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Coenen MA, Eggink H, van Egmond ME, Oterdoom DLM, van Dijk JMC, van Laar T, Spikman JM, Tijssen MAJ. Deep brain stimulation in dystonia: The added value of neuropsychological assessments. J Neuropsychol 2024; 18 Suppl 1:8-18. [PMID: 37309888 DOI: 10.1111/jnp.12331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 05/27/2023] [Indexed: 06/14/2023]
Abstract
Deep brain stimulation (DBS) of the internal globus pallidus (GPi) is a recognized treatment for medication-refractory dystonia. Problems in executive functions and social cognition can be part of dystonia phenotypes. The impact of pallidal DBS on cognition appears limited, but not all cognitive domains have been investigated yet. In the present study, we compare cognition before and after GPi DBS. Seventeen patients with dystonia of various aetiology completed pre- and post-DBS assessment (mean age 51 years; range 20-70 years). Neuropsychological assessment covered intelligence, verbal memory, attention and processing speed, executive functioning, social cognition, language and a depression questionnaire. Pre-DBS scores were compared with a healthy control group matched for age, gender and education, or with normative data. Patients were of average intelligence but performed significantly poorer than healthy peers on tests for planning and for information processing speed. Otherwise, they were cognitively unimpaired, including social cognition. DBS did not change the baseline neuropsychological scores. We confirmed previous reports of executive dysfunctions in adult dystonia patients with no significant influence of DBS on cognitive functioning in these patients. Pre-DBS neuropsychological assessments appear useful as they support clinicians in counselling their patients. Decisions about post-DBS neuropsychological evaluations should be made on a case-by-case basis.
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Affiliation(s)
- Maraike A Coenen
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Hendriekje Eggink
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Martje E van Egmond
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - D L Marinus Oterdoom
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J Marc C van Dijk
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Teus van Laar
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Jacoba M Spikman
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Marina A J Tijssen
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
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Coenen MA, Eggink H, van der Stouwe AMM, Spikman JM, Tijssen MAJ. Early Onset Dystonia: Complaints about Executive Functioning, Depression and Anxiety. Brain Sci 2023; 13:brainsci13020236. [PMID: 36831779 PMCID: PMC9954039 DOI: 10.3390/brainsci13020236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/20/2023] [Accepted: 01/28/2023] [Indexed: 02/03/2023] Open
Abstract
Early Onset Dystonia (EOD) is thought to result from basal ganglia dysfunction, structures also involved in non-motor functions, like regulation of behavior, mood and anxiety. Problems in these domains have been found in proxy-reports but not yet in self-reports of EOD patients. The main questions are whether proxy-reports differ from those of patients and how problems relate to everyday social functioning. Subjective complaints about executive problems (BRIEF) and symptoms of depression and anxiety (CBCL) were obtained through a cross-sectional questionnaire study conducted on 45 EOD patients. Scores were in the normal range in patients and proxies. Proxy-rated behavior regulation was correlated with the estimated number of friends and quality of relations. Proxy-reported scores of depression correlated with the quality of relations and were higher than self-reports of adolescent/young adult patients. EOD patients and proxies do not seem to experience problematic regulation of behavior, mood and anxiety. Still, our study revealed two important aspects: (1) all measures were related to the estimated quality of relations with others, relating questionnaires to everyday social functioning; (2) proxies reported more symptoms of depression than patients. This may indicate overestimation by proxies or higher sensitivity of proxies to these symptoms, implying underestimation of problems by patients.
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Rafee S, Hutchinson M, Reilly R. The Collicular-Pulvinar-Amygdala Axis and Adult-Onset Idiopathic Focal Dystonias. ADVANCES IN NEUROBIOLOGY 2023; 31:195-210. [PMID: 37338703 DOI: 10.1007/978-3-031-26220-3_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Adult-onset idiopathic focal dystonias (AOIFD) are the most common type of dystonia. It has varied expression including multiple motor (depending on body part affected) and non-motor symptoms (psychiatric, cognitive and sensory). The motor symptoms are usually the main reason for presentation and are most often treated with botulinum toxin. However, non-motor symptoms are the main predictors of quality of life and should be addressed appropriately, as well as treating the motor disorder. Rather than considering AOIFD as a movement disorder, a syndromic approach should be taken, one that accommodates all the symptoms. Dysfunction of the collicular-pulvinar-amygdala axis, with the superior colliculus as a central node, can explain the diverse expression of this syndrome.
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Affiliation(s)
- Shameer Rafee
- Department of Neurology, St Vincent's University Hospital, Dublin, Ireland
| | - Michael Hutchinson
- Department of Neurology, St Vincent's University Hospital, Dublin, Ireland
| | - Richard Reilly
- Trinity Centre for Biomedical Engineering, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland.
