Cognitive impairment in Parkinson's disease revealed by event-related potential N270

Does transcranial direct current stimulation enhance cognitive performance in Parkinson's disease mild cognitive impairment? An event-related potentials and neuropsychological assessment study

BACKGROUND

Parkinson's disease-mild cognitive impairment (PD-MCI) is garnering attention as a key interventional period for cognitive impairment. Currently, there are no approved treatments for PD-MCI and encouraging results of transcranial direct current stimulation (tDCS) combined with other interventions have been proposed, though the efficacy and neural mechanisms of tDCS alone have not been studied in PD-MCI yet.

OBJECTIVES

The present double-blind, randomized, sham-controlled study assessed the effects of tDCS over the dorsolateral prefrontal cortex on cognitive functions via neuropsychological and electrophysiological evaluations in individuals with PD-MCI for the first time.

METHOD

Twenty-six individuals with PD-MCI were administered 10 sessions of active (n = 13) or sham (n = 13) prefrontal tDCS twice a day, for 5 days. Changes were tested through a comprehensive neuropsychological battery and event-related potential recordings, which were performed before, immediately, and 1 month after the administrations.

RESULTS

Neuropsychological assessment showed an improvement in delayed recall and executive functions in the active group. N1 amplitudes in response to targets in the oddball test-likely indexing attention and discriminability and NoGo N2 amplitudes in the continuous performance test-likely indexing cognitive control and conflict monitoring increased in the active group. Active stimulation elicited higher benefits 1 month after the administrations.

CONCLUSION

The present findings substantiate the efficacy of tDCS on cognitive control and episodic memory, along with the neural underpinnings of cognitive control, highlighting its potential for therapeutic utility in PD-MCI.

TRIAL REGISTRATION

NCT 04,171,804. Date of registration: 21/11/2019.

Impaired Phasic Discharge of Locus Coeruleus Neurons Based on Persistent High Tonic Discharge-A New Hypothesis With Potential Implications for Neurodegenerative Diseases

The locus coeruleus (LC) is a small brainstem nucleus with widely distributed noradrenergic projections to the whole brain, and loss of LC neurons is a prominent feature of age-related neurodegenerative diseases, such as Alzheimer's disease (AD) and Parkinson's disease (PD). This article discusses the hypothesis that in early stages of neurodegenerative diseases, the discharge mode of LC neurons could be changed to a persistent high tonic discharge, which in turn might impair phasic discharge. Since phasic discharge of LC neurons is required for the release of high amounts of norepinephrine (NE) in the brain to promote anti-inflammatory and neuroprotective effects, persistent high tonic discharge of LC neurons could be a key factor in the progression of neurodegenerative diseases. Transcutaneous vagal stimulation (t-VNS), a non-invasive technique that potentially increases phasic discharge of LC neurons, could therefore provide a non-pharmacological treatment approach in specific disease stages. This article focuses on LC vulnerability in neurodegenerative diseases, discusses the hypothesis that a persistent high tonic discharge of LC neurons might affect neurodegenerative processes, and finally reflects on t-VNS as a potentially useful clinical tool in specific stages of AD and PD.

Event-related potential changes due to early-onset Parkinson's disease in parkin (PARK2) gene mutation carriers and non-carriers

OBJECTIVE

To investigate cognitive functions in non-demented patients with early-onset Parkinson's disease (PD), and to compare PARK2 gene mutation carriers and non-carriers by means of event-related brain potentials (ERPs).

METHODS

The participants comprised patients with early-onset PD (EOPD) and healthy controls (HC). Patients with EOPD were divided into two groups as carriers of known pathogenic variants of PARK2 gene (EOPD-PC) and non-carriers of genes involved in familial PD (EOPD-NC). ERP data were collected during auditory oddball and visual continuous performance test (CPT).

RESULTS

Both EOPD groups (EOPD-PC and EOPD-NC) displayed reduced and delayed P3 in response to oddball target and CPT NoGo. CPT Go P3 was reduced in EOPD-NC but not in EOPD-PC. Oddball target N1 was reduced and P2 was enhanced in both EOPD-PC and EOPD-NC. In both cognitive tasks, RTs were prolonged and accuracy was lower in EOPD-PC and EOPD-NC.

CONCLUSIONS

We found several EOPD-related neurophysiologic changes, implying impairments in cognitive functions. Pairwise comparisons between EOPD-PC and EOPD-NC revealed no significant ERP marker.

