use of complex action observation to improve or slow the deterioration of motor abilities and levodopa-induced dyskinesias in PD patients. Indeed, the modulation of the neural area involved in complex action observation could be considered a promising target for neuro-rehabilitative intervention mediated by the elicitation of the MNS.
Collapse
Affiliation(s)
- Sara Palermo
- Department of Neuroscience, Center for the Study of Movement Disorders, University of Turin, Turin, Italy
- European Innovation Partnership on Active and Healthy Ageing, Bruxelles, Belgium
| | - Rosalba Morese
- Faculty of Communication, Culture and Society, Università della Svizzera italiana, Lugano, Switzerland
- Institute of Public Health, Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
| | - Maurizio Zibetti
- Department of Neuroscience, Center for the Study of Movement Disorders, University of Turin, Turin, Italy
| | - Alberto Romagnolo
- Department of Neuroscience, Center for the Study of Movement Disorders, University of Turin, Turin, Italy
| | | | - Andrea Zardi
- Dipartimento di Studi Umanistici, University of Turin, Turin, Italy
| | - Maria Consuelo Valentini
- Neuroradiology Unit, Azienda Ospedaliera Universitaria “Città della Salute e della Scienza di Torino”, Turin, Italy
| | | | - Leonardo Lopiano
- Department of Neuroscience, Center for the Study of Movement Disorders, University of Turin, Turin, Italy
| |
Collapse
|
10
|
Amanzio M, Bartoli M, Cipriani GE, Palermo S. Executive Dysfunction and Reduced Self-Awareness in Patients With Neurological Disorders. A Mini-Review. Front Psychol 2020; 11:1697. [PMID: 32760331 PMCID: PMC7371941 DOI: 10.3389/fpsyg.2020.01697] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/22/2020] [Indexed: 11/13/2022] Open
Abstract
Awareness of deficits in patients with neurological disorders may be described as a theoretical unitary phenomenon, which has been analysed reaching interesting results in the last decades. Awareness of deficits manifests itself in a continuum ranging from full awareness to total absence. In line with a neurocognitive approach, a reduction in self-awareness could be explained considering executive dysfunction associated with prefrontal cortex anatomo-functional changes. Our mini-review will focus on reduced self-awareness in neurological disorders, such as Alzheimer’s disease, behavioural Frontotemporal Dementia and Acquired Brain Injuries. Results achieved thanks to an explanatory investigative approach combined with a theoretical reference model will be presented. Data suggest the key role of executive functions in supporting adequate self-awareness towards patients’ cognitive-behavioural profile and instrumental activity autonomy. The Cognitive Awareness Model seems to be one of the best theoretical model to better approach this phenomenon.
Collapse
Affiliation(s)
- Martina Amanzio
- Department of Psychology, University of Turin, Turin, Italy.,European Innovation Partnership on Active and Healthy Ageing, Brussels, Belgium
| | | | | | - Sara Palermo
- Department of Psychology, University of Turin, Turin, Italy.,European Innovation Partnership on Active and Healthy Ageing, Brussels, Belgium
| |
Collapse
|
11
|
Tan SJ, Ismail IS. Potency of Selected Berries, Grapes, and Citrus Fruit as Neuroprotective Agents. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2020; 2020:3582947. [PMID: 32565853 PMCID: PMC7277024 DOI: 10.1155/2020/3582947] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 04/29/2020] [Indexed: 12/12/2022]
Abstract
A healthy diet should nourish the brain with essential nutrients, including bioactive compounds, for normal brain functioning and to protect it from the negative effects of inflammation and oxidative stress. In this review, a concise summation of the protective effects of selected fruits, namely, berries, grapes, and citrus fruits, against neurological disorder is presented. The focus is on the neuroprotective potential of these fruits against neurodegenerative and mental disorders. The fruits selection was based on the vast reported pharmacological studies on their neuroprotection efficacies. Hence, the respective knowledge and limitations are discussed based on the biological and pharmacological evidence compiled from the previously reported laboratory, epidemiology, and intervention trials.
