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Culicetto L, Formica C, Lo Buono V, Latella D, Maresca G, Brigandì A, Sorbera C, Di Lorenzo G, Quartarone A, Marino S. Possible Implications of Managing Alexithymia on Quality of Life in Parkinson's Disease: A Systematic Review. PARKINSON'S DISEASE 2024; 2024:5551796. [PMID: 39228428 PMCID: PMC11371456 DOI: 10.1155/2024/5551796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 06/17/2024] [Accepted: 08/16/2024] [Indexed: 09/05/2024]
Abstract
Alexithymia, characterized by difficulty in recognizing and verbalizing emotions, is reported to be more prevalent in subjects with Parkinson's disease (PD) than in the general population. Although it is one of the nonmotor symptoms of PD, alexithymia is often overlooked in clinical practice. The aim of this systematic review is to investigate the prevalence of alexithymia in PD, assess its impact on quality of life, and explore the rehabilitation approaches for alexithymia. Research articles, selected from PubMed, Scopus, and Web of Science, were limited to those published in English from 2013 to 2023. The search terms combined were "Alexithymia," "Parkinson's disease,", and "Quality of life." Current literature review indicates that alexithymia is commonly assessed using the Toronto Alexithymia Scale (TAS-20), and it is associated with deficits in visuospatial and executive functions. Presently, rehabilitation interventions for alexithymia are scarce, and their effectiveness remains controversial. Future research should focus on developing comprehensive assessments and rehabilitation strategies for emotional processing, considering its significant impact on the quality of life of both patients and caregivers.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Silvia Marino
- IRCCS Centro Neurolesi “Bonino Pulejo”, Messina, Italy
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2
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Sagar R, Talwar S, Desai G, Chaturvedi SK. Relationship between alexithymia and depression: A narrative review. Indian J Psychiatry 2021; 63:127-133. [PMID: 34194055 PMCID: PMC8214133 DOI: 10.4103/psychiatry.indianjpsychiatry_738_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 04/10/2020] [Accepted: 02/28/2021] [Indexed: 12/04/2022] Open
Abstract
Alexithymia has been described as difficulty in expressing as well as experiencing feelings. It has been studied in relation with medical as well as psychological conditions and has been seen to impact treatment outcomes. The current review focuses on the relationship of alexithymia with depression and the role of culture in this relationship. The keywords for literature included terms such as depression, alexithymia, depression and alexithymia, Toronto Alexithymia Scale, assessing alexithymia and depression, and alexithymia as a trait. The main findings of the review were that alexithymia and depression are highly correlated, and severity of depression and gender are independently associated with alexithymia and may interfere with treatment outcomes.
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Affiliation(s)
- Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Shivangi Talwar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Geetha Desai
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Santosh K Chaturvedi
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Arroyo-Anlló EM, Souchaud C, Ingrand P, Chamorro Sánchez J, Melero Ventola A, Gil R. Alexithymia in Alzheimer's Disease. J Clin Med 2020; 10:jcm10010044. [PMID: 33375608 PMCID: PMC7795069 DOI: 10.3390/jcm10010044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 11/16/2022] Open
Abstract
Alexithymia is widely recognized as the inability to identify and express emotions. It is a construct which consists of four cognitive traits such as difficulty in identifying feelings, describing feelings to others, externally oriented thinking, and limited imaginative capacity. Several studies have linked alexithymia to cognitive functioning, observing greater alexithymia scores associated with poorer cognitive abilities. Despite Alzheimer's disease (AD) being a neurodegenerative pathology characterized by cognitive troubles from the early stages, associated to behavioral and emotional disturbances, very few investigations have studied the alexithymia in AD. These studies have shown that alexithymia scores-assessed with Toronto Alexithymia Scale (TAS)-were greater in AD patients than healthy participants. The objective of the study was to investigate if the alexithymia was present in patients with mild AD. We hypothesized that the AD group would show more alexithymia features than the control group. We evaluated 54 subjects, including 27 patients diagnosed with mild AD and 27 normal healthy controls, using the Shalling Sifneos Psychosomatic Scale (SSPS-R) and a neuropsychological test battery. Using non-parametric statistical analyses-Wilcoxon and Mann-Whitney U tests-we observed that the SSPS-R scores were similar in the AD and control groups. All participants showed SSPS-R scores below to 10 points, which means no-alexithymia. We did not find significant correlations between SSPS-R scores and cognitive variables in both groups (p > 0.22), but we observed a negative association between name abilities and alexithymia, but it does not reach to significance (p = 0.07). However, a significant correlation between SSPS-R score and mood state, assessed using Zerssen Rating Scale, was found in both groups (p = 0.01). Because we did not find a significant difference in the alexithymia assessment between both subject groups, pot hoc analyses were computed for each item of the SSPS-R. We made comparisons of alexithymic responses percentages in each SSPS-R item between AD and control groups, using Fisher's test. We observed that AD patients produced more alexithymic responses in some items of SSPS-R test than the control group, particularly about difficulties to find the words to describe feelings, as well as difficulties of imagination capacity and externally oriented thinking. The present results do not confirm our hypothesis and they do not support the results of previous studies revealing great alexithymia in AD.