SIGNIFICANCE

In this study, the confounding effect of normative aging was somewhat excluded compared with many previous studies. In contrast with the many oddball studies in non-demented PD, we clearly observed reduced and prolonged P3 in early-onset PD. Our NoGo P3 findings also contribute to the limited ERP research concerning response inhibition.

Feature-based information filtering in visual working memory is impaired in Parkinson's disease

Increasing attention has been given to working memory (WM) impairment in Parkinson's disease (PD) patients. Previous studies revealed that the space-orientated feature-based filtering (target and distractors in distinct locations) was impaired in PD patients. However, the object-orientated feature-based filtering (target and distractor information pertaining to one object) ability in PD patients remains unclear. In this study, we examined the object-orientated feature-based filtering ability of 14 PD patients and 14 healthy controls in a change detection task under EEG monitoring. Participants were asked to remember the colors of two different objects while ignoring their shapes. Critically, the irrelevant feature could be changed in the probe. A failure in complete feature-based filtering would lead to an "irrelevant-change distracting effect," where the change of the irrelevant feature would impair the performance of the target feature, and lead to an enhanced anterior N2. We found that the distracting effect was larger in PD patients than in the control group in terms of d'; however, the N2 amplitude evoked by the irrelevant change was smaller in PD patients than in the control group. These results suggested that the object-orientated feature-based filtering ability was impaired in PD, which might derive from the deficit of their executive control.

Electrophysiological Correlates of Change Detection during Delayed Matching Task: A Comparison of Different References

Detecting the changed information between memory representation and incoming sensory inputs is a fundamental cognitive ability. By offering the promise of excellent temporal resolution, event-related potential (ERP) technique has served as a primary tool for studying this process with reference of the linked mastoid (LM). However, given that LM may distort the ERP signals, it is still undetermined whether LM is the best reference choice. The goal of the current study was to systematically compare LM, reference electrode standardization technique (REST) and average reference (AR) for assessing the ERP correlates of change detection during a delayed matching task. Colored shapes were adopted as materials while both the task-relevant shape feature and -irrelevant color feature could be changed. The results of the ERP amplitude showed that both of the task-relevant and -conjunction feature changes elicited significantly more positive posterior P2 in REST and AR, but not in LM. Besides, significantly increased N270 was observed in task-relevant and -conjunction feature changes in both the REST and LM, but in the conjunction feature change in AR. Only the REST-obtained N270 revealed a significant increment in task-irrelevant feature change, which was compatible with the delayed behavioral performance. Statistical parametric scalp mapping (SPSM) results showed a left posterior distribution for AR, an anterior distribution for LM, and both the anterior and left posterior distributions for REST. These results indicate that different types of references may provide distinct cognitive interpretations. Interestingly, only the SPSM of REST was consistent with previous fMRI findings. Combined with the evidence of simulation studies and the current observations, we take the REST-based results as the objective one, and recommend using REST technology in the future ERP data analysis.

Decrease of Delta Oscillatory Responses in Cognitively Normal Parkinson's Disease

Parkinson's disease (PD) is a common progressive neurodegenerative disorder. This study aims to compare sensory-evoked oscillations (SEOs) and event-related oscillations (EROs) of visual modality in cognitively normal PD patients and healthy controls. Sixteen PD and 16 age-, gender-, and education-matched healthy controls participated in the study. A simple flashlight was used for SEO and a classical visual oddball paradigm was used for target ERO. Oscillatory responses in the delta frequency range (0.5-3.5 Hz) were examined. Significantly lower delta ERO and SEO responses were found in PD patients than healthy controls. Delta ERO responses were decreased at all frontal, central and parietal locations, whereas delta SEO responses were decreased over mid and right central locations in PD. According to the notion that SEO reflects the activity of sensory networks and ERO reflects cognitive networks, these findings indicate that PD patients have impairments in both cognitive and sensory networks of visual modality. Decreased delta ERO responses indicate that the subliminal cognitive changes in PD can be detected by electrophysiological methods. These results demonstrate that brain oscillatory responses have the potential to be studied as a biomarker for visual cognitive and sensory networks in PD.