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Bailey GA, Martin E, Peall KJ. Cognitive and Neuropsychiatric Impairment in Dystonia. Curr Neurol Neurosci Rep 2022; 22:699-708. [PMID: 36201146 PMCID: PMC9633506 DOI: 10.1007/s11910-022-01233-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW To review recent literature evaluating psychiatric and cognitive symptoms in dystonia, the two non-motor symptom groups most frequently evaluated in dystonia research and recognised in clinical practice. RECENT FINDINGS Recent work has embedded clinical recognition of psychiatric symptoms in dystonia, with depressive and anxiety-related symptoms routinely observed to be the most common. Less explored symptoms, such as self-harm, suicidal ideation, and substance abuse, represent newer areas of investigation, with initial work suggesting higher rates than the background population. Investigation of cognitive function has provided less consistent results, both within individual dystonia subtypes and across the spectrum of dystonias, partly reflecting the heterogeneity in approaches to assessment. However, recent work indicates impairments of higher cognitive function, e.g. social cognition, and disrupted visual and auditory sensory processing. Dystonia demonstrates psychiatric and cognitive symptom heterogeneity, with further work needed to recognise endophenotypes and improve diagnostic accuracy, symptom recognition, and management.
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Affiliation(s)
- Grace A Bailey
- Neuroscience and Mental Health Research Institute, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ, UK
| | - Eva Martin
- School of Medicine, Cardiff University, Cardiff, UK
| | - Kathryn J Peall
- Neuroscience and Mental Health Research Institute, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ, UK.
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Guo Y, Peng K, Liu Y, Zhong L, Dang C, Yan Z, Wang Y, Zeng J, Zhang W, Ou Z, Liu G. Topological Alterations in White Matter Structural Networks in Blepharospasm. Mov Disord 2021; 36:2802-2810. [PMID: 34320254 DOI: 10.1002/mds.28736] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Accumulating evidence indicates regional structural changes in the white matter (WM) of brains in patients with blepharospasm (BSP); however, whether large-scale WM structural networks undergo widespread reorganization in these patients remains unclear. OBJECTIVE We investigated topology changes and global and local features of large-scale WM structural networks in BSP patients compared with hemifacial spasm (HFS) patients or healthy controls (HCs). METHODS This cross-sectional study applied graph theoretical analysis to assess deterministic diffusion tensor tractography findings in 41 BSP patients, 41 HFS patients, and 41 HCs. WM structural connectivity in 246 cortical and subcortical regions was assessed, and topological parameters of the resulting graphs were calculated. Networks were compared among BSP, HFS, and HCs groups. RESULTS Compared to HCs, both BSP and HFS patients showed alterations in network integration and segregation characterized by increased global efficiency and modularity and reduced shortest path length. Moreover, increased nodal efficiency in multiple cortical and subcortical regions was found in BSP and HFS patients compared with HCs. However, these differences were not found between BSP and HFS patients. Whereas all participants showed highly similar hub distribution patterns, BSP patients had additional hub regions not present in either HFS patients or HCs, which were located in the primary head and face motor cortex and basal ganglia. CONCLUSIONS Our findings suggest that the large-scale WM structural network undergoes an extensive reorganization in BSP, probably due to both dystonia-specific abnormalities and facial hyperkinetic movements. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Yaomin Guo
- Department of Neurology, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Kangqiang Peng
- Department of Medical Imaging, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Ying Liu
- Department of Neurology, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Linchang Zhong
- Department of Medical Imaging, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Chao Dang
- Department of Neurology, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhicong Yan
- Department of Neurology, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ying Wang
- Department of Neurology, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jinsheng Zeng
- Department of Neurology, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Weixi Zhang
- Department of Neurology, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zilin Ou
- Department of Neurology, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Gang Liu
- Department of Neurology, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Guangzhou, China
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Correlates of deep brain stimulation consensus conference decision to treat primary dystonia. Clin Neurol Neurosurg 2021; 207:106747. [PMID: 34237680 DOI: 10.1016/j.clineuro.2021.106747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 12/03/2020] [Accepted: 05/24/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Deep brain stimulation (DBS) is an effective treatment for motor disturbance in people with primary dystonia (PWD). Numerous factors are considered by an interdisciplinary consensus conference before deciding candidacy for DBS surgery (e.g., demographic, medical, cognitive, and behavioral factors). However, little is known about which of these factors are associated with PWD DBS surgery consensus conference decisions. OBJECTIVE Our goal was to examine whether pre-operative demographic, medical, and cognitive/behavioral variables are associated DBS consensus conference decisions in patients with dystonia. METHODS Thirty-two PWD completed comprehensive presurgery workup included neurological and neuropsychological exams, and neuroimaging in consideration for DBS surgery. An interdisciplinary conference committee either recommended or did not recommend DBS surgery based upon these data. Demographic and medical data (e.g., dystonia disease characteristics, medical comorbidities, medications) were also collected. We also examined impact from cardiovascular disease factors, using a Revised Cardiac Risk Index. PWD were grouped based on DBS conference decision (eligible: n = 21, ineligible: n = 11) and compared across demographic, medical, and cognitive/behavioral variables. RESULTS Across clinical variables, PWD who were deemed ineligible for DBS surgery had a higher Revised Cardiac Risk Index. PWD who were classified as ineligible displayed lower global cognitive functioning, working memory, phonemic fluency, memory retrieval, and cognitive flexibility. CONCLUSIONS Consensus decision making regarding DBS surgery eligibility involves a multifactorial process. We found that deficits in executive functioning were associated with the DBS consensus committee decision. We also observed elevated cardiac risk among these individuals, likely reflecting the relation between vascular health and cognition. Implications, and clinical and scientific applications of these findings are discussed.
