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Yun SJ, Lee HS, Kim DH, Im S, Yoo YJ, Kim NY, Lee J, Kim D, Park HY, Yoon MJ, Kim YS, Chang WH, Seo HG. Efficacy of personalized repetitive transcranial magnetic stimulation based on functional reserve to enhance ambulatory function in patients with Parkinson's disease: study protocol for a randomized controlled trial. Trials 2024; 25:543. [PMID: 39152467 PMCID: PMC11328369 DOI: 10.1186/s13063-024-08385-2] [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: 04/28/2024] [Accepted: 08/06/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) is one of the non-invasive brain stimulations that modulate cortical excitability through magnetic pulses. However, the effects of rTMS on Parkinson's disease (PD) have yielded mixed results, influenced by factors including various rTMS stimulation parameters as well as the clinical characteristics of patients with PD. There is no clear evidence regarding which patients should be applied with which parameters of rTMS. The study aims to investigate the efficacy and safety of personalized rTMS in patients with PD, focusing on individual functional reserves to improve ambulatory function. METHODS This is a prospective, exploratory, multi-center, single-blind, parallel-group, randomized controlled trial. Sixty patients with PD will be recruited for this study. This study comprises two sub-studies, each structured as a two-arm trial. Participants are classified into sub-studies based on their functional reserves for ambulatory function, into either the motor or cognitive priority group. The Timed-Up and Go (TUG) test is employed under both single and cognitive dual-task conditions (serial 3 subtraction). The motor dual-task effect, using stride length, and the cognitive dual-task effect, using the correct response rate of subtraction, are calculated. In the motor priority group, high-frequency rTMS targets the primary motor cortex of the lower limb, whereas the cognitive priority group receives rTMS over the left dorsolateral prefrontal cortex. The active comparator for each sub-study is bilateral rTMS of the primary motor cortex of the upper limb. Over 4 weeks, the participants will undergo 10 rTMS sessions, with evaluations conducted pre-intervention, mid-intervention, immediately post-intervention, and at 2-month follow-up. The primary outcome is a change in TUG time between the pre- and immediate post-intervention evaluations. The secondary outcome variables are the TUG under cognitive dual-task conditions, Movement Disorder Society-Unified Parkinson's Disease Rating Scale Part III, New Freezing of Gait Questionnaire, Digit Span, trail-making test, transcranial magnetic stimulation-induced motor-evoked potentials, diffusion tensor imaging, and resting state functional magnetic resonance imaging. DISCUSSION The study will reveal the effect of personalized rTMS based on functional reserve compared to the conventional rTMS approach in PD. Furthermore, the findings of this study may provide empirical evidence for an rTMS protocol tailored to individual functional reserves to enhance ambulatory function in patients with PD. TRIAL REGISTRATION ClinicalTrials.gov NCT06350617. Registered on 5 April 2024.
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Affiliation(s)
- Seo Jung Yun
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ho Seok Lee
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dae Hyun Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sun Im
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yeun Jie Yoo
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Na Young Kim
- Department of Rehabilitation Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Jungsoo Lee
- Department of Medical IT Convergence Engineering, Kumoh National Institute of Technology, Gumi, Republic of Korea
| | - Donghyeon Kim
- Research Institute, NEUROPHET Inc, Seoul, Republic of Korea
| | - Hae-Yeon Park
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Mi-Jeong Yoon
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young Seok Kim
- Department of Rehabilitation Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
- Department of Health Science and Technology, Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea.
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Ophey A, Wirtz K, Wolfsgruber S, Balzer-Geldsetzer M, Berg D, Hilker-Roggendorf R, Kassubek J, Liepelt-Scarfone I, Becker S, Mollenhauer B, Reetz K, Riedel O, Schulz JB, Storch A, Trenkwalder C, Witt K, Wittchen HU, Dodel R, Roeske S, Kalbe E. Mid- and late-life lifestyle activities as main drivers of general and domain-specific cognitive reserve in individuals with Parkinson's disease: cross-sectional and longitudinal evidence from the LANDSCAPE study. J Neurol 2024; 271:5411-5424. [PMID: 38951175 PMCID: PMC11319368 DOI: 10.1007/s00415-024-12484-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 04/06/2024] [Accepted: 05/27/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND Cognitive reserve (CR) is considered a protective factor for cognitive function and may explain interindividual differences of cognitive performance given similar levels of neurodegeneration, e.g., in Alzheimer´s disease. Recent evidence suggests that CR is also relevant in Parkinson's disease (PD). OBJECTIVE We aimed to explore the role of life-stage specific CR for overall cognition and specific cognitive domains cross-sectionally and longitudinally in PD. METHODS The cross-sectional analysis with data from the DEMPARK/LANDSCAPE study included 81 individuals without cognitive impairment (PD-N) and 87 individuals with mild cognitive impairment (PD-MCI). Longitudinal data covered 4 years with over 500 observations. CR was operationalized with the Lifetime of Experiences Questionnaire (LEQ), capturing the complexity of lifestyle activities across distinct life-stages. Cognition was assessed using a comprehensive neuropsychological test battery. RESULTS Higher LEQ scores, particularly from mid- and late-life, were observed in PD-N compared to PD-MCI [F(1,153) = 4.609, p = .033, ηp2 = 0.029]. They were significantly associated with better cognitive performance (0.200 ≤ β ≤ 0.292). Longitudinally, linear mixed effect models (0.236 ≤ marginal R2 ≤ 0.441) revealed that LEQ scores were positively related to cognitive performance independent of time. However, the decline in overall cognition and memory over time was slightly more pronounced with higher LEQ scores. CONCLUSIONS This study emphasizes the association between complex lifestyle activities and cognition in PD. Data indicate that while CR might be related to a delay of cognitive decline, individuals with high CR may experience a more pronounced drop in overall cognition and memory. Future studies will have to replicate these findings, particularly regarding domain-specific effects and considering reverse causal mechanisms.