Demonstration of Early Cognitive Impairment in Parkinson's Disease with Visual P300 Responses

INTRODUCTION

Parkinson's disease (PD) is the second most common neurodegenerative disease after Alzheimer's disease. Cognitive changes in PD are less observable than motor symptoms; thus, research on cognitive processes, which are known to be impaired from the early stages of PD, is minimal. The purpose of this study is to research the brain dynamics of cognitively normal PD patients and healthy elderly controls using event-related potentials (ERPs) and to evaluate their relationships with neuropsychological tests.

METHODS

Eighteen cognitively normal PD patients and 18 age-, gender-, and education-matched healthy controls were included in the study. Detailed neuropsychological tests were applied to all participants. Electroencephalography (EEG) was performed according to the international 10-20 system, and a classical visual oddball paradigm was used in the experiments. ERP responses in the 0.5 to 25 Hz frequency range were examined. P300 amplitude and latency values were measured from the F₃, F_z, F₄, C₃, C_z, C₄, P₃, P_z, P₄, O₁, O_z, and O₂ electrode sites. In addition, the correlations between P300 responses and neuropsychological test scores were analyzed.

RESULTS

Significant differences were found between the P300 amplitudes of cognitively normal PD patients and healthy elderly controls [F_(1,31)=9.265; p=0.005]. P300 amplitudes were significantly lower for PD patients at the F₃, F_Z, C_z, C₄, P_z, and P₄ electrode sites than for healthy elderly controls. Moderate correlations were found between Stroop test score and P₄ amplitude, digit span forward and C₃ and P_z amplitude, and digit span backward and O₁ amplitude.

CONCLUSION

The major finding of this study was the detection of cognitive changes by electrophysiological methods in PD patients who were indicated to be cognitively normal by neuropsychological tests. These finding suggests that cognitive changes in PD patients, which are not yet reflected in neuropsychological tests, may be detected by electrophysiological methods in earlier stages.

Event-Related Potentials in Parkinson’s Disease Patients with Visual Hallucination

Using neuropsychological investigation and visual event-related potentials (ERPs), we aimed to compare the ERPs and cognitive function of nondemented Parkinson's disease (PD) patients with and without visual hallucinations (VHs) and of control subjects. We recruited 12 PD patients with VHs (PD-H), 23 PD patients without VHs (PD-NH), and 18 age-matched controls. All subjects underwent comprehensive neuropsychological assessment and visual ERPs measurement. A visual odd-ball paradigm with two different fixed interstimulus intervals (ISI) (1600 ms and 5000 ms) elicited visual ERPs. The frontal test battery was used to assess attention, visual-spatial function, verbal fluency, memory, higher executive function, and motor programming. The PD-H patients had significant cognitive dysfunction in several domains, compared to the PD-NH patients and controls. The mean P3 latency with ISI of 1600 ms in PD-H patients was significantly longer than that in controls. Logistic regression disclosed UPDRS-on score and P3 latency as significant predictors of VH. Our findings suggest that nondemented PD-H patients have worse cognitive function and P3 measurements. The development of VHs in nondemented PD patients might be implicated in executive dysfunction with altered visual information processing.

Cognitive impairment in generalized anxiety disorder revealed by event-related potential N270

BACKGROUND

Cognitive function in anxiety disorders has been the subject of limited investigation, especially in generalized anxiety disorder (GAD). The purpose of this study was to investigate the cognitive function in subjects with GAD using mismatch-triggered negativity N270.

METHODS

Fifteen medication-free patients with a DSM-IV diagnosis of GAD, and 15 well-matched healthy controls performed a dual-feature delayed matching task while event-related potentials were recorded from their scalp.

RESULTS

The GAD group was characterized by the decreased N270 amplitude in the left hemisphere. The smaller N270 amplitude was associated with greater symptoms of anxiety and depression.

CONCLUSION

Since N270 is thought to index cognitive function in different domains, including attention and memory, our results suggest that individuals with GAD have an impaired cognitive function, particularly in selective attention and working memory. These cognitive deficits may have clinical significance in subjects with GAD and should be considered in treatment planning.

Non-motor symptoms of Parkinson's disease in China: a review of the literature

Parkinson's disease (PD) is generally considered as a neurodegenerative disorder commonly characterized by bradykinesia, resting tremor, rigidity and postural instability. However, increasing evidence demonstrates that serial non-motor symptoms (NMSs), including sensory symptoms, dysautonomia, neurobehavioral disorders and sleep disturbances frequently occur prior to motor signs and invariably emerge with the disease progression. Compared with motor symptoms, the NMSs are frequently under-recognized and poorly managed in clinical practice. A growing number of clinical studies on NMSs of PD have been carried out in China over the past decade. They revealed that there were not only common features, but also some differences on NMSs between Chinese patients and those in the West. Meanwhile, pharmacological and non-pharmacological strategies are available for the treatment of some NMSs associated with PD in China contained in Chinese guidelines for the treatment of PD. Large cohort studies across the country are warranted in the future to explore the epidemiological and biological features of specific NMSs in Chinese PD patients.