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Affiliation(s)
- Eva Mª Arroyo-Anlló
- Department of Psychobiology, Neuroscience Institute of Castilla-León, University of Salamanca, 37007 Salamanca, Spain
- Correspondence: ; Tel.: +34-629460944
| | - Corinne Souchaud
- Department of Neurology and Neuropsychology, University Hospital, CHU La Milétrie, 86000 Poitiers, France;
| | - Pierre Ingrand
- Department of Biostatistics, University of Poitiers, 86000 Poitiers, France;
| | - Jorge Chamorro Sánchez
- Faculty of Psychology, Pontifical University of Salamanca, 37002 Salamanca, Spain; (J.C.S.); (A.M.V.)
| | - Alejandra Melero Ventola
- Faculty of Psychology, Pontifical University of Salamanca, 37002 Salamanca, Spain; (J.C.S.); (A.M.V.)
| | - Roger Gil
- Department of Neurology, University Hospital, 86000 Poitiers, France;
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Alvarado-Bolaños A, Cervantes-Arriaga A, Zuazua-Vidal L, Esquivel-Zapata Ó, Alcocer-Salas Á, Rodríguez-Violante M. Determinants and impact of alexithymia on quality of life in Parkinson's disease. Neurologia 2020; 38:S0213-4853(20)30338-8. [PMID: 33317969 DOI: 10.1016/j.nrl.2020.10.012] [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: 07/22/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Alexithymia is a neuropsychiatric symptom conceptualized as difficulty identifying and describing feelings. Although associated with other non-motor symptoms, mainly neuropsychiatric, alexithymia may present as an isolated symptom in persons with Parkinson's Disease (PwP). The objective of the study is to identify determinants of alexithymia and its association with quality of life (QoL) in Parkinson's disease. METHODS Subjects with Parkinson's disease were recruited. The following instruments were applied: Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Non-Motor Symptoms Scale (NMSS), Montreal Cognitive Assessment (MoCA), Toronto alexithymia scale (TAS-20) and Parkinson's Disease Questionnaire (PDQ-8). Matched healthy controls were screened using TAS-20. Clinical and demographical variables were compared between alexithymic and non-alexithymic. Regression models were used to find determinants of alexithymia. Impact of alexithymia on QoL was estimated with a linear regression model. RESULTS 98 patients were included. 56.1% PwP and 28.8% controls were alexithymic (p<0.001). Education level (OR 0.86) and NMSS urinary score (OR 1.09) determined alexithymia as well as TAS-20 score. Alexithymia was an independent determinant of QoL. CONCLUSIONS Alexithymia is a prevalent independent non-motor symptom in PwP with impact on QoL. Low education level and urinary symptoms are important determinants of alexithymia.
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Affiliation(s)
- A Alvarado-Bolaños
- Clinical Neurodegenerative Research Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - A Cervantes-Arriaga
- Clinical Neurodegenerative Research Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - L Zuazua-Vidal
- Clinical Neurodegenerative Research Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Ó Esquivel-Zapata
- Clinical Neurodegenerative Research Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Á Alcocer-Salas
- Clinical Neurodegenerative Research Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - M Rodríguez-Violante
- Clinical Neurodegenerative Research Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico; Movement Disorder Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.
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Palmeri R, Lo Buono V, Bonanno L, Allone C, Drago N, Sorbera C, Cimino V, di Lorenzo G, Bramanti A, Marino S. Impaired Recognition of Facial Emotion in Patients With Parkinson Disease Under Dopamine Therapy. J Geriatr Psychiatry Neurol 2020; 33:265-271. [PMID: 31635513 DOI: 10.1177/0891988719882094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Parkinson disease (PD) is a neurodegenerative disorder characterized by motor and nonmotor symptoms. The impaired ability to recognize facial emotion expressions represents an important nonmotor symptom. The aim of this study is to investigate the ability in recognizing facial emotion expressions in patients with PD under dopamine replacement therapy. METHODS Thirty medicated patients with PD and 15 healthy controls (HC) were enrolled. All participants performed the Ekman 60-Faces test for emotional recognition. All patients underwent a neuropsychological evaluation for global cognitive functioning, depression, and anxiety. RESULTS Patients with PD were impaired in recognizing emotions. Significant differences between PD and HC were found in Ekman 60-Faces test scores (P < .001), and in Ekman 60-Faces test subscales, in particular, sadness, fear, disgust, anger, and surprise (P < .001). CONCLUSIONS The nigrostriatal dopaminergic depletion seems to determine emotional information processing dysfunction. This relevant nonmotor symptom could have consequences in daily living reducing interactions and social behavioral competence.