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Rafee S, O'Keeffe F, O'Riordan S, Reilly R, Hutchinson M. Adult onset dystonia: A disorder of the collicular-pulvinar-amygdala network. Cortex 2021; 143:282-289. [PMID: 34148640 DOI: 10.1016/j.cortex.2021.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/10/2021] [Accepted: 05/21/2021] [Indexed: 11/30/2022]
Abstract
Models attempting to explain the pathogenesis of adult onset idiopathic focal dystonia often fail to accommodate the entire spectrum of this disorder: the diverse motor and non-motor symptoms, psychiatric and cognitive dysfunction, as well as the sub-clinical, physiological and anatomical, abnormalities. We propose, and present the accumulating evidence, that the adult onset dystonia syndrome is due to disruption in the covert-attentional network, the unconscious sub-cortical mechanism for the detection of potentially environmentally threatening (salient) stimuli, involving the collicular-pulvinar-amygdala network. A critical consideration of this network indicates a number of hypothesis-generated research questions aimed at elucidating the pathogenesis of adult onset dystonia. Given the rarity of adult onset dystonia, international, multidisciplinary, multicentre studies are required to elucidate the prevalence of non-motor symptoms in unaffected relatives, in particular, using temporal discrimination. Research focussing on the non-motor symptoms and the collicular-pulvinar-amygdala pathway may be the key to understanding adult-onset idiopathic focal dystonias (AOIFD) pathophysiology.
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Affiliation(s)
- Shameer Rafee
- Department of Neurology, St Vincent's University Hospital, Dublin, Ireland.
| | - Fiadhnait O'Keeffe
- Department of Psychology, St Vincent's University Hospital, Dublin, Ireland
| | - Sean O'Riordan
- Department of Neurology, St Vincent's University Hospital, Dublin, Ireland
| | - Richard Reilly
- Trinity Centre for Bio-engineering, Trinity College Dublin, Dublin, Ireland
| | - Michael Hutchinson
- Department of Neurology, St Vincent's University Hospital, Dublin, Ireland
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Bajenaru OL, Popescu-Olaru I, Dumitrescu L, Serban E, Cozma L, Raicu F, Cocos R, Popescu OB. Non-Motor Manifestations in Idiopathic Dystonia with Focal Onset - A Pilot Study. J Med Life 2020; 13:170-174. [PMID: 32742509 PMCID: PMC7378344 DOI: 10.25122/jml-2020-0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Recent studies emphasize an increased prevalence of non-motor symptoms in idiopathic dystonia with focal onset (IDFO), but their pathophysiological relationship is not clear. We aimed to identify the prevalence of depression and neurocognitive impairment in a group of patients with idiopathic dystonia with focal onset and their impact on the patients' quality of life. This study represents a component of an ongoing research project - GENDYS. From the database of this project, we selected 48 patients 56.62+/-14.16 years old who have been examined clinically and using specific scales: Patient Health Questionnaire-9 (for depression), Montreal Cognitive Assessment - MoCA (for cognitive impairment), and a 5-degree analog scale for subjective perception of the severity of the disease. We conducted a descriptive cross-sectional study on patients with depression and cognition evaluated by the above-mentioned scales. We also performed a nested case-control analysis on 20 IDFO patients with and without at least moderate depression matched for age and gender; the cut-offs for depression were PHQ-9 score ≥10 and PHQ9 <5, for the depression group and the control group, respectively. The cut-off for MoCA was 26 points. 22 IDFO patients (46%) had depression; 54.5% of IDFO patients with depression had cognitive impairment, indicating a slight trend of increased cognitive impairment in those with depression compared to those without; the perception of the severity of disease was the greatest in patients with depression. Depression is more prevalent in patients with IDFO and is associated with a worse perception of the disease severity.