Parkinson's disease dementia and potential therapeutic strategies

Dementia in Parkinson's disease (PD-D) has only been acknowledged in the recent three decades, but research in this field has accelerated. The purpose of this review was to discuss advances in PD-D regarding biomarker correlates and potential therapeutic targets. Attention and executive dysfunction, memory deficits that improve with cueing, and visual hallucinations are characteristic in PD-D. PD-D dramatically increases the disability and misery of the disease. Current treatment for PD-D is symptomatic, modest, and only transiently effective. There is wide agreement that more effective treatment is needed, but this will require more knowledge about PD-D pathophysiology. Advances in the pathogenesis of PD have focused on the substantia nigra, which is the location from where the pathophysiology of motor symptoms primarily arises in initial stages. In contradistinction, pathology studies have suggested that cognitive decline correlates with cortical and subcortical-cortical projection pathway abnormalities. There is evidence that substantia nigra mechanisms, including protein aggregation of α-synuclein (e.g., Lewy bodies) may also play a role in cortical neuron degeneration. Other different mechanisms, such as Alzheimer's disease pathology (e.g., Aβ aggregation) may be operant for PD-D. Biomarkers of various types are being proposed for the study of PD-D as well as for objective measures of PD-D prediction and progression. Therapeutic targets are currently derived mostly from general PD neurodegeneration research rather than cortical PD neurodegeneration per se. Protein aggregation, genes that are associated with PD, oxidative stress, inflammation, and trophic factors constitute the major classes of therapeutic targets for PD-D. More research is needed on the specific aspects of cortical dysfunction and degeneration that create PD-D.

Event-related desynchronization/synchronization during discrimination task conditions in patients with Parkinson's disease

Parkinson's disease is a neurodegenerative disorder with symptoms, which include movement disturbances and changes of cognitive information processing. The aim of the present study was to investigate the functional relationships between oscillatory electroencephalographic (EEG) dominant components with event-related desynchronization/synchronization (ERD/ERS) method for idiopathic non-demented Parkinson's patients (PP) and control subjects (CS) during auditory discrimination tasks within two post-stimulus intervals of 0-250 and 250-600 ms. When comparing the CS and PP during the first post-stimulus period, we found delta- and theta-ERS significantly pronounced in CS for both tone types (low--800, high--1,000 Hz) with the following exceptions: at Fz, PP displayed higher delta-ERS, while at C3' theta-ERD in response to a high tone. Alpha-ERS was found in PP in response to either tone at all electrodes and mainly alpha-ERD in CS. In the second post-stimulus interval, the significant differences between the groups were: (i) delta-ERS in CS and delta-ERD in PP in response to the low tone and (ii) delta-ERS for both groups in answer to the high tone, more prominent in CS at Cz and Pz, except for delta-ERD in PP at C3'. For both groups, we detected predominantly theta-ERD and alpha-ERD following both tone types within this second interval. PP showed more expressed theta-ERD at Fz and parietal theta-ERS. Alpha-ERD was significantly higher in CS, while frontal alpha-ERD was more prominent in the PP in response to both tones. The data obtained showed specific functional differences of event-related oscillatory activity in cognitive and sensory-motor information processing between the PP and CS.

Attention changes in epilepsy patients following 3-month topiramate or valproate treatment revealed by event-related potential