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Affiliation(s)
- Anja Ophey
- Department of Medical Psychology | Neuropsychology and Gender Studies, Center for Neuropsychological Diagnostic and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - Kathrin Wirtz
- Department of Medical Psychology | Neuropsychology and Gender Studies, Center for Neuropsychological Diagnostic and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | | | - Daniela Berg
- Department of Neurology, University Medical Center Schleswig-Holstein, Christian Albrechts-University (CAU), Campus Kiel, Kiel, Germany
| | | | - Jan Kassubek
- Department of Neurology, University Hospital Ulm, Ulm, Germany
- German Center for Neurodegenerative Diseases (DZNE), Ulm, Germany
| | - Inga Liepelt-Scarfone
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Tübingen, Germany
- IB-Hochschule, Stuttgart, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Sara Becker
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Tübingen, Germany
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Britt Mollenhauer
- Paracelsus-Elena Klinik, Kassel, Germany
- Department of Neurosurgery, University Medical Center, Goettingen, Germany
| | - Kathrin Reetz
- Department of Neurology, RWTH Aachen University Hospital, Aachen, Germany
- JARA Institute Molecular Neuroscience and Neuroimaging (INM-11), Juelich, Aachen, Germany
| | - Oliver Riedel
- Department Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Jörg B Schulz
- Department of Neurology, RWTH Aachen University Hospital, Aachen, Germany
- JARA Institute Molecular Neuroscience and Neuroimaging (INM-11), Juelich, Aachen, Germany
| | - Alexander Storch
- Department of Neurology, University of Rostock and German Center for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, Rostock, Germany
| | - Claudia Trenkwalder
- Paracelsus-Elena Klinik, Kassel, Germany
- Department of Neurosurgery, University Medical Center, Goettingen, Germany
| | - Karsten Witt
- Department of Neurology, School of Medicine and Health Sciences and Research Center Neurosensory Science, University of Oldenburg, Oldenburg, Germany
- Department of Neurology, Evangelic Hospital Oldenburg, Oldenburg, Germany
| | - Hans-Ullrich Wittchen
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Richard Dodel
- Department of Geriatric Medicine, University Duisburg-Essen, Essen, Germany
| | - Sandra Roeske
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Elke Kalbe
- Department of Medical Psychology | Neuropsychology and Gender Studies, Center for Neuropsychological Diagnostic and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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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.
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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.