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Affiliation(s)
- Ovidiu-Lucian Bajenaru
- Department of Clinical Neurosciences, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,"Ana Aslan" National Institute of Geriatrics and Gerontology, Bucharest, Romania
| | - Iulia Popescu-Olaru
- Department of Clinical Neurosciences, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Neurology, clinical Hospital Colentina, Bucharest, Romania
| | - Laura Dumitrescu
- Department of Clinical Neurosciences, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Neurology, clinical Hospital Colentina, Bucharest, Romania
| | - Elena Serban
- Department of Clinical Neurosciences, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Liviu Cozma
- Department of Clinical Neurosciences, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Neurology, clinical Hospital Colentina, Bucharest, Romania
| | - Florina Raicu
- Department of Medical Genetics, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Relu Cocos
- Department of Medical Genetics, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Ovidiu Bogdan Popescu
- Department of Clinical Neurosciences, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Neurology, clinical Hospital Colentina, Bucharest, Romania.,Laboratory of Molecular Biology, "Victor Babes" National Institute of Pathology, Bucharest, Romania
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Faustino B, Oliveira J, Lopes P. Normative scores of the Wisconsin Card Sorting Test in a sample of the adult Portuguese population. APPLIED NEUROPSYCHOLOGY-ADULT 2020; 29:767-774. [PMID: 32898451 DOI: 10.1080/23279095.2020.1810040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The Wisconsin Card Sorting Test (WCST) is a neuropsychological instrument that is widely used for assessment of executive functioning in both clinical and research settings. The aim of this study was to provide the normative scores for the WCST in a sample of Portuguese healthy adults. METHODS The data was collected from archival data in a total sample of 359 individuals, 149 men (41.5%, Mage = 38.3; SD = 20.3) and 210 women (58.5%, Mage = 52.2; SD = 19.4). Descriptive statistics were calculated to describe mean scores, standard-deviation and percentiles of the WCST indexes by gender, age and education. ANOVAs were used to explore the differences between these scores in sociodemographic variables. The normative scores were adjusted for age and educational level. RESULTS Significant statistical differences in mean scores were found in several WCST indexes, such as, total errors, perseverations, perseverative errors and conceptual level responses regarding age and education. Percentiles for WCST indexes were stratified by age group and educational level. CONCLUSIONS Age and education are important factors explaining performance on the WCST. This is the first study focused on the development of WCST normative scores for the adult Portuguese population, which can be applied in clinical, educational and research contexts.
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Affiliation(s)
- Bruno Faustino
- Department of Cognitive, Behavioral and Integrative Psychotherapy, Faculty of Psychology, University of Lisbon, Lisboa, Portugal
| | - Jorge Oliveira
- Department of Psychology, School of Psychology and Life Sciences, University Lusófona de Humanidades e Tecnologias/HEI-Lab, Lisboa, Portugal
| | - Paulo Lopes
- Department of Psychology, School of Psychology and Life Sciences, University Lusófona de Humanidades e Tecnologias/HEI-Lab, Lisboa, Portugal
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Ospina-García N, Escobar-Barrios M, Rodríguez-Violante M, Benitez-Valenzuela J, Cervantes-Arriaga A. Neuropsychiatric profile of patients with craniocervical dystonia: A case-control study. Clin Neurol Neurosurg 2020; 193:105794. [PMID: 32203707 DOI: 10.1016/j.clineuro.2020.105794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 02/20/2020] [Accepted: 03/16/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Depression, anxiety, and obsessive-compulsive disorder have been widely reported in patients with dystonia. On the other hand, cognitive impairment, frontal lobe function, impulsiveness and pseudobulbar affect are less studied. The objective of the study is to assess these neuropsychiatric symptoms along with the quality of life of subjects with craniocervical dystonia. PATIENTS AND METHODS A cross-sectional study was carried out in patients with craniocervical dystonia. Sex- and age-matched healthy controls were included. Neuropsychiatric assessment included the Montreal Cognitive Assessment (MoCA), Frontal Assessment Battery (FAB), Barrat Impulsiveness Scale (BIS-11), Center for Neurologic Study-Lability Scale (CNS-LS), Anxiety Rating Scale (HAM-A), Hamilton Depression Rating Scale (HAM-D), and the 12-item Short Form Health Survey (SF-12). RESULTS A total of 44 patients with craniocervical dystonia and 44 controls were included. The mean age was 57 ± 13.7 years. Depression (56.1 % vs 9.1 %, p < 0.001), anxiety (56.8 % vs 6.8 %, p < 0.001), and pseudobulbar affect (31.8 % vs 9.1 %, p = 0.02) were more common in the dystonia group in comparison to controls. No difference between groups was found in impulsiveness (p = 0.65), MoCA score (p = 0.14) or executive dysfunction (p = 0.42). Quality of life was worst in the dystonia group with 90.9 % (p = 0.03) and 61.4 % (p < 0.001) of the subjects scoring under average in the Physical Composite Score (PCS) and Mental Composite Score (MCS) of the SF-12. CONCLUSION MoCA scores ≤18, pseudobulbar affect, depression and anxiety are more prevalent in subjects with craniocervical dystonia in comparison to sex- and age-matched healthy controls. Regarding quality of life, MCS is more affected that the PCS in subjects with dystonia.