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Affiliation(s)
| | | | - Lilla Bonanno
- IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | | | - Nancy Drago
- IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | | | | | | | | | - Silvia Marino
- IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
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6
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Sengul Y, Sengul HS, Gokcal E, Ustun I, Ozturk A, Yilmaz O, Yildiz GB, Louis ED. Alexithymia is a non motor symptom of essential tremor regardless of the presence of depression and anxiety. Neurol Res 2020; 42:946-951. [PMID: 32657241 DOI: 10.1080/01616412.2020.1792702] [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] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Essential tremor (ET) is one of the most common movement disorders. Aside from tremor, patients may exhibit other motor features as well as non-motor features, including neuropsychiatric symptoms. The cerebellum and cerebellar connections are thought to play a key role in the pathophysiology of ET. Cognitive and affective disturbances can occur in the context of cerebellar disease. Our aim was to study the prevalence and clinical correlates of alexithymia and its relationship to depression and anxiety in ET patients and control subjects (CS). METHOD We enrolled 100 ET patients and 100 age- and gender-matched CS. The Toronto Alexithymia Scale-20 (TAS-20), the Beck depression inventory-II and the Beck anxiety inventory were administered. RESULTS Alexithymia levels were significantly higher in ET patients than CS (respective mean TAS-20 scores = 50.63 ± 9.79 vs. 44.05 ± 12.51, p < 0.001). There were robust associations between alexithymia, depressive symptoms, and anxiety but, after excluding the ET patients and the CS who had moderate or severe depression or who had moderate or severe anxiety, the total alexithymia score remained significantly higher in the ET than the CS group (46.78 ± 9.19 vs. 41.18 ± 11.79, p ≤ 0.01). CONCLUSION This study suggests that prevalence of alexithymia is significantly higher in ET patients. Alexithymia might be another non-motor neuropsychiatric symptom of the disease. Further studies are needed to confirm and expand upon our findings.
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Affiliation(s)
- Yildizhan Sengul
- Department of Neurology, Faculty of Medicine, Bezmialem Foundation University, IST , City of Istanbul, TR.,Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University , New Haven, CT, USA
| | - Hakan Serdar Sengul
- Department of Psychiatry, GOP Taksim Research and Training Hospital, IST , City of Istanbul, TR
| | - Elif Gokcal
- Department of Neurology, Faculty of Medicine, Bezmialem Foundation University, IST , City of Istanbul, TR
| | - Ismet Ustun
- Department of Neurology, Faculty of Medicine, Bezmialem Foundation University, IST , City of Istanbul, TR
| | - Ahmet Ozturk
- Department of Psychiatry, Faculty of Medicine, Bezmialem Foundation University, IST , City of Istanbul, TR
| | - Onur Yilmaz
- Department of Psychiatry, Faculty of Medicine, Bezmialem Foundation University, IST , City of Istanbul, TR
| | - Gulsen B Yildiz
- Department of Neurology, Faculty of Medicine, Bezmialem Foundation University, IST , City of Istanbul, TR
| | - Elan D Louis
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern , Dallas TX, USA
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Alexithymia Is Associated with Reduced Quality of Life and Increased Caregiver Burden in Parkinson's Disease. Brain Sci 2020; 10:brainsci10060401. [PMID: 32599704 PMCID: PMC7348697 DOI: 10.3390/brainsci10060401] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/21/2020] [Accepted: 06/22/2020] [Indexed: 12/19/2022] Open
Abstract
Parkinson's disease (PD) is the second most frequent neurodegenerative disease of people who are beyond 50 years of age. People with PD (PwP) suffer from a large variety of motor and non-motor symptoms resulting in reduced health-related quality of life (HR-QoL). In the last two decades, alexithymia was identified as an additional non-motor symptom in PD. Alexithymia is defined as a cognitive affective disturbance resulting in difficulty to identify and distinguish feelings from bodily sensations of emotional arousal. In PD, the frequency of patients suffering of alexithymia is increased compared to healthy controls. The aim of the present study was to determine the relationship of alexithymia to HR-QoL of the PwP and caregiver burden of the corresponding caregiver. This cross-sectional questionnaire-based study used disease specific questionnaires for HR-QoL and caregiver burden. In total 119 PwP and their corresponding caregivers were included in the study. HR-QoL of the PwP correlated significantly with alexithymia (p < 0.001), especially the sub-components "identifying feelings" (p < 0.001) and "difficulties describing feelings" (p = 0.001). Caregiver burden also correlated significantly with PwP alexithymia (p < 0.001). However, caregiver burden was associated with sub-components "identifying feelings" (p < 0.008) and "external oriented thinking" (p < 0.004). These data support the importance of alexithymia as a non-motor symptom in PD.
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8
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Salas Muñoz RM, López Morales P, Fernández Jiménez AJ. Valoración de los niveles de alexitimia en pacientes en hemodiálisis. ENFERMERÍA NEFROLÓGICA 2019. [DOI: 10.4321/s2254-28842019000400008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCCIÓN La alexitimia es una alteración del estado de ánimo que se manifiesta en forma de dificultad para tomar conciencia sobre los propios sentimientos y fantasías, así como para poder expresarlos verbalmente. Ha sido relacionada con el desarrollo de otras patologías y con la presencia de enfermedades crónicas. En el caso particular de la insuficiencia renal, se ha relacionado con una peor adherencia al tratamiento y mayor riesgo de mortalidad. Por ello, nos planteamos valorar su presencia en un grupo de pacientes en hemodiálisis en nuestro centro. MÉTODO Muestra de 63 pacientes en hemodiálisis, hombres y mujeres, con edades entre 22 y 83 años. Se recogió también el tiempo que cada uno llevaba en tratamiento en hemodiálisis. Estudio descriptivo de corte transversal con datos recogidos entre febrero y abril de 2019. Se aplicó individualmente la Escala de Alexitimia de Toronto. Se cuantificaron los valores de frecuencia para las puntuaciones obtenidas en el test y se realizaron comparaciones de medias para sexo, edad y tiempo en diálisis. RESULTADOS Encontramos que un 22,2% de la muestra (14 sujetos) muestra valores de alexitimia clínicamente relevantes. No se encontraron diferencias significativas en los puntajes de alexitimia según el sexo, edad o tiempo en diálisis. CONCLUSIONES Los hallazgos de este estudio permiten concluir que casi una cuarta parte de los pacientes en diálisis presenta alexitimia, alertando sobre la necesidad de que estas personas reciban tratamiento psicológico especializado.
