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Pourzinal D, Yang J, McMahon KL, Copland DA, Mitchell L, O'Sullivan JD, Byrne GJ, Dissanayaka NN. Hippocampal resting-state connectivity is associated with posterior-cortical cognitive impairment in Parkinson's disease. Brain Behav 2024; 14:e3454. [PMID: 38468574 DOI: 10.1002/brb3.3454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 02/08/2024] [Accepted: 02/10/2024] [Indexed: 03/13/2024] Open
Abstract
AIM Frontal and posterior-cortical cognitive subtypes in Parkinson's disease (PD) present with executive/attention and memory/visuospatial deficits, respectively. As the posterior-cortical subtype is predicted to progress rapidly toward dementia, the present study aimed to explore biological markers of this group using resting-state functional magnetic resonance imaging (rs-fMRI). METHODS K-means cluster analysis delineated subtypes (cognitively intact, frontal, posterior-cortical, and globally impaired) among 85 people with PD. A subset of PD participants (N = 42) and 20 healthy controls (HCs) underwent rs-fMRI. Connectivity of bilateral hippocampi with regions of interest was compared between posterior-cortical, cognitively intact, and HC participants using seed-based analysis, controlling for age. Exploratory correlations were performed between areas of interest from the group analysis and a series of cognitive tests. RESULTS The posterior-cortical subtype (N = 19) showed weaker connectivity between the left hippocampus and right anterior temporal fusiform cortex compared to the cognitively intact (N = 11) group, p-false discovery rate (FDR) = .01, and weaker connectivity between bilateral hippocampi and most fusiform regions compared to HCs (N = 20). No differences were found between HCs and cognitively intact PD. Exploratory analyses revealed strongest associations between connectivity of the right anterior temporal fusiform cortex and left hippocampus with category fluency (p-FDR = .01). CONCLUSION Results suggest that weakened connectivity between the hippocampus and fusiform region is a unique characteristic of posterior-cortical cognitive deficits in PD. Further exploration of hippocampal and fusiform functional integrity as a marker of cognitive decline in PD is warranted.
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Affiliation(s)
- Dana Pourzinal
- Faculty of Medicine, The University of Queensland Centre for Clinical Research, Herston, Australia
| | - Jihyun Yang
- Faculty of Medicine, The University of Queensland Centre for Clinical Research, Herston, Australia
| | - Katie L McMahon
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - David A Copland
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
| | - Leander Mitchell
- School of Psychology, The University of Queensland, St Lucia, Australia
| | - John D O'Sullivan
- Faculty of Medicine, The University of Queensland Centre for Clinical Research, Herston, Australia
- Department of Neurology, Royal Brisbane & Women's Hospital, Herston, Australia
| | - Gerard J Byrne
- Faculty of Medicine, The University of Queensland Centre for Clinical Research, Herston, Australia
- Mental Health Service, Royal Brisbane & Women's Hospital, Herston, Australia
| | - Nadeeka N Dissanayaka
- Faculty of Medicine, The University of Queensland Centre for Clinical Research, Herston, Australia
- School of Psychology, The University of Queensland, St Lucia, Australia
- Department of Neurology, Royal Brisbane & Women's Hospital, Herston, Australia
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Roper A, Brooks D, Mitchell LK, Pachana NA, Au TR, Byrne GJ, O'Sullivan JD, Dissanayaka NN. Feasibility and Acceptability of a Videoconferencing CBT Intervention for Anxiety in People with Parkinson's Disease. Clin Gerontol 2024:1-16. [PMID: 38277135 DOI: 10.1080/07317115.2024.2306861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
OBJECTIVES In people with Parkinson's disease (PwPD), non-motor symptoms such as anxiety are common and have negative impacts on their quality of life. There are currently few interventions that address anxiety in PwPD, and access to diagnosis and treatment is often limited for those living in rural areas. The aim of this study was to evaluate the feasibility and acceptability of a telehealth videoconferencing CBT intervention for anxiety in PwPD. METHODS A pre- and post-test feasibility study (N = 10) was conducted and evaluated utilizing the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance). RESULTS Lack of access to the internet and videoconferencing technology were identified as barriers to participation. Physical health issues also impacted recruitment and retention. Non-completers were significantly older and less likely to have a carer involved in the intervention. Clinician adoption of the intervention was low while participant acceptability of videoconferencing technology varied and required carer support. CONCLUSIONS Providing access to technology and support to overcome technological issues, as well as telehealth training for clinicians, are recommended in future studies to improve recruitment, retention, and implementation. CLINICAL IMPLICATIONS Identification of barriers and facilitators provides future studies with the knowledge to tailorize their program to better suit PwPD.