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Affiliation(s)
- Natalia Ospina-García
- Movement Disorder Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico; Faculty of Health Sciences, University of Tolima, Ibague, Colombia
| | - Marisa Escobar-Barrios
- Movement Disorder Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico; Neurodegenerative Disease Clinical Research Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Mayela Rodríguez-Violante
- Movement Disorder Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico; Neurodegenerative Disease Clinical Research Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.
| | - Juan Benitez-Valenzuela
- Neurodegenerative Disease Clinical Research Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Amin Cervantes-Arriaga
- Movement Disorder Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico; Neurodegenerative Disease Clinical Research Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
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11
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Abstract
Background: Chronic consumption of alcohol and marijuana, especially when initiated at an early age, has been implicated in cognitive alterations in the domain of executive functioning. Despite the robustness of this finding in Western populations, its generalizability to other cultural contexts is largely unknown. In this study, we examined whether the regular use of alcohol or marijuana use relates to impaired executive functioning in male students of a Nigerian university. Methods: Chronic alcohol users (n = 39), chronic marijuana users (n = 35) and drug-abstinent control participants (n = 40) recruited through snow-ball sampling technique completed a computerized version of the Wisconsin Card Sorting Test (cWCST). As an established measure of executive functioning, the cWCST allows for the simultaneous assessment of three distinct executive processes: set shifting, rule inference, and set maintenance. Results revealed a selective set-shifting deficit in both alcohol and marijuana users. Results: Both groups committed significantly more perseverative errors than the control group, and group differences were significantly stronger on this indicator of set shifting than on indicators of rule inference or set maintenance. Conclusions: Our findings support the generalizability of drug-related deficits in executive functioning and contribute to the characterization of executive dysfunction in non-Western populations. Future longitudinal studies are required to clarify whether executive dysfunction is an antecedent or consequence of alcohol and marijuana use in young Nigerians.
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Affiliation(s)
- Tochukwu Nweze
- Department of Psychology, University of Nigeria, Nsukka, Nigeria
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Cyprian C. Eze
- Department of Psychology, University of Nigeria, Nsukka, Nigeria
| | - Florian Lange
- Behavioral Engineering Group, KU Leuven, Leuven, Belgium
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Pekrul M, Seer C, Lange F, Dressler D, Kopp B. Flanker Task Performance in Isolated Dystonia (Blepharospasm): A Focus on Sequential Effects. Brain Sci 2020; 10:brainsci10020076. [PMID: 32024200 PMCID: PMC7071414 DOI: 10.3390/brainsci10020076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 01/29/2020] [Accepted: 01/30/2020] [Indexed: 11/16/2022] Open
Abstract
Isolated dystonia manifests with involuntary muscle hyperactivity, but the extent of cognitive impairment remains controversial. We examined the executive functions in blepharospasm while accounting for motor symptom-related distractions as a factor often limiting the interpretability of neuropsychological studies in dystonia. Our control group comprised of patients with hemifacial spasm, which is a condition producing similar motor symptoms without any central nervous system pathology. Nineteen patients with blepharospasm and 22 patients with hemifacial spasm completed a flanker task. Stimulus congruency on the current trial, on the preceding trial, and a response sequence served as independent variables. We analyzed the response time and accuracy. Gross overall group differences were not discernible. While congruency, congruency sequence, and response sequence exerted the expected effects, no group differences emerged with regard to these variables. A difference between patients with blepharospasm and those with hemifacial spasm consisted in longer reaction times when responses had to be repeated following stimulus incongruency on the preceding trial. We conclude that patients with blepharospasm seem to have difficulties in repeating their responses when incongruency on preceding trials interferes with habit formation or other forms of fast routes to action. Our specific finding may provide an opportunity to study altered basal ganglia plasticity in focal dystonia.
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Affiliation(s)
- Max Pekrul
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany; (C.S.); (F.L.); (D.D.); (B.K.)
- Correspondence:
| | - Caroline Seer
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany; (C.S.); (F.L.); (D.D.); (B.K.)
- Movement Control & Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven, Tervuursevest 101, 3001 Leuven, Belgium
- LBI—KU Leuven Brain Institute, KU Leuven, 3000 Leuven, Belgium
| | - Florian Lange
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany; (C.S.); (F.L.); (D.D.); (B.K.)
- Behavioral Engineering Research Group, KU Leuven, Naamsestraat 69, 3000 Leuven, Belgium
| | - Dirk Dressler
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany; (C.S.); (F.L.); (D.D.); (B.K.)
- Movement Disorders Section, Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Bruno Kopp
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany; (C.S.); (F.L.); (D.D.); (B.K.)