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Assogna F, Pellicano C, Cravello L, Savini C, Pierantozzi M, Mercuri B, Caltagirone C, Pontieri FE, Spalletta G, Stefani A. Psychiatric profile of motor subtypes of de novo drug-naïve Parkinson's disease patients. Brain Behav 2018; 8:e01094. [PMID: 30160376 PMCID: PMC6192407 DOI: 10.1002/brb3.1094] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 07/03/2018] [Accepted: 07/17/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Parkinson's disease (PD) is a heterogeneous neurodegenerative disorder. It is well established that different motor subtypes of PD evolve with different clinical courses and prognoses. The complete psychiatric profile underlying these different phenotypes since the very early stage of the disease is debated. AIMS OF THE STUDY We aimed at investigating the psychiatric profile of the three motor subtypes of PD (akinetic-rigid, tremor-dominant, and mixed) in de novo drug-naïve patients with PD. METHODS Sixty-eight patients with PD, divided into 39 akinetic-rigid (AR), seven mixed (MIX), and 22 tremor-dominant (TD) patients underwent a complete assessment of psychiatric, cognitive, and motor symptoms. RESULTS No significant differences were found among groups. CONCLUSIONS Our results suggest that a differentiation of the psychiatric symptoms associated with specific motor subtypes of PD is not detectable in de novo drug-naïve patients. Previous evidence that emerges later along the disease progression may be a consequence of the dopaminergic and nondopaminergic damage increase.
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Affiliation(s)
- Francesca Assogna
- Centro Fermi - Museo Storico della Fisica e Centro Studi e Ricerche "Enrico Fermi", Rome, Italy.,Fondazione Santa Lucia IRCCS, Rome, Italy
| | - Clelia Pellicano
- Fondazione Santa Lucia IRCCS, Rome, Italy.,Department of Neuroscience, Movement Disorder Service, "Sant'Andrea" Hospital, Mental Health and Sensory Organs - NESMOS, "Sapienza" University, Rome, Italy
| | | | | | | | - Bruno Mercuri
- Neurology Unit, "San Giovanni Addolorata" Hospital, Rome, Italy
| | - Carlo Caltagirone
- Fondazione Santa Lucia IRCCS, Rome, Italy.,Department of Medicine of Systems, University "Tor Vergata", Rome, Italy
| | - Francesco E Pontieri
- Fondazione Santa Lucia IRCCS, Rome, Italy.,Department of Neuroscience, Movement Disorder Service, "Sant'Andrea" Hospital, Mental Health and Sensory Organs - NESMOS, "Sapienza" University, Rome, Italy
| | | | - Alessandro Stefani
- Department of Medicine of Systems, University "Tor Vergata", Rome, Italy
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Dafsari HS, Ray-Chaudhuri K, Mahlstedt P, Sachse L, Steffen JK, Petry-Schmelzer JN, Dembek TA, Reker P, Barbe MT, Visser-Vandewalle V, Fink GR, Timmermann L. Beneficial effects of bilateral subthalamic stimulation on alexithymia in Parkinson's disease. Eur J Neurol 2018; 26:222-e17. [PMID: 30107062 DOI: 10.1111/ene.13773] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 08/09/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE Subthalamic nucleus (STN) deep brain stimulation (DBS) improves quality of life (QoL) and motor and non-motor symptoms in advanced Parkinson's disease (PD). However, its effect on alexithymia and its relationship to other neuropsychiatric symptoms and QoL in PD is unclear. METHODS In this prospective, observational study of 39 patients with PD undergoing STN-DBS, we examined the Parkinson's Disease Questionnaire-8 (PDQ-8), 20-item Toronto Alexithymia Scale (TAS-20), Hospital Anxiety and Depression Scale (HADS), Self-Report Manic Inventory (SRMI), Apathy Evaluation Scale (AES), Unified Parkinson's Disease Rating Scale (UPDRS) activities of daily living, UPDRS motor examination and UPDRS complications (UPDRS-II/-III/-IV) and levodopa-equivalent daily dose (LEDD) pre-operatively and at 5-month follow-up. Outcome changes were tested with Wilcoxon signed-rank or paired t-test when parametric tests were applicable and corrected for multiple comparisons. The relationship between outcome changes was explored with bivariate correlations. Additionally, partial correlations between PDQ-8 and TAS-20 were computed controlling for HADS, SRMI and AES change scores. Predictor analyses for PDQ-8 improvement were calculated for all baseline parameters. RESULTS The baseline prevalence of alexithymia was 17.9%. We observed significant beneficial effects of STN-DBS on PDQ-8, TAS-20, HADS, UPDRS-II, -III and -IV scores and significant LEDD reduction. The correlation between TAS-20 and PDQ-8 improvements remained significant after controlling for all other aforementioned outcomes. Predictor analyses for PDQ-8 improvement were significant for PDQ-8 and TAS-20. CONCLUSIONS This is the first report of beneficial effects of STN-DBS on alexithymia. Alexithymia was significantly associated with QoL outcome independent of anxiety, depression, mania and apathy. Our study highlights the importance of alexithymia for holistic assessments of DBS outcomes.
