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Liepelt-Scarfone I, Gräber S, Kalbe E, Riedel O, Ringendahl H, Schmidt N, Witt K, Roeske S. [Guidelines for the Neuropsychological Assessment of Patients with Parkinson's Disease]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2021; 89:363-373. [PMID: 33561875 DOI: 10.1055/a-1099-9332] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Presence of mild cognitive impairment is currently the best predictor for the development of Parkinson's disease dementia. Diagnostic criteria for both Parkinson's with mild cognitive impairment and Parkinson's disease dementia have been suggested by the Movement Disorder Society. However, not all cognitive tests recommended are available in the German language with proper standard values. OBJECTIVES To define evidence-based guidelines for neuropsychological assessment of patients with Parkinson's disease in German. METHODS Two systematic literature searches were conducted. First, articles that presented international guidelines (consensus papers or reviews) for the application of standardized neuropsychological assessments for the diagnosis of cognitive impairment in Parkinson's disease were selected. Of those, only neuropsychological assessments in German language with normative values referring either to a German, Austrian, or Swiss population were considered. Second, articles comparing test performances of healthy controls vs. Parkinson's disease and/or different cognitive Parkinson's disease subtypes (e.g. no cognitive impairment, Parkinson's with mild cognitive impairment, Parkinson's disease dementia) were selected. Effect sizes for group differentiation were calculated. RESULTS Out of 127 full-text articles reviewed, 48 tests were identified during the first literature search. In the second search, 1716 articles were reviewed and 23 papers selected. The strongest effect sizes for group discrimination were revealed for tests assessing executive function, attention, and visuo-cognitive abilities. Based on the results of the two literature searches, consensus guidelines were defined by the authors, allowing for Level-II diagnosis for Parkinson's with mild cognitive impairment and Parkinson's disease dementia. CONCLUSIONS The presented guidelines may have the potential to standardize and improve the neuropsychological assessment of Parkinson's disease patients in German speaking countries.
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Affiliation(s)
- Inga Liepelt-Scarfone
- Deutsches Zentrum für Neurodegenerative Erkrankungen, Standort Tübingen, Deutschland.,Abteilung Neurodegeneration, Hertie Institut für Klinische Forschung, Tübingen, Deutschland
| | - Susanne Gräber
- Deutsches Zentrum für Neurodegenerative Erkrankungen, Standort Tübingen, Deutschland.,Zentrum für ambulante Rehabilitation am Universitätsklinikum Tübingen, Deutschland
| | - Elke Kalbe
- Medizinische Psychologie: Neuropsychologie und Genderforschung & Center für Neuropsychologische Diagnostik und Intervention, Universitätsklinikum Köln, Köln, Deutschland
| | - Oliver Riedel
- Abteilung Klinische Epidemiologie, Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS GmbH, Bremen, Deutschland
| | - Hubert Ringendahl
- Klinik für Neurologie und klinische Neurophysiologie, Helios Universitätsklinikum Wuppertal, Universitäts Witten/Herdecke, Wuppertal, Deutschland
| | - Nele Schmidt
- Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel, Deutschland
| | - Karsten Witt
- Forschungszentrum Neurosensorik, Carl von Ossietzy Universität Oldenburg, Universitätsklinik für Neurologie, Oldenburg, Deutschland
| | - Sandra Roeske
- Deutsches Zentrum für Neurodegenerative Erkrankungen, Bonn, Deutschland
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Dopamine substitution alters effective connectivity of cortical prefrontal, premotor, and motor regions during complex bimanual finger movements in Parkinson's disease. Neuroimage 2019; 190:118-132. [DOI: 10.1016/j.neuroimage.2018.04.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 03/23/2018] [Accepted: 04/12/2018] [Indexed: 01/31/2023] Open
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Olson M, Lockhart TE, Lieberman A. Motor Learning Deficits in Parkinson's Disease (PD) and Their Effect on Training Response in Gait and Balance: A Narrative Review. Front Neurol 2019; 10:62. [PMID: 30792688 PMCID: PMC6374315 DOI: 10.3389/fneur.2019.00062] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 01/17/2019] [Indexed: 01/30/2023] Open
Abstract
Parkinson's disease (PD) is a neurological disorder traditionally associated with degeneration of the dopaminergic neurons within the substantia nigra, which results in bradykinesia, rigidity, tremor, and postural instability and gait disability (PIGD). The disorder has also been implicated in degradation of motor learning. While individuals with PD are able to learn, certain aspects of learning, especially automatic responses to feedback, are faulty, resulting in a reliance on feedforward systems of movement learning and control. Because of this, patients with PD may require more training to achieve and retain motor learning and may require additional sensory information or motor guidance in order to facilitate this learning. Furthermore, they may be unable to maintain these gains in environments and situations in which conscious effort is divided (such as dual-tasking). These shortcomings in motor learning could play a large part in degenerative gait and balance symptoms often seen in the disease, as patients are unable to adapt to gradual sensory and motor degradation. Research has shown that physical and exercise therapy can help patients with PD to adapt new feedforward strategies to partially counteract these symptoms. In particular, balance, treadmill, resistance, and repeated perturbation training therapies have been shown to improve motor patterns in PD. However, much research is still needed to determine which of these therapies best alleviates which symptoms of PIGD, the needed dose and intensity of these therapies, and long-term retention effects. The benefits of such technologies as augmented feedback, motorized perturbations, virtual reality, and weight-bearing assistance are also of interest. This narrative review will evaluate the effect of PD on motor learning and the effect of motor learning deficits on response to physical therapy and training programs, focusing specifically on features related to PIGD. Potential methods to strengthen therapeutic effects will be discussed.
