1
|
Durmaz Celik N, Topal A, Kuzu Kumcu M, Ozkan S, Tezcan Aydemir S. Sensitivity of Clock Drawing Test Alone to Screen for Cognitive Impairment in Patients with Parkinson's Disease. SISLI ETFAL HASTANESI TIP BULTENI 2024; 58:381-388. [PMID: 39411036 PMCID: PMC11472191 DOI: 10.14744/semb.2024.94758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Revised: 07/11/2024] [Accepted: 07/16/2024] [Indexed: 10/19/2024]
Abstract
Objectives Cognitive impairment is a prevalent non-motor symptom of Parkinson's disease (PD), significantly impacting patient quality of life. The Clock Drawing Test (CDT) evaluates cognitive abilities, including planning, organization, and executive functions such as attention, memory, and visuospatial skills. This study aimed to determine the sensitivity of the CDT in diagnosing cognitive impairment in PD. Methods We reviewed the records of 44 PD patients (16 female, 28 male) diagnosed with dementia (30 patients) or mild cognitive impairment (14 patients) between 2018 and 2022. These patients were compared to 106 visitors to the neurological outpatient clinic, serving as a control group. A separate researcher assessed the patients' CDT scores, maintaining confidentiality of all other patient data except age and education level. Results Among the 44 PD patients, two with mild cognitive impairment were rated as normal, while all PD dementia cases were identified solely through the CDT. In the healthy control group, 72 out of 106 individuals reported no cognitive complaints, whereas 34 individuals (32.1%) reported cognitive complaints as assessed by a blind investigator. The CDT demonstrated a positive predictive value of 55.3% and a negative predictive value of 97.3%. Sensitivity was calculated at 95.5%, and specificity was 67.9%. Conclusion The findings suggest that the CDT is sensitive in detecting cognitive impairment in PD patients with cognitive deficits. While the CDT serves as an effective rapid screening tool, high scores indicate the absence of cognitive impairment, but low scores alone are insufficient for a definitive diagnosis of dementia. Comprehensive neurological evaluation and detailed cognitive assessment remain essential for confirming dementia diagnoses.
Collapse
Affiliation(s)
- Nazli Durmaz Celik
- Department of Neurology, Osmangazi University Faculty of Medicine, Eskisehir, Türkiye
| | - Aydan Topal
- Department of Neurology, Samsun Training and Research Hospital, Samsun, Türkiye
| | - Muge Kuzu Kumcu
- Department of Neurology, Lokman Hekim University Faculty of Medicine, Ankara, Türkiye
| | - Serhat Ozkan
- Department of Neurology, Osmangazi University Faculty of Medicine, Eskisehir, Türkiye
| | | |
Collapse
|
2
|
Colautti L, Iannello P, Silveri MC, Giovagnoli AR, Elia AE, Pepe F, Magni E, Antonietti A. Deepening the decisional processes under value-based conditions in patients affected by Parkinson's disease: A comparative study. COGNITIVE, AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2024:10.3758/s13415-024-01211-x. [PMID: 39266937 DOI: 10.3758/s13415-024-01211-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/08/2024] [Indexed: 09/14/2024]
Abstract
Patients affected by Parkinson's disease (PD) display a tendency toward making risky choices in value-based conditions. Possible causes may encompass the pathophysiologic characteristics of PD that affect neural structures pivotal for decision making (DM) and the dopaminergic medications that may bias choices. Nevertheless, excluding patients with concurrent impulse control disorders, results are few and mixed. Conversely, other factors, such as individual differences (e.g., emotional state, impulsivity, consideration for future consequences) and cognitive functioning, in particular executive functions (EFs), are involved, even though few studies investigated their possible role. The present study investigated (1) the differences in value-based DM between 33 patients with PD without impulse control disorders and 33 matched healthy controls, and (2) the relationships among decisional performances, EFs, and individual differences in a group of 42 patients with PD who regularly undertake dopaminergic medications. All participants underwent an individual assessment to investigate value-based DM, cognitive abilities, and individual differences associated with DM. Nonparametric analyses showed the presence of riskier decisions in patients compared with healthy controls, depending on the characteristics of the decisional situation. Moreover, parameters of the decisional tasks involving the number of risky choices were significantly related to the posology of dopaminergic medications, EFs, and individual differences. Findings were discussed, highlighting possible clinical implications.
Collapse
Affiliation(s)
- Laura Colautti
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 1, 20123, Milan, Italy.
| | - Paola Iannello
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 1, 20123, Milan, Italy
| | - Maria Caterina Silveri
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 1, 20123, Milan, Italy
| | - Anna Rita Giovagnoli
- Department of Diagnostics and Technology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Antonio Emanuele Elia
- Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Fulvio Pepe
- Department of Neuroscience, Fondazione Poliambulanza Istituto Ospedaliero Brescia, Milan, Italy
| | - Eugenio Magni
- Department of Neuroscience, Fondazione Poliambulanza Istituto Ospedaliero Brescia, Milan, Italy
| | - Alessandro Antonietti
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 1, 20123, Milan, Italy
| |
Collapse
|
3
|
Patrick K, Cousins E, Spitznagel MB. Associations between cognitive screening performance and motor symptoms in Parkinson's disease:a systematic review and meta-analysis. Dement Neuropsychol 2024; 18:e20230102. [PMID: 39258165 PMCID: PMC11386525 DOI: 10.1590/1980-5764-dn-2023-0102] [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: 03/22/2024] [Accepted: 04/27/2024] [Indexed: 09/12/2024] Open
Abstract
Although the most prominent symptoms of Parkinson's disease (PD) are those impacting movement, cognitive dysfunction is prevalent and often presents early in the disease process. Individuals with cognitive symptoms of PD often complete cognitive screening, making it important to identify factors associated with cognitive screening performance to ensure prompt and accurate detection of cognitive impairments. Objective Despite a body of research examining relationships between motor symptoms and cognitive dysfunction in PD, no prior study has undertaken a systematic review of the magnitude of the relationship between motor symptoms and cognitive screening performance in PD. Methods This study was a systematic review and meta-analysis of the relationship between cognitive screening performance, as assessed by the Montreal Cognitive Assessment (MoCA), and motor symptoms of PD. After the systematic screening, 20 studies were included, and meta-regressions using mixed-effects models were conducted. Results Motor symptoms across included studies were relatively mild, but average MoCA scores were at the established cutoff for risk of dementia in PD. The average disease duration was 5 years. Consistent with hypotheses, more severe motor symptoms were associated with lower MoCA scores (r=-0.22 (95%CI -0.29 to -0.16), p<0.001), indicating worse cognitive functioning. Conclusion The results indicate a significant negative correlation between MoCA performance and motor symptoms of PD. Average MoCA scores captured early disease-stage cognitive impairment when motor symptoms remained relatively mild. Serial screening for cognitive impairment beginning early in the disease course may be of benefit to ensure that cognitive dysfunction is detected as it arises.
Collapse
Affiliation(s)
- Karlee Patrick
- Kent State University, College of Arts and Sciences, Department of Psychological Sciences, Kent, Ohio, USA
| | - Elizabeth Cousins
- Kent State University, College of Arts and Sciences, Department of Psychological Sciences, Kent, Ohio, USA
| | - Mary Beth Spitznagel
- Kent State University, College of Arts and Sciences, Department of Psychological Sciences, Kent, Ohio, USA
| |
Collapse
|
4
|
Magnante AT, Ord AS, Holland JA, Sautter SW. Neurocognitive functioning of patients with early-stage Parkinson's disease. APPLIED NEUROPSYCHOLOGY. ADULT 2024; 31:1041-1052. [PMID: 35931087 DOI: 10.1080/23279095.2022.2106865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Parkinson's disease (PD) is a neurological disorder commonly associated with motor deficits. However, cognitive impairment is also common in patients with PD. Cognitive concerns in PD may affect multiple domains of neurocognition and vary across different stages of the disease. Extant research has focused mainly on cognitive deficits in middle to late stages of PD, whereas few studies have examined the unique cognitive profiles of patients with early-stage PD. This study addressed this gap in the published literature and examined neurocognitive functioning and functional capacity of patients with de novo PD, focusing on the unique pattern of cognitive deficits specific to the early stage of the disease. Results indicated that the pattern of cognitive deficits in patients with PD (n = 55; mean age = 72.93) was significantly different from healthy controls (n = 59; mean age = 71.88). Specifically, tasks related to executive functioning, attention, and verbal memory demonstrated the most pronounced deficits in patients with early-stage PD. Clinical implications of these findings are discussed.
Collapse
Affiliation(s)
- Anna Theresa Magnante
- College of Health and Behavioral Sciences, Regent University, Virginia Beach, VA, USA
| | - Anna Shirokova Ord
- College of Health and Behavioral Sciences, Regent University, Virginia Beach, VA, USA
| | - Jamie A Holland
- College of Health and Behavioral Sciences, Regent University, Virginia Beach, VA, USA
| | - Scott W Sautter
- College of Health and Behavioral Sciences, Regent University, Virginia Beach, VA, USA
- Hampton Roads Neuropsychology Inc., Virginia Beach, VA, USA
| |
Collapse
|
5
|
Guedi AB, Ikram S, Youssef A, Alya G, Amira S, Saloua M, Amina N, Mouna BD, Imen K, Amina GB, Riadh G. Glutathione S-transferase polymorphisms (GSTM1/GSTT1) outcomes in clinical profile and treatment responsiveness among Tunisian cohort of Parkinson's disease. J Neural Transm (Vienna) 2024:10.1007/s00702-024-02815-w. [PMID: 39123072 DOI: 10.1007/s00702-024-02815-w] [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: 05/15/2024] [Accepted: 07/23/2024] [Indexed: 08/12/2024]
Abstract
Glutathione S-transferases are involved in the oxidative stress which contributes to the pathogenesis of Parkinson's disease (PD). our aim was to investigate the influence of GSTM1 and GSTT1 polymorphisms on the clinical features and treatments outcomes among PD Tunisian patients. We included 300-PD patients followed in neurology department at Razi-University-hospital. GSTM1 and GSTT1 were screened using PCR methods. Correlation between the clinical phenotype and the genotypes was then assessed after adequate parameters adjustment. Individuals carrying inactive GSTT1/GSTM1 were estimated to have 2.5-fold higher risk of developing PD, p = 0.035. The demographic and clinical baseline analysis of GSTM1 polymorphism revealed significant association between the inactive gene and development of tremor as first symptoms (p = 0.046), further, it was correlated to asymmetric start (p = 0.044). The evaluation of the impact of GSTM1/GSTT1 activity among PD at last follow-up revealed the significant variability of motor impairment among cases carrier of the active genes (p = 0.048). As patients with inactive GSTM1/GSTT1 had higher UPDRS-III score. Additionally, higher frequency of cases with good treatment responsiveness was reported among PD with active GSTM1/GSTT1 (p = 0.038).No motor complications were observed among PD by considering the GSTs genotypes (p > 0.05). Finally, we noted significant impairment of memory among cases with inactivate GSTs (p = 0.04), attention deficit (p = 0.013) and impaired judgement (p = 0.0031). This study represents one of the most comprehensive and extensive investigation to date regarding the influence of GSTT1/GSTM1 genotype among PD patients.We speculate that the impact of GSTT1/GSTM1 on PD progression may occur through a cumulative effect, potentially not manifesting during the initial PD stages. Further studies are necessary to validate our conclusions.
Collapse
Affiliation(s)
- Ali Barreh Guedi
- Neurology Department LR18SP03, Razi University Hospital, 1 rue des Orangers Manouba, Tunis, PC: 2010, Tunisia
- Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi University Hospital, 1 rue des Orangers Manouba, Tunis, 2010, Tunisia
| | - Sghaier Ikram
- Neurology Department LR18SP03, Razi University Hospital, 1 rue des Orangers Manouba, Tunis, PC: 2010, Tunisia
- Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi University Hospital, 1 rue des Orangers Manouba, Tunis, 2010, Tunisia
| | - Abida Youssef
- Neurology Department LR18SP03, Razi University Hospital, 1 rue des Orangers Manouba, Tunis, PC: 2010, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, 15, Rue Djebel Akhdhar, La Rabta, Tunis, 1007, Tunisia
- Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi University Hospital, 1 rue des Orangers Manouba, Tunis, 2010, Tunisia
| | - Gharbi Alya
- Neurology Department LR18SP03, Razi University Hospital, 1 rue des Orangers Manouba, Tunis, PC: 2010, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, 15, Rue Djebel Akhdhar, La Rabta, Tunis, 1007, Tunisia
- Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi University Hospital, 1 rue des Orangers Manouba, Tunis, 2010, Tunisia
| | - Souissi Amira
- Neurology Department LR18SP03, Razi University Hospital, 1 rue des Orangers Manouba, Tunis, PC: 2010, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, 15, Rue Djebel Akhdhar, La Rabta, Tunis, 1007, Tunisia
- Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi University Hospital, 1 rue des Orangers Manouba, Tunis, 2010, Tunisia
| | - Mrabet Saloua
- Neurology Department LR18SP03, Razi University Hospital, 1 rue des Orangers Manouba, Tunis, PC: 2010, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, 15, Rue Djebel Akhdhar, La Rabta, Tunis, 1007, Tunisia
- Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi University Hospital, 1 rue des Orangers Manouba, Tunis, 2010, Tunisia
| | - Nasri Amina
- Neurology Department LR18SP03, Razi University Hospital, 1 rue des Orangers Manouba, Tunis, PC: 2010, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, 15, Rue Djebel Akhdhar, La Rabta, Tunis, 1007, Tunisia
- Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi University Hospital, 1 rue des Orangers Manouba, Tunis, 2010, Tunisia
| | - Ben Djebara Mouna
- Neurology Department LR18SP03, Razi University Hospital, 1 rue des Orangers Manouba, Tunis, PC: 2010, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, 15, Rue Djebel Akhdhar, La Rabta, Tunis, 1007, Tunisia
- Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi University Hospital, 1 rue des Orangers Manouba, Tunis, 2010, Tunisia
| | - Kacem Imen
- Neurology Department LR18SP03, Razi University Hospital, 1 rue des Orangers Manouba, Tunis, PC: 2010, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, 15, Rue Djebel Akhdhar, La Rabta, Tunis, 1007, Tunisia
- Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi University Hospital, 1 rue des Orangers Manouba, Tunis, 2010, Tunisia
| | - Gargouri-Berrechid Amina
- Neurology Department LR18SP03, Razi University Hospital, 1 rue des Orangers Manouba, Tunis, PC: 2010, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, 15, Rue Djebel Akhdhar, La Rabta, Tunis, 1007, Tunisia
- Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi University Hospital, 1 rue des Orangers Manouba, Tunis, 2010, Tunisia
| | - Gouider Riadh
- Neurology Department LR18SP03, Razi University Hospital, 1 rue des Orangers Manouba, Tunis, PC: 2010, Tunisia.
- Faculty of Medicine of Tunis, University of Tunis El Manar, 15, Rue Djebel Akhdhar, La Rabta, Tunis, 1007, Tunisia.
- Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi University Hospital, 1 rue des Orangers Manouba, Tunis, 2010, Tunisia.
- Research Laboratory "Neurodegenerative Diseases and Psychiatric Disorders", LR18SP03, Tunis, poste 522, Tunisia.
| |
Collapse
|
6
|
Saywell I, Foreman L, Child B, Phillips-Hughes AL, Collins-Praino L, Baetu I. Influence of cognitive reserve on cognitive and motor function in α-synucleinopathies: A systematic review and multilevel meta-analysis. Neurosci Biobehav Rev 2024; 161:105672. [PMID: 38608829 DOI: 10.1016/j.neubiorev.2024.105672] [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: 01/14/2024] [Revised: 03/26/2024] [Accepted: 04/08/2024] [Indexed: 04/14/2024]
Abstract
Cognitive reserve has shown promise as a justification for neuropathologically unexplainable clinical outcomes in Alzheimer's disease. Recent evidence suggests this effect may be replicated in conditions like Parkinson's disease, dementia with Lewy bodies, and multiple system atrophy. However, the relationships between cognitive reserve and different cognitive abilities, as well as motor outcomes, are still poorly understood in these conditions. Additionally, it is unclear whether the reported effects are confounded by medication. This review analysed studies investigating the relationship between cognitive reserve and clinical outcomes in these α-synucleinopathy cohorts, identified from MEDLINE, Scopus, psycINFO, CINAHL, and Web of Science. 85 records, containing 176 cognition and 31 motor function effect sizes, were pooled using multilevel meta-analysis. There was a significant, positive association between higher cognitive reserve and both better cognition and motor function. Cognition effect sizes differed by disease subtype, cognitive reserve measure, and outcome type; however, no moderators significantly impacted motor function. Review findings highlight the clinical implications of cognitive reserve and importance of engaging in reserve-building behaviours.
Collapse
Affiliation(s)
- Isaac Saywell
- School of Psychology, University of Adelaide, Adelaide 5005, Australia.
| | - Lauren Foreman
- School of Psychology, University of Adelaide, Adelaide 5005, Australia
| | - Brittany Child
- School of Psychology, University of Adelaide, Adelaide 5005, Australia
| | | | | | - Irina Baetu
- School of Psychology, University of Adelaide, Adelaide 5005, Australia.
| |
Collapse
|
7
|
Scott BM, Eisinger RS, Mara R, Rana AN, Thompson S, Okun MS, Gunduz A, Bowers D. Co-Occurrence of Apathy and Impulse Control Disorders in Parkinson Disease: Variation across Multiple Measures. Arch Clin Neuropsychol 2024:acae036. [PMID: 38704737 DOI: 10.1093/arclin/acae036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/21/2024] [Accepted: 04/17/2024] [Indexed: 05/07/2024] Open
Abstract
OBJECTIVE To determine if the co-occurrence of apathy and impulse control disorders (ICDs) in Parkinson disease is dependent on instrument selection and assess the concurrent validity of three motivation measures by examining interrelationships between them. METHOD Ninety-seven cognitively normal individuals with idiopathic Parkinson disease (PD) completed the Questionnaire for Impulsive-Compulsive Disorders in Parkinson Disease-Rating Scale (QUIP-RS) and three apathy measures: the Apathy Scale, Lille Apathy Rating Scale, and Item 4 of the Movement Disorder Society-Unified Parkinson Disease Rating Scale. RESULTS Fifty (51.5%) participants were classified as apathetic on at least one measure, and only four individuals (4.3%) obtained clinically elevated scores on all three measures. The co-occurrence of apathy and ICD varied across measures. CONCLUSIONS We observed a co-occurrence of apathy and ICDs in PD patients with each apathy instrument; however, limited concurrent validity exists across measures. This is important for future investigations into shared pathophysiology and the design of future clinical trials aimed at improving the early detection and treatment of these debilitating syndromes.
Collapse
Affiliation(s)
- Bonnie M Scott
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, TX, USA
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Robert S Eisinger
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Roshan Mara
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Amtul-Noor Rana
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Sable Thompson
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Michael S Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Aysegul Gunduz
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
- J. Crayton Pruitt Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Dawn Bowers
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| |
Collapse
|
8
|
Lau HY, Lin YH, Lin KC, Li YC, Yao G, Lin CY, Wu YH. Reliability of the Montreal Cognitive Assessment in people with stroke. Int J Rehabil Res 2024; 47:46-51. [PMID: 38323890 DOI: 10.1097/mrr.0000000000000612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
This study examined the relative and absolute reliability of the Taiwanese version of the MoCA (MoCA-T) in people with stroke. The study recruited 114 individuals who were at least 3 months after the onset of a first-ever unilateral stroke. The MoCA-T was administered twice, at a 6-week interval, to all participants. The relative reliability was assessed using the intraclass correlation coefficient (ICC), and the absolute reliability was assessed using standard error of measurement (SEM), the smallest real difference (SRD), the SRD percentage, and the Bland-Altman method. The ICC analysis showed the MoCA-T was highly reliable (ICC = 0.85). The absolute reliability was between an acceptable and excellent level, where the SEM and the SRD at the 95% confidence interval were 1.38 and 3.83, respectively. The Bland-Altman analyses showed no systematic bias between repeated measurements. The range of the 95% limits of agreement was narrow, indicating a high level of stability over time. These findings suggest that the MoCA-T has high agreement between repeated measurements without systematic bias. The threshold to detect real change stands between an acceptable and excellent level. The MoCA-T is a reliable tool for cognitive screening in stroke rehabilitation.
Collapse
Affiliation(s)
- Hiu-Ying Lau
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei
| | - Yi-Hung Lin
- Department of Education, National Kaohsiung Normal University, Kaohsiung
| | - Keh-Chung Lin
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei
- Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei
| | - Yi-Chun Li
- Department of Occupational Therapy, College of Medicine, I-Shou University, Kaohsiung
| | - Grace Yao
- Department of Psychology, National Taiwan University, Taipei, Taiwan
| | - Chih-Yu Lin
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei
| | - Yi-Hsuan Wu
- Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei
| |
Collapse
|
9
|
Johnsson C, Malinowsky C, Leavy B. Everyday technology use among people with Parkinson's disease. Aging Ment Health 2023; 27:2430-2437. [PMID: 37139925 DOI: 10.1080/13607863.2023.2202628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/03/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVES To explore the relevance of and ability to use everyday technology (ET) among people with Parkinson's Disease (PD) and to explore associations between ET use and global cognition and motor ability. MATERIALS AND METHODS Cross-sectional data was collected from 34 people with PD using the Short Everyday Technology Use Questionnaire+ (S-ETUQ+), the Movement Disorder Society-Unified Parkinson's Disease Rating Scale and the Montreal Cognitive Assessment (MoCA). RESULTS Out of 41 ETs in the S-ETUQ+, the mean number perceived as relevant was 27.5 (min-max 19-35, SD 3.6). A good ability to use ET was reported where many ETs had a challenge measure below participants' ability to use them. A strong positive correlation between the ability to use ET and global cognition (MoCA) (r = .676, p = <0.01) was shown. CONCLUSIONS ET use has become integrated into everyday life and is important for participation. This study showed a high relevance of and good ability to use ET and a correlation between ET use and global cognition among people with mild-moderate PD. Evaluation and support to use ET in PD are important for maintaining independence and participation, especially among those with cognitive decline.
Collapse
Affiliation(s)
- Cecilia Johnsson
- Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Stockholms Sjukhem Foundation, Stockholm, Sweden
| | - Camilla Malinowsky
- Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Breiffni Leavy
- Stockholms Sjukhem Foundation, Stockholm, Sweden
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| |
Collapse
|
10
|
Rivasi G, D'Andria MF, Bulgaresi M, Sgrilli F, Casini G, Falzone D, Turrin G, Tortù V, Giordano A, Mossello E, Ungar A. Screening for cognitive impairment in older adults with hypertension: the HYPER-COG study. J Hum Hypertens 2023; 37:1000-1006. [PMID: 36932153 DOI: 10.1038/s41371-023-00817-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 02/07/2023] [Accepted: 03/03/2023] [Indexed: 03/19/2023]
Abstract
Hypertension is a major risk factor for dementia. Yet, the most suitable cognitive screening test for hypertensive patients has yet to be identified. This study investigated cognitive impairment in hypertensive older adults and compared the discriminative ability of the most widely used cognitive screening tests. The study involved hypertensive patients aged 65+ without prior diagnosis of cognitive impairment, from the Hypertension Clinic of Careggi Hospital, Florence, Italy. Mini Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), MiniCog and Clock Drawing Test (CDT) were administered, using a comprehensive neuropsychological assessment as gold standard. The ROC curve analysis and the paired chi-square test were used to compare the discriminative ability, sensitivity and specificity for cognitive impairment of the different screening instruments. Cognitive impairment was diagnosed in 37% of 94 participants (mean age 76, 55% female), mainly involving attention and executive functions. The MoCA (AUC = 0.746), the MMSE (AUC = 0.689) and the MiniCog (AUC = 0.684) showed similar ability in detecting cognitive impairment, while the CDT had a poorer discriminative capacity (AUC = 0.535). The sensitivity of MoCA (80%) and of MMSE/MiniCog combination (74%) was higher in comparison with MiniCog alone (49%, p = 0.007 and 0.004, respectively), while MiniCog achieved the highest specificity (88%, p < 0.001 vs all). Cognitive impairment was detected in more than one-third of hypertensive older adults without prior diagnosis of dementia. MoCA, MMSE and MiniCog showed similar discriminative ability for cognitive impairment, with MoCa and MMSE showing greater sensitivity and MiniCog the highest specificity.
Collapse
Affiliation(s)
- Giulia Rivasi
- Hypertension Clinic, Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
| | - Maria Flora D'Andria
- Hypertension Clinic, Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Matteo Bulgaresi
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit "Toscana Centro", Florence, Italy
| | - Federica Sgrilli
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit "Toscana Centro", Florence, Italy
| | - Giulia Casini
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Daniele Falzone
- Occupational Medicine Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Giada Turrin
- Hypertension Clinic, Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Virginia Tortù
- Hypertension Clinic, Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Antonella Giordano
- Hypertension Clinic, Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Enrico Mossello
- Hypertension Clinic, Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Andrea Ungar
- Hypertension Clinic, Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| |
Collapse
|
11
|
Palma GCS, Freitas TB, Bonuzzi GMG, Torriani-Pasin C. Does Cognitive Impairment Impact Motor Learning? A Scoping Review of Elderly Individuals With Alzheimer's Disease and Mild Cognitive Impairment. Percept Mot Skills 2023; 130:1924-1951. [PMID: 37337358 DOI: 10.1177/00315125231182732] [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] [Indexed: 06/21/2023]
Abstract
Individuals with cognitive impairment may have motor learning deficits due to the high engagement of cognitive mechanisms during motor skill acquisition. We conducted a scoping review to address the quality of current research on the relationship between cognitive impairments (i.e., deficits in attention, memory, planning and executive functions) and motor learning among older adults with Alzheimer's Disease or Mild Cognitive Impairment. After screening thousands of articles, we selected 15 studies describing cognitive assessment tools, experimental designs, and the severity of cognitive impairment. Although seven studies reported that cognitive impairment impaired motor learning, most studies included a high risk of bias. We identified multiple assessment tools across these studies that make comparisons among findings difficult. Future research in this area should focus on the influence of increased practice days during motor learning acquisition and incorporate both retention and transfer tests. Cognitive assessments should target the specific cognitive skills or deficits most closely related to the motor learning process.
Collapse
Affiliation(s)
- Gisele C S Palma
- Motor Behavior Research in Neurorehabilitation (GEPENEURO), Laboratory of Motor Behavior (LACOM), University of São Paulo, São Paulo, Brazil
| | - Tatiana B Freitas
- Motor Behavior Research in Neurorehabilitation (GEPENEURO), Laboratory of Motor Behavior (LACOM), University of São Paulo, São Paulo, Brazil
| | - Giordano Márcio G Bonuzzi
- Department of Physical Education, State University of Piauí, Picos, Piauí, Brazil
- Department of Physical Education, Federal University of Vale do São Francisco, Petrolina, Pernambuco, Brazil
| | - Camila Torriani-Pasin
- Motor Behavior Research in Neurorehabilitation (GEPENEURO), Laboratory of Motor Behavior (LACOM), University of São Paulo, São Paulo, Brazil
- Neurorehabilitation, Exercise Science and Learning (NEUROEXCEL), Department of Physical Therapy and Movement Sciences, The University of Texas at El Paso, El Paso, Texas, USA
| |
Collapse
|
12
|
Brincks J, Johnsen EL, Callesen J. A study of the reliability and validity of the Six-Spot Step Test Cognitive in ambulatory persons with Parkinson's disease. Parkinsonism Relat Disord 2023; 111:105412. [PMID: 37119663 DOI: 10.1016/j.parkreldis.2023.105412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/19/2023] [Accepted: 04/22/2023] [Indexed: 05/01/2023]
Abstract
INTRODUCTION Although dual-task walking deficits challenge ambulatory function in persons with Parkinson's disease (PwPD), ambulation measures that incorporate cognitive dual-task loads seem scarce. In its construct and instruction, the Six-Spot Step Test Cognitive (SSSTcog) ensures an equal focus on cognitive and motor tasks. The present study investigated the construct validity and test-retest reliability of the SSSTcog in PwPD. METHODS Seventy-eight PwPD were recruited from outpatient clinics. The SSSTcog was completed twice within the same day and again three to seven days later. In addition, the cognitive Timed "Up and Go" test (TUGcog) and the Mini-BESTest were also conducted on the last day. Reliability and validity were estimated using Bland-Altman statistics, the minimal difference (MD), Intraclass Correlation Coefficient (ICC), and Spearman's rank correlation coefficient (ρ). RESULTS The SSSTcog was found reliable (ICC: 0.84-0.89; MD: 23.7%-30.2%) and showed moderate construct validity to the TUGcog (ρ = 0.62, p < 0.001). Weak correlations to the Mini-BESTest (ρ = -0.33, p < 0.003) indicated low construct validity. Significantly (p < 0.001) higher dual-task costs were seen when performing the SSSTcog (77.6%) compared to the TUGcog (24.3%). CONCLUSIONS In PwPD, the SSSTcog showed promising construct validity, acceptable to excellent reliability, making it a valid measure of functional mobility, including cognitive dual-tasking. Higher dual-task cost for the SSSTcog indicated actual cognitive-motor interference while performing the test.