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Affiliation(s)
- H S Dafsari
- Department of Neurology, University Hospital Cologne, Cologne, Germany.,National Parkinson Foundation Centre of Excellence, King's College Hospital, London, UK
| | - K Ray-Chaudhuri
- National Parkinson Foundation Centre of Excellence, King's College Hospital, London, UK
| | - P Mahlstedt
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - L Sachse
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - J K Steffen
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | | | - T A Dembek
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - P Reker
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - M T Barbe
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - V Visser-Vandewalle
- Department of Stereotaxy and Functional Neurosurgery, University Hospital Cologne, Cologne
| | - G R Fink
- Department of Neurology, University Hospital Cologne, Cologne, Germany.,Cognitive Neuroscience Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - L Timmermann
- Department of Neurology, University Hospital Cologne, Cologne, Germany.,Department of Neurology, University Hospital Giessen and Marburg, Campus Marburg, Germany
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Titova N, Chaudhuri KR. Personalized Medicine and Nonmotor Symptoms in Parkinson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 134:1257-1281. [DOI: 10.1016/bs.irn.2017.05.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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12
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Costa A, Caltagirone C. Alexithymia in Parkinson's disease: a point of view on current evidence. Neurodegener Dis Manag 2016; 6:215-22. [PMID: 27230483 DOI: 10.2217/nmt-2016-0001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The risk of alexithymia in individuals with Parkinson's disease (PD) is about double compared with that observed in the general population. This finding indicates that alexithymia may be a relevant phenomenon in PD. However, several issues have to be clarified. The review here proposed outlines two main points. First, available data do not allow the clarification of whether alexithymia is independently associated with PD or if it is secondary to other mood and/or cognitive disorders. Second, it is not well understood how PD-related neurobiological changes may account for alexithymic expression. Our examination of extant literature also evidenced some potential limits of current tools and designs used that should carefully taken into account in further investigations of above issues.
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Affiliation(s)
- Alberto Costa
- 'Niccolò Cusano' University, Via Don Carlo Gnocchi, 3, 00166, Rome, Italy.,IRCCS Fondazione Santa Lucia, Via Ardeatina, 306, 00179, Rome, Italy
| | - Carlo Caltagirone
- IRCCS Fondazione Santa Lucia, Via Ardeatina, 306, 00179, Rome, Italy.,Dipartimento di Medicina dei Sistemi, 'Tor Vergata' Rome University, Via Montpellier, 1, 00133, Rome, Italy
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13
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Enrici I, Adenzato M, Ardito RB, Mitkova A, Cavallo M, Zibetti M, Lopiano L, Castelli L. Emotion processing in Parkinson's disease: a three-level study on recognition, representation, and regulation. PLoS One 2016. [PMID: 26110271 DOI: 10.1371/journal.pone.013147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Parkinson's disease (PD) is characterised by well-known motor symptoms, whereas the presence of cognitive non-motor symptoms, such as emotional disturbances, is still underestimated. One of the major problems in studying emotion deficits in PD is an atomising approach that does not take into account different levels of emotion elaboration. Our study addressed the question of whether people with PD exhibit difficulties in one or more specific dimensions of emotion processing, investigating three different levels of analyses, that is, recognition, representation, and regulation. METHODOLOGY Thirty-two consecutive medicated patients with PD and 25 healthy controls were enrolled in the study. Participants performed a three-level analysis assessment of emotional processing using quantitative standardised emotional tasks: the Ekman 60-Faces for emotion recognition, the full 36-item version of the Reading the Mind in the Eyes (RME) for emotion representation, and the 20-item Toronto Alexithymia Scale (TAS-20) for emotion regulation. PRINCIPAL FINDINGS Regarding emotion recognition, patients obtained significantly worse scores than controls in the total score of Ekman 60-Faces but not in any other basic emotions. For emotion representation, patients obtained significantly worse scores than controls in the RME experimental score but no in the RME gender control task. Finally, on emotion regulation, PD and controls did not perform differently at TAS-20 and no specific differences were found on TAS-20 subscales. The PD impairments on emotion recognition and representation do not correlate with dopamine therapy, disease severity, or with the duration of illness. These results are independent from other cognitive processes, such as global cognitive status and executive function, or from psychiatric status, such as depression, anxiety or apathy. CONCLUSIONS These results may contribute to better understanding of the emotional problems that are often seen in patients with PD and the measures used to test these problems, in particular on the use of different versions of the RME task.