Collapse
Affiliation(s)
- Shih Jen Tan
- Laboratory of Natural Products, Institute of Bioscience, Universiti Putra Malaysia, 43000 Serdang, Selangor, Malaysia
| | - Intan Safinar Ismail
- Laboratory of Natural Products, Institute of Bioscience, Universiti Putra Malaysia, 43000 Serdang, Selangor, Malaysia
- Department of Chemistry, Faculty of Science, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| |
Collapse
|
12
|
Buchwitz TM, Maier F, Greuel A, Eggers C. Improving Self-Awareness of Motor Symptoms in Patients With Parkinson's Disease by Using Mindfulness - A Study Protocol for a Randomized Controlled Trial. Front Psychol 2020; 11:743. [PMID: 32362861 PMCID: PMC7180229 DOI: 10.3389/fpsyg.2020.00743] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 03/26/2020] [Indexed: 12/23/2022] Open
Abstract
Objective This study aims to increase self-awareness in patients with Parkinson’s disease (PD) using a newly developed mindfulness-based intervention, tailored for the specific needs of PD patients. Its impact on self-awareness and patients’ daily lives is currently being evaluated. Background Recently, the phenomenon of impaired self-awareness for motor symptoms (ISAm) and some non-motor symptoms has been described in PD. ISAm can negatively influence patients’ daily lives, e.g., by affecting therapy adherence, and is therefore the main focus of this study. The main goal is the development of IPSUM (“Insight into Parkinson’s Disease Symptoms by using Mindfulness”), a PD-specific intervention for increasing patients’ mindfulness and thereby reducing ISAm. Methods The effectiveness of IPSUM is evaluated by comparison of an intervention group with a waitlist-control group. A pre-post design with an additional 8-week follow-up measurement is applied, resulting in three measurement points: before, directly after and 8 weeks after completing the intervention protocol. In total, up to 180 non-depressed PD patients without severe cognitive impairment (non-demented) will be included. The primary outcome is a quantitative score for measuring ISAm. Secondary outcome measures are affective changes, neuropsychological performance and self-awareness of cognition. At pre- and post-measurement an fMRI scan is performed to connect behavioral and neurobiological findings. At post- and follow-up-measurement each patient will take part in a semi-structured interview to explore IPSUM’s impact on self-awareness and patients’ everyday lives. Results The conception of the intervention protocol is finished, the resulting 8-week program is presented in detail. It has successfully been tested in the first group of patients, their feedback so far was quite promising. Recruitment is ongoing and a first interim analysis will be performed once 30 patients have completed IPSUM. Conclusion For the first time, the intervention protocol of IPSUM has successfully been tested in a group of PD patients. As the study goes on, more quantitative data is collected for statistical analyses to evaluate its effectiveness. More qualitative data is collected to evaluate feasibility and effectiveness. We hope for this intervention to be capable of reducing the patients’ ISAm and improving their quality of life on many levels.
Collapse
Affiliation(s)
| | - Franziska Maier
- Department of Psychiatry, University Hospital Cologne, Medical Faculty, Cologne, Germany
| | - Andrea Greuel
- Department of Neurology, University Hospital Marburg, Marburg, Germany
| | - Carsten Eggers
- Department of Neurology, University Hospital Marburg, Marburg, Germany.,Center for Mind, Brain and Behavior, University of Marburg, Marburg, Germany
| |
Collapse
|
13
|
Cenci MA, Riggare S, Pahwa R, Eidelberg D, Hauser RA. Dyskinesia matters. Mov Disord 2019; 35:392-396. [PMID: 31872501 DOI: 10.1002/mds.27959] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 11/18/2019] [Accepted: 12/02/2019] [Indexed: 12/12/2022] Open
Abstract
Levodopa-induced dyskinesia (LID) represents a significant source of discomfort for people with Parkinson's disease (PD). It negatively affects quality of life, it is associated with both motor and nonmotor fluctuations, and it brings an increased risk of disability, balance problems, and falls. Although the prevalence of severe LID appears to be lower than in previous eras (likely owing to a more conservative use of oral levodopa), we have not yet found a way to prevent the development of this complication. Advanced surgical therapies, such as deep brain stimulation, ameliorate LID, but only a minority of PD patients qualify for these interventions. Although some have argued that PD patients would rather be ON with dyskinesia than OFF, the deeper truth is that patients would very much prefer to be ON without dyskinesia. As researchers and clinicians, we should aspire to make that goal a reality. To this end, translational research on LID is to be encouraged and persistently pursued. © 2019 International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- M Angela Cenci
- Basal Ganglia Pathophysiology Unit, Dept. of Experimental Medical Science, Lund University, Lund, Sweden
| | - Sara Riggare
- Department for Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Rajesh Pahwa
- University of Kansas Medical Center, Movement Disorders Division, Kansas City, Kansas, USA
| | - David Eidelberg
- Center for Neurosciences, The Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Robert A Hauser
- University of South Florida, Department of Neurology, Tampa, Florida, USA
| |
Collapse
|
14
|
Delamarre A, Tison F, Li Q, Galitzky M, Rascol O, Bezard E, Meissner WG. Assessment of plasma creatine kinase as biomarker for levodopa-induced dyskinesia in Parkinson's disease. J Neural Transm (Vienna) 2019; 126:789-793. [PMID: 31098725 DOI: 10.1007/s00702-019-02015-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 05/11/2019] [Indexed: 10/26/2022]
Abstract
We tested in a translational approach the usefulness of plasma creatine kinase (CK) as an objective biomarker for levodopa-induced dyskinesia (LID). Plasma CK levels were measured in five dyskinetic parkinsonian non-human primates (NHP) and in ten PD patients with LID who participated in a treatment trial with simvastatin. Plasma CK levels were increased in dyskinetic NHP and correlated with LID severity while they were not affected by LID severity in PD patients.