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13
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Drexel SC, Klietz M, Kollewe K, Paracka L, Kutschenko A, Kopp B, Lange F, Wegner F, Dressler D. Caregiver burden and health-related quality of life in idiopathic dystonia patients under botulinum toxin treatment: a cross-sectional study. J Neural Transm (Vienna) 2019; 127:61-70. [PMID: 31802240 PMCID: PMC6942568 DOI: 10.1007/s00702-019-02109-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 11/25/2019] [Indexed: 12/12/2022]
Abstract
Dystonia is a chronic movement disorder that is associated with a reduction in health-related quality of life (HR-QoL) and restriction of activities of daily living. Botulinum neurotoxin (BT) improves disease-specific HR-QoL by reducing abnormal movements, postures, and pain. We examined the burden of the corresponding primary caregiver as a potential important factor for disease management and HR-QoL of dystonia patients under treatment with BT. 114 patients with focal, segmental, or generalized dystonia were recruited, together with 93 corresponding caregivers, whose burden was investigated using the Caregiver Burden Inventory. In addition, all participants were assessed for cognitive impairment, depression, anxiety, alexithymia, and HR-QoL. Only a small proportion of caregivers suffered from caregiver burden. Despite BT therapy, patients’ HR-QoL was decreased compared to the age-matched general German population. Psychological symptoms, notably anxiety, and depression correlated significantly with reduced HR-QoL. Our data imply that caregiver burden emerged to be an issue in subgroups of dystonia patients. Furthermore, HR-QoL of dystonia patients is reduced even under optimized BT treatment in a specialized center.
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Affiliation(s)
- S C Drexel
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - M Klietz
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - K Kollewe
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - L Paracka
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - A Kutschenko
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - B Kopp
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - F Lange
- Behavioral Engineering Research Group, KU Leuven, Naamsestraat 69, 3000, Leuven, Belgium
| | - F Wegner
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - D Dressler
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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14
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Marvel CL, Morgan OP, Kronemer SI. How the motor system integrates with working memory. Neurosci Biobehav Rev 2019; 102:184-194. [PMID: 31039359 PMCID: PMC6604620 DOI: 10.1016/j.neubiorev.2019.04.017] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 04/18/2019] [Accepted: 04/24/2019] [Indexed: 02/07/2023]
Abstract
Working memory is vital for basic functions in everyday life. During working memory, one holds a finite amount of information in mind until it is no longer required or when resources to maintain this information are depleted. Convergence of neuroimaging data indicates that working memory is supported by the motor system, and in particular, by regions that are involved in motor planning and preparation, in the absence of overt movement. These "secondary motor" regions are physically located between primary motor and non-motor regions, within the frontal lobe, cerebellum, and basal ganglia, creating a functionally organized gradient. The contribution of secondary motor regions to working memory may be to generate internal motor traces that reinforce the representation of information held in mind. The primary aim of this review is to elucidate motor-cognitive interactions through the lens of working memory using the Sternberg paradigm as a model and to suggest origins of the motor-cognitive interface. In addition, we discuss the implications of the motor-cognitive relationship for clinical groups with motor network deficits.
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Affiliation(s)
- Cherie L Marvel
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Owen P Morgan
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sharif I Kronemer
- Department of Neurology, Yale University, New Haven, CT, USA; Interdepartmental Neuroscience Program, Yale University, New Haven, CT, USA
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15
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Lange F, Brückner C, Knebel A, Seer C, Kopp B. Executive dysfunction in Parkinson’s disease: A meta-analysis on the Wisconsin Card Sorting Test literature. Neurosci Biobehav Rev 2018; 93:38-56. [DOI: 10.1016/j.neubiorev.2018.06.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 06/14/2018] [Accepted: 06/15/2018] [Indexed: 12/13/2022]
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16
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Lange F, Kip A, Klein T, Müller D, Seer C, Kopp B. Effects of rule uncertainty on cognitive flexibility in a card-sorting paradigm. Acta Psychol (Amst) 2018; 190:53-64. [PMID: 30015136 DOI: 10.1016/j.actpsy.2018.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 07/03/2018] [Accepted: 07/04/2018] [Indexed: 12/13/2022] Open
Abstract
Cognitive flexibility has been studied in two separate research traditions. Neuropsychologists typically rely on rather complex assessment tools such as the Wisconsin Card Sorting Test (WCST). In contrast, task-switching paradigms are used in experimental psychology to obtain more specific measures of cognitive flexibility. We aim to contribute to the integration of these research traditions by examining the role of the key factor that differs between the WCST and experimental task-switching paradigms: rule uncertainty. In two experimental studies, we manipulated the degree of rule uncertainty after rule switches in a computerized version of the WCST. Across a variety of task parameters, reducing rule uncertainty consistently impaired the speed and accuracy of responses when the rule designated to be more likely turned out to be incorrect. Other performance measures such as the number of perseverative errors were not significantly affected by rule uncertainty. We conclude that a fine-grained analysis of WCST performance can dissociate behavioural indicators that are affected vs. unaffected by rule uncertainty. By this means, it is possible to integrate WCST results and findings obtained from task-switching paradigms that do not involve rule uncertainty.