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Di Tella S, Isernia S, Cabinio M, Rossetto F, Borgnis F, Pagliari C, Cazzoli M, Navarro J, Silveri MC, Baglio F. Cognitive Reserve proxies can modulate motor and non-motor basal ganglia circuits in early Parkinson's Disease. Brain Imaging Behav 2024; 18:220-230. [PMID: 37993754 PMCID: PMC10844415 DOI: 10.1007/s11682-023-00829-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2023] [Indexed: 11/24/2023]
Abstract
Parkinson's Disease (PD) is hallmarked by dysfunctional circuitry between the basal ganglia and dorsolateral-prefrontal cortex. Recently progress has been made in understanding factors contributing to differential susceptibility to pathology mitigating disease-related cognitive decline. Cognitive reserve, the brain processing resources accumulated throughout life while engaged in mentally stimulating activities, can play an important protective role in cognitive performance. We tested the hypothesis that Cognitive Reserve proxies may exert an impact on the basal ganglia and dorsolateral-prefrontal atrophy in early PD. Forty-five early patients with PD and 20 age-gender-matched healthy controls (HC) completed the Cognitive Reserve Index questionnaire to quantify Cognitive Reserve proxies by three indexes (CRI-Education, CRI-Working Activity, CRI-Leisure Time) and a structural MRI examination (3T). Morphometrical indexes for basal ganglia (bilateral putamen, caudate, pallidum volume) and dorsolateral-prefrontal cortex (cortical thickness) were computed. Significant differences between HC and PD were tested by direct comparisons in demographics, cognitive level, and cognitive reserve proxies indexes. Then two multiple regression analyses were performed to identify predictors of the basal ganglia and dorsolateral-prefrontal cortex structural integrity. Regression analysis revealed that basal ganglia volume was significantly predicted by CRI-Education (pFDR = 0.029), sex (pFDR = 0.029), and Total Intracranial Volume (pFDR < 0.001). Instead, the dorsolateral-prefrontal thickness was predicted by CRI-Leisure Time (pFDR = 0.030) and age (pFDR = 0.010). Cognitive Reserve proxies, especially education and leisure-time activities, can play a protective role on the structural integrity of the basal ganglia and dorsolateral-prefrontal cortex, respectively, critical regions hallmarking brain status of early phases of PD.
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Affiliation(s)
- Sonia Di Tella
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Sara Isernia
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy.
| | - Monia Cabinio
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | | | | | | | - Marta Cazzoli
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Jorge Navarro
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
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Latagliata EC, Orsini C, Cabib S, Biagioni F, Fornai F, Puglisi-Allegra S. Prefrontal Dopamine in Flexible Adaptation to Environmental Changes: A Game for Two Players. Biomedicines 2023; 11:3189. [PMID: 38137410 PMCID: PMC10740496 DOI: 10.3390/biomedicines11123189] [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: 09/27/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023] Open
Abstract
Deficits in cognitive flexibility have been characterized in affective, anxiety, and neurodegenerative disorders. This paper reviews data, mainly from studies on animal models, that support the existence of a cortical-striatal brain circuit modulated by dopamine (DA), playing a major role in cognitive/behavioral flexibility. Moreover, we reviewed clinical findings supporting misfunctioning of this circuit in Parkinson's disease that could be responsible for some important non-motoric symptoms. The reviewed findings point to a role of catecholaminergic transmission in the medial prefrontal cortex (mpFC) in modulating DA's availability in the nucleus accumbens (NAc), as well as a role of NAc DA in modulating the motivational value of natural and conditioned stimuli. The review section is accompanied by a preliminary experiment aimed at testing weather the extinction of a simple Pavlovian association fosters increased DA transmission in the mpFC and inhibition of DA transmission in the NAc.
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Affiliation(s)
| | - Cristina Orsini
- I.R.C.C.S. Fondazione Santa Lucia, 00143 Rome, Italy; (C.O.); (S.C.)
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy
| | - Simona Cabib
- I.R.C.C.S. Fondazione Santa Lucia, 00143 Rome, Italy; (C.O.); (S.C.)
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy
| | - Francesca Biagioni
- I.R.C.C.S. Neuromed, Via Atinense 18, 86077 Pozzilli, Italy; (F.B.); (F.F.)
| | - Francesco Fornai
- I.R.C.C.S. Neuromed, Via Atinense 18, 86077 Pozzilli, Italy; (F.B.); (F.F.)
- Department of Translational Research and New Technologies on Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
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Gialluisi A, De Bartolo MI, Costanzo S, Belvisi D, Falciglia S, Ricci M, Di Castelnuovo A, Panzera T, Donati MB, Fabbrini G, de Gaetano G, Berardelli A, Iacoviello L. Risk and protective factors in Parkinson's disease: a simultaneous and prospective study with classical statistical and novel machine learning models. J Neurol 2023; 270:4487-4497. [PMID: 37294324 DOI: 10.1007/s00415-023-11803-1] [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: 03/20/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Several environmental/lifestyle factors have been individually investigated in previous Parkinson's disease (PD) studies with controversial results. No study has prospectively and simultaneously investigated potential risk/protective factors of PD using both classical statistical and novel machine learning analyses. The latter may reveal more complex associations and new factors that are undetected by merely linear models. To fill this gap, we simultaneously investigated potential risk/protective factors involved in PD in a large prospective population study using both approaches. METHODS Participants in the Moli-sani study were enrolled between 2005 and 2010 and followed up until December 2018. Incident PD cases were identified by individual-level record linkage to regional hospital discharge forms, the Italian death registry, and the regional prescription register. Exposure to potential risk/protective factors was assessed at baseline. Multivariable Cox Proportional Hazards (PH) regression models and survival random forests (SRF) were built to identify the most influential factors. RESULTS We identified 213 incident PD cases out of 23,901 subjects. Cox PH models revealed that age, sex, dysthyroidism and diabetes were associated with an increased risk of PD. Both hyper and hypothyroidism were independently associated with PD risk. SRF showed that age was the most influential factor in PD risk, followed by coffee intake, daily physical activity, and hypertension. CONCLUSION This study sheds light on the role of dysthyroidism, diabetes and hypertension in PD onset, characterized to date by an uncertain relationship with PD, and also confirms the relevance of most factors (age, sex, coffee intake, daily physical activity) reportedly shown be associated with PD. Further methodological developments in SRF models will allow to untangle the nature of the potential non-linear relationships identified.