Collapse
Affiliation(s)
- John Brincks
- VIA University College, Research Centre for Health and Welfare Technology - Programme for Rehabilitation, Hedeager 2, 8200, Aarhus N, Denmark.
| | - Erik L Johnsen
- Aarhus University Hospital, Department of Neurology, 8200, Aarhus N, Denmark; Department of Neurology, Clinical Medicine, Aarhus University, Denmark
| | - Jacob Callesen
- VIA University College, Research Centre for Health and Welfare Technology - Programme for Rehabilitation, Hedeager 2, 8200, Aarhus N, Denmark
| |
Collapse
|
13
|
Kim H, Yang S, Park J, Kim BC, Yu KH, Kang Y. Effect of Education on Discriminability of Montreal Cognitive Assessment Compared to Mini-Mental State Examination. Dement Neurocogn Disord 2023; 22:69-77. [PMID: 37179689 PMCID: PMC10166679 DOI: 10.12779/dnd.2023.22.2.69] [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: 04/03/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
Background and Purpose The Montreal Cognitive Assessment (MoCA) has been known as a screening test for detecting mild cognitive impairment (MCI) better than Mini-Mental State Examination (MMSE). However, in previous domestic studies, no significant difference was found in the discriminability between MoCA and MMSE. Researchers have suggested that this might be because older Koreans are less educated than older Westerners. This study was conducted to examine the effect of education on the discriminability of MoCA compared to the MMSE. Methods Participants were 123 cognitively normal elderly, 118 with vascular MCI, 108 with amnestic MCI, 121 with vascular dementia, and 113 with dementia of the Alzheimer's type. The Korean-MoCA (K-MoCA) and Korean-MMSE (K-MMSE) were administered. Multiple regression analyses and receiver operating characteristic (ROC) curve analyses were performed. Results In all participants, education significantly affected both K-MoCA and K-MMSE scores along with age. The effect of education was re-examined by subgroup analysis after dividing subjects according to the level of education. Effect of education on K-MoCA and K-MMSE was only shown in the group with <9 years of education. ROC curve analyses revealed that the discriminability of K-MoCA to differentiate between vascular MCI and normal elderly was significantly higher than that of K-MMSE. When re-examining subgroups divided by education level, however, this higher discriminability of K-MoCA disappeared in the group with <9 years of education. Conclusions These results indicate no difference in discriminating cognitive deficits between K-MoCA and K-MMSE in Korean elderly with <9 years of education.
Collapse
Affiliation(s)
- Haeyoon Kim
- Department of Psychology, College of Social Sciences, Hallym University, Chuncheon, Korea
- Department of Neurology, Choennam National University Hospital, Gwangju, Korea
| | - Seonyeong Yang
- Department of Psychology, College of Social Sciences, Hallym University, Chuncheon, Korea
| | - Jaesel Park
- Department of Psychology, College of Social Sciences, Hallym University, Chuncheon, Korea
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Byeong Chae Kim
- Department of Neurology, Choennam National University Hospital, Gwangju, Korea
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Yeonwook Kang
- Department of Psychology, College of Social Sciences, Hallym University, Chuncheon, Korea
| |
Collapse
|
14
|
The Executive-Function-Related Cognitive-Motor Dual Task Walking Performance and Task Prioritizing Effect on People with Parkinson's Disease. Healthcare (Basel) 2023; 11:healthcare11040567. [PMID: 36833101 PMCID: PMC9956339 DOI: 10.3390/healthcare11040567] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/31/2023] [Accepted: 02/04/2023] [Indexed: 02/17/2023] Open
Abstract
To safely walk in a community environment requires dual cognitive-walking ambulation ability for people with Parkinson's disease (PD). A past study showed inconsistent results on cognitive-walking performance for PD patients, possibly due to the various cognitive tasks used and task priority assignment. This study designed cognitive-walking tests that used executive-related cognitive tasks to evaluate patients with early-stage Parkinson's disease who did not have obvious cognitive deficits. The effect of assigning task prioritization was also evaluated. Sixteen individuals with PD (PD group) and 16 individuals without PD (control group) underwent single cognitive tests, single walking tests, dual walking tests, and prioritizing task tests. Three types of cognitive, spatial memory, Stroops, and calculation tasks were employed. The cognitive performance was evaluated by response time, accuracy, and speed-accuracy trade off composite score. The walking performance was evaluated by the temporal spatial gait characteristics and variation in gait. The results showed that the walking performance of the PD group was significantly worse than the control group in both single and dual walking conditions. The group difference in cognitive performance was shown in composite score under the dual calculation walking task but not under the single task. While assigning priority to walking, no group difference in walking was observed but the response accuracy rate of PD groups declined. This study concluded that the dual task walking test could sharpen the cognitive deficits for early-stage PD patients. The task priority assignment might not be recommended while testing gait deficits since it decreased the ability to discriminate group differences.
Collapse
|
15
|
Delay discounting in Parkinson’s disease: A systematic review and meta-analysis. Behav Brain Res 2023; 436:114101. [DOI: 10.1016/j.bbr.2022.114101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/23/2022]
|
16
|
Probiotic Bifidobacterium longum BB68S Improves Cognitive Functions in Healthy Older Adults: A Randomized, Double-Blind, Placebo-Controlled Trial. Nutrients 2022; 15:nu15010051. [PMID: 36615708 PMCID: PMC9824790 DOI: 10.3390/nu15010051] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/14/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022] Open
Abstract
Probiotics could improve cognitive functions in patients with neurological disorders such as Alzheimer’s disease, but the effects on cognitive function in healthy older adults without cognitive impairment need further study. The purpose of this study was to investigate the effect of Bifidobacterium longum BB68S (BB68S) on cognitive functions among healthy older adults without cognitive impairment. A randomized, double-blind, placebo-controlled trial was conducted with 60 healthy older adults without cognitive impairment who were divided into probiotic or placebo groups and required to consume either a sachet of probiotic (BB68S, 5 × 1010 CFU/sachet) or placebo once daily for 8 weeks. The Montreal Cognitive Assessment (MoCA) was used as an inclusion screening tool to screen elderly participants with healthy cognitive function in our study, and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was used to assess cognitive function in subjects before and after intervention as an assessment tool. BB68S significantly improved subjects’ cognitive functions (total RBANS score increased by 18.89 points after intervention, p < 0.0001), especially immediate memory, visuospatial/constructional, attention, and delayed memory domains. BB68S intervention increased the relative abundances of beneficial bacteria Lachnospira, Bifidobacterium, Dorea, and Cellulosilyticum, while decreasing those of bacteria related to cognition impairment, such as Collinsella, Parabacteroides, Tyzzerella, Bilophila, unclassified_c_Negativicutes, Epulopiscium, Porphyromonas, and Granulicatella. In conclusion, BB68S could improve cognitive functions in healthy elderly adults without cognitive impairment, along with having beneficial regulatory effects on their gut microbiota. This study supports probiotics as a strategy to promote healthy aging and advances cognitive aging research.
Collapse
|
17
|
Scott BM, Eisinger RS, Rana AN, Benge JF, Hilsabeck RC, Okun MS, Gunduz A, Bowers D. From pleasure to punding: Distinct patterns of anhedonia and impulsivity linked to motivational disturbances in Parkinson disease. APPLIED NEUROPSYCHOLOGY. ADULT 2022:1-6. [PMID: 36409466 DOI: 10.1080/23279095.2022.2146506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Apathy and impulse control disorders (ICD) are common comorbid motivational syndromes in Parkinson disease (PD). This study aimed to determine if patients with these motivational disturbances exhibit different patterns of anhedonia and trait impulsivity. METHODS Sixty-four non-demented patients with PD completed questionnaires assessing apathy and ICD symptoms, which were used to classify participants into one of the following groups: apathy only, ICD only, both, and neither. Participants also completed multidimensional measures of anhedonia and trait impulsivity, which were compared across groups defined by motivational status. RESULTS Individuals with both apathy and ICD had significantly greater symptoms of positive and negative urgency than all other groups and had significantly greater consummatory anhedonia and lack of premeditation and perseverance than those with ICD only and neither. Patients with apathy only also reported significantly greater anticipatory anhedonia than those with ICD only and the neither group. There were no significant between-group differences in sensation seeking. CONCLUSION Distinct patterns of impulsivity and anhedonia characterize unique behavioral phenotypes of motivational disturbances in PD and may reflect important differences in the underlying neurobiological mechanisms. Clinicians should be aware that motivational disturbances may be more severe in cases where apathy co-occurs with one or more ICD.HIGHLIGHTSHighlights are mandatory for all submissions except letters. They consist of a short collection of bullet points that convey the core findings of the article and should be submitted in a separate file in the online submission system. Please use "Highlights" in the file name and include 3-5 bullet points (maximum 85 characters, including spaces, per bullet point). See https://www.elsevier.com/highlights for examples.
Collapse
Affiliation(s)
- Bonnie M Scott
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Robert S Eisinger
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Amtul-Noor Rana
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Jared F Benge
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Robin C Hilsabeck
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Michael S Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Aysegul Gunduz
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
- J. Crayton Pruitt Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | | |
Collapse
|
18
|
Miyamoto M, Miyamoto T. Montreal Cognitive Assessment Predicts the Short-Term Risk of Lewy Body Disease in Isolated REM Sleep Behavior Disorder with Reduced MIBG Scintigraphy. Mov Disord Clin Pract 2022; 10:32-41. [PMID: 36698993 PMCID: PMC9847289 DOI: 10.1002/mdc3.13569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/05/2022] [Accepted: 08/30/2022] [Indexed: 01/28/2023] Open
Abstract
Background Long-term follow-up of isolated rapid eye movement (REM) sleep behavior disorder (IRBD) patients reveals a high risk of α-synucleinopathies. Objective We explored the early clinical predictive factors of phenoconversion from IRBD to Parkinson's disease (PD) or dementia with Lewy bodies (DLB). Methods We assessed baseline office-based cognitive test scores (Montreal Cognitive Assessment [MoCA-J], Mini-Mental State Examination [MMSE], and Frontal Assessment Battery [FAB]), motor function, and olfactory function in 36 consecutive polysomnography (PSG)-confirmed IRBD patients with reduced metaiodobenzylguanidine (MIBG) accumulation. PD or DLB was confirmed by medical chart review retrospectively. Results Of 36 IRBD patients, 19 (n = 19, 52.8%) with abnormal MoCA-J score (< 26) had significantly lower scores in trail making B, phonetic verbal fluency sub-items in the executive domain, and in delayed recall in the memory domain. In total, 12 (33.3%) patients developed PD or DLB; seven of 12 patients (58.3%) developed DLB at a mean follow-up period of 6.8 years. In the normal MoCA-J group (n = 17, 47.2%), two patients developed PD, but none developed dementia. Furthermore, in the abnormal MoCA-J group, seven patients developed DLB and three developed PD without dementia. The phenoconverter group had significantly lower scores in delayed recall in the memory domain compared to the disease-free group. Cox hazard analysis showed that MoCA-J was superior to MMSE. Conclusions Among IRBD patients with reduced cardiac MIBG accumulation, MoCA-J score of <26 (Mild Cognitive Impairment-Lewy body) and a low sub-item score for delayed recall predicted short-term progression to probable DLB.
Collapse
Affiliation(s)
- Masayuki Miyamoto
- School of NursingDokkyo Medical UniversityMibuTochigiJapan,Department of Neurology, Center of Sleep MedicineDokkyo Medical UniversityMibuTochigiJapan
| | - Tomoyuki Miyamoto
- Department of NeurologyDokkyo Medical University Saitama Medical CenterKoshigayaSaitamaJapan
| |
Collapse
|
19
|
Gryfe P, Sexton A, McGibbon CA. Using gait robotics to improve symptoms of Parkinson's disease: an open-label, pilot randomized controlled trial. Eur J Phys Rehabil Med 2022; 58:723-737. [PMID: 35708047 PMCID: PMC10019475 DOI: 10.23736/s1973-9087.22.07549-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND People with Parkinson's Disease (PD) have difficulty participating in exercise. AIM The primary objective of this pilot randomized controlled trial (RCT) was to determine if 8 weeks (2x per week) of bilateral exoskeleton (Exo) exercise results in positive changes in cognition and participation in adults with PD compared to exercising without an exoskeleton (Nxo) or wait-list control (Con). DESIGN Open-label, parallel, pilot randomized controlled trial. SETTING Neurorehabilitation clinic in a large urban center. POPULATION Adults 50-85 years old with a confirmed diagnosis of PD. METHODS Eight weeks of twice-weekly combined aerobic, strength and mobility exercise or wait-list control. Participants were randomly assigned to exercise with no exoskeleton (Nxo), exercise with the exoskeleton (Exo), or waitlist control (Con). Primary endpoints were change in cognitive function (SCOPA-COG) and mood. Secondary endpoints were change in gait speed, six-minute walk test (6MWT), freezing of gait, balance, and PD-specific health and quality of life outcomes. Safety endpoint was analysis of adverse events (AE). RESULTS Forty participated in the trial (Exo, N.=13; Nxo, N.=14; Con, N.=13). Significant improvement in the Memory & Learning domain of the SCOPA-COG (P=0.014) and 6MWT (P=0.008) were detected for the Exo group compared to the Nxo and/or Con group. No other statistically significant between-groups effects were found. There were no serious or unanticipated AE. CONCLUSIONS Functional exercise with a low-profile overground exoskeleton showed promising results for improving memory and gait endurance in people with PD across HY stages I-IV. CLINICAL REHABILITATION IMPACT Exoskeletons can improve participation in high-intensity exercise.
Collapse
Affiliation(s)
- Pearl Gryfe
- Assistive Technology Clinic, Toronto, ON, Canada
| | - Andrew Sexton
- Institute of Biomedical Engineering, University of New Brunswick, Fredericton, NB, Canada
| | - Chris A McGibbon
- Institute of Biomedical Engineering, University of New Brunswick, Fredericton, NB, Canada - .,Faculty of Kinesiology, University of New Brunswick, Fredericton, NB, Canada
| |
Collapse
|
20
|
The association between urinary pentosidine levels and cognition in drug-naïve patients with Parkinson’s disease. Neurol Sci 2022; 43:6323-6328. [DOI: 10.1007/s10072-022-06332-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 08/08/2022] [Indexed: 11/26/2022]
|
21
|
Kanser RJ, VandenBussche Jantz AB, Logan PM, Bailey EK, Kamper JE. Comparing Detection of Alzheimer's and Vascular Disease-Related Cognitive Impairment With Brief Cognitive Screens. J Neuropsychiatry Clin Neurosci 2022; 34:361-366. [PMID: 35578799 DOI: 10.1176/appi.neuropsych.21040091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objectives: The study compared the accuracy of the Mini-Mental State Examination (MMSE) with its modified version (3MS) in distinguishing healthy older adults from adults with cognitive impairment due to suspected Alzheimer’s disease (AD) or vascular disease (VaD). Method: Participants were 98 veterans who underwent comprehensive neuropsychological evaluation due to concern for cognitive decline. Participants were selected via retrospective chart review on the basis of diagnosis. They had diagnoses of mild or major neurocognitive disorder due to suspected AD (N=20), mild or major neurocognitive disorder due to suspected VaD (N=44), or no neurocognitive diagnosis (i.e., healthy adult comparisons; HC, N=34). Results: The 3MS demonstrated superior detection of cognitive impairment. The extent of this enhanced detection was influenced by the suspected etiology of cognitive impairment. The 3MS and MMSE had comparable discrimination of AD and HC. With respect to VaD, the 3MS showed superior discriminability compared to the MMSE. Conclusions: Overall, results support the adoption of the 3MS over that of the MMSE. The 3MS is a superior (and free) tool for detecting cognitive impairment in geriatric populations. Its use is recommended for first-line screening of cognitive symptoms in older adult populations, especially those with concern for VaD.