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Affiliation(s)
- Florian Lange
- Department of Neurology, Hannover Medical School, Hannover, Germany; Behavioral Engineering Research Group, KU Leuven, Leuven, Belgium.
| | - Ahlke Kip
- Department of Neurology, Hannover Medical School, Hannover, Germany; Department of Psychology, Technische Universität Braunschweig, Germany
| | - Tabea Klein
- Department of Neurology, Hannover Medical School, Hannover, Germany; Department of Psychology, Technische Universität Braunschweig, Germany
| | - Dorothea Müller
- Department of Neurology, Hannover Medical School, Hannover, Germany; Department of Psychology, Technische Universität Braunschweig, Germany
| | - Caroline Seer
- Department of Neurology, Hannover Medical School, Hannover, Germany; Movement Control & Neuroplasticity Research Group, KU Leuven, Leuven, Belgium
| | - Bruno Kopp
- Department of Neurology, Hannover Medical School, Hannover, Germany
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17
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Coenen MA, Eggink H, Tijssen MA, Spikman JM. Cognition in childhood dystonia: a systematic review. Dev Med Child Neurol 2018; 60:244-255. [PMID: 29238959 DOI: 10.1111/dmcn.13632] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2017] [Indexed: 11/29/2022]
Abstract
AIM Cognitive impairments have been established as part of the non-motor phenomenology of adult dystonia. In childhood dystonia, the extent of cognitive impairments is less clear. This systematic review aims to present an overview of the existing literature to elucidate the cognitive profile of primary and secondary childhood dystonia. METHOD Studies focusing on cognition in childhood dystonia were searched in MEDLINE and PsychInfo up to October 2017. We included studies on idiopathic and genetic forms of dystonia as well as dystonia secondary to cerebral palsy and inborn errors of metabolism. RESULTS Thirty-four studies of the initial 527 were included. Studies for primary dystonia showed intact cognition and IQ, but mild working memory and processing speed deficits. Studies on secondary dystonia showed more pronounced cognitive deficits and lower IQ scores with frequent intellectual disability. Data are missing for attention, language, and executive functioning. INTERPRETATION This systematic review shows possible cognitive impairments in childhood dystonia. The severity of cognitive impairment seems to intensify with increasing neurological abnormalities. However, the available data on cognition in childhood dystonia are very limited and not all domains have been investigated yet. This underlines the need for future research using standardized neuropsychological procedures in this group. WHAT THIS PAPER ADDS There is limited data on cognition in childhood dystonia. Primary dystonia showed intact cognition and IQ, but mild working memory and processing speed deficits. Secondary dystonia showed more pronounced deficits and lower IQ, with frequent intellectual disability. There is a strong need for case-control studies assessing cognition using standardized neuropsychological tests.
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Affiliation(s)
- Maraike A Coenen
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Hendriekje Eggink
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Marina A Tijssen
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jacoba M Spikman
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Abstract
OBJECTIVES There is increasing evidence of non-motor, sensory symptoms, mainly involving the spatial domain, in cervical dystonia (CD). These manifestations are likely driven by dysfunctional overactivity of the parietal cortex during the execution of a sensory task. Few studies also suggest the possibility that visuospatial attention might be specifically affected in patients with CD. Therefore, we asked whether non-motor manifestations in CD might also comprise impairment of higher level visuospatial processing. METHODS To this end, we investigated visuospatial attention in 23 CD patients and 12 matched healthy controls (for age, gender, education, and ocular dominance). The patients were identified according to the dystonia pattern type (laterocollis vs. torticollis). Overall, participants were right-handers, and the majority of them was right-eye dominant. Visuospatial attention was assessed using a line bisection task. Participants were asked to bisect horizontal lines, using their right or left hand. RESULTS Participants bisected more to the left of true center when using their left hand to perform the task than when using their right hand. However, overall, torticollis patients produced a significantly greater leftward deviation than controls. CONCLUSIONS These data are consistent with preliminary findings suggesting the presence of biased spatial attention in patients with idiopathic cervical dystonia. The presence of an attentional bias in patients with torticollis seem to indicate that alterations of attentional circuits might be implicated in the pathophysiology of this type of CD. (JINS, 2018, 24, 23-32).