The present study was designed to reveal changes of cognitive processes in epilepsy (EP) patients with Topiramate (TPM) or Valproate (VPA) treatment using Wechsler Adult Intelligence Scale (WAIS-CR) and event-related potential (ERP). Thirty untreated epilepsy patients were randomly divided into two groups receiving TPM or VPA, respectively. Fifteen healthy volunteers were included as controls. All the patients were examined by WAIS-CR and ERP before and 3 months after drug treatment. Controls were examined by ERP at the time recruited into the study and 3 months later. Unfamiliar grey-scale photographs of faces (front view) were used as stimuli. ERP were recorded at the same time. Mean Intelligence Quotient (IQ) in TPM group decreased after the 3-month treatment (90.40 vs. 81.00, P<0.05). One component of ERP-P300 was smaller in epilepsy patients than controls (P<0.05), but remained unchanged after TPM or VPA treatment (P>0.05). A delayed and smaller N270 was detected in patients compared to controls (P<0.05). After 3 months TPM treatment, it decreased further compared to before treatment (P<0.05). N170 was lower in patient groups, and it became lower after TPM treatment than before. Our results demonstrate that in all epilepsy patients with mild cognitive impairment ERP changes were found. TPM affected the cognitive functions in epilepsy patients reflected by the decreased full-scale intelligence quotient (FIQ). The imperative effects of TPM on visual perception function reflected by N170 were more obvious than that of VPA. Attention reflected by N270 was impaired after TPM treatment.

Clinical diagnostic criteria for dementia associated with Parkinson's disease

Dementia has been increasingly more recognized to be a common feature in patients with Parkinson's disease (PD), especially in old age. Specific criteria for the clinical diagnosis of dementia associated with PD (PD-D), however, have been lacking. A Task Force, organized by the Movement Disorder Study, was charged with the development of clinical diagnostic criteria for PD-D. The Task Force members were assigned to sub-committees and performed a systematic review of the literature, based on pre-defined selection criteria, in order to identify the epidemiological, clinical, auxillary, and pathological features of PD-D. Clinical diagnostic criteria were then developed based on these findings and group consensus. The incidence of dementia in PD is increased up to six times, point-prevelance is close to 30%, older age and akinetic-rigid form are associated with higher risk. PD-D is characterized by impairment in attention, memory, executive and visuo-spatial functions, behavioral symptoms such as affective changes, hallucinations, and apathy are frequent. There are no specific ancillary investigations for the diagnosis; the main pathological correlate is Lewy body-type degeneration in cerebral cortex and limbic structures. Based on the characteristic features associated with this condition, clinical diagnostic criteria for probable and possible PD-D are proposed.

Antiepileptic Drugs and the Significance of Event-Related Potentials

The authors compared cognitive changes in epilepsy patients with or without antiepileptic drugs using event-related potential (ERP) N270 and P300. The patients were divided into three groups according to treatment type: carbamazepine, valproate acid (VPA), or no treatment. One control group composed of healthy subjects was included. The Mini-Mental State Examination detected no clinical dementia in all subjects. A modified Sternberg paradigm was used as a task when an ERP was recorded. When a stimulus was different from the memorized item (conflict condition), N270 was elicited in both controls and patients. All the three patient groups showed a delayed and smaller N270 than the control group. P300 was elicited when a stimulus was the same one as the memorized item (match condition), and its amplitude decreased in the VPA group. P300 latency did not differ among the four groups. ERP (N270 and P300) was abnormal in patients with epilepsy. These results indicate that antiepileptic drugs, especially VPA, might enhance the impairment of cognitive processing. N270 is more sensitive than P300 in the early detection of minor cognitive impairment in epileptics.

Event-Related Potential N270 in Detecting Cognitive Impairment in Patients With Transient Ischemic Attack

Latency and amplitude of the visual P300 and N270 were examined in patients with transient ischemic attack (TIA) and in age-matched healthy control subjects to investigate the feasibility of N270 as a clinical examination method to evaluate the cognitive status of patients with TIA. Stimulus pairs with identical (match condition) or different (conflict condition) colors were randomly presented to subjects. Each pair consisted of two sequential stimuli (S1 and S2) that lasted for 300 ms; the onset interval between them was 700 ms. Thirty TIA patients without clinical dementia and 30 age-matched control subjects determined if the two stimuli in a pair had the same color. Subjects were required to press a button in the match condition and another button in the conflict condition. Event-related potentials (ERPs) were recorded from their scalp electrodes at the same time. N270 was evoked by the second stimulus (S2) of the conflict condition in either control subjects or patients. The patient group exhibited a delayed N270 than the control group. TIA patients as a group showed cognitive decline. N270 is an effective index to detect the cognitive impairment of TIA patients.

Event-related desynchronization/synchronization during an auditory–verbal working memory task in mild Parkinson's disease

OBJECTIVE

Event-related desynchronization (ERD) and synchronization (ERS) were studied during an auditory-verbal working memory task in patients suffering from Parkinson's disease (PD).