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Affiliation(s)
- Amy Roper
- The University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Deborah Brooks
- The University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | | | - Nancy A Pachana
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Tiffany R Au
- The University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Gerard J Byrne
- The University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Mental Health Service, Royal Brisbane & Women's Hospital, Brisbane, Australia
| | - John D O'Sullivan
- The University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Neurology, Royal Brisbane & Women's Hospital, Brisbane, Australia
| | - Nadeeka N Dissanayaka
- The University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- School of Psychology, The University of Queensland, Brisbane, Australia
- Department of Neurology, Royal Brisbane & Women's Hospital, Brisbane, Australia
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Roper A, Pacas Fronza G, Dobkin RD, Beaudreau SA, Mitchell LK, Pachana NA, Thangavelu K, Dissanayaka NN. A Systematic Review of Psychotherapy Approaches for Anxiety in Parkinson's Disease. Clin Gerontol 2024; 47:188-214. [PMID: 35634720 DOI: 10.1080/07317115.2022.2074814] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Anxiety is common in Parkinson's disease (PD), negatively impacting daily functioning and quality of life in PD patients and their families. This systematic review evaluates the effectiveness of different psychotherapeutic approaches for reducing anxiety in PD and provides recommendations for clinical practise. METHODS Following PRISMA guidelines, 36 studies were included and risk of bias was evaluated. RESULTS We identified cognitive behavioral therapy (CBT), mindfulness-based therapies, acceptance and commitment therapy, and psychodrama psychotherapies. There is good evidence-base for anxiety reduction using CBT approaches, but with mixed results for mindfulness-based therapies. Other therapeutic approaches were under researched. Most randomized control trials examined anxiety as a secondary measure. There was a paucity of interventions for anxiety subtypes. Secondarily, studies revealed the consistent exclusion of PD patients with cognitive concerns, an importance of care partner involvement, and a growing interest in remote delivery of psychotherapy interventions. CONCLUSIONS Person-centered anxiety interventions tailored for PD patients, including those with cognitive concerns, and trials exploring modalities other than CBT, warrant future investigations. CLINICAL IMPLICATIONS Practitioners should consider PD-specific anxiety symptoms and cognitive concerns when treating anxiety. Key distinctions between therapeutic modalities, therapy settings and delivery methods should guide treatment planning.
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Affiliation(s)
- Amy Roper
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Gabriela Pacas Fronza
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Roseanne D Dobkin
- Department of Psychiatry, Rutgers University, Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
| | - Sherry A Beaudreau
- School of Psychology, The University of Queensland, Brisbane, Australia
- Sierra Pacific Mental Illness Research, Education, and Clinical Centers (MIRECC), Palo Alto Veterans Administration Health Care System & Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | | | - Nancy A Pachana
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Karthick Thangavelu
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Nadeeka N Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- School of Psychology, The University of Queensland, Brisbane, Australia
- Department of Neurology, Royal Brisbane & Women's Hospital, Brisbane, Australia
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Pourzinal D, Yang J, Sivakumaran K, McMahon KL, Mitchell L, O'Sullivan JD, Byrne GJ, Dissanayaka NN. Longitudinal follow up of data-driven cognitive subtypes in Parkinson's disease. Brain Behav 2023; 13:e3218. [PMID: 37574595 PMCID: PMC10570472 DOI: 10.1002/brb3.3218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/26/2023] [Accepted: 07/31/2023] [Indexed: 08/15/2023] Open
Abstract
AIM The dual syndrome hypothesis proposes that there are two cognitive subtypes in Parkinson's disease (PD): a frontal subtype with executive/attention impairment and gradual cognitive decline, and a posterior-cortical subtype with memory/visuospatial deficits and rapid cognitive decline. We aimed to compare the rate of global cognitive decline between subtypes derived using data-driven methods and explore their longitudinal performance within specific cognitive domains to better understand the prognosis of each subtype. METHOD Frontal, posterior-cortical, globally impaired, and cognitively intact PD subtypes were identified at baseline using k-means clustering (N = 85), and 29 participants (34%) returned for follow-up assessments on average 4.87 years from baseline. Linear mixed effects models compared progression of subtypes on global cognition; psychological symptoms; parkinsonism; and the memory, attention, executive, language, and visuospatial cognitive domains. RESULTS The frontal subtype was lost to attrition. While rate of change in parkinsonism, anxiety, and apathy differed between subtypes, there was no difference in the rate of global cognitive decline. However, the posterior-cortical subtype declined most rapidly in verbal memory, card sorting, trail making, and judgement of line orientation (JLO), while the cognitively intact group declined most rapidly on verbal memory and semantic fluency. The globally impaired subtype declined most rapidly in JLO, although this should be interpreted with caution due to high attrition. CONCLUSION Despite limited sample size, the present study supports the differential progression of the posterior-cortical subtype compared to cognitively intact and globally impaired PD. These results encourage further, large-scale longitudinal investigations of cognitive subtypes in PD.