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Affiliation(s)
- Ivan Enrici
- Department of Philosophy and Educational Sciences, University of Turin, Turin, Italy; Center for Cognitive Science, University of Turin, Turin, Italy; Neuroscience Institute of Turin, Turin, Italy
| | - Mauro Adenzato
- Center for Cognitive Science, University of Turin, Turin, Italy; Neuroscience Institute of Turin, Turin, Italy; Department of Psychology, University of Turin, Turin, Italy
| | - Rita B Ardito
- Center for Cognitive Science, University of Turin, Turin, Italy; Department of Psychology, University of Turin, Turin, Italy
| | | | - Marco Cavallo
- eCampus University, Novedrate, Como, Italy; Azienda Sanitaria Locale Torino 3, Turin, Italy
| | | | - Leonardo Lopiano
- Neuroscience Institute of Turin, Turin, Italy; Department of Neuroscience, University of Turin, Turin, Italy
| | - Lorys Castelli
- Department of Psychology, University of Turin, Turin, Italy
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Assogna F, Cravello L, Orfei MD, Cellupica N, Caltagirone C, Spalletta G. Alexithymia in Parkinson's disease: A systematic review of the literature. Parkinsonism Relat Disord 2016; 28:1-11. [PMID: 27086264 DOI: 10.1016/j.parkreldis.2016.03.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 02/29/2016] [Accepted: 03/28/2016] [Indexed: 01/23/2023]
Abstract
INTRODUCTION In this systematic review, we aimed to evaluate the role of alexithymia in Parkinson's disease (PD) and its relationship to neurological, neuropsychiatric, cognitive, and neuroimaging correlates. METHODS The database was selected using PubMed Services, Cochrane, PsycNET and Scopus and a number of key words. Further studies were sought by manually searching for secondary sources, including relevant journals and references in primary articles. The search was restricted to articles written in English between January 1980 and August 2015. RESULTS Ten studies reported that alexithymia prevalence was about double in PD patients compared to control subjects and that specific dimensions of alexithymia might be related to depression, anxiety, apathy and impulsivity. Some studies investigated the relationship between alexithymia and neuropsychological symptoms and found correlations with frontal and parietal lobe functions. Two studies on neurological features reported a link between alexithymia and disease stage or a specific motor subtype of PD; the remaining studies found that alexithymia was independent from neurological symptoms, dopaminergic therapy and laterality of motor symptom onset. Data on neuroimaging correlates and therapeutic intervention on alexithymia in PD patients are still lacking. CONCLUSION Although results suggest that alexithymia is a primary characteristics of PD, further studies with larger patient samples are needed to definitively clarify the impact of alexithymia on the clinical features of PD patients.
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Affiliation(s)
| | - Luca Cravello
- I.R.C.C.S. Santa Lucia Foundation, Rome, Italy; ASST-Rhodense, Rho, Milan, Italy
| | | | | | - Carlo Caltagirone
- I.R.C.C.S. Santa Lucia Foundation, Rome, Italy; Department of Medicine of Systems, University "Tor Vergata", Rome, Italy
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15
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Diederich NJ, Goldman JG, Stebbins GT, Goetz CG. Failing as doorman and disc jockey at the same time: Amygdalar dysfunction in Parkinson's disease. Mov Disord 2015; 31:11-22. [PMID: 26650182 DOI: 10.1002/mds.26460] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 09/20/2015] [Accepted: 09/23/2015] [Indexed: 02/01/2023] Open
Abstract
In Braak's model of ascending degeneration in Parkinson's disease (PD), involvement of the amygdala occurs simultaneously with substantia nigra degeneration. However, the clinical manifestations of amygdalar involvement in PD have not been fully delineated. Considered a multitask manager, the amygdala is a densely connected "hub," coordinating and integrating tasks ranging from prompt, multisensorial emotion recognition to adequate emotional responses and emotional tuning of memories. Although phylogenetically predisposed to handle fear, the amygdala handles both aversive and positive emotional inputs. In PD, neuropathological and in vivo studies suggest primarily amygdalar hypofunction. However, as dopamine acts as an inverted U-shaped amygdalar modulator, medication-induced hyperactivity of the amygdala can occur. We propose that amygdalar (network) dysfunction contributes to reduced recognition of negative emotional face expressions, impaired theory of mind, reactive hypomimia, and impaired decision making. Similarly, impulse control disorders in predisposed individuals, hallucinations, anxiety, and panic attacks may be related to amygdalar dysfunction. When available, we discuss amygdala-independent trigger mechanisms of these symptoms. Although dopaminergic agents have mostly an activation effect on amygdalar function, adaptive and compensatory network changes may occur as well, but these have not been sufficiently explored. In conclusion, our model of amygdalar involvement brings together several elements of Parkinson's disease phenomenology heretofore left unexplained and provides a framework for testable hypotheses in patients during life and in autopsy analyses.
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Affiliation(s)
- Nico J Diederich
- Department of Neurosciences, Centre Hospitalier de Luxembourg, Luxembourg-City, Luxembourg.,Centre for Systems Biomedicine, University of Luxembourg, Campus Esch-Belval, Esch-s.-Alzette, Luxembourg.,Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Jennifer G Goldman
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Glenn T Stebbins
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Christopher G Goetz
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
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16
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Reduced facial expressiveness in Parkinson's disease: A pure motor disorder? J Neurol Sci 2015; 358:125-30. [DOI: 10.1016/j.jns.2015.08.1516] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Revised: 08/04/2015] [Accepted: 08/21/2015] [Indexed: 11/22/2022]
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17
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The range and nature of non-motor symptoms in drug-naive Parkinson's disease patients: a state-of-the-art systematic review. NPJ PARKINSONS DISEASE 2015; 1:15013. [PMID: 28725682 PMCID: PMC5516558 DOI: 10.1038/npjparkd.2015.13] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 05/16/2015] [Accepted: 06/03/2015] [Indexed: 12/21/2022]
Abstract
Non-motor symptoms (NMS) are a key component of Parkinson’s disease (PD). A range of NMS, most notably impaired sense of smell, sleep dysfunction, and dysautonomia are present from the ‘pre-motor’ phase to the final palliative stage. Theories as to the pathogenesis of PD such as those proposed by Braak and others also support the occurrence of NMS in PD years before motor symptoms start. However, research addressing the range and nature of NMS in PD has been confounded by the fact that many NMS arise as part of drug-related side effects. Thus, drug-naive PD (DNPD) patients provide an ideal population to study the differences in the presentation of NMS. The aim of this paper is therefore to systematically review all the available studies of NMS in DNPD patients. We believe this is the first review of its kind. The current review confirms the increasing research being conducted into NMS in DNPD patients as well as the necessity for further investigation into less-studied NMS, such as pain. Moreover, the data confirms non-motor heterogeneity among PD patients, and, therefore, further research into the concept of non-motor subtyping is encouraged. The review suggests that the clinical assessment of NMS should be integral to any assessment of PD in clinical and research settings.