METHODS

PD patients (n=7, mean age 59) at a mild stage of the disease volunteered in the study. A group of healthy subjects (n=10, mean age 61) served as control group. ERD and ERS of the 1-25 Hz EEG frequencies were studied using wavelet transforms during memory encoding and retrieval.

RESULTS

Both groups performed equally well on the memory task. Statistically significant differences in ERD/ERS responses were observed in posterior electrodes during encoding of the memory set due to the fact that alpha ( approximately 10-15 Hz) ERS was elicited in the controls, but not in the PD group. In broad frequency bands ( approximately 6-25 Hz) ERD responses were observed in both groups during memory retrieval. A pre-stimulus alpha ERS seen in the control group was absent in the PD group.

CONCLUSIONS

The results of this preliminary study indicate that Parkinson's disease might affect brain oscillatory responses in the alpha frequency range in the encoding phase of auditory-verbal working memory.

SIGNIFICANCE

The ERD/ERS patterns may reflect neurophysiological alterations in the processes underlying working memory deficits in PD.

Differential cognitive impairment for diverse forms of multiple sclerosis

BACKGROUND

Cognitive impairment is a common feature in multiple sclerosis (MS) patients and occurs in 60% of all cases. Unfortunately, neurological examination does not always agree with the neuropsychological evaluation in determining the cognitive profile of the patient. On the other hand, psychophysiological techniques such as event-related potentials (ERPs) can help in evaluating cognitive impairment in different pathologies. Behavioural responses and EEG signals were recorded during the experiment in three experimental groups: 1) a relapsing-remitting group (RRMS), 2) a benign multiple sclerosis group (BMS) and 3) a Control group. The paradigm employed was a spatial attention task with central cues (Posner experiment). The main aim was to observe the differences in the performance (behavioural variables) and in the latency and amplitude of the ERP components among these groups.

RESULTS

Our data indicate that both MS groups showed poorer task performance (longer reaction times and lower percentage of correct responses), a latency delay for the N1 and P300 component, and a different amplitude for the frontal N1. Moreover, the deficit in the BMS group, indexed by behavioural and pyschophysiological variables, was more pronounced compared to the RRMS group.

CONCLUSION

The present results suggest a cognitive impairment in the information processing in all of these patients. Comparing both pathological groups, cognitive impairment was more accentuated in the BMS group compared to the RMSS group. This suggests a silent deterioration of cognitive skills for the BMS that is not usually treated with pharmacological or neuropsychological therapy.

Assessing neurocognitive dysfunction in cranial radiotherapy: can cognitive event-related potentials help?

Cognitive changes are common sequelae of cancer and cancer treatment, particularly in patients receiving cranial radiotherapy (RT). These effects are typically assessed by subjective clinical examination or using objective neuropsychological tests. Biologically based neurophysiological methods have been increasingly applied to the study of cognitive processing in neuropsychiatric and neurological disorders and as objective measures of cognitive status for patients with dementia. These methods detect the activation of neural circuits that directly mediate cognitive function in the human brain and include metabolic and electrophysiology based techniques. Neuroimaging procedures such as 18FDG PET and more recently fMRI, which detect metabolic activation associated with cognitive processing, provide excellent spatial resolution and can be directly correlated with neuroradiological findings associated with cranial RT neurotoxicity. Clinical electrophysiology procedures such as cognitive event-related potentials (ERP), which detect the neuronal electrical activity associated with cognitive processing, offer excellent temporal resolution at low cost. Cognitive ERP techniques are already being used to assess severity and progression of cognitive dysfunction in patients with vascular and degenerative dementias, but have been largely overlooked in studies of radiation-related cognitive impairments. We review these various electrophysiological methods in the context of their relevance to assessing cranial RT effects on cognitive function, and provide recommendations for a neurophysiological approach to supplement current neuropsychological tests for RT cognitive impairments. This technology is well suited for clinical assessment of neurocognitive sequelae of cancer and should provide new insights into the mechanism of RT-related cognitive dysfunction.