Collapse
Affiliation(s)
- Robert J Kanser
- Department of Mental Health & Behavioral Sciences, James A. Haley Veterans' Hospital, Tampa, Florida
| | | | - Patrick M Logan
- Department of Mental Health & Behavioral Sciences, James A. Haley Veterans' Hospital, Tampa, Florida
| | - Erin K Bailey
- Department of Mental Health & Behavioral Sciences, James A. Haley Veterans' Hospital, Tampa, Florida
| | - Joel E Kamper
- Department of Mental Health & Behavioral Sciences, James A. Haley Veterans' Hospital, Tampa, Florida
| |
Collapse
|
22
|
Boshkovski T, Cohen‐Adad J, Misic B, Arnulf I, Corvol J, Vidailhet M, Lehéricy S, Stikov N, Mancini M. The Myelin-Weighted Connectome in Parkinson's Disease. Mov Disord 2022; 37:724-733. [PMID: 34936123 PMCID: PMC9303520 DOI: 10.1002/mds.28891] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Even though Parkinson's disease (PD) is typically viewed as largely affecting gray matter, there is growing evidence that there are also structural changes in the white matter. Traditional connectomics methods that study PD may not be specific to underlying microstructural changes, such as myelin loss. OBJECTIVE The primary objective of this study is to investigate the PD-induced changes in myelin content in the connections emerging from the basal ganglia and the brainstem. For the weighting of the connectome, we used the longitudinal relaxation rate as a biologically grounded myelin-sensitive metric. METHODS We computed the myelin-weighted connectome in 35 healthy control subjects and 81 patients with PD. We used partial least squares to highlight the differences between patients with PD and healthy control subjects. Then, a ring analysis was performed on selected brainstem and subcortical regions to evaluate each node's potential role as an epicenter for disease propagation. Then, we used behavioral partial least squares to relate the myelin alterations with clinical scores. RESULTS Most connections (~80%) emerging from the basal ganglia showed a reduced myelin content. The connections emerging from potential epicentral nodes (substantia nigra, nucleus basalis of Meynert, amygdala, hippocampus, and midbrain) showed significant decrease in the longitudinal relaxation rate (P < 0.05). This effect was not seen for the medulla and the pons. CONCLUSIONS The myelin-weighted connectome was able to identify alteration of the myelin content in PD in basal ganglia connections. This could provide a different view on the importance of myelination in neurodegeneration and disease progression. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
| | - Julien Cohen‐Adad
- NeuroPoly Lab, Polytechnique MontréalMontréalQuebecCanada
- Mila – Quebec AI InstituteMontréalQuebecCanada
- Functional Neuroimaging Unit, Centre de Recherche de l'Institut Universitaire de Gériatrie de MontréalMontréalQuebecCanada
| | | | - Isabelle Arnulf
- Sorbonne Université, Paris Brain Institute – ICM, INSERM, CNRS, Assistance Publique Hôpitaux de Paris, Hôpital Pitié‐SalpêtrièreParisFrance
| | - Jean‐Christophe Corvol
- Sorbonne Université, Paris Brain Institute – ICM, INSERM, CNRS, Assistance Publique Hôpitaux de Paris, Hôpital Pitié‐SalpêtrièreParisFrance
| | - Marie Vidailhet
- Sorbonne Université, Paris Brain Institute – ICM, INSERM, CNRS, Assistance Publique Hôpitaux de Paris, Hôpital Pitié‐SalpêtrièreParisFrance
| | - Stéphane Lehéricy
- Sorbonne Université, Paris Brain Institute – ICM, INSERM, CNRS, Assistance Publique Hôpitaux de Paris, Hôpital Pitié‐SalpêtrièreParisFrance
| | - Nikola Stikov
- NeuroPoly Lab, Polytechnique MontréalMontréalQuebecCanada
- Montreal Heart InstituteMontréalQuebecCanada
| | - Matteo Mancini
- NeuroPoly Lab, Polytechnique MontréalMontréalQuebecCanada
- Department of NeuroscienceBrighton and Sussex Medical School, University of SussexBrightonUnited Kingdom
- Cardiff University Brain Research Imaging Centre (CUBRIC), Cardiff UniversityCardiffUnited Kingdom
| |
Collapse
|
23
|
Bock MA, Tanner CM. The epidemiology of cognitive function in Parkinson's disease. PROGRESS IN BRAIN RESEARCH 2022; 269:3-37. [PMID: 35248199 DOI: 10.1016/bs.pbr.2022.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Epidemiology is the study of the distribution of disease in human populations, which is important in evaluating burden of illness, identifying modifiable risk factors, and planning for current and projected needs of the health care system. Parkinson's disease (PD) is the second most common serious neurodegenerative illness and is expected to further increase in prevalence. Cognitive changes are increasingly viewed as an integral non-motor feature in PD, emerging even in the prodromal phase of the disease. The prevalence of PD-MCI ranges from 20% to 40% depending on the population studied. The incidence of PD-dementia increases with duration of disease, with estimates growing from 3% to 30% of individuals followed for 5 years or less to over 80% after 20 years. There are several challenges in estimating the frequency of cognitive change, including only recently standardized diagnostic criteria, variation depending on exact neuropsychological evaluations performed, and differences in population sampling. Clinical features associated with cognitive decline include older age, increased disease duration and severity, early gait dysfunction, dysautonomia, hallucinations and other neuropsychiatric features, the presence of REM behavior disorder, and posterior predominant dysfunction on neuropsychological testing. There is increasing evidence that genetic risk factors, in particular GBA and MAPT mutations, contribute to cognitive change. Possible protective factors include higher cognitive reserve and regular exercise. Important sequelae of cognitive decline in PD include higher caregiver burden, decreased functional status, and increased risk of institutionalization and mortality. Many remaining uncertainties regarding the epidemiology of cognitive change in PD require future research, with improved biomarkers and more sensitive and convenient outcome measures.
Collapse
Affiliation(s)
- Meredith A Bock
- Movement Disorders and Neuromodulation Center, Department of Neurology, Weill Institute for Neuroscience, University of California, San Francisco, CA, United States; Mental Illness Research, Education, and Clinical Center, San Francisco Veteran's Affairs Health Care System, San Francisco, CA, United States; Parkinson's Disease Research Education and Clinical Center, San Francisco Veteran's Affairs Health Care System, San Francisco, CA, United States
| | - Caroline M Tanner
- Movement Disorders and Neuromodulation Center, Department of Neurology, Weill Institute for Neuroscience, University of California, San Francisco, CA, United States; Parkinson's Disease Research Education and Clinical Center, San Francisco Veteran's Affairs Health Care System, San Francisco, CA, United States.
| |
Collapse
|
24
|
Guttuso T, Sirica D, Tosun D, Zivadinov R, Pasternak O, Weintraub D, Baglio F, Bergsland N. Thalamic Dorsomedial Nucleus Free Water Correlates with Cognitive Decline in Parkinson's Disease. Mov Disord 2022; 37:490-501. [PMID: 34936139 PMCID: PMC8940677 DOI: 10.1002/mds.28886] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Brain diffusion tensor imaging (DTI) has been shown to reflect cognitive changes in early Parkinson's disease (PD) but the diffusion-based measure free water (FW) has not been previously assessed. OBJECTIVES To assess if FW in the thalamic nuclei primarily involved with cognition (ie, the dorsomedial [DMN] and anterior [AN] nuclei), the nucleus basalis of Meynert (nbM), and the hippocampus correlates with and is associated with longitudinal cognitive decline and distinguishes cognitive status at baseline in early PD. Also, to explore how FW compares with conventional DTI, FW-corrected DTI, and volumetric assessments for these outcomes. METHODS Imaging data and Montreal Cognitive Assessment (MoCA) scores from the Parkinson's Progression Markers Initiative database were analyzed using partial correlations and ANCOVA. Primary outcome multiple comparisons were corrected for false discovery rate (q value). RESULTS Thalamic DMN FW changes over 1 year correlated with MoCA changes over both 1 and 3 years (partial correlations -0.222, q = 0.040, n = 130; and - 0.229, q = 0.040, n = 123, respectively; mean PD duration at baseline = 6.85 months). NbM FW changes over 1 year only correlated with MoCA changes over 3 years (-0.222, q = 0.040). Baseline hippocampal FW was associated with cognitive impairment at 3 years (q = 0.040) and baseline nbM FW distinguished PD-normal cognition (MoCA ≥26) from PD-cognitive impairment (MoCA ≤25), (q = 0.008). The exploratory comparisons showed FW to be the most robust assessment modality for all outcomes. CONCLUSIONS Thalamic DMN FW is a promising cognition progression biomarker in early PD that may assist in identifying cognition protective therapies in clinical trials. FW is a robust assessment modality for these outcomes. © 2021 International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Thomas Guttuso
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY
| | - Daniel Sirica
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY
| | - Duygu Tosun
- University of California, San Francisco, San Francisco, CA
| | - Robert Zivadinov
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY,Center for Biomedical Imaging, Clinical and Translational Science Institute, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY
| | - Ofer Pasternak
- Departments of Psychiatry and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Daniel Weintraub
- Departments of Psychiatry and Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA,Parkinson’s Disease Research, Education and Clinical Center (PADRECC and MIRECC), Philadelphia Veterans Affairs Medical Center, Philadelphia, PA
| | | | - Niels Bergsland
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY,IRCCS, Fondazione Don Carlo Gnocchi, Milan, Italy
| |
Collapse
|
25
|
Sakhare A, Stradford J, Ravichandran R, Deng R, Ruiz J, Subramanian K, Suh J, Pa J. Simultaneous Exercise and Cognitive Training in Virtual Reality Phase 2 Pilot Study: Impact on Brain Health and Cognition in Older Adults. Brain Plast 2021; 7:111-130. [PMID: 34868877 PMCID: PMC8609488 DOI: 10.3233/bpl-210126] [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] [Accepted: 07/27/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Aerobic exercise and environmental enrichment have been shown to enhance brain function. Virtual reality (VR) is a promising method for combining these activities in a meaningful and ecologically valid way. Objective: The purpose of this Phase 2 pilot study was to calculate relative change and effect sizes to assess the impact of simultaneous exercise and cognitive training in VR on brain health and cognition in older adults. Methods: Twelve cognitively normal older adults (64.7±8.8 years old, 8 female) participated in a 12-week intervention, 3 sessions/week for 25–50 minutes/session at 50–80% HRmax. Participants cycled on a custom-built stationary exercise bike while wearing a VR head-mounted display and navigating novel virtual environments to train spatial memory. Brain and cognitive changes were assessed using MRI imaging and a cognitive battery. Results: Medium effect size (ES) improvements in cerebral flow and brain structure were observed. Pulsatility, a measure of peripheral vascular resistance, decreased 10.5% (ES(d) = 0.47). Total grey matter volume increased 0.73% (ES(r) = 0.38), while thickness of the superior parietal lobule, a region associated with spatial orientation, increased 0.44% (ES(r) = 0.30). Visual memory discrimination related to pattern separation showed a large improvement of 68% (ES(ηp2) = 0.43). Cognitive flexibility (Trail Making Test B) (ES(r) = 0.42) and response inhibition (ES(W) = 0.54) showed medium improvements of 14% and 34%, respectively. Conclusions: Twelve weeks of simultaneous exercise and cognitive training in VR elicits positive changes in brain volume, vascular resistance, memory, and executive function with moderate-to-large effect sizes in our pilot study.
Collapse
Affiliation(s)
- Ashwin Sakhare
- Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA.,Department of Neurology, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, USA
| | - Joy Stradford
- Department of Neurology, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, USA
| | - Roshan Ravichandran
- Department of Neurology, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, USA
| | - Rong Deng
- Department of Neurology, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, USA
| | - Julissa Ruiz
- Department of Neurology, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, USA
| | - Keshav Subramanian
- Department of Neurology, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, USA
| | - Jaymee Suh
- Department of Neurology, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, USA
| | - Judy Pa
- Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA.,Department of Neurology, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
26
|
Hergert DC, Cimino CR. Predictors of Caregiver Burden in Huntington's Disease. Arch Clin Neuropsychol 2021; 36:1426–1437. [PMID: 33723593 DOI: 10.1093/arclin/acab009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 11/19/2020] [Accepted: 02/10/2021] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE Huntington's disease (HD) is a genetic neurodegenerative condition that is characterized by cognitive, motor, and psychiatric dysfunction. The purpose of this study was to explore which disease characteristics influence caregiver burden in HD. METHODS Fifty participants with HD and 50 of their caregivers participated in the study at the University of South Florida. Participants were administered a neuropsychological battery, the Unified Huntington's Disease Rating Scale (UHDRS) motor exam, and the Frontal Systems Behavior Scale (FrSBe) self-report. Caregivers completed the Caregiving Appraisal Scale and the FrSBe family-report. RESULTS There were significant correlations between caregiver burden and caregiver age and sex, UHDRS motor scores, cognitive functioning, and self and caregiver-reported FrSBe scores. The significant variables were entered into a regression model and explained 63.1% of the variance in caregiver burden scores. Caregiver age, cognitive functioning, and caregiver-reported FrSBe scores continued to be significant predictors of caregiver burden, whereas the other variables were no longer significant. CONCLUSIONS There were significant relationships between caregiver burden, cognitive functioning, and frontally mediated behaviors, but not motor scores. The results suggest that possible interventions for caregivers may include education to caregivers on how to cope with apathy/executive dysfunction and cognitive decline. Caregiver age was associated with burden, with younger age being associated with increased burden when controlling for symptom severity. This has implications for this population in that HD typically has a younger age of onset than other neurodegenerative diseases and therefore, these caregivers may be particularly at risk for caregiver burden.