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Enrici I, Adenzato M, Ardito RB, Mitkova A, Cavallo M, Zibetti M, Lopiano L, Castelli L. Emotion processing in Parkinson's disease: a three-level study on recognition, representation, and regulation. PLoS One 2015; 10:e0131470. [PMID: 26110271 PMCID: PMC4482447 DOI: 10.1371/journal.pone.0131470] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 06/02/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Parkinson's disease (PD) is characterised by well-known motor symptoms, whereas the presence of cognitive non-motor symptoms, such as emotional disturbances, is still underestimated. One of the major problems in studying emotion deficits in PD is an atomising approach that does not take into account different levels of emotion elaboration. Our study addressed the question of whether people with PD exhibit difficulties in one or more specific dimensions of emotion processing, investigating three different levels of analyses, that is, recognition, representation, and regulation. METHODOLOGY Thirty-two consecutive medicated patients with PD and 25 healthy controls were enrolled in the study. Participants performed a three-level analysis assessment of emotional processing using quantitative standardised emotional tasks: the Ekman 60-Faces for emotion recognition, the full 36-item version of the Reading the Mind in the Eyes (RME) for emotion representation, and the 20-item Toronto Alexithymia Scale (TAS-20) for emotion regulation. PRINCIPAL FINDINGS Regarding emotion recognition, patients obtained significantly worse scores than controls in the total score of Ekman 60-Faces but not in any other basic emotions. For emotion representation, patients obtained significantly worse scores than controls in the RME experimental score but no in the RME gender control task. Finally, on emotion regulation, PD and controls did not perform differently at TAS-20 and no specific differences were found on TAS-20 subscales. The PD impairments on emotion recognition and representation do not correlate with dopamine therapy, disease severity, or with the duration of illness. These results are independent from other cognitive processes, such as global cognitive status and executive function, or from psychiatric status, such as depression, anxiety or apathy. CONCLUSIONS These results may contribute to better understanding of the emotional problems that are often seen in patients with PD and the measures used to test these problems, in particular on the use of different versions of the RME task.
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Affiliation(s)
- Ivan Enrici
- Department of Philosophy and Educational Sciences, University of Turin, Turin, Italy
- Center for Cognitive Science, University of Turin, Turin, Italy
- Neuroscience Institute of Turin, Turin, Italy
| | - Mauro Adenzato
- Center for Cognitive Science, University of Turin, Turin, Italy
- Neuroscience Institute of Turin, Turin, Italy
- Department of Psychology, University of Turin, Turin, Italy
- * E-mail:
| | - Rita B. Ardito
- Center for Cognitive Science, University of Turin, Turin, Italy
- Department of Psychology, University of Turin, Turin, Italy
| | | | - Marco Cavallo
- eCampus University, Novedrate, Como, Italy
- Azienda Sanitaria Locale Torino 3, Turin, Italy
| | | | - Leonardo Lopiano
- Neuroscience Institute of Turin, Turin, Italy
- Department of Neuroscience, University of Turin, Turin, Italy
| | - Lorys Castelli
- Department of Psychology, University of Turin, Turin, Italy
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Ostergaard SD, Petrides G, Dinesen PT, Skadhede S, Bech P, Munk-Jørgensen P, Nielsen J. The association between physical morbidity and subtypes of severe depression. PSYCHOTHERAPY AND PSYCHOSOMATICS 2013; 82:45-52. [PMID: 23147239 DOI: 10.1159/000337746] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 03/02/2012] [Indexed: 01/13/2023]
Abstract
BACKGROUND Physical illness and depression are related, but the association between specific physical diseases and diagnostic subtypes of depression remains poorly understood. This study aimed to clarify the relationship between a number of physical diseases and the nonpsychotic and psychotic subtype of severe depression. METHODS This is a historical prospective cohort study. The study population consisted of all patients diagnosed with ICD-10 severe depression, either nonpsychotic or psychotic subtype, in Danish psychiatric hospitals between 1994 and 2008. The patients' history of physical disease was assessed using the Danish National Patient Register. Using logistic regression it was investigated whether specific physical diseases were associated with relative increased risk for subsequent development of either the nonpsychotic or psychotic depressive subtype. RESULTS A total of 24,173 patients with severe depression were included in the study. Of those, 8,260 (34%) were of the psychotic subtype. A history of the following physical diseases, as opposed to their absence, increased the relative risk for subsequent development of the nonpsychotic compared to the psychotic depressive subtype [adjusted incidence odds ratio (AIOR) nonpsychotic vs. psychotic]: ischemic heart disease (AIOR = 1.3, p < 0.001), hypertension (AIOR = 1.2, p = 0.008), stroke (AIOR = 1.2, p = 0.042) and chronic lower pulmonary disease (AIOR = 1.2, p = 0.005). The total load of physical disease also increased the relative risk of nonpsychotic depression [AIOR = 1.05 (per disease), p = 0.001]. CONCLUSIONS This study revealed that, in severe depression, a history of physical disease increased the relative risk of the nonpsychotic rather than the psychotic subtype.