Collapse
Affiliation(s)
- Anna Delamarre
- Service de Neurologie, Hôpital Pellegrin, CHU de Bordeaux, 33000, Bordeaux, France.,Institut des Maladies Neurodégénératives, Université de Bordeaux, UMR 5293, 146 rue Léo Saignat, 33000, Bordeaux Cedex, France.,CNRS, Institut des Maladies Neurodégénératives, UMR 5293, 33000, Bordeaux, France
| | - François Tison
- Service de Neurologie, Hôpital Pellegrin, CHU de Bordeaux, 33000, Bordeaux, France.,Institut des Maladies Neurodégénératives, Université de Bordeaux, UMR 5293, 146 rue Léo Saignat, 33000, Bordeaux Cedex, France.,CNRS, Institut des Maladies Neurodégénératives, UMR 5293, 33000, Bordeaux, France
| | - Qin Li
- Institute of Laboratory Animal Sciences, China Academy of Medical Sciences, Beijing, China.,Motac Neuroscience, Manchester, UK
| | | | - Olivier Rascol
- CIC Toulouse, Toulouse, France.,Départements de Pharmacologie Clinique et Neurosciences, INSERM CIC9302, CHU de Toulouse, Toulouse, France.,Service de Pharmacologie, Faculté de Médecine, CHU de Toulouse, Université de Toulouse, Toulouse, France
| | - Erwan Bezard
- Service de Neurologie, Hôpital Pellegrin, CHU de Bordeaux, 33000, Bordeaux, France.,Institut des Maladies Neurodégénératives, Université de Bordeaux, UMR 5293, 146 rue Léo Saignat, 33000, Bordeaux Cedex, France.,CNRS, Institut des Maladies Neurodégénératives, UMR 5293, 33000, Bordeaux, France.,Institute of Laboratory Animal Sciences, China Academy of Medical Sciences, Beijing, China.,Motac Neuroscience, Manchester, UK
| | - Wassilios G Meissner
- Service de Neurologie, Hôpital Pellegrin, CHU de Bordeaux, 33000, Bordeaux, France. .,Institut des Maladies Neurodégénératives, Université de Bordeaux, UMR 5293, 146 rue Léo Saignat, 33000, Bordeaux Cedex, France. .,CNRS, Institut des Maladies Neurodégénératives, UMR 5293, 33000, Bordeaux, France. .,Department Medicine, University of Otago, Christchurch, New Zealand. .,New Zealand Brain Research Institute, Christchurch, New Zealand.