Collapse
Affiliation(s)
- Danielle C Hergert
- New Mexico Department of Health, Developmental Disabilities Supports Division, Albuquerque, NM, USA
| | - Cynthia R Cimino
- Deparment of Psychology, University of South Florida, Tampa, FL, USA
| |
Collapse
|
27
|
García AM, Arias-Vergara T, C Vasquez-Correa J, Nöth E, Schuster M, Welch AE, Bocanegra Y, Baena A, Orozco-Arroyave JR. Cognitive Determinants of Dysarthria in Parkinson's Disease: An Automated Machine Learning Approach. Mov Disord 2021; 36:2862-2873. [PMID: 34390508 DOI: 10.1002/mds.28751] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 07/20/2021] [Accepted: 07/23/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Dysarthric symptoms in Parkinson's disease (PD) vary greatly across cohorts. Abundant research suggests that such heterogeneity could reflect subject-level and task-related cognitive factors. However, the interplay of these variables during motor speech remains underexplored, let alone by administering validated materials to carefully matched samples with varying cognitive profiles and combining automated tools with machine learning methods. OBJECTIVE We aimed to identify which speech dimensions best identify patients with PD in cognitively heterogeneous, cognitively preserved, and cognitively impaired groups through tasks with low (reading) and high (retelling) processing demands. METHODS We used support vector machines to analyze prosodic, articulatory, and phonemic identifiability features. Patient groups were compared with healthy control subjects and against each other in both tasks, using each measure separately and in combination. RESULTS Relative to control subjects, patients in cognitively heterogeneous and cognitively preserved groups were best discriminated by combined dysarthric signs during reading (accuracy = 84% and 80.2%). Conversely, patients with cognitive impairment were maximally discriminated from control subjects when considering phonemic identifiability during retelling (accuracy = 86.9%). This same pattern maximally distinguished between cognitively spared and impaired patients (accuracy = 72.1%). Also, cognitive (executive) symptom severity was predicted by prosody in cognitively preserved patients and by phonemic identifiability in cognitively heterogeneous and impaired groups. No measure predicted overall motor dysfunction in any group. CONCLUSIONS Predominant dysarthric symptoms appear to be best captured through undemanding tasks in cognitively heterogeneous and preserved cohorts and through cognitively loaded tasks in patients with cognitive impairment. Further applications of this framework could enhance dysarthria assessments in PD. © 2021 International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Adolfo M García
- Cognitive Neuroscience Center, Universidad de San Andrés, Buenos Aires, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina.,Departamento de Lingüística y Literatura, Facultad de Humanidades, Universidad de Santiago de Chile, Santiago, Chile.,Global Brain Health Institute, University of California, San Francisco, California, USA
| | - Tomás Arias-Vergara
- GITA Lab, Faculty of Engineering, Universidad de Antioquia UdeA, Medellín, Colombia.,Pattern Recognition Lab, Friedrich-Alexander University, Erlangen, Nürnberg, Germany.,Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians University, Munich, Germany
| | - Juan C Vasquez-Correa
- GITA Lab, Faculty of Engineering, Universidad de Antioquia UdeA, Medellín, Colombia.,Pattern Recognition Lab, Friedrich-Alexander University, Erlangen, Nürnberg, Germany
| | - Elmar Nöth
- Friedrich-Alexander University Erlangen-Nuremberg
| | - Maria Schuster
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians University, Munich, Germany
| | - Ariane E Welch
- Memory and Aging Center, University of California, San Francisco, California, USA
| | - Yamile Bocanegra
- Grupo de Neurociencias de Antioquia, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - Ana Baena
- Grupo de Neurociencias de Antioquia, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - Juan R Orozco-Arroyave
- GITA Lab, Faculty of Engineering, Universidad de Antioquia UdeA, Medellín, Colombia.,Pattern Recognition Lab, Friedrich-Alexander University, Erlangen, Nürnberg, Germany
| |
Collapse
|
28
|
Snyder A, Gruber-Baldini AL, Rainer von Coelln F, Savitt JM, Reich SG, Armstrong MJ, Shulman LM. Comparison of Mini-Mental State Examination and Montreal Cognitive Assessment Ratings Across Levels of Parkinson's Disease Severity. JOURNAL OF PARKINSONS DISEASE 2021; 11:1995-2003. [PMID: 34366371 DOI: 10.3233/jpd-212705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cognitive impairment (CI) is common in Parkinson's disease (PD) and an important cause of disability. Screening facilitates early detection of CI and has implications for management. Preclinical disability is when patients have functional limitations but maintain independence through compensatory measures. OBJECTIVE The objective of this study was to investigate the relationship between scores on the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) with levels of PD severity and disability. METHODS PD patients (n = 2,234) in a large observational study were stratified by disease severity, based on Total Unified Parkinson's Disease Rating Scale (Total UPDRS) and Hoehn and Yahr (HY) stage. Using MMSE (n = 1,184) or MoCA (n = 1,050) and basic (ADL) and instrumental activities of daily living (IADL) scales for disability, linear regression analysis examined associations between cognitive status and disability. RESULTS Cognition and disability were highly correlated, with the strongest correlation between IADL and MoCA. Only 16.0% of mean MMSE scores were below threshold for CI (28) and only in advanced PD (Total UPDRS 60+, HY≥3). MoCA scores fell below CI threshold (26) in 66.2% of the sample and earlier in disease (Total UPDRS 30+, HY≥2), corresponding with impairments in ADLs. CONCLUSION In a large clinical dataset, a small fraction of MMSE scores fell below cutoff for CI, reinforcing that MMSE is an insensitive screening tool in PD. MoCA scores indicated CI earlier in disease and coincided with disability. This study shows that MoCA, but not MMSE is sensitive to the emergence of early cognitive impairment in PD and correlates with the concomitant onset of disability.
Collapse
Affiliation(s)
- Allison Snyder
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ann L Gruber-Baldini
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - F Rainer von Coelln
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Joseph M Savitt
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Stephen G Reich
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Melissa J Armstrong
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Lisa M Shulman
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| |
Collapse
|
29
|
Arroyo-Ferrer A, Andreo J, Periáñez JA, Ríos-Lago M, Lubrini G, Herreros-Rodríguez J, García-Caldentey J, Romero JP. Computerized Simple Reaction Time and Balance in Nondemented Parkinson's Patients. NEURODEGENER DIS 2021; 20:193-199. [PMID: 34274926 DOI: 10.1159/000517437] [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: 01/20/2021] [Accepted: 05/23/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Parkinson's disease (PD) patients are known to suffer from subtle cognitive and balance deficits from the early stages although they usually manifest in advanced stages. Postural instability (PI) has been correlated with slower information processing speed. Simple reaction time (SRT) tasks can be used to measure the speed of information processing. The main objective of this study was to examine the usefulness of SRT as a valid predictor of balance in PD, thus providing a simple and complementary assessment method. METHODS This cross-sectional study included 52 PD patients without dementia who were evaluated for balance using the pull test (PT) maneuver and Biodex® limits of stability (LOS). In addition, a reaction time task was used to measure processing speed. Correlation and linear regression analyses were performed. RESULTS The performance of SRT tasks was correlated with the evaluation of LOS% and PT, suggesting that the SRT may be a predictor of balance performance. Longer reaction time and poorer postural stability were also associated with disease duration but not with age. CONCLUSIONS Poor performance in a simple reaction task can predict altered PI and can complement staging and evaluation in PD patients.
Collapse
Affiliation(s)
- Aida Arroyo-Ferrer
- Facultad de Ciencias Experimentales, Universidad Francisco de Vitoria, Madrid, Spain
| | - Jorge Andreo
- Facultad de Ciencias Experimentales, Universidad Francisco de Vitoria, Madrid, Spain
| | - José A Periáñez
- Department of Experimental Psychology, Universidad Complutense de Madrid, Madrid, Spain
| | - Marcos Ríos-Lago
- Basic Psychology II Department, UNED, Madrid, Spain.,Brain Damage Unit, Hospital Beata María Ana, Madrid, Spain
| | - Genny Lubrini
- Department of Experimental Psychology, Universidad Complutense de Madrid, Madrid, Spain
| | | | | | - Juan Pablo Romero
- Facultad de Ciencias Experimentales, Universidad Francisco de Vitoria, Madrid, Spain.,Brain Damage Unit, Hospital Beata María Ana, Madrid, Spain
| |
Collapse
|
30
|
Abnormal center of mass feedback responses during balance: A potential biomarker of falls in Parkinson's disease. PLoS One 2021; 16:e0252119. [PMID: 34043678 PMCID: PMC8158870 DOI: 10.1371/journal.pone.0252119] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/10/2021] [Indexed: 02/01/2023] Open
Abstract
Although Parkinson disease (PD) causes profound balance impairments, we know very little about how PD impacts the sensorimotor networks we rely on for automatically maintaining balance control. In young healthy people and animals, muscles are activated in a precise temporal and spatial organization when the center of body mass (CoM) is unexpectedly moved that is largely automatic and determined by feedback of CoM motion. Here, we show that PD alters the sensitivity of the sensorimotor feedback transformation. Importantly, sensorimotor feedback transformations for balance in PD remain temporally precise, but become spatially diffuse by recruiting additional muscle activity in antagonist muscles during balance responses. The abnormal antagonist muscle activity remains precisely time-locked to sensorimotor feedback signals encoding undesirable motion of the body in space. Further, among people with PD, the sensitivity of abnormal antagonist muscle activity to CoM motion varies directly with the number of recent falls. Our work shows that in people with PD, sensorimotor feedback transformations for balance are intact but disinhibited in antagonist muscles, likely contributing to balance deficits and falls.
Collapse
|
31
|
Omoto S, Murakami H, Shiraishi T, Bono K, Umehara T, Iguchi Y. Risk factors for minor hallucinations in Parkinson's disease. Acta Neurol Scand 2021; 143:538-544. [PMID: 33222164 DOI: 10.1111/ane.13380] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/26/2020] [Accepted: 11/14/2020] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Minor hallucinations (MHs), including sense of presence, passage hallucinations, and visual illusions, have been reported in Parkinson's disease (PD). Here, we investigated the prevalence and associated risk factors for MHs according to appearance time. METHODS Data on the clinical characteristics and the appearance time of MHs for 100 PD patients were collected using a questionnaire and analyzed. MHs were classified into two groups according to the time when MHs appeared: MHs appearing while awake during the daytime (dMHs) and MHs appearing at arousal from sleep during the night or early morning (aMHs). RESULTS Thirty-eight patients (38%) experienced MHs. dMHs and aMHs were present in 21 (21%) and 28 patients (28%), respectively. Compared to patients without MHs, patients with dMHs had more severe motor symptoms, longer disease duration, higher levodopa equivalent daily dose (LEDD), and higher rates of cognitive impairment and visual hallucinations during the daytime, whereas patients with aMHs had a higher rate of rapid eye movement sleep behavior disorder (RBD), longer disease duration, higher LEDD, and higher dopamine agonist dosage. Logistic regression analysis showed that cognitive impairment was significantly associated with dMHs (odds ratio (OR) 7.292, p = .001), and that RBD (OR 8.306, p < .001) and LEDD (OR 1.002, p = .049) were significantly associated with aMHs. CONCLUSIONS Patients with MHs have different clinical characteristics according to the time when MHs appear. These findings have important clinical and prognostic implications and suggest appropriate therapeutic options for psychotic symptoms.
Collapse
Affiliation(s)
- Shusaku Omoto
- Department of Neurology The Jikei University School of Medicine Tokyo Japan
| | - Hidetomo Murakami
- Department of Neurology The Jikei University School of Medicine Tokyo Japan
| | - Tomotaka Shiraishi
- Department of Neurology The Jikei University School of Medicine Tokyo Japan
| | - Keiko Bono
- Department of Neurology The Jikei University School of Medicine Tokyo Japan
| | - Tadashi Umehara
- Department of Neurology The Jikei University School of Medicine Tokyo Japan
| | - Yasuyuki Iguchi
- Department of Neurology The Jikei University School of Medicine Tokyo Japan
| |
Collapse
|
32
|
Motazedian S, Solat N, Banihashem SS, Kheradmand A, Mohammadi SD, Chalakinia N. Cognitive function in methadone maintenance patients compared with abstinent opioid users. J Addict Dis 2021; 39:537-544. [PMID: 33829960 DOI: 10.1080/10550887.2021.1907501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Opioid is the second most prevalent illicit drug worldwide, whose consumption is very high in Iran, due to Iran's geographical proximity to producing countries. Methadone maintenance therapy is one of the most prevalent and accepted methods of substance abuse treatment. Nevertheless, cognitive disorders have been reported as one of its complications. AIM This study was conducted to evaluate cognitive impairment in methadone maintenance patients (MMPs) and to compare it with abstinent opioid users (AOUs). MATERIALS AND METHODS This cross-sectional analytical study was performed on 25 MMPs and 25 AOUs. Samples were selected through convenience sampling method whereby a self-made questionnaire was distributed among them to assess demographic information, clinical variables such as methadone and opioid use history, underlying disease and medication history, as well as 13-item Beck depression inventory. Then, they were interviewed using the Montreal Cognitive Assessment (MoCA) questionnaire. RESULTS Significant differences were found in MoCA questionnaire total scores (p = 0.018) and orientation to time and place dimension (p = 0.008) between the two groups, with the mean scores being higher in AOU group. Duration of opioid use was the only factor influencing cognitive assessment score in both Groups. (p = 0.029). CONCLUSION We suggest monitoring and assessing cognition function in patients receiving methadone especially for those with a long history of opioid use.
Collapse
Affiliation(s)
- Somayeh Motazedian
- Department of Psychosomatic Medicine, Taleghani Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Niloofar Solat
- Department of Psychiatry, School of Medicine, Fasa University of Medical Sciences, Fasa, Shiraz, Iran
| | - Seyed Shahab Banihashem
- Department of Psychosomatic Medicine, Taleghani Hospital Research Development Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Kheradmand
- Department of Psychiatry, Taleghani Hospital Research Development Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Davood Mohammadi
- Department of Clinical Psychology, School of Medicine, Fasa University of Medical Sciences, Fasa, Shiraz, Iran
| | - Nasrin Chalakinia
- Department of Psychosomatic Medicine, Taleghani Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
33
|
Progression of Nonmotor Symptoms in Parkinson's Disease by Sex and Motor Laterality. PARKINSONS DISEASE 2021; 2021:8898887. [PMID: 33868631 PMCID: PMC8035033 DOI: 10.1155/2021/8898887] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 03/04/2021] [Indexed: 01/10/2023]
Abstract
Nonmotor symptoms (NMS) in Parkinson's disease (PD) can start up to a decade before motor manifestations and strongly correlate with the quality of life. Understanding patterns of NMS can provide clues to the incipient site of PD pathology. Our goal was to systematically characterize the progression of NMS in PD (n = 489), compared to healthy controls, HC (n = 241), based on the sex of the subjects and laterality of motor symptom onset. Additionally, NMS experienced at the onset of PD were also compared to subjects with scans without dopaminergic deficit, SWEDD (n = 81). The Parkinson's Progression Markers Initiative (PPMI) database was utilized to analyze several NMS scales. NMS experienced by PD and SWEDD cohorts were significantly higher than HC and both sex and laterality influenced several NMS scales at the onset of motor symptoms. Sex Differences. PD males experienced significant worsening of sexual, urinary, sleep, and cognitive functions compared to PD females. PD females reported significantly increased thermoregulatory dysfunction and anxious mood over 7 years and significantly more constipation during the first 4 years after PD onset. Laterality Differences. At onset, PD subjects with right-sided motor predominance reported significantly higher autonomic dysfunction. Subjects with left-sided motor predominance experienced significantly more anxious mood at onset which continued as Parkinson's progressed. In conclusion, males experienced increased NMS burden in Parkinson's disease. Laterality of motor symptoms did not significantly influence NMS progression, except anxious mood. We analyzed NMS in a large cohort of PD patients, and these data are valuable to improve PD patients' quality of life by therapeutically alleviating nonmotor symptoms.