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Affiliation(s)
- Markey Olson
- Locomotion Research Laboratory, School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, United States
- Muhammad Ali Movement Disorders Clinic, St. Joseph's Hospital and Medical Center, Barrow Neurological Institute, Phoenix, AZ, United States
| | - Thurmon E. Lockhart
- Locomotion Research Laboratory, School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, United States
| | - Abraham Lieberman
- Muhammad Ali Movement Disorders Clinic, St. Joseph's Hospital and Medical Center, Barrow Neurological Institute, Phoenix, AZ, United States
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Freitas TBD, Silva KGD, Nuvolini RA, Doná F, Pompeu JE, Swarowsky A, Torriani-Pasin C. Dual-task demands in various motor skills through Parkinson’s disease progression. MOTRIZ: REVISTA DE EDUCACAO FISICA 2019. [DOI: 10.1590/s1980-6574201900010011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | | | - Flávia Doná
- Universidade Anhanguera de São Paulo, Brazil
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5
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Motor cognition in patients treated with subthalamic nucleus deep brain stimulation: Limits of compensatory overactivity in Parkinson's disease. Neuropsychologia 2018; 117:491-499. [PMID: 30003903 DOI: 10.1016/j.neuropsychologia.2018.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 05/07/2018] [Accepted: 07/06/2018] [Indexed: 01/17/2023]
Abstract
Recent fMRI findings revealed that impairment in a serial prediction task in patients suffering from Parkinson's disease (PD) results from hypoactivity of the SMA. Furthermore, hyperactivity of the lateral premotor cortex sustained performance after withdrawal of medication. To further explore these findings, we here examined the impact of deep brain stimulation of the subthalamic nucleus on the activity of the putamen and premotor areas while performing the serial prediction task. To this end, we measured eight male PD patients ON and OFF deep brain stimulation and eight healthy age-matched male controls using [15O] water positron emission tomography to measure regional cerebral blood flow. As expected, PD patients showed poorer performance than healthy controls while performance did not differ between OFF and ON stimulation. Hypoactivity of the putamen and hyperactivity of the left lateral premotor cortex was found in patients compared to controls. Lateral premotor hyperactivity further increased OFF compared to ON stimulation and was positively related to task performance. These results confirm that the motor loop's dysfunction has impact on cognitive processes (here: prediction of serial stimuli) in PD. Extending prior data regarding the role of the lateral premotor cortex in cognitive compensation, our results indicate that lateral premotor cortex hyperactivity, while beneficial in moderate levels of impairment, might fail to preserve performance in more severe stages of the motor loop's degeneration.
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Trempler I, Binder E, El-Sourani N, Schiffler P, Tenberge JG, Schiffer AM, Fink GR, Schubotz RI. Association of grey matter changes with stability and flexibility of prediction in akinetic-rigid Parkinson's disease. Brain Struct Funct 2018; 223:2097-2111. [PMID: 29374792 DOI: 10.1007/s00429-018-1616-2] [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] [Received: 04/10/2017] [Accepted: 01/22/2018] [Indexed: 10/18/2022]
Abstract
Parkinson's disease (PD), which is caused by degeneration of dopaminergic neurons in the midbrain, results in a heterogeneous clinical picture including cognitive decline. Since the phasic signal of dopamine neurons is proposed to guide learning by signifying mismatches between subjects' expectations and external events, we here investigated whether akinetic-rigid PD patients without mild cognitive impairment exhibit difficulties in dealing with either relevant (requiring flexibility) or irrelevant (requiring stability) prediction errors. Following our previous study on flexibility and stability in prediction (Trempler et al. J Cogn Neurosci 29(2):298-309, 2017), we then assessed whether deficits would correspond with specific structural alterations in dopaminergic regions as well as in inferior frontal cortex, medial prefrontal cortex, and the hippocampus. Twenty-one healthy controls and twenty-one akinetic-rigid PD patients on and off medication performed a task which required to serially predict upcoming items. Switches between predictable sequences had to be indicated via button press, whereas sequence omissions had to be ignored. Independent of the disease, midbrain volume was related to a general response bias to unexpected events, whereas right putamen volume correlated with the ability to discriminate between relevant and irrelevant prediction errors. However, patients compared with healthy participants showed deficits in stabilisation against irrelevant prediction errors, associated with thickness of right inferior frontal gyrus and left medial prefrontal cortex. Flexible updating due to relevant prediction errors was also affected in patients compared with controls and associated with right hippocampus volume. Dopaminergic medication influenced behavioural performance across, but not within the patients. Our exploratory study warrants further research on deficient prediction error processing and its structural correlates as a core of cognitive symptoms occurring already in early stages of the disease.