| |
Collapse
|
15
|
Goubault E, Nguyen HP, Bogard S, Blanchet PJ, Bézard E, Vincent C, Sarna J, Monchi O, Duval C. Remnants of Cardinal Symptoms of Parkinson's Disease, Not Dyskinesia, Are Problematic for Dyskinetic Patients Performing Activities of Daily Living. Front Neurol 2019; 10:256. [PMID: 30967832 PMCID: PMC6440171 DOI: 10.3389/fneur.2019.00256] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 02/26/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction: The impact of levodopa-induced dyskinesia (LID) on the daily lives of patients with Parkinson's disease (PD) remains to be determined. Furthermore, evidence suggests that cardinal motor symptoms of PD may coexist with LID, but their impact on activities of daily living (ADL) relative to LID is not known. This cross-sectional study aimed at determining the effect of LID and cardinal motor symptoms of PD on ADL in patients who were experiencing peak-dose choreic-type LID. Method: One hundred and twenty-one patients diagnosed with PD known to experience choreic-type LID were recruited for the study. Patients were asked to perform a set of ADL. Levels of LID, tremor, bradykinesia, and freezing of gait (FoG) were measured using 17 inertial sensors design to capture full body movements, while rigidity, and postural instability were assessed using clinical evaluations. Cognition was also assessed using the mini-mental state examination. Success criteria were set for each ADL using the time needed to perform the task and errors measured in 69 age-gender-matched healthy controls. Binary logistic regressions were used to identify symptoms influencing success or failure for each activity. Receiver operating characteristic curves were computed on each significant symptom, and Youden indexes were calculated to determine the critical level of symptomatology at which the performance significantly changed. Results: Results show that 97.7% of patients who presented with LID during the experiment also presented with at least one cardinal motor symptom. On average, patients took more time and did more errors during ADL. Multivariate analyses revealed that for the great majority of ADL, LID were not associated with worsening of performance; however, postural instability, tremor, rigidity, and cognitive decline significantly decreased the odds of success. Conclusions: Residual symptoms of PD, such as tremor, rigidity, and postural instability still present at peak-dose were more problematic than LID in the performance of ADL for patients experiencing slight-to-moderate LID. We also found that cognitive decline was associated with decreased performance in certain tasks. Therefore, a strategy using lower doses of medication to manage LID may be counterproductive since it would not address most of these symptoms already present in patients.
Collapse
Affiliation(s)
- Etienne Goubault
- Département des Sciences de l'Activité Physique, Université du Québec à Montréal, Montréal, QC, Canada.,Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada
| | - Hung P Nguyen
- Département des Sciences de l'Activité Physique, Université du Québec à Montréal, Montréal, QC, Canada.,Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada
| | - Sarah Bogard
- Département des Sciences de l'Activité Physique, Université du Québec à Montréal, Montréal, QC, Canada.,Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada
| | - Pierre J Blanchet
- Département de Stomatologie, Faculté de Médecine Dentaire, Université de Montréal, Montréal, QC, Canada.,Département de Médecine, CHU Montréal, Montréal, QC, Canada
| | - Erwan Bézard
- Laboratoire de Neurophysiologie, Université de Bordeaux, Institut des Maladies Neurodégénératives, Bordeaux, France.,Unité Mixte de Recherche 5293, Centre National de la Recherche Scientifique, Institut des Maladies Neurodégénératives, Bordeaux, France
| | - Claude Vincent
- Département de Réadaptation, Faculté de Médecine, Université Laval, Quebec, QC, Canada
| | - Justyna Sarna
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Oury Monchi
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Christian Duval
- Département des Sciences de l'Activité Physique, Université du Québec à Montréal, Montréal, QC, Canada.,Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada
| |
Collapse
|
16
|
Morese R, Stanziano M, Palermo S. Commentary: Metacognition and Perspective-Taking in Alzheimer's Disease: A Mini-Review. Front Psychol 2018; 9:2010. [PMID: 30405494 PMCID: PMC6204392 DOI: 10.3389/fpsyg.2018.02010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 10/01/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rosalba Morese
- Faculty of Biomedical Sciences, Institute of Public Health, Università della Svizzera Italiana, Lugano, Switzerland.,Faculty of Communication, Culture and Society, Università della Svizzera Italiana, Lugano, Switzerland
| | - Mario Stanziano
- Neuroradiology Unit, Azienda Ospedaliera Universitaria “Città della Salute e della Scienza di Torino”, Turin, Italy
| | - Sara Palermo