Performance monitoring and error processing during a lexical decision task in patients with Parkinson's disease

To evaluate performance monitoring and error processing during lexical decision tasks, event-related potentials (ERPs) obtained by time-locked to correct and error responses were studied in 17 Parkinson's disease (PD) patients without dementia and 15 healthy elderly participants. The amplitude of error negativity (Ne) obtained by averages time-locked to error response was significantly reduced in the PD patients, whereas there were no significant differences in the negative component for the correct response (Nc) between the two participant groups. The amplitude of the error positivity (Pe) and correct positivity (Pc) after the Ne and Nc components was also significantly reduced in the PD patients. The PD patients showed significantly slower reaction times and higher error rates. The reduced amplitude of the Ne, Pe, and Pc components in the PD patients suggested impaired performance and conflict monitoring as well as abnormal response strategy adjustments and deviant in later error monitoring processes associated with emotional, conscious evaluation of the error.

Cognitive impairment in major depressive disorder revealed by event-related potential N270

Major depressive disorder (MDD) is a mood disorder that is often accompanied by the impairment of cognitive functions. The aim of this study was to investigate the feasibility of N270 as an index for evaluating the cognitive impairment in MDD patients. Twenty-five patients with MDD diagnosed according to DSM-IV and 25 age matched normal controls performed a matching task while event-related potentials (ERPs) were recorded from their scalp. There were two kinds of stimulus pairs in this study: match condition, the second stimulus (S2) in a pair was identical to the first one (S1); mismatch condition, S2 conflicted with S1 in the color attribute. Subjects were required to press a button in the match condition and to press another button in the mismatch condition. A negative ERP component, N270, which was considered to reflect conflict processing activity in human brain, was evoked by S2 of the mismatch condition. The patient group showed a delayed and smaller N270 than the control group. The prolongation of its peak latency was significant at P3 and P4 electrodes, and the reduction of its peak amplitude was significant at F3, F4, P3 and P4 electrodes. The amplitude of P300 elicited in the match condition was decreased in the patient group at P3 and P4 electrodes, but its latency did not differ from the control group. The results indicate that MDD patients as a group showed cognitive decline. N270 is a sensitive index in revealing cognitive impairment.

Blunted reduction in night-time blood pressure is associated with cognitive deterioration in subjects with long-standing hypertension

OBJECTIVE

Data about the relationship of blunted reduction of night-time blood pressure (BP) with cognitive deterioration (CD) are conflicting. This study aims to explore this possible association in elderly people with long-standing hypertension.

METHODS

Twenty-six hypertensive subjects consecutively admitted to a rehabilitation unit over a six-month period were recruited. Exclusion criteria concerned all clinical conditions potentially related to BP variability or leading to CD. All patients underwent a clinic and 24-h BP non-invasive monitoring assessment of BP, as well as a cognitive assessment with the Mini Mental State Examination (MMSE). The presence of cerebrovascular disease (CVD) was assessed on CT films, with a standardized visual rating scale.

RESULTS

Blunted reduction of both systolic and diastolic night-time BP were significantly associated with poorer cognitive performances (r=0.61, p=0.001 for systolic; and r=0.57, p=0.002 for diastolic, respectively). In a multiple regression model, blunted reduction of night-time BP (B=0.17, [95% confidence intervals: 1.1-1.3], p=0.008 for systolic; and B=0.15, [95% confidence intervals: 1.0-1.3], p=0.02 for diastolic) independently predicted poorer cognitive performances.

CONCLUSIONS

In subjects with long-standing hypertension the blunted reduction of night-time BP is independently associated with lower cognitive performances.

Response selection and execution in patients with Parkinson's disease

Different studies report diverse, sometimes conflicting findings, regarding the ability of Parkinson's disease (PD) patients to benefit from advanced cuing in choice reaction time (RT). Thus, conclusions about the changed state of underlying processes such as set formation, motor programming and motor initiation are not certain. In the present study, visual choice RT testing that utilized brief (100 ms) color signals (red/blue), was followed by auditory choice reaction time (CRT) testing with brief (100 ms) low/high pitch sound stimuli. Response consisted of either index or middle finger flexion. The signals were then combined so that the color stimuli cued the sound stimuli with an 800-ms interstimuli interval. Cuing validity was reduced from 100% during training to 76% during final testing. In addition, the same sound stimuli were presented randomly, without visual cuing, in which case response should have been suppressed. Tested subjects include 19 moderate PD patients, 21 elderly controls and 20 young controls. The patients did not differ from the controls in error rate but were slower to respond, except under 100% congruent cuing, indicating that their extended RT in CRT results from slowed stimulus-response linking and not from impaired motor initiation/execution. In the final condition patients showed no perseverance and demonstrated normal speed of set shifting in incongruent trials.