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Affiliation(s)
- Ima Trempler
- Department of Psychology, Westfälische Wilhelms-Universität, 48149, Münster, Germany. .,Institute of Neuroscience and Medicine (INM3), Cognitive Neuroscience, Research Centre Jülich, 52425, Jülich, Germany. .,Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience, Westfälische Wilhelms-Universität, Fliednerstr. 21, 48149, Münster, Germany.
| | - Ellen Binder
- Institute of Neuroscience and Medicine (INM3), Cognitive Neuroscience, Research Centre Jülich, 52425, Jülich, Germany.,Department of Neurology, University Hospital Cologne, 50937, Cologne, Germany
| | - Nadiya El-Sourani
- Department of Psychology, Westfälische Wilhelms-Universität, 48149, Münster, Germany.,Department of Neurology, University Hospital Cologne, 50937, Cologne, Germany
| | - Patrick Schiffler
- Department of Neurology, University Hospital Münster, 48149, Münster, Germany
| | - Jan-Gerd Tenberge
- Department of Neurology, University Hospital Münster, 48149, Münster, Germany
| | - Anne-Marike Schiffer
- Department of Life Sciences, Division of Psychology, Brunel University, UB8 3PH, Uxbridge, UK
| | - Gereon R Fink
- Institute of Neuroscience and Medicine (INM3), Cognitive Neuroscience, Research Centre Jülich, 52425, Jülich, Germany.,Department of Neurology, University Hospital Cologne, 50937, Cologne, Germany
| | - Ricarda I Schubotz
- Department of Psychology, Westfälische Wilhelms-Universität, 48149, Münster, Germany.,Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience, Westfälische Wilhelms-Universität, Fliednerstr. 21, 48149, Münster, Germany.,Department of Neurology, University Hospital Cologne, 50937, Cologne, Germany
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7
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Loehrer PA, Nettersheim FS, Jung F, Weber I, Huber C, Dembek TA, Pelzer EA, Fink GR, Tittgemeyer M, Timmermann L. Ageing changes effective connectivity of motor networks during bimanual finger coordination. Neuroimage 2016; 143:325-342. [DOI: 10.1016/j.neuroimage.2016.09.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 07/13/2016] [Accepted: 09/06/2016] [Indexed: 10/21/2022] Open
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8
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Schiffer AM, Nevado-Holgado AJ, Johnen A, Schönberger AR, Fink GR, Schubotz RI. Intact action segmentation in Parkinson's disease: Hypothesis testing using a novel computational approach. Neuropsychologia 2015; 78:29-40. [PMID: 26432343 DOI: 10.1016/j.neuropsychologia.2015.09.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 09/14/2015] [Accepted: 09/28/2015] [Indexed: 11/18/2022]
Abstract
Action observation is known to trigger predictions of the ongoing course of action and thus considered a hallmark example for predictive perception. A related task, which explicitly taps into the ability to predict actions based on their internal representations, is action segmentation; the task requires participants to demarcate where one action step is completed and another one begins. It thus benefits from a temporally precise prediction of the current action. Formation and exploitation of these temporal predictions of external events is now closely associated with a network including the basal ganglia and prefrontal cortex. Because decline of dopaminergic innervation leads to impaired function of the basal ganglia and prefrontal cortex in Parkinson's disease (PD), we hypothesised that PD patients would show increased temporal variability in the action segmentation task, especially under medication withdrawal (hypothesis 1). Another crucial aspect of action segmentation is its reliance on a semantic representation of actions. There is no evidence to suggest that action representations are substantially altered, or cannot be accessed, in non-demented PD patients. We therefore expected action segmentation judgments to follow the same overall patterns in PD patients and healthy controls (hypothesis 2), resulting in comparable segmentation profiles. Both hypotheses were tested with a novel classification approach. We present evidence for both hypotheses in the present study: classifier performance was slightly decreased when it was tested for its ability to predict the identity of movies segmented by PD patients, and a measure of normativity of response behaviour was decreased when patients segmented movies under medication-withdrawal without access to an episodic memory of the sequence. This pattern of results is consistent with hypothesis 1. However, the classifier analysis also revealed that responses given by patients and controls create very similar action-specific patterns, thus delivering evidence in favour hypothesis 2. In terms of methodology, the use of classifiers in the present study allowed us to establish similarity of behaviour across groups (hypothesis 2). The approach opens up a new avenue that standard statistical methods often fail to provide and is discussed in terms of its merits to measure hypothesised similarities across study populations.