- Department of Psychology, University of Turin, Turin, Italy.,European Innovation Partnership on Active and Healthy Ageing (EIP-AHA), Brussels, Belgium
| |
Collapse
|
17
|
Palermo S, Lopiano L, Morese R, Zibetti M, Romagnolo A, Stanziano M, Rizzone MG, Geminiani GC, Valentini MC, Amanzio M. Role of the Cingulate Cortex in Dyskinesias-Reduced-Self-Awareness: An fMRI Study on Parkinson's Disease Patients. Front Psychol 2018; 9:1765. [PMID: 30294293 PMCID: PMC6159748 DOI: 10.3389/fpsyg.2018.01765] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 08/31/2018] [Indexed: 12/16/2022] Open
Abstract
Objectives: The detection of dyskinesias-reduced-self-awareness (DRSA), in Parkinson’s disease (PD), was previously associated to executive and metacognitive deficits mainly due to dopaminergic overstimulation of mesocorticolimbic circuits. Response-inhibition dysfunction is often observed in PD. Apart from being engaged in response-inhibition tasks, the anterior cingulate cortex (ACC), is part of a functional system based on self-awareness and engaged across cognitive, affective and behavioural contexts. The purpose of the study was to examine the relationship between response-inhibition disabilities and DRSA using whole-brain event-related functional magnetic resonance imaging (fMRI), over the course of a specific executive task. Methods: Twenty-seven cognitively preserved idiopathic PD patients – presenting motor fluctuations and dyskinesias – were studied. They underwent a neurological and neuropsychological evaluation. The presence of DRSA was assessed using the Dyskinesias Subtracted-Index (DS-I). Cingulate functionality was evaluated with fMRI, while patients performed an ACC-sensitive GO-NoGO task. Association between blood oxygenation level dependent response over the whole-brain during the response-inhibition task and DS-I scores was investigated by regression analysis. Results: The presence of DRSA was associated with reduced functional recruitment in the bilateral ACC, bilateral anterior insular cortex and right dorsolateral prefrontal cortex (pFWE<0.05). Moreover, DS-I scores significantly correlated with percent errors on the NoGO condition (r = 0.491, pFWE = 0.009). Discussion: These preliminary findings add evidence to the relevant role of executive dysfunctions in DRSA pathogenesis beyond the effects of chronic dopaminergic treatment, with a key leading role played by ACC as part of a functionally impaired response-inhibition network. Imaging biomarkers for DRSA are important to be studied, especially when the neuropsychological assessment seems to be normal.
Collapse
Affiliation(s)
- Sara Palermo
- Department of Psychology, University of Turin, Turin, Italy
| | - Leonardo Lopiano
- Department of Neuroscience, University of Turin, Turin, Italy.,Neuroscience Institute of Turin, University of Turin, Turin, Italy
| | - Rosalba Morese
- Department of Psychology, University of Turin, Turin, Italy.,Faculty of Communication Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | | | | | - Mario Stanziano
- Azienda Ospedaliera Universitaria "Città della Salute e della Scienza di Torino", Neuroradiology Unit, Turin, Italy
| | | | - Giuliano Carlo Geminiani
- Department of Psychology, University of Turin, Turin, Italy.,Neuroscience Institute of Turin, University of Turin, Turin, Italy
| | - Maria Consuelo Valentini
- Azienda Ospedaliera Universitaria "Città della Salute e della Scienza di Torino", Neuroradiology Unit, Turin, Italy
| | - Martina Amanzio
- Department of Psychology, University of Turin, Turin, Italy.,Neuroscience Institute of Turin, University of Turin, Turin, Italy.,European Innovation Partnership on Active and Healthy Ageing, Bruxelles, Belgium
| |
Collapse
|
18
|
Maier F, Prigatano GP. Impaired Self-Awareness of Motor Disturbances in Parkinson's Disease. Arch Clin Neuropsychol 2018; 32:802-809. [PMID: 29028874 DOI: 10.1093/arclin/acx094] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 09/13/2017] [Indexed: 01/01/2023] Open
Abstract
Traditionally, anosognosia for cognitive or motor impairments in patients with Parkinson's disease (PD) was viewed as unlikely unless the patient was demented. More recent research has suggested that a portion of non-demented PD patients (30%-50%) in fact have impaired subjective awareness (ISA) of their motor impairments (ISAm). This empirical finding has implications for the clinical neuropsychological examination of PD patients and raises theoretical questions relevant to the broader study of anosognosia seen in other patient groups. The purpose of this paper is to primarily review our own research in this area and to summarize research findings of other investigators who have examined ISA in PD patients. Our secondary goal is to demonstrate the relevance of assessing ISA when conducting a neuropsychological examination of PD patients. Our findings suggest ISAm in PD patients is related to motor signs of right hemispheric dysfunction, but the brain imaging correlates of ISA for hypokinesias appear different than those obtained for ISA for dyskinesia in this patient group.