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Affiliation(s)
- Dana Pourzinal
- Faculty of MedicineThe University of Queensland Centre for Clinical ResearchHerstonQLDAustralia
| | - Jihyun Yang
- Faculty of MedicineThe University of Queensland Centre for Clinical ResearchHerstonQLDAustralia
| | - Kumareshan Sivakumaran
- Faculty of MedicineThe University of Queensland Centre for Clinical ResearchHerstonQLDAustralia
| | - Katie L. McMahon
- School of Clinical Sciences, Faculty of HealthQueensland University of TechnologyBrisbaneQLDAustralia
| | - Leander Mitchell
- School of PsychologyThe University of QueenslandSt. LuciaAustralia
| | - John D. O'Sullivan
- Faculty of MedicineThe University of Queensland Centre for Clinical ResearchHerstonQLDAustralia
- Department of NeurologyRoyal Brisbane and Women's HospitalHerstonQLDAustralia
| | - Gerard J. Byrne
- Faculty of MedicineThe University of Queensland Centre for Clinical ResearchHerstonQLDAustralia
- Mental Health ServiceRoyal Brisbane and Women's HospitalHerstonQLDAustralia
| | - Nadeeka N. Dissanayaka
- Faculty of MedicineThe University of Queensland Centre for Clinical ResearchHerstonQLDAustralia
- School of PsychologyThe University of QueenslandSt. LuciaAustralia
- Department of NeurologyRoyal Brisbane and Women's HospitalHerstonQLDAustralia
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Li Y, Yang J, Evans K, Wong JBW, Dissanayaka NN, Vogel AP. Optimising verbal fluency analysis in neurological patients with dysarthria: examples from Parkinson's disease and hereditary ataxia. J Clin Exp Neuropsychol 2023; 45:452-463. [PMID: 37656122 DOI: 10.1080/13803395.2023.2249172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 08/12/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Verbal fluency tests (VFTs) are widely used to assess cognitive-linguistic performance in neurological diseases. However, the influence of dysarthria on performance in tests requiring oral responses is unclear in ataxia and Parkinson's disease. OBJECTIVES To determine the impact of dysarthria on VFT performance and evaluate the validity and reliability of alternative methods for analyzing VFT data. METHOD Trained raters evaluated dysarthria using VFT recordings in people with ataxia (N = 61) or Parkinson's disease (PD; N = 69). Total Correct Items scores and qualitative parameters (intrusions, ambiguous verbalizations, perseverations, and interjections) were compared across semantic, phonemic, and alternating fluency tasks. Disease severity was considered as a covariate in the regression model. RESULTS VFT dysarthria ratings correlated with the benchmark (ground truth) dysarthria scores derived from a monologue. Ambiguous responses resulting from unclear speech impeded the rater's ability to determine if a response was correct. Regression analysis indicated that more severe dysarthria ratings predicted diminished scores in all three tasks (semantic fluency, phonemic fluency and alternating fluency) in the ataxia group. The contribution of disease severity to semantic, phonemic and alternating fluency was reduced substantially in the ataxia group after accounting for dysarthria severity in the model in both groups. CONCLUSIONS Dysarthria severity can be estimated based on speech samples derived from VFT. Dysarthria can lead to lower total correct items and is associated with more ambiguous verbalizations in VFT. Dysarthria severity should be considered when interpreting VFT performance in common movement disorders.