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Affiliation(s)
| | - Alejo J Nevado-Holgado
- Department of Experimental Psychology, University of Oxford, Oxford, UK; Department of Psychiatry, University of Oxford, Oxford, UK
| | - Andreas Johnen
- Department of Neurology, University Hospital Münster, Münster, Germany
| | | | - Gereon R Fink
- Department of Neurology, University Hospital Cologne, Cologne, Germany; Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM3), Research Centre Jülich, Jülich, Germany
| | - Ricarda I Schubotz
- Department of Neurology, University Hospital Cologne, Cologne, Germany; Biological Psychology, Department of Psychology, Westfälische-Wilhelms Universität Münster, Münster, Germany
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9
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Schönberger AR, Hagelweide K, Pelzer EA, Fink GR, Schubotz RI. Motor loop dysfunction causes impaired cognitive sequencing in patients suffering from Parkinson's disease. Neuropsychologia 2015; 77:409-20. [PMID: 26382750 DOI: 10.1016/j.neuropsychologia.2015.09.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 09/02/2015] [Accepted: 09/11/2015] [Indexed: 11/25/2022]
Abstract
Cognitive impairment in Parkinson's disease (PD) is often attributed to dopamine deficiency in the prefrontal-basal ganglia-thalamo-cortical loops. Although recent studies point to a close interplay between motor and cognitive abilities in PD, the so-called "motor loop" connecting supplementary motor area (SMA) and putamen has been considered solely with regard to the patients' motor impairment. Our study challenges this view by testing patients with the serial prediction task (SPT), a cognitive task that requires participants to predict stimulus sequences and particularly engages premotor sites of the motor loop. We hypothesised that affection of the motor loop causes impaired SPT performance, especially when the internal sequence representation is challenged by suspension of external stimuli. As shown for motor tasks, we further expected this impairment to be compensated by hyperactivity of the lateral premotor cortex (PM). We tested 16 male PD patients ON and OFF dopaminergic medication and 16 male age-matched healthy controls in an functional Magnetic Resonance Imaging study. All subjects performed two versions of the SPT: one with on-going sequences (SPT0), and one with sequences containing non-informative wildcards (SPT+) increasing the demands on mnemonic sequence representation. Patients ON (compared to controls) revealed an impaired performance coming along with hypoactivity of SMA and putamen. Patients OFF compared to ON medication, while showing poorer performance, exhibited a significantly increased PM activity for SPT+ vs. SPT0. Furthermore, patients' performance positively co-varied with PM activity, corroborating a compensatory account. Our data reveal a contribution of the motor loop to cognitive impairment in PD, and suggest a close interplay of SMA and PM beyond motor control.
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Affiliation(s)
- Anna R Schönberger
- Department of Neurology, University Hospital Cologne, Kerpener Str. 62 D-50937 Cologne, Germany; Max Planck Institute for Neurological Research, Gleueler Str. 50 D-50931 Cologne, Germany
| | - Klara Hagelweide
- Department of Neurology, University Hospital Cologne, Kerpener Str. 62 D-50937 Cologne, Germany; Department of Psychology, University of Muenster, Fliednerstr. 21 D-48149 Münster, Germany
| | - Esther A Pelzer
- Department of Neurology, University Hospital Cologne, Kerpener Str. 62 D-50937 Cologne, Germany; Max Planck Institute for Neurological Research, Gleueler Str. 50 D-50931 Cologne, Germany
| | - Gereon R Fink
- Department of Neurology, University Hospital Cologne, Kerpener Str. 62 D-50937 Cologne, Germany; Institute of Neuroscience and Medicine (INM3), Cognitive Neuroscience, Research Centre Jülich, Leo-Brandt-Straße D-52425 Jülich, Germany
| | - Ricarda I Schubotz
- Department of Neurology, University Hospital Cologne, Kerpener Str. 62 D-50937 Cologne, Germany; Department of Psychology, University of Muenster, Fliednerstr. 21 D-48149 Münster, Germany.
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