Collapse
Affiliation(s)
- Franziska Maier
- Department of Neurology, University of Marburg, Marburg, Germany.,Klinik und Poliklinik für Neurologie, Universitätsklinikum Köln (AöR), Cologne, Germany
| | - George P Prigatano
- Department of Clinical Neuropsychology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| |
Collapse
|
19
|
Palermo S, Salatino A, Romagnolo A, Zibetti M, Chillemi G, Lopiano L. Preliminary evidence from a Line-Bisection Task for visuospatial neglect in Parkinson's disease. Parkinsonism Relat Disord 2018; 54:113-115. [PMID: 29628330 DOI: 10.1016/j.parkreldis.2018.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 03/25/2018] [Accepted: 04/01/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Sara Palermo
- Department of Neuroscience, University of Turin, Via Cherasco 15, 10126 Turin, Italy
| | - Adriana Salatino
- SAMBA (SpAtial, Motor and Bodily Awareness) Research Group, Department of Psychology, University of Turin, Via Po 14, Turin, Italy.
| | - Alberto Romagnolo
- Department of Neuroscience, University of Turin, Via Cherasco 15, 10126 Turin, Italy
| | - Maurizio Zibetti
- Department of Neuroscience, University of Turin, Via Cherasco 15, 10126 Turin, Italy
| | - Gaetana Chillemi
- IRCCS Centro Neurolesi "BoninoPulejo", S.S. 113, Via Palermo, C.da Casazza, 98124 Messina, Italy
| | - Leonardo Lopiano
- Department of Neuroscience, University of Turin, Via Cherasco 15, 10126 Turin, Italy
| |
Collapse
|
20
|
Amanzio M, Palermo S, Zucca M, Rosato R, Rubino E, Leotta D, Bartoli M, Rainero I. Neuropsychological Correlates of Pre-Frailty in Neurocognitive Disorders: A Possible Role for Metacognitive Dysfunction and Mood Changes. Front Med (Lausanne) 2017; 4:199. [PMID: 29188218 PMCID: PMC5694746 DOI: 10.3389/fmed.2017.00199] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 10/31/2017] [Indexed: 12/21/2022] Open
Abstract
Background Recent studies have suggested that cognitive functions in patients with neurocognitive disorders have a significant role in the pathogenic mechanisms of frailty. Although pre-frailty is considered an intermediate, preclinical state, epidemiological research has begun to dislodge cognition and frailty into their specific subcomponents to understand the relationship among them. We aim to analyse the possible association between pre-frailty and neuropsychological variables to outline which factors can contribute to minor and major neurocognitive disorders. Methods 60 subjects complaining of different cognitive deficits underwent a deep-in-wide frailty and neuropsychological assessment. We conducted three multiple linear regression analyses adjusted for a combination of demographic measures and involving several neuropsychological–behavioural parameters selected by the literature on physical frailty. Results We found a significant association between frailty—as measured by the multidimensional prognostic index (MPI)—and action monitoring and monetary gain (cognitive domain), depression and disinhibition (behavioural domain). Moreover, an association between MPI and impaired awareness for instrumental activities disabilities exists. Conclusion We propose a novel framework for understanding frailty associated with metacognitive–executive dysfunction.
Collapse
Affiliation(s)
- Martina Amanzio
- Department of Psychology, University of Turin, Turin, Italy.,European Innovation Partnership on Active and Healthy Ageing, Brussels, Belgium
| | - Sara Palermo
- Department of Psychology, University of Turin, Turin, Italy
| | - Milena Zucca
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Rosalba Rosato
- Department of Psychology, University of Turin, Turin, Italy.,Unit of Cancer Epidemiology, "Città della Salute e della Scienza" Hospital and CPO Piemonte, Turin, Italy
| | - Elisa Rubino
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | | | | | - Innocenzo Rainero
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| |
Collapse
|
21
|
Tripathi RK, Kapse SV, Potey AV. Prescription pattern and awareness of disease and treatment in patients of Parkinson's disease. Neurodegener Dis Manag 2017; 7:299-306. [PMID: 29043907 DOI: 10.2217/nmt-2017-0020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM This cross-sectional study aimed to evaluate the prescription pattern, awareness of disease and treatment in patients with Parkinson's disease (PD). MATERIALS & METHODS A total of 100 PD patients, attending a tertiary care hospital in Mumbai were included. Prescriptions were analyzed and awareness was evaluated using a questionnaire. RESULTS The mean number of anti-Parkinson agents (APA) prescribed was 1.52 ± 0.65. Number of APA strongly correlated with disease duration (ρ = 0.818; p < 0.001). Many APA were underutilized (prescribed daily dose/defined daily dose < 1). There was no awareness of all items on symptoms and alternative therapeutic options. Awareness of disease impairments (32%), long-term complications (28%), dosing regimen (46%) and follow-up (36%) was poor. CONCLUSION More than one APA is commonly prescribed in PD patients. Awareness of disease and treatment of PD is poor among the patients.