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Jahanshahi M. Neuropsychological and Neuropsychiatric Features of Idiopathic and DYT1 Dystonia and the Impact of Medical and Surgical treatment. Arch Clin Neuropsychol 2017; 32:888-905. [DOI: 10.1093/arclin/acx095] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Indexed: 11/14/2022] Open
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Lange F, Seer C, Kopp B. Cognitive flexibility in neurological disorders: Cognitive components and event-related potentials. Neurosci Biobehav Rev 2017; 83:496-507. [PMID: 28903059 DOI: 10.1016/j.neubiorev.2017.09.011] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 08/29/2017] [Accepted: 09/08/2017] [Indexed: 12/12/2022]
Abstract
Performance deficits on the Wisconsin Card Sorting Test (WCST) in patients with prefrontal cortex (PFC) lesions are traditionally interpreted as evidence for a role of the PFC in cognitive flexibility. However, WCST deficits do not occur exclusively after PFC lesions, but also in various neurological and psychiatric disorders. We propose a multi-component approach that can accommodate this pattern of omnipresent WCST deficits: the WCST is not a pure test of cognitive flexibility, but relies on the effective functioning of multiple dissociable cognitive components. Our review of recent efforts to decompose WCST performance deficits supports this view by revealing that WCST deficits in different neurological disorders can be attributed to alterations in different components. Frontoparietal changes underlying impaired set shifting seem to give rise to WCST deficits in patients with amyotrophic lateral sclerosis, whereas the WCST deficits associated with primary dystonia and Parkinson's disease are rather related to frontostriatal changes underlying deficient rule inference. Clinical implications of these findings and of a multi-component view of WCST performance are discussed.
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Affiliation(s)
- Florian Lange
- Department of Neurology, Hannover Medical School, Hannover, Germany; Behavioral Engineering Research Group, KU Leuven, Leuven, Belgium.
| | - Caroline Seer
- Department of Neurology, Hannover Medical School, Hannover, Germany; Movement Control & Neuroplasticity Research Group, KU Leuven, Leuven, Belgium
| | - Bruno Kopp
- Department of Neurology, Hannover Medical School, Hannover, Germany
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Lange F, Seer C, Müller-Vahl K, Kopp B. Cognitive flexibility and its electrophysiological correlates in Gilles de la Tourette syndrome. Dev Cogn Neurosci 2017; 27:78-90. [PMID: 28863370 PMCID: PMC6987949 DOI: 10.1016/j.dcn.2017.08.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/10/2017] [Accepted: 08/14/2017] [Indexed: 12/19/2022] Open
Abstract
Gilles de la Tourette syndrome (GTS) may involve cognitive inflexibility. A meta-analysis reveals GTS-related deficits on the Wisconsin Card Sorting Test. Card-sorting deficits are larger in children than in adults with GTS. Adults with GTS show electrophysiological signs of enhanced cognitive control. This change may underlie the normalization of cognitive flexibility in adult GTS.
Motor symptoms in Gilles de la Tourette syndrome (GTS) have been related to changes in frontostriatal brain networks. These changes may also give rise to alterations in cognitive flexibility. However, conclusive evidence for altered cognitive flexibility in patients with GTS is still lacking. Here, we meta-analyzed data from 20 neuropsychological studies that investigated cognitive flexibility in GTS using the Wisconsin Card Sorting Test (WCST). Results revealed medium-sized GTS-related performance deficits, which were significantly modulated by age: Whilst being substantial in children and adolescents with GTS, WCST deficits seem to dissolve in adult patients with GTS. This age-related normalization of WCST performance might result from the compensatory recruitment of cognitive control in adult patients with GTS. We addressed this possibility by examining neural correlates of proactive and reactive cognitive control in an event-related potential (ERP) study. We analyzed cue- and target-locked ERPs from 23 adult patients with GTS and 26 matched controls who completed a computerized version of the WCST. Compared to controls, patients with GTS showed a marked increase in parietal cue-locked P3 activity, indicating enhanced proactive cognitive control. We conclude that the additional recruitment of proactive cognitive control might ensure flexible cognitive functioning in adult patients with GTS.
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Affiliation(s)
- Florian Lange
- Department of Neurology, Hannover Medical School, Hannover, Germany; Behavioral Engineering Research Group, KU Leuven, Leuven, Belgium.
| | - Caroline Seer
- Department of Neurology, Hannover Medical School, Hannover, Germany; Movement Control & Neuroplasticity Research Group, KU Leuven, Leuven, Belgium
| | - Kirsten Müller-Vahl
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Bruno Kopp
- Department of Neurology, Hannover Medical School, Hannover, Germany
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22
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Neural correlates of cognitive set shifting in amyotrophic lateral sclerosis. Clin Neurophysiol 2016; 127:3537-3545. [DOI: 10.1016/j.clinph.2016.09.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 08/30/2016] [Accepted: 09/26/2016] [Indexed: 12/11/2022]
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23
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Lange F, Seer C, Loens S, Wegner F, Schrader C, Dressler D, Dengler R, Kopp B. Neural mechanisms underlying cognitive inflexibility in Parkinson's disease. Neuropsychologia 2016; 93:142-150. [DOI: 10.1016/j.neuropsychologia.2016.09.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 09/02/2016] [Accepted: 09/26/2016] [Indexed: 01/14/2023]
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