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Affiliation(s)
- Alessandro Gialluisi
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli, Italy
- Department of Medicine and Surgery, EPIMED Research Center, University of Insubria, Varese, Italy
| | | | - Simona Costanzo
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli, Italy
| | - Daniele Belvisi
- IRCCS NEUROMED, Pozzilli, Italy
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Stefania Falciglia
- UOC Governance del Farmaco, Azienda Sanitaria Regionale del Molise -ASREM, Campobasso, Italy
| | - Moreno Ricci
- UOC Governance del Farmaco, Azienda Sanitaria Regionale del Molise -ASREM, Campobasso, Italy
| | | | - Teresa Panzera
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli, Italy
| | | | - Giovanni Fabbrini
- IRCCS NEUROMED, Pozzilli, Italy
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | - Alfredo Berardelli
- IRCCS NEUROMED, Pozzilli, Italy.
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.
| | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli, Italy
- Department of Medicine and Surgery, EPIMED Research Center, University of Insubria, Varese, Italy
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Timpka J, Dahlström Ö, Nilsson MH, Iwarsson S, Odin P. Time to workforce exit after a Parkinson's disease diagnosis. NPJ Parkinsons Dis 2023; 9:72. [PMID: 37156779 PMCID: PMC10167319 DOI: 10.1038/s41531-023-00513-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/20/2023] [Indexed: 05/10/2023] Open
Abstract
The impact of Parkinson's disease (PD) on workforce participation has received little attention even though demographic, lifestyle, and political changes together will result in an increased burden of PD on the working-age population. In this study, we investigate workforce survival after a PD diagnosis, as well as what demographic factors that are associated with workforce survival. As an exploratory outcome, we investigate workforce survival in persons with and without device-aided treatment (DAT). This is a nested case-cohort study based on Swedish national data from 2001-2016. Controls were matched on year of birth, sex, and municipality of residence. The used registers contain data on demographics, social insurance, in- and outpatient visits, filled drug prescriptions, and cause of death on the person-level. A total of 4781 persons with PD and 23,905 controls were included. The median survival until all-cause workforce exit was 43 months among persons that were workforce-active at the time of PD diagnosis, compared to 66 months in non-PD controls. Being female, ≥50 years old at diagnosis, or having a lower education were contributing factors to health-related workforce exit. Persons receiving DAT during follow-up exhibited shorter workforce survival than controls. However, this needs further investigation, particularly as patients have generally already left the workforce at the time for start of DAT. It is evident that PD has grave negative effects on workforce participation. Thus, supportive measures need to start at an early stage after diagnosis, and the development of new interventions is urgently needed.
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Affiliation(s)
- Jonathan Timpka
- Division of Neurology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
- Department of Neurology, Skåne University Hospital, Lund, Sweden.
| | - Örjan Dahlström
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Athletics Research Center, Linköping University, Linköping, Sweden
| | - Maria H Nilsson
- Department of Health Sciences, Lund University, Lund, Sweden
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | | | - Per Odin
- Division of Neurology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Neurology, Skåne University Hospital, Lund, Sweden
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Role of Stress-Related Dopamine Transmission in Building and Maintaining a Protective Cognitive Reserve. Brain Sci 2022; 12:brainsci12020246. [PMID: 35204009 PMCID: PMC8869980 DOI: 10.3390/brainsci12020246] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/05/2022] [Accepted: 02/08/2022] [Indexed: 01/27/2023] Open
Abstract
This short review presents the hypothesis that stress-dependent dopamine (DA) transmission contributes to developing and maintaining the brain network supporting a cognitive reserve. Research has shown that people with a greater cognitive reserve are better able to avoid symptoms of degenerative brain changes. The paper will review evidence that: (1) successful adaptation to stressors involves development and stabilization of effective but flexible coping strategies; (2) this process requires dynamic reorganization of functional networks in the adult brain; (3) DA transmission is amongst the principal mediators of this process; (4) age- and disease-dependent cognitive impairment is associated with dysfunctional connectivity both between and within these same networks as well as with reduced DA transmission.
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