Collapse
Affiliation(s)
- Raakhi K Tripathi
- Department of Pharmacology & Therapeutics, Seth GS Medical College & KEM Hospital, Parel, Mumbai, India
| | - Sandip V Kapse
- Department of Pharmacology & Therapeutics, Seth GS Medical College & KEM Hospital, Parel, Mumbai, India
| | - Anirudha V Potey
- Department of Pharmacology & Therapeutics, Seth GS Medical College & KEM Hospital, Parel, Mumbai, India
| |
Collapse
|
22
|
Impulse control disorder and response-inhibition alterations in Parkinson's disease. A rare case of totally absent functionality of the medial-prefrontal cortex and review of literature. J Adv Res 2017; 8:713-716. [PMID: 29034115 PMCID: PMC5633757 DOI: 10.1016/j.jare.2017.09.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 09/20/2017] [Accepted: 09/21/2017] [Indexed: 11/24/2022] Open
Abstract
This report illustrates a Parkinson’s disease (PD) patient with impulse-control disorder (ICD) and selective impairment in response-inhibition abilities as revealed by the performance in a functional magnetic resonance imaging (fMRI) anterior cingulate cortex - sensitive go-nogo task. In line with hypothesis on the role of response-inhibition disabilities in the arising of impulsivity in PD, the patient completely failed the go-nogo task. Moreover, fMRI acquisition revealed absent task-sensitive activity in the anterior cingulate cortex, medial prefrontal, and orbitofrontal cortices for the contrast nogo versus go, which signifying that a hypo-function of this network could be associated with ICD. A fronto-striatal and cingulo-frontal dysfunction may reflect impairment in metacognitive-executive abilities (such as response-inhibition, action monitoring, and error awareness) and promote compulsive repetition of behavior. Response-inhibition tasks may be useful in PD post-diagnostic phase, to better identify individuals at risk of developing ICD with dopaminergic medication.
Collapse
|
23
|
Freitas ME, Hess CW, Fox SH. Motor Complications of Dopaminergic Medications in Parkinson's Disease. Semin Neurol 2017; 37:147-157. [PMID: 28511255 DOI: 10.1055/s-0037-1602423] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Motor complications are a consequence of the chronic treatment of Parkinson's disease (PD) and include motor fluctuations (wearing-off phenomenon) and levodopa-induced dyskinesia. Both can have a significant impact on functionality and quality of life; thus, proper recognition and management is essential. The phenomenology and temporal relationship of motor complications to the schedule of levodopa dosing can be helpful in characterizing them. There are several therapeutic approaches to motor complications, including pharmacological and surgical options. The authors summarize the different types of motor complications according to phenomenology and the currently available medical treatments, including ongoing trials for the management of this condition.
Collapse
Affiliation(s)
- Maria Eliza Freitas
- Division of Neurology, Department of Medicine, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Christopher W Hess
- Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Florida
| | - Susan H Fox
- Division of Neurology, Department of Medicine, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada
| |
Collapse
|
24
|
Palermo S, Lopiano L, Zibetti M, Rosato R, Leotta D, Amanzio M. A novel framework for understanding reduced awareness of dyskinesias in Parkinson's Disease. Parkinsonism Relat Disord 2017; 39:58-63. [PMID: 28325582 DOI: 10.1016/j.parkreldis.2017.03.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 03/06/2017] [Accepted: 03/13/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Although dyskinesias-reduced-self-awareness (DRSA) in Parkinson's disease (PD) is related to deficit in metacognition, other factors, such as "Theory of Mind" (ToM), could operate. METHODS Forty-one PD patients were assessed using the Global Awareness of Movement Disorders (GAM) and the Dyskinesias Subtracted-Index (DS-I). To study whether GAM and DS-I scores could be influenced by second-type ToM or Reading the Mind in the Eyes (RME) tasks, we conducted two multiple logistic regression analyses. RESULTS The association between the GAM, the DS-I and RME task were highly significant. The association between DS-I and Trail Making Test B-A version was also verified. CONCLUSION DRSA was related with affective component of ToM and executive functions, thus caused by a complex interplay between specific neuropsychological and motor factors.