Collapse
|
34
|
O'Neill RA, Maxwell AP, Paterson EN, Kee F, Young I, Hogg RE, Cruise S, Murphy S, McGuinness B, McKay GJ. Retinal microvascular parameters are not significantly associated with mild cognitive impairment in the Northern Ireland Cohort for the Longitudinal Study of Ageing. BMC Neurol 2021; 21:112. [PMID: 33706706 PMCID: PMC7948373 DOI: 10.1186/s12883-021-02137-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 03/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The retinal and cerebral microvasculature share similar embryological origins and physiological characteristics. Improved imaging technologies provide opportunistic non-invasive assessment of retinal microvascular parameters (RMPs) against cognitive outcomes. We evaluated baseline measures for associations between RMPs and mild cognitive impairment (MCI) from participants of the Northern Ireland Cohort for the Longitudinal Study of Ageing (NICOLA). METHODS RMPs (central retinal arteriolar / venular equivalents, arteriole to venular ratio, fractal dimension and tortuosity) were measured from optic disc centred fundus images and analysed using semi-automated software. Associations between RMPs and MCI were assessed by multivariable logistic regression with adjustment for potential confounders including age, sex, alcohol consumption, smoking status, educational attainment, physical activity, cardiovascular disease (CVD), hypertension, mean arterial blood pressure, triglycerides, diabetes, body mass index, and high density lipoprotein levels. P < 0.05 was considered statistically significant. RESULTS Data were available for 1431 participants, of which 156 (10.9%) were classified with MCI defined by a Montreal Cognitive Assessment (MoCA) score ≤ 26, with subjective cognitive decline, in the absence of depression or problems with activities of daily living. Participants had a mean age of 62.4 ± 8.5 yrs. and 52% were female. As expected, individuals with MCI had a lower MoCA score than those without (23.5 ± 2.6 versus 26.3 ± 2.7, respectively), were more likely to be female, have a lower level of educational attainment, be less physically active, more likely to have CVD, have higher levels of triglycerides and lower levels of high density lipoprotein. No significant associations between RMPs and MCI were detected in unadjusted, minimally adjusted or fully adjusted regression models or subsequent sensitivity analyses. CONCLUSION Previous studies have reported both increased retinal venular calibre and reduced fractal dimension in association with mild cognitive impairment. Our study failed to detect any associations between RMPs and those individuals at an early stage of cognitive loss in an older community-based cohort.
Collapse
Affiliation(s)
- R A O'Neill
- Centre for Public Health, Queens University Belfast, Belfast, Northern Ireland
| | - A P Maxwell
- Centre for Public Health, Queens University Belfast, Belfast, Northern Ireland
| | - E N Paterson
- Centre for Public Health, Queens University Belfast, Belfast, Northern Ireland
| | - F Kee
- Centre for Public Health, Queens University Belfast, Belfast, Northern Ireland
| | - I Young
- Centre for Public Health, Queens University Belfast, Belfast, Northern Ireland
| | - R E Hogg
- Centre for Public Health, Queens University Belfast, Belfast, Northern Ireland
| | - S Cruise
- Centre for Public Health, Queens University Belfast, Belfast, Northern Ireland
| | - S Murphy
- Centre for Public Health, Queens University Belfast, Belfast, Northern Ireland
| | - B McGuinness
- Centre for Public Health, Queens University Belfast, Belfast, Northern Ireland
| | - G J McKay
- Centre for Public Health, Queens University Belfast, Belfast, Northern Ireland.
| |
Collapse
|
35
|
Arroyo A, Periáñez JA, Ríos-Lago M, Lubrini G, Andreo J, Benito-León J, Louis ED, Romero JP. Components determining the slowness of information processing in parkinson's disease. Brain Behav 2021; 11:e02031. [PMID: 33452724 PMCID: PMC7994698 DOI: 10.1002/brb3.2031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/16/2020] [Accepted: 12/25/2020] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Bradyphrenia is a key cognitive feature in Parkinson's disease (PD). There is no consensus on whether information processing speed is impaired or not beyond motor performance. OBJECTIVE This study aims to explore which perceptual, motor, or cognitive components of information processing are involved in the slowdown affecting cognitive performance. METHODS The study included 48 patients with PD (age: 63, 3 ± 8, 18; HY I-III; UPDRS 15,46 ± 7,76) and 53 healthy controls (age: 60,09 ± 12,83). Five reaction time (RT) tasks were administered to all participants. The average RT in each of the tasks and the percentage of correct answers were measured. Patients with PD were in "ON state" at the time of the evaluation. Perceptual, motor, and cognitive components were isolated by means of a series of ANCOVAs. RESULTS As expected, the motor component was slowed down in patients with PD. Moreover, while patients with PD showed slower RT than controls in all tasks, differences between groups did not exponentially increase with the increasing task complexity. ANCOVA analyses also revealed that the perceptual and sustained alert component resulted to be slowed down, with no differences being found in any of the remaining isolated cognitive components (i.e., response strategy-inhibition, decisional, visual search, or interference control). CONCLUSIONS The results revealed that slowness of information processing in PD was mainly associated with an impaired processing speed of the motor and perceptual-alertness components analyzed. The results may help designing new neurorehabilitation strategies, focusing on the improvement of perceptual and alertness mechanisms.
Collapse
Affiliation(s)
- Aida Arroyo
- Facultad de Ciencias Experimentales, Universidad Francisco de Vitoria, Madrid, Spain
| | - José A Periáñez
- Experimental Psychology Department, Universidad Complutense de Madrid, Madrid, Spain
| | - Marcos Ríos-Lago
- Basic Psychology II Department, UNED, Madrid 28040, Spain; Brain Damage Unit, Hospital Beata María Ana, Madrid, Spain
| | - Genny Lubrini
- Experimental Psychology Department, Universidad Complutense de Madrid, Madrid, Spain
| | - Jorge Andreo
- Facultad de Ciencias Experimentales, Universidad Francisco de Vitoria, Madrid, Spain
| | - Julián Benito-León
- Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Spain; Department of Medicine, Complutense University, Madrid, Spain
| | - Elan D Louis
- Department of Neurology and Neurotherapeutics at UT Southwestern Medical Center
| | - Juan Pablo Romero
- Facultad de Ciencias Experimentales, Universidad Francisco de Vitoria, Madrid 28223, Spain; Brain Damage Unit, Hospital Beata María Ana, Madrid, Spain
| |
Collapse
|
36
|
Katz MJ, Wang C, Nester CO, Derby CA, Zimmerman ME, Lipton RB, Sliwinski MJ, Rabin LA. T-MoCA: A valid phone screen for cognitive impairment in diverse community samples. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2021; 13:e12144. [PMID: 33598528 PMCID: PMC7864219 DOI: 10.1002/dad2.12144] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/23/2020] [Accepted: 12/02/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION There is an urgent need to validate telephone versions of widely used general cognitive measures, such as the Montreal Cognitive Assessment (T-MoCA), for remote assessments. METHODS In the Einstein Aging Study, a diverse community cohort (n = 428; mean age = 78.1; 66% female; 54% non-White), equivalence testing was used to examine concordance between the T-MoCA and the corresponding in-person MoCA assessment. Receiver operating characteristic analyses examined the diagnostic ability to discriminate between mild cognitive impairment and normal cognition. Conversion methods from T-MoCA to the MoCA are presented. RESULTS Education, race/ethnicity, gender, age, self-reported cognitive concerns, and telephone administration difficulties were associated with both modes of administration; however, when examining the difference between modalities, these factors were not significant. Sensitivity and specificity for the T-MoCA (using Youden's index optimal cut) were 72% and 59%, respectively. DISCUSSION The T-MoCA demonstrated sufficient psychometric properties to be useful for screening of MCI, especially when clinic visits are not feasible.
Collapse
Affiliation(s)
- Mindy J. Katz
- Saul R. Korey Department of NeurologyAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Cuiling Wang
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Caroline O. Nester
- Department of PsychologyBrooklyn CollegeCity University of New York (CUNY)BrooklynNew YorkUSA
| | - Carol A. Derby
- Saul R. Korey Department of NeurologyAlbert Einstein College of MedicineBronxNew YorkUSA
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
| | | | - Richard B. Lipton
- Saul R. Korey Department of NeurologyAlbert Einstein College of MedicineBronxNew YorkUSA
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
- Department of Psychiatry and Behavioral MedicineAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Martin J. Sliwinski
- Department of Human Development & Family StudiesCenter for Healthy AgingThe Pennsylvania State UniversityUniversity ParkPennsylvaniaUSA
| | - Laura A. Rabin
- Saul R. Korey Department of NeurologyAlbert Einstein College of MedicineBronxNew YorkUSA
- Department of PsychologyBrooklyn CollegeCity University of New York (CUNY)BrooklynNew YorkUSA
| |
Collapse
|
37
|
Ibañez A, Fittipaldi S, Trujillo C, Jaramillo T, Torres A, Cardona JF, Rivera R, Slachevsky A, García A, Bertoux M, Baez S. Predicting and Characterizing Neurodegenerative Subtypes with Multimodal Neurocognitive Signatures of Social and Cognitive Processes. J Alzheimers Dis 2021; 83:227-248. [PMID: 34275897 PMCID: PMC8461708 DOI: 10.3233/jad-210163] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Social cognition is critically compromised across neurodegenerative diseases, including the behavioral variant frontotemporal dementia (bvFTD), Alzheimer's disease (AD), and Parkinson's disease (PD). However, no previous study has used social cognition and other cognitive tasks to predict diagnoses of these conditions, let alone reporting the brain correlates of prediction outcomes. OBJECTIVE We performed a diagnostic classification analysis using social cognition, cognitive screening (CS), and executive function (EF) measures, and explored which anatomical and functional networks were associated with main predictors. METHODS Multiple group discriminant function analyses (MDAs) and ROC analyses of social cognition (facial emotional recognition, theory of mind), CS, and EF were implemented in 223 participants (bvFTD, AD, PD, controls). Gray matter volume and functional connectivity correlates of top discriminant scores were investigated. RESULTS Although all patient groups revealed deficits in social cognition, CS, and EF, our classification approach provided robust discriminatory characterizations. Regarding controls, probabilistic social cognition outcomes provided the best characterization for bvFTD (together with CS) and PD, but not AD (for which CS alone was the best predictor). Within patient groups, the best MDA probabilities scores yielded high classification rates for bvFTD versus PD (98.3%, social cognition), AD versus PD (98.6%, social cognition + CS), and bvFTD versus AD (71.7%, social cognition + CS). Top MDA scores were associated with specific patterns of atrophy and functional networks across neurodegenerative conditions. CONCLUSION Standardized validated measures of social cognition, in combination with CS, can provide a dimensional classification with specific pathophysiological markers of neurodegeneration diagnoses.
Collapse
Affiliation(s)
- Agustín Ibañez
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago, Chile
- Cognitive Neuroscience Center (CNC), Universidad de San Andrés, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
- Global Brain Health Institute, University of California, San Francisco, CA, USA
- Global Brain Health Institute, Trinity College Dublin (TCD), Dublin, Ireland
| | - Sol Fittipaldi
- Cognitive Neuroscience Center (CNC), Universidad de San Andrés, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
- Facultad de Psicología, Universidad Nacional de Córdoba, Córdoba, Argentina
| | | | - Tania Jaramillo
- Instituto de Psicología, Universidad del Valle, Cali, Colombia
| | | | - Juan F. Cardona
- Instituto de Psicología, Universidad del Valle, Cali, Colombia
| | - Rodrigo Rivera
- Neuroradiology Department, Instituto de Neurocirugia, Universidad de Chile, Santiago, Chile
| | - Andrea Slachevsky
- Geroscience Center for Brain Health and Metabolism (GERO), Faculty of Medicine, University of Chile, Santiago, Chile
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department - ICBM, Neuroscience and East Neuroscience Departments, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Adolfo García
- Cognitive Neuroscience Center (CNC), Universidad de San Andrés, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
- Global Brain Health Institute, University of California, San Francisco, CA, USA
- Departamento de Lingüística y Literatura, Facultad de Humanidades, Universidad de Santiago de Chile, Santiago, Chile
| | - Maxime Bertoux
- Lille Center of Excellence for Neurodegenerative Disorders (LICEND), CHU Lille, U1172 - Lille Neurosciences & Cognition, Université de Lille, Inserm, Lille, France
| | | |
Collapse
|
38
|
Ramezani Ghamsari M, Ghourchian S, Emamikhah M, Safdarian M, Shahidi G, Parvaresh M, Moghaddasi M, Habibi SAH, Munhoz RP, Rohani M. Long term follow-up results of deep brain stimulation of the Globus pallidus interna in pediatric patients with DYT1-positive dystonia. Clin Neurol Neurosurg 2020; 201:106449. [PMID: 33395620 DOI: 10.1016/j.clineuro.2020.106449] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 12/18/2020] [Accepted: 12/19/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Primary generalized dystonia (PGD) due to heterozygous torsin 1A (TOR1A) gene mutation (DYT1) is a childhood onset dystonia with rapid deterioration of symptoms, leading to severe disability in adolescence. Globus pallidus interna deep brain stimulation (GPi-DBS) has been shown to provide significant improvement in these cases. METHODS This was a retrospective study of TOR1A mutation positive dystonia patients, conducted at a university hospital from 2006 to 2018. Burke-Fahn-Marsden Dystonia Rating Scale (BFM-DRS) was used to evaluate dystonia severity before and after surgery. Emergence of postsurgical parkinsonian symptoms was evaluated using the Unified Parkinson Disease Rating Scale (UPDRS) part III. Montreal Cognitive Assessment (MOCA) was applied to assess cognitive dysfunction. SPSS version 18 was used for data analysis. RESULTS Eleven patients entered for analysis with an average age of 22.36 (±3.35) years (range: 18-28). Seven patients (63.6 %) were female. Mean follow-up period was 8.72 (±0.87). Difference between baseline and most recent BFM scores was significant (disability: 10.5 ±4.52 versus 2.09 (±3.20), P: 0.001; severity: 48.45 (±17.88) versus 9.36 (±10.47), P<0.001). The mean MOCA and UPDRS III scores after 7-9 years of DBS were 27.18 (±2.99), and 6.09 (±4.15), respectively. CONCLUSION Our experience confirms that GPi-DBS in pediatric patients with DYT1 dystonia is overall successful, with significant and long-lasting positive effects on motor and cognitive functions. There was no prominent side effect in long-term follow up.
Collapse
Affiliation(s)
- Mona Ramezani Ghamsari
- Department of Neurology, Hazrat Rasool Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Shadi Ghourchian
- Department of Neurology, University of Maryland, School of Medicine, Baltimore, Maryland, USA
| | - Maziar Emamikhah
- Department of Neurology, Hazrat Rasool Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mahdi Safdarian
- Department of Neurology, Hazrat Rasool Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Gholamali Shahidi
- Department of Neurology, Hazrat Rasool Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mansour Parvaresh
- Department of Neurosurgery, Hazrat Rasool Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Moghaddasi
- Department of Neurology, Hazrat Rasool Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Amir Hassan Habibi
- Department of Neurology, Hazrat Rasool Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Renato P Munhoz
- The Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, University Health Network, Toronto Western Hospital, Division of Neurology, University of Toronto Toronto Ontario, Canada; Krembil Brain Institute Toronto Ontario, Canada
| | - Mohammad Rohani
- Department of Neurology, Hazrat Rasool Hospital, Iran University of Medical Sciences, Tehran, Iran; Skull Base Research Center, Five Senses Health Institute, Iran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
39
|
Bezdicek O, Červenková M, Moore TM, Georgi HS, Sulc Z, Wolk DA, Weintraub DA, Moberg PJ, Jech R, Kopecek M, Roalf DR. Determining a Short Form Montreal Cognitive Assessment (s-MoCA) Czech Version: Validity in Mild Cognitive Impairment Parkinson's Disease and Cross-Cultural Comparison. Assessment 2020; 27:1960-1970. [PMID: 29929376 PMCID: PMC6274600 DOI: 10.1177/1073191118778896] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Montreal Cognitive Assessment (MoCA) is one of the most common screening instruments for mild cognitive impairment. However, the standard MoCA is approximately two times longer to administer than the Mini-Mental State Examination. A total of 699 Czech and 175 American participants received the standard MoCA Czech and English versions and in the clinical part, a sample of 102 nondemented patients with Parkinson's disease (PD). We created a validated Czech short version (s-MoCA-CZ) from the original using item response theory. As expected, s-MoCA-CZ scores were highly correlated with the standard version (Pearson r = .94, p < .001). s-MoCA-CZ also had 80% classification accuracy in the differentiation of PD mild cognitive impairment from PD without impairment. The s-MoCA-CZ, a brief screening tool, is shorter to administer than the standard MoCA. It provides high-classification accuracy for PD mild cognitive impairment and is equivalent to that of the standard MoCA-CZ.
Collapse
Affiliation(s)
- Ondrej Bezdicek
- Department of Neurology, First Faculty of Medicine, Charles University, Prague, Czech Republic
- National Institute of Mental Health, Klecany, Czech Republic
| | - Markéta Červenková
- Department of Neurology, First Faculty of Medicine, Charles University, Prague, Czech Republic
- National Institute of Mental Health, Klecany, Czech Republic
| | - Tyler M. Moore
- Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - Zdenek Sulc
- National Institute of Mental Health, Klecany, Czech Republic
| | - David A. Wolk
- Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Daniel A. Weintraub
- Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA
- Parkinson’s Disease and Mental Illness Research, Education and Clinical Centers (PADRECC and MIRECC), Philadelphia Veterans Affairs Medical Center, Philadelphia, PA
| | - Paul J. Moberg
- Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Robert Jech
- Department of Neurology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Miloslav Kopecek
- Department of Neurology, First Faculty of Medicine, Charles University, Prague, Czech Republic
- National Institute of Mental Health, Klecany, Czech Republic
| | - David R. Roalf
- Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA
| |
Collapse
|
40
|
Baez S, Herrera E, Trujillo C, Cardona JF, Diazgranados JA, Pino M, Santamaría-García H, Ibáñez A, García AM. Classifying Parkinson's Disease Patients With Syntactic and Socio-emotional Verbal Measures. Front Aging Neurosci 2020; 12:586233. [PMID: 33328964 PMCID: PMC7719774 DOI: 10.3389/fnagi.2020.586233] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 11/05/2020] [Indexed: 01/25/2023] Open
Abstract
Frontostriatal disorders, such as Parkinson's disease (PD), are characterized by progressive disruption of cortico-subcortical dopaminergic loops involved in diverse higher-order domains, including language. Indeed, syntactic and emotional language tasks have emerged as potential biomarkers of frontostriatal disturbances. However, relevant studies and models have typically considered these linguistic dimensions in isolation, overlooking the potential advantages of targeting multidimensional markers. Here, we examined whether patient classification can be improved through the joint assessment of both dimensions using sentential stimuli. We evaluated 31 early PD patients and 24 healthy controls via two syntactic measures (functional-role assignment, parsing of long-distance dependencies) and a verbal task tapping social emotions (envy, Schadenfreude) and compared their classification accuracy when analyzed in isolation and in combination. Complementarily, we replicated our approach to discriminate between patients on and off medication. Results showed that specific measures of each dimension were selectively impaired in PD. In particular, joint analysis of outcomes in functional-role assignment and Schadenfreude improved the classification accuracy of patients and controls, irrespective of their overall cognitive and affective state. These results suggest that multidimensional linguistic assessments may better capture the complexity and multi-functional impact of frontostriatal disruptions, highlighting their potential contributions in the ongoing quest for sensitive markers of PD.
Collapse
Affiliation(s)
- Sandra Baez
- Department of Psychology, Universidad de los Andes, Bogotá, Colombia
| | - Eduar Herrera
- Departamento de Estudios Psicológicos, Universidad Icesi, Cali, Colombia
| | | | - Juan F. Cardona
- Instituto de Psicología, Universidad del Valle, Cali, Colombia
| | | | - Mariana Pino
- Department of Psychology, Universidad Autónoma del Caribe, Barranquilla, Colombia
| | - Hernando Santamaría-García
- Centro de Memoria y Cognición, Intellectus-Hospital Universitario San Ignacio, Bogotá, Colombia
- Department of Psychiatry-Physiology and Ph.D. Program in Neuroscience, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Agustín Ibáñez
- Department of Psychology, Universidad Autónoma del Caribe, Barranquilla, Colombia
- Universidad de San Andrés, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
- Center for Social and Cognitive Neuroscience (CSCN), School of Psychology, Universidad Adolfo Ibáñez, Santiago de Chile, Chile
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States
| | - Adolfo M. García
- Universidad de San Andrés, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States
- Faculty of Education, National University of Cuyo (UNCuyo), Mendoza, Argentina
| |
Collapse
|
41
|
Stuckenschneider T, Askew CD, Menêses AL, Baake R, Weber J, Schneider S. The Effect of Different Exercise Modes on Domain-Specific Cognitive Function in Patients Suffering from Parkinson's Disease: A Systematic Review of Randomized Controlled Trials. JOURNAL OF PARKINSONS DISEASE 2020; 9:73-95. [PMID: 30741688 DOI: 10.3233/jpd-181484] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Supervised exercise training alleviates motor symptoms in people with Parkinson's disease (PD). However, the efficacy of exercise to improve nonmotor symptoms such as cognitive function is less well known. OBJECTIVE To systematically review evidence on the efficacy of different exercise modes (coordination exercise, resistance exercise, aerobic exercise) on domain-specific cognitive function in patients with PD. METHODS Parallel-group randomized controlled trials published before March 2018 were included. Primary outcome measures included global cognitive function and its subdomains, and the Unified Parkinson's Disease Rating Scale was included as a secondary outcome. Methodological quality was assessed using the Physiotherapy Evidence Database scale. RESULTS The literature search yielded 2,000 articles, of which 11 met inclusion criteria. 508 patients (mean age 68±4 years) were included with a disease severity from 1 to 4 on the Hoehn & Yahr stage scale. Overall study quality was modest (mean 6±2, range 3-8/10). In 5 trials a significant between-group effect size (ES) was identified for tests of specific cognitive domains, including a positive effect of aerobic exercise on memory (ES = 2.42) and executive function (ES = 1.54), and of combined resistance and coordination exercise on global cognitive function (ES = 1.54). Two trials found a significant ES for coordination exercise (ES = 0.84-1.88), which led to improved executive function compared with that of non-exercising control subjects. CONCLUSION All modes of exercise are associated with improved cognitive function in individuals with PD. Aerobic exercise tended to best improve memory; however, a clear effect of exercise mode was not identified.
Collapse
Affiliation(s)
- Tim Stuckenschneider
- Institute of Movement and Neurosciences, German Sport University, Cologne, Germany.,VasoActive Research Group, School of Health and Sport Sciences, University of the Sunshine Coast, QLD, Australia
| | - Christopher D Askew
- VasoActive Research Group, School of Health and Sport Sciences, University of the Sunshine Coast, QLD, Australia
| | - Annelise L Menêses
- VasoActive Research Group, School of Health and Sport Sciences, University of the Sunshine Coast, QLD, Australia
| | - Ricarda Baake
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Jan Weber
- Institute of Movement and Neurosciences, German Sport University, Cologne, Germany
| | - Stefan Schneider
- Institute of Movement and Neurosciences, German Sport University, Cologne, Germany.,VasoActive Research Group, School of Health and Sport Sciences, University of the Sunshine Coast, QLD, Australia
| |
Collapse
|
42
|
Scheffels JF, Fröhlich L, Kalbe E, Kessler J. Concordance of Mini-Mental State Examination, Montreal Cognitive Assessment and Parkinson Neuropsychometric Dementia Assessment in the classification of cognitive performance in Parkinson's disease. J Neurol Sci 2020; 412:116735. [DOI: 10.1016/j.jns.2020.116735] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 02/07/2020] [Accepted: 02/12/2020] [Indexed: 10/25/2022]
|
43
|
Aumann MA, Stark AJ, Hughes SB, Lin Y, Kang H, Bradley E, Zald DH, Claassen DO. Self-reported rates of impulsivity in Parkinson's Disease. Ann Clin Transl Neurol 2020; 7:437-448. [PMID: 32227451 PMCID: PMC7187703 DOI: 10.1002/acn3.51016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 02/05/2020] [Accepted: 02/19/2020] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Impulsive decision-making is characterized by actions taken without considering consequences. Patients with Parkinson's disease (PD) who receive dopaminergic treatment, especially dopamine agonists, are at risk of developing impulsive-compulsive behaviors (ICBs). We assessed impulse-related changes across a large heterogeneous PD population using the Barratt impulsivity scale (BIS-11) by evaluating BIS-11 first- and second-order factors. METHODS We assessed a total of 204 subjects: 93 healthy controls (HCs), and 68 ICB- and 43 ICB + PD patients who completed the BIS-11. Using a general linear model and a least absolute shrinkage and selection operation regression, we compared BIS-11 scores between the HC, ICB- PD, and ICB + PD groups. RESULTS Patients with PD rated themselves as more impulsive than HCs in the BIS-11 total score, second-order attention domain, and first-order attention and self-control domains. ICB + patients recorded higher total scores as well as higher scores in the second-order non-planning domain and in self-control and cognitive complexity than ICB- patients. INTERPRETATION These results indicate that the patients with PD show particular problems with attentional control, whereas ICB + patients show a distinct problem in cognitive control and complexity. Additionally, it appears that all patients with PD are more impulsive than their age- and sex-matched healthy peers. Increased impulsivity may be a result of the disease course, or attributed to dopaminergic medication use, but these results emphasize the importance of the cognitive components of impulsivity in patients with PD.
Collapse
Affiliation(s)
- Megan A. Aumann
- Vanderbilt Brain InstituteDepartment of PsychologyVanderbilt UniversityNashvilleTennessee
- Department of NeurologyVanderbilt University Medical CenterNashvilleTennessee
| | - Adam J. Stark
- Department of NeurologyVanderbilt University Medical CenterNashvilleTennessee
| | - Shelby B. Hughes
- Department of NeurologyVanderbilt University Medical CenterNashvilleTennessee
| | - Ya‐Chen Lin
- Department of BiostatisticsVanderbilt University Medical CenterNashvilleTennessee
| | - Hakmook Kang
- Department of BiostatisticsVanderbilt University Medical CenterNashvilleTennessee
| | - Elise Bradley
- Department of NeurologyVanderbilt University Medical CenterNashvilleTennessee
| | - David H. Zald
- Department of PsychiatryVanderbilt University Medical SchoolNashvilleTennessee
- Department of PsychologyVanderbilt UniversityNashvilleTennessee
| | - Daniel O. Claassen
- Department of NeurologyVanderbilt University Medical CenterNashvilleTennessee
| |
Collapse
|
44
|
Tickle-Degnen L, Stevenson MT, Gunnery SD, Saint-Hilaire M, Thomas CA, Sprague Martinez L, Habermann B, Naumova EN. Profile of social self-management practices in daily life with Parkinson's disease is associated with symptom severity and health quality of life. Disabil Rehabil 2020; 43:3212-3224. [PMID: 32233702 DOI: 10.1080/09638288.2020.1741035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: Social participation is a key determinant of healthy aging, yet little is known about how people with Parkinson's disease manage social living. This study describes individual differences in social self-management practices and their association with symptom severity and health quality of life.Methods: People with Parkinson's disease (N = 90) completed measures of healthy routines, activities and relationships, symptom severity, and health related quality of life. Cluster analysis identified profiles of social self-management practices. Analysis of variance tested differences between profiles in symptom severity and health quality of life.Results: Participants clustered into one of seven groups according to different combinations of three practices: health resources utilization, activities in home and community, and social support relationships. The healthiest cluster engaged equally in all three practices at above sample average degree of engagement. Four clusters that engaged at or above sample average in activities in home and community experienced less health problems than three clusters that engaged below average. Variation in aspects of social lifestyle unrelated to health appeared also to contribute to profile diversity.Conclusion: Findings provide insight into similarity and variation in how people with Parkinson's disease engage with social self-management resources and point to person-centered interventions.Implications for RehabilitationSocial self-management is a biopsychosocial construct to identify and describe self-care practices that engage one's social resources for managing healthful daily living.People with Parkinson's disease vary in their profiles of engaging in social self-management practices in daily living, and this variability relates to severity of symptoms and health quality of life.Learning how to identify health-centered social self-management practices may help people with Parkinson's disease to focus on the healthfulness of their own practices.Learning how to strategically engage one's social resources as part of self-care may help people with Parkinson's disease to master managing their health and well-being in daily life.
Collapse
Affiliation(s)
- Linda Tickle-Degnen
- Department of Occupational Therapy, School of Arts & Sciences, Tufts University, Medford, MA, USA
| | - Michael T Stevenson
- Department of Occupational Therapy, School of Arts & Sciences, Tufts University, Medford, MA, USA
| | - Sarah D Gunnery
- Department of Psychology, New England College, Henniker, NH, USA
| | | | - Cathi A Thomas
- Department of Neurology, Boston University Medical Center, Boston, MA, USA
| | | | - Barbara Habermann
- School of Nursing, College of Health Sciences, University of Delaware, Newark, DE, USA
| | - Elena N Naumova
- The Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| |
Collapse
|
45
|
Tian R, Guo Y, Ye P, Zhang C, Luo Y. The validation of the Beijing version of the Montreal Cognitive Assessment in Chinese patients undergoing hemodialysis. PLoS One 2020; 15:e0227073. [PMID: 31917792 PMCID: PMC6952078 DOI: 10.1371/journal.pone.0227073] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 12/10/2019] [Indexed: 11/18/2022] Open
Abstract
Objective Cognitive impairment is common among hemodialysis patient, but still lack adequate screening in clinical settings. The Montreal Cognitive Assessment (MoCA) is reportedly to be a sensitive screening tool for cognitive impairment, but its clinical value in patients undergoing hemodialysis is not well established. We aimed to validate the utility of the Beijing version of the MoCA (MoCA-BJ) for detecting cognitive impairment in comparison to a detailed neuropsychological battery as the gold standard. Methods We assessed 613 patients undergoing hemodialysis using the MoCA-BJ, the Mini-Mental State Examination (MMSE), and a comprehensive neuropsychological battery. Cognitive dysfunction was defined by the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Spearman’s correlation and linear regression were used to estimate the performance of the MoCA-BJ and MMSE in predicting cognitive impairment. A receiver operating characteristic (ROC) curve analysis was used to evaluate the utility of various cutoffs of the MoCA-BJ and MMSE for predicting cognitive impairment. Results Cognitive impairment was diagnosed in 80.91% (496/613), 75.69% (464/613), and 61.34% (376 /613) of the patients using the DSM-V, MoCA-BJ, and MMSE, respectively. Spearman’s rank correlation analysis indicated that the MoCA-BJ was significantly correlated with the neuropsychological battery (rs = 0.639, p<0.001), whereas the MMSE had a weaker correlation with the battery. The area under the ROC curve for cognitive impairment diagnosis using the MoCA-BJ was 0.891 (95% confidence interval: 0.859–0.924) while using the MMSE was 0.823 (95% confidence interval: 0.786–0.860). The optimal MoCA-BJ cutoff score in discriminating patients with and without cognitive impairment was 24 points with a sensitivity of 0.877 and specificity of 0.752. Conclusion The MoCA-BJ offers good sensitivity and specificity levels in detecting cognitive impairment in hemodialysis patients. These findings support the utility of the MoCA-BJ as a screening tool for cognitive impairment in Chinese patients undergoing hemodialysis.
Collapse
Affiliation(s)
- Ru Tian
- Division of Nephrology, Beijing Shijitan Hospital, Capital Medical University, Bejing, China
| | - Yidan Guo
- Division of Nephrology, Beijing Shijitan Hospital, Capital Medical University, Bejing, China
| | - Pengpeng Ye
- Division of Injury Prevention and Mental Health National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Chunxia Zhang
- Division of Nephrology, Beijing Shijitan Hospital, Capital Medical University, Bejing, China
| | - Yang Luo
- Division of Nephrology, Beijing Shijitan Hospital, Capital Medical University, Bejing, China
- * E-mail:
| |
Collapse
|
46
|
Wang B, Shen T, Mao L, Xie L, Fang QL, Wang XP. Establishment of a Risk Prediction Model for Mild Cognitive Impairment among Elderly Chinese. J Nutr Health Aging 2020; 24:255-261. [PMID: 32115605 DOI: 10.1007/s12603-020-1335-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Mild cognitive impairment (MCI) is a transitional stage of cognitive function between normal aging and dementia. Substantial variations in the prevalence of MCI in different countries have been studied including China. In this study, we established a prediction system to assess the risk of MCI among the elderly in China. METHODS The Rothman-Keller model was conducted on the basis of the risk factors of MCI obtained by the combined results of a meta-analysis. The accuracy of the model was verified using actual population data. RESULTS A total of 1826 subjects as a verification set were enrolled in this study in February 2019. There were statistically significant differences in the combined results of 10 risk factors including hypertension, diabetes, educational level, hyperlipidemia, smoking, physical exercise, living alone, stroke, drinking and heart disease (P<0.05). The area under the curve (AUC) of the actual data and the predictive results of this model was 0.859 (95%CI: 0.812-0.906, P<0.05), the sensitivity was 86.6% and the specificity was 76.5%. CONCLUSIONS This model performs an effective prediction that may be applied to the primary prevention for patients with MCI, helping to reduce the risk of MCI.
Collapse
Affiliation(s)
- B Wang
- Xiaoping Wang, Department of Neurology, Shanghai General Hospital of Nanjing Medical University, Tongren Hospital Shanghai Jiao Tong University School of Medicine, No.1111 Xianxia Road, Changning District, Shanghai 200336, P.R China, Tel.: +86 021 52039999, Fax: +86 021 63243755, E-mail:
| | | | | | | | | | | |
Collapse
|
47
|
Siqueira GSA, Hagemann PDMS, Coelho DDS, Santos FHD, Bertolucci PHF. Can MoCA and MMSE Be Interchangeable Cognitive Screening Tools? A Systematic Review. THE GERONTOLOGIST 2019; 59:e743-e763. [PMID: 30517634 DOI: 10.1093/geront/gny126] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Cognitive disorders may be an early sign of neuropsychiatric disorders; however, it remains unclear whether the screening measures are interchangeable. The aim of this study was to contrast the most commonly used screening tools-Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA)-for early detection of neurocognitive disorder (NCD). RESEARCH DESIGN AND METHODS This study presents a descriptive systematic review and informative literature according to the Cochrane Foundation's guidelines. The keywords "Mini-Mental State Examination" and "Montreal Cognitive Assessment" were searched in the Web of Science, SciELO, and LILACS databases. RESULTS Fifty-one studies were selected including a total sample of 11,870 participants (8,360 clinical patients and 3,510 healthy controls). Most studies were published in the past 5 years using a cross-sectional design, carried out across the world. They were organized by age ranges (18-69 years and 20-89 years), years of schooling, and mental status (with and without mental and behavior disorders). Sixteen of 18 studies had participants aged 18-69 years, and 21 out of 33 studies within the older set suggested that the MoCA is a more sensitive tool for detecting NCD. DISCUSSION AND IMPLICATIONS Thirty-seven studies suggested that the MoCA is a more sensitive tool for NCD detection because it assesses executive function and visuospatial abilities. Some individuals who demonstrated normal cognitive function on the MMSE had lower performance on the MoCA. However, it seems necessary to establish different cutoffs based on years of schooling to avoid false positives. Future studies should contrast MoCA with other screening tools designed for NCD assessment.
Collapse
Affiliation(s)
| | | | - Daniela de S Coelho
- Departments of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Flávia Heloísa Dos Santos
- Faculty of Sciences, São Paulo State University (UNESP), Bauru
- Departments of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- Department of Basic Psychology and Methodology, University of Murcia, Murcia, Spain
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Paulo H F Bertolucci
- Departments of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| |
Collapse
|
48
|
Borchers EE, McIsaac TL, Bazan-Wigle JK, Elkins AJ, Bay RC, Farley BG. A physical therapy decision-making tool for stratifying persons with Parkinson's disease into community exercise classes. Neurodegener Dis Manag 2019; 9:331-346. [PMID: 31686582 DOI: 10.2217/nmt-2019-0019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Aim: Physical therapy and exercise are considered essential components in the management of Parkinson's disease (PD). Using our retrospective data and years of experience in assigning persons with PD to multilevel group classes we propose a two-part physical therapy decision-making tool consisting of participant and exercise program considerations. Methods: Retrospective medical record review and therapist consensus identified evaluation considerations determined to aide clinical decision making. The ability of these variables (i.e., demographics, clinical characteristics, clinical measures cut-offs) to predict the class assignment decision of PD-specialized physical therapists was evaluated using discriminant function analysis. Results: Therapist-assigned groups differed significantly on all clinical measures (p < 0.001) which provided the categorical data required for discriminant analysis. Using all variables, the discriminant function analysis predicted class assignment of the therapists with 79% agreement. Conclusion: This proposed tool provides a framework that may guide the process for increasing access to multilevel group classes.
Collapse
Affiliation(s)
- Emily E Borchers
- NeuroFit Networks, Inc. DBA Parkinson Wellness Recovery
- PWR!, 3849 E. Broadway Blvd. STE163, Tucson, AZ 85716, USA
| | - Tara L McIsaac
- Department of Physical Therapy, Arizona School of Health Sciences, A.T. Still University, 5850 E. Still Circle, Mesa, AZ 85206, USA
| | - Jennifer K Bazan-Wigle
- NeuroFit Networks, Inc. DBA Parkinson Wellness Recovery
- PWR!, 3849 E. Broadway Blvd. STE163, Tucson, AZ 85716, USA
| | - Aaron J Elkins
- NeuroFit Networks, Inc. DBA Parkinson Wellness Recovery
- PWR!, 3849 E. Broadway Blvd. STE163, Tucson, AZ 85716, USA
| | - Ralph C Bay
- Department of Interdisciplinary Sciences, Arizona School of Health Sciences, A.T. Still University, 5850 E. Still Circle, Mesa, AZ 85206, USA
| | - Becky G Farley
- NeuroFit Networks, Inc. DBA Parkinson Wellness Recovery
- PWR!, 3849 E. Broadway Blvd. STE163, Tucson, AZ 85716, USA
| |
Collapse
|
49
|
Ringkøbing SP, Larsen IU, Jørgensen K, Vinther-Jensen T, Vogel A. Cognitive Screening Tests in Huntington Gene Mutation Carriers: Examining the Validity of the Mini-Mental State Examination and the Montreal Cognitive Assessment. J Huntingtons Dis 2019; 9:59-68. [PMID: 31658065 DOI: 10.3233/jhd-190350] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Due to high prevalence of cognitive impairment in Huntington's disease (HD) gene mutation carriers, even before onset of motor symptoms, cognitive screening is important for the optimal management of patients. The Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) are widely used, but the validity for HD has only been evaluated in few studies with important limitations. OBJECTIVE To evaluate the discriminative validity of the MMSE and the MoCA for the assessment of cognitive dysfunction in HD gene mutation carriers, independently of motor manifestation and furthermore, to report estimated probabilities for cognitive impairment with different score ranges on the MMSE and the MoCA. METHODS 106 pre-motor-manifest and motor-manifest HD gene mutation carriers and 40 non-HD gene mutation carriers were administered the MMSE, the MoCA, and an extensive neuropsychological battery with operationalized criteria for cognitive impairment. The same physician and the same neuropsychologist performed all examinations; blinded to one another. RESULTS The area under the receiver operating characteristic (ROC) curve was 0.70 for the MMSE and 0.82 for the MoCA. The latter correctly diagnosed 82% of the cognitively impaired and not-impaired HD gene mutation carriers and non-HD gene mutation carriers, whereas the MMSE only diagnosed 73% correctly. CONCLUSIONS The MMSE and the MoCA can both be used as cognitive screening tests in HD gene mutation carriers, but both have important limitations. Our results indicate that the MoCA is a better cognitive screening test for HD than the MMSE. In addition, our study provides estimated probabilities for cognitive impairment with different score ranges, which may be used as clinical guidelines in the interpretation of results from the two tests.
Collapse
Affiliation(s)
- Signe Pertou Ringkøbing
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark
| | - Ida Unmack Larsen
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark
| | - Kasper Jørgensen
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark
| | - Tua Vinther-Jensen
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark
| | - Asmus Vogel
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark.,Department of Psychology, University of Copenhagen, Denmark
| |
Collapse
|
50
|
Saunders-Pullman R, Mirelman A, Alcalay RN, Wang C, Ortega RA, Raymond D, Mejia-Santana H, Orbe-Reilly M, Johannes BA, Thaler A, Ozelius L, Orr-Urtreger A, Marder KS, Giladi N, Bressman SB. Progression in the LRRK2-Asssociated Parkinson Disease Population. JAMA Neurol 2019; 75:312-319. [PMID: 29309488 DOI: 10.1001/jamaneurol.2017.4019] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Few prospective longitudinal studies have evaluated the progression of Parkinson disease (PD) in patients with the leucine-rich repeat kinase 2 (LRRK2 [OMIM 609007]) mutation. Knowledge about such progression will aid clinical trials. Objective To determine whether the longitudinal course of PD in patients with the LRRK2 mutation differs from the longitudinal course of PD in patients without the mutation. Design, Setting, and Participants A prospective comprehensive assessment of a large cohort of patients from 3 sites with LRRK2 PD or with nonmutation PD was conducted from July 21, 2009, to September 30, 2016. All patients of Ashkenazi Jewish ancestry with PD were approached at each site; approximately 80% agreed to an initial visit. A total of 545 patients of Ashkenazi Jewish descent with PD who had 1 to 4 study visits were evaluated. A total of 144 patients (26.4%) had the LRRK2 G2019S mutation. Patients with GBA (OMIM 606463) mutations were excluded from the analysis. Main Outcomes and Measures Linear mixed-effects models for longitudinal motor scores were used to examine the association of LRRK2 mutation status with the rate of change in Unified Parkinson's Disease Rating Scale III scores using disease duration as the time scale, adjusting for sex, site, age, disease duration, cognitive score, and levodopa-equivalent dose at baseline. Mixed-effects models were used to assess change in cognition, as measured by Montreal Cognitive Assessment scores. Results Among the 545 participants, 233 were women, 312 were men, and the mean (SD) age was 68.2 (9.1) years for participants with the LRRK2 mutation and 67.8 (10.7) years for those without it. Seventy-two of 144 participants with the LRRK2 mutation and 161 of 401 participants with no mutation were women. The estimate (SE) of the rate of change in the Unified Parkinson's Disease Rating Scale III motor score per year among those with the LRRK2 mutation (0.689 [0.192] points per year) was less than among those without the mutation (1.056 [0.187] points per year; difference, -0.367 [0.149] points per year; P = .02). The estimate (SE) of the difference in the rate of change of the Montreal Cognitive Assessment score between those with the LRRK2 mutation (-0.096 [0.090] points per year) and those without the mutation (-0.192 [0.102] points per year) did not reach statistical significance (difference, 0.097 [0.055] points per year; P = .08). Conclusions and Relevance Prospective longitudinal follow-up of patients with PD with or without the LRRK2 G2019S mutation supports data from a cross-sectional study and demonstrates a slower decline in motor Unified Parkinson's Disease Rating Scale scores among those with LRRK2 G2019S-associated PD.
Collapse
Affiliation(s)
- Rachel Saunders-Pullman
- Department of Neurology, Mount Sinai Beth Israel Medical Center, New York, New York.,Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anat Mirelman
- Movement Disorders Unit, Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Sagol School for Neuroscience, Tel Aviv University, Tel Aviv, Israel.,Department of Physical Therapy, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Roy N Alcalay
- Department of Neurology, College of Physicians and Surgeons, New York, New York
| | - Cuiling Wang
- Department of Neurology, College of Physicians and Surgeons, New York, New York.,Department of Epidemiology and Family Health, Albert Einstein College of Medicine, Yeshiva University, Bronx, New York.,Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, Bronx, New York
| | - Roberto A Ortega
- Department of Neurology, Mount Sinai Beth Israel Medical Center, New York, New York.,Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Deborah Raymond
- Department of Neurology, Mount Sinai Beth Israel Medical Center, New York, New York.,Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Brooke A Johannes
- Department of Neurology, Mount Sinai Beth Israel Medical Center, New York, New York.,Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Avner Thaler
- Movement Disorders Unit, Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Sagol School for Neuroscience, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Laurie Ozelius
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Avi Orr-Urtreger
- Movement Disorders Unit, Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Sagol School for Neuroscience, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.,Genetic Institute, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Karen S Marder
- Department of Neurology, College of Physicians and Surgeons, New York, New York.,Taub Institute for Alzheimer's Disease and the Aging Brain, Columbia University, New York, New York
| | - Nir Giladi
- Movement Disorders Unit, Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Sagol School for Neuroscience, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Susan B Bressman
- Department of Neurology, Mount Sinai Beth Israel Medical Center, New York, New York.,Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | | |
Collapse
|