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Affiliation(s)
- Yanjun Li
- Centre for Neuroscience of Speech, The University of Melbourne, Melbourne, Victoria, Australia
- Redenlab, Melbourne, Victoria, Australia
| | - Jihyun Yang
- UQ Centre for Clinical Research, Faculty of Medicine, the University of Queensland, Herston QLD, Australia
| | - Kristine Evans
- Centre for Neuroscience of Speech, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Nadeeka N Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine, the University of Queensland, Herston QLD, Australia
- Department of Neurology, Royal Brisbane & Women's Hospital, Herston QLD, Australia
- School of Psychology, The University of Queensland, St Lucia, QLD, Australia
| | - Adam P Vogel
- Centre for Neuroscience of Speech, The University of Melbourne, Melbourne, Victoria, Australia
- Redenlab, Melbourne, Victoria, Australia
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany & Center for Neurology, University Hospital Tübingen, Germany
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Yang J, Pourzinal D, Byrne GJ, McMahon KL, Copland DA, O'Sullivan JD, Mitchell L, Dissanayaka NN. Global assessment, cognitive profile, and characteristics of mild cognitive impairment in Parkinson's disease. Int J Geriatr Psychiatry 2023; 38:e5955. [PMID: 37318156 DOI: 10.1002/gps.5955] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 06/07/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Cognitive deficits are evident throughout the course of Parkinson's disease (PD), with 24% of patients experiencing subtle cognitive disturbances at the time of diagnosis, and with up to 80% of patients developing PD dementia (PDD) at advanced stages of the disease PD patients with mild cognitive impairment (MCI), an at-risk phenotype of PDD, present with heterogeneous clinical characteristics that complicate the management of PD. OBJECTIVES This study aims to examine the characteristics of PD-MCI by using the Movement Disorder Society (MDS) diagnostic criteria and evaluate the validity of global cognitive scales in identifying PD-MCI. METHODS Seventy-nine (79) PD patients completed neuropsychological assessments and a comprehensive cognitive battery. PD-MCI was classified according to the level 2 MDS task force criteria. Mini-Mental State Examination (sMMSE), Montreal Cognitive Assessment (MoCA) and Parkinson's Disease Cognitive Rating Scale (PDCRS) were examined against a level 2 dichotomised PD-MCI diagnosis. Characteristics of PD-MCI were evaluated using logistic regression analysis. RESULTS Twenty-seven patients met criteria for PD-MCI (34%). The MoCA and PDCRS demonstrated high validity to screen for PD-MCI. Impairments in multiple cognitive domains were observed in 77.8% of PD-MCI patients. There were significantly more males in the PD-MCI group compared to PD patients without MCI (p < 0.01). CONCLUSIONS PD patients with MCI exhibited impairments in the attention/working memory, executive function and memory domains. Heterogeneous cognitive characteristics in PD warrant further investigation into specific cognitive subtypes to advance understanding and effective evaluation of PD-MCI.
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Affiliation(s)
- Jihyun Yang
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Dana Pourzinal
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Gerard J Byrne
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- Mental Health Service, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Katie L McMahon
- School of Clinical Sciences, Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Queensland, Australia
| | - David A Copland
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- School of Health & Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - John D O'Sullivan
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- Department of Neurology, Royal Brisbane & Women's Hospital, Herston, Queensland, Australia
| | - Leander Mitchell
- School of Psychology, The University of Queensland, St Lucia, Queensland, Australia
| | - Nadeeka N Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- Department of Neurology, Royal Brisbane & Women's Hospital, Herston, Queensland, Australia
- School of Psychology, The University of Queensland, St Lucia, Queensland, Australia
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Huo Y, Couzner L, Windsor T, Laver K, Dissanayaka NN, Cations M. Barriers and enablers for the implementation of trauma-informed care in healthcare settings: a systematic review. Implement Sci Commun 2023; 4:49. [PMID: 37147695 PMCID: PMC10161455 DOI: 10.1186/s43058-023-00428-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 04/05/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Healthcare services can be re-traumatising for trauma survivors where they trigger memories of past distressing events and exert limits to a survivor's sense of autonomy, choice, and control. The benefits of receiving trauma-informed healthcare are well established; however, factors that promote or impede the implementation of trauma-informed care are not yet well characterised and understood. The aim of this review was to systematically identify and synthesise evidence regarding factors that promote or reduce the implementation of TIC in healthcare settings. METHODS This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2.0 guidelines. Scopus, MEDLINE, Proquest, PsycINFO and grey literature were searched for original research or evaluations published between January 2000 and April 2021 reporting barriers and/or facilitating factors for the implementation of trauma-informed care in a healthcare setting. Two reviewers independently assessed the quality of each included study using the Mixed Methods Appraisal Tool (MMAT) Checklist. RESULTS Twenty-seven studies were included, 22 of which were published in the USA. Implementation occurred in a range of health settings, predominantly mental health services. The barriers and facilitators of implementing trauma-informed care were categorised as follows: intervention characteristics (perceived relevance of trauma-informed care to the health setting and target population), influences external to the organisation (e.g. interagency collaboration or the actions of other agencies) and influences within the organisation in which implementation occurred (e.g. leadership engagement, financial and staffing resources and policy and procedure changes that promote flexibility in protocols). Other factors related to the implementation processes (e.g. flexible and accessible training, service user feedback and the collection and review of initiative outcomes) and finally the characteristics of individuals within the service or system such as a resistance to change. CONCLUSIONS This review identifies key factors that should be targeted to promote trauma-informed care implementation. Continued research will be helpful for characterising what trauma-informed care looks like when it is delivered well, and providing validated frameworks to promote organisational uptake for the benefit of trauma survivors. REGISTRATION The protocol for this review was registered on the PROSPERO database (CRD42021242891).
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Affiliation(s)
- Yan Huo
- College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
| | - Leah Couzner
- College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
| | - Tim Windsor
- College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
| | - Kate Laver
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Nadeeka N Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- School of Psychology, The University of Queensland, Brisbane, QLD, Australia
- Department of Neurology, Royal Brisbane and Woman's Hospital, Brisbane, QLD, Australia
| | - Monica Cations
- College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia.
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Interian A, Miller RB, Hill LMS, Latorre M, King AR, Rodriguez KM, Mann SL, Kashan RS, Dissanayaka NN, Dobkin RD. A Pilot Study of Telehealth Mindfulness-Based Cognitive Therapy for Depression in Parkinson's Disease. J Geriatr Psychiatry Neurol 2023; 36:143-154. [PMID: 35603772 DOI: 10.1177/08919887221103579] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Parkinson's disease (PD) is characterized by high-rates of depression with limited evidence-based treatment options to improve mood. Objective: To expand therapeutic options, we evaluated the feasibility and effect of a telehealth mindfulness-based cognitive therapy intervention adapted for PD (MBCT-PD) in a sample of participants with DSM-5 depressive disorders. Methods: Fifteen participants with PD and clinically-significant depression completed 9 sessions of MBCT-PD. Depression, anxiety, and quality of life were evaluated at baseline, endpoint, and 1-month follow-up. Results: Telehealth MBCT-PD was feasible and beneficial. Completion rates exceeded 85% and treatment satisfaction rates were high. Notable improvements were observed for depression, anxiety, and quality of life over the course of the trial. Conclusion: Telehealth MBCT-PD shows promise and warrants further evaluation via randomized clinical trial with more diverse participants. Such research holds the potential to expand the range of therapeutic options for depression in PD, thereby setting the stage for personalized care.
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Affiliation(s)
- Alejandro Interian
- 20063VA New Jersey Healthcare System, Lyons, NJ, USA.,20061Rutgers-Robert Wood Johnson Medical School, Department of Psychiatry, Piscataway, NJ, USA
| | | | | | | | - Arlene R King
- 20063VA New Jersey Healthcare System, Lyons, NJ, USA
| | | | - Sarah L Mann
- 20063VA New Jersey Healthcare System, Lyons, NJ, USA
| | - Rachel S Kashan
- 20061Rutgers-Robert Wood Johnson Medical School, Department of Psychiatry, Piscataway, NJ, USA
| | - Nadeeka N Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine, 25056The University of Queensland, Brisbane, AU-QLD, Australia.,School of Psychology, 12287University of Queensland, Brisbane, AU-QLD, Australia.,Department of Neurology, 303224Royal Brisbane & Women's Hospital, Brisbane, AU-QLD, Australia
| | - Roseanne D Dobkin
- 20061Rutgers-Robert Wood Johnson Medical School, Department of Psychiatry, Piscataway, NJ, USA
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Dawson A