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Affiliation(s)
- Søren Dinesen Ostergaard
- Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aarhus University Hospital, Aalborg, Denmark.
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Abstract
The Diagnostic Criteria for Psychosomatic Research (DCPR) were introduced in 1995 by an international group of investigators to expand the traditional domains of the disease model. The DCPR are a set of 12 'psychosomatic syndromes' which provide operational tools for psychosocial variables with prognostic and therapeutic implications in clinical settings. Eight syndromes concern the main manifestations of abnormal illness behaviour: somatization, hypochondriacal fears and beliefs, and illness denial. The other four syndromes (alexithymia, type A behaviour, demoralization and irritable mood) refer to the domain of psychological factors affecting medical conditions. This review describes the conceptual bases of the DCPR and the main findings concerning their application, with particular reference to the incremental information they added to the customary psychiatric classification. The DCPR were also compared with the provisional DSM-5 somatic symptom disorders. The DCPR were found to be more sensitive than DSM-IV in identifying subthreshold psychological distress and characterizing patients' psychological response to medical illness. DSM-5 somatic symptom disorders seem to neglect important clinical phenomena, such as illness denial, resulting in a narrow view of patients' functioning. The additional information provided by the DCPR may enhance the decision-making process.
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Affiliation(s)
- Laura Sirri
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Bologna, Italy
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21
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Spalletta G, Assogna F, Caltagirone C. Alexithymia in Parkinson’s disease: secondary phenomenon or primary neuropsychiatric feature? Neurodegener Dis Manag 2012. [DOI: 10.2217/nmt.12.31] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Gianfranco Spalletta
- Laboratory of Neuropsychiatry, Department of Clinical & Behavioral Neurology, IRCCS Santa Lucia Foundation, Via Ardeatina, Rome 306-00179, Italy
| | - Francesca Assogna
- Laboratory of Neuropsychiatry, Department of Clinical & Behavioral Neurology, IRCCS Santa Lucia Foundation, Via Ardeatina, Rome 306-00179, Italy
| | - Carlo Caltagirone
- Laboratory of Neuropsychiatry, Department of Clinical & Behavioral Neurology, IRCCS Santa Lucia Foundation, Via Ardeatina, Rome 306-00179, Italy
- Department of Neuroscience, Tor Vergata University of Rome, Rome, Italy
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22
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Poletti M, De Rosa A, Bonuccelli U. Affective symptoms and cognitive functions in Parkinson's disease. J Neurol Sci 2012; 317:97-102. [DOI: 10.1016/j.jns.2012.02.022] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 01/24/2012] [Accepted: 02/23/2012] [Indexed: 01/12/2023]
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23
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Poletti M, Bonuccelli U. Impulse control disorders in Parkinson’ disease: the role of personality and cognitive status. J Neurol 2012; 259:2269-77. [PMID: 22532171 DOI: 10.1007/s00415-012-6506-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 03/29/2012] [Indexed: 12/15/2022]
Affiliation(s)
- Michele Poletti
- Department of Neuroscience, University of Pisa, Via Savi 10, 56100, Pisa, Italy
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Personality traits in patients with Parkinson's disease: assessment and clinical implications. J Neurol 2011; 259:1029-38. [PMID: 22083431 DOI: 10.1007/s00415-011-6302-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 10/21/2011] [Accepted: 10/24/2011] [Indexed: 10/15/2022]
Abstract
This study reviews empirical evidence on the association between personality traits and Parkinson's disease (PD), with a twofold aim. First, to better identify non-motor symptoms, such as affective symptoms and personality changes, that could help to define the pre-motor phase of PD; second, to better understand the neurobiological bases of personality traits, a goal that is not fully accomplished by a purely anatomical approach. A literature review was performed on studies of personality traits in PD patients, in electronic databases ISI Web of Knowledge, Medline and PsychInfo, conducted in July 2011. We found evidence that the existence of a characteristic premorbid personality profile of PD patients is not actually sustained by robust empirical evidence, mainly due to the methodological bias of the retrospective assessment of personality; PD patients present a personality profile of low novelty seeking and high harm avoidance. We concluded that the definition of a pre-motor phase of PD, based on non-motor symptoms, should search for the presence of concomitant affective disorders and for a positive psychiatric history for affective disorders rather than for a typical personality profile or personality changes. The low novelty seeking profile is probably related to the dopaminergic deficit, while the high harm avoidance profile is probably associated with the presence of affective disorders. Clinical implications of these findings, in regard to personality assessment and pharmacological treatments in PD, are also discussed.
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