Collapse
Affiliation(s)
- Sara Palermo
- Department of Neuroscience, Via Cherasco 15, 10126 Turin, Italy
| | - Leonardo Lopiano
- Department of Neuroscience, Via Cherasco 15, 10126 Turin, Italy; Centro Interdipartimentale di Studi Avanzati in Neuroscienze - National Institute of Turin (NIT), Regione Gonzole 10, 10043 Orbassano, Italy
| | | | - Rosalba Rosato
- Department of Psychology, University of Turin, Via Verdi 10, 10123 Turin, Italy; Cancer Epidemiology Unit, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | | | - Martina Amanzio
- Centro Interdipartimentale di Studi Avanzati in Neuroscienze - National Institute of Turin (NIT), Regione Gonzole 10, 10043 Orbassano, Italy; Department of Psychology, University of Turin, Via Verdi 10, 10123 Turin, Italy.
| |
Collapse
|
25
|
Abstract
Safinamide (Xadago®) is an orally active, selective, reversible monoamine oxidase-B inhibitor with both dopaminergic and non-dopaminergic (glutamatergic) properties. In the EU, safinamide is approved for the treatment of mid- to late-stage fluctuating Parkinson's disease (PD) as add-on therapy to a stable dose of levodopa alone or in combination with other PD medications. Safinamide 50-100 mg/day administered as a fixed or flexible dose significantly increased daily 'on' time without dyskinesia (primary endpoint) in patients with mid- to late-stage PD with motor fluctuations in 24-week, placebo-controlled clinical trials. Other outcomes, including motor function, overall clinical status and health-related quality of life, were also generally improved with safinamide. Furthermore, in an 18-month extension of one study, although dyskinesia (primary endpoint) was not significantly improved with safinamide relative to placebo, treatment benefits in other outcomes were generally sustained over 24 months of treatment. Safinamide was generally well tolerated in clinical trials; dyskinesia was the most common adverse event. Although further studies are needed, including comparative and long-term studies, current evidence indicates that safinamide extends the treatment options available for use as add-on therapy to levodopa and other PD medications in patients with mid- to late-stage PD experiencing motor fluctuations.
Collapse
Affiliation(s)
- Hannah A Blair
- Springer, Private Bag 65901, Mairangi Bay, 0754, Auckland, New Zealand.
| | - Sohita Dhillon
- Springer, Private Bag 65901, Mairangi Bay, 0754, Auckland, New Zealand
| |
Collapse
|
26
|
Friedman JH. Misperceptions and Parkinson's disease. J Neurol Sci 2017; 374:42-46. [PMID: 28073433 DOI: 10.1016/j.jns.2016.12.059] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 12/27/2016] [Indexed: 01/08/2023]
Abstract
Most of the neurobehavioral aspects of Parkinson's disease have been well established and studied, but many are not well known, and hardly studied. This article focuses on several behavioral abnormalities that are common, and frequently cause difficulty for the patient and family due to lack of recognition as part of the disease. While it is well known that L-Dopa dyskinesias are frequently not recognized or under appreciated by patients, a similar lack of recognition may affect the patient's own speech volume, where their center of gravity is located, whether they are tilted to one side, and their under-recognition of others' emotional displays. In addition, PD patients are often misperceived by others incorrect impression of their emotional and cognitive state based purely on facial expression. These changes and others are briefly reviewed.
Collapse
Affiliation(s)
- Joseph H Friedman
- Butler Hospital, Dept of Neurology, Warren Alpert Medical School of Brown University, 345 Blackstone Blvd, Providence, RI 02906, USA.
| |
Collapse
|
27
|
Behavioural and neuroimaging correlates of impaired self-awareness of hypo- and hyperkinesia in Parkinson's disease. Cortex 2016; 82:35-47. [DOI: 10.1016/j.cortex.2016.05.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 02/29/2016] [Accepted: 05/31/2016] [Indexed: 02/06/2023]
|
28
|
Loss of awareness of hyposmia is associated with mild cognitive impairment in Parkinson's disease. Parkinsonism Relat Disord 2016; 22:74-9. [DOI: 10.1016/j.parkreldis.2015.11.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 10/29/2015] [Accepted: 11/16/2015] [Indexed: 12/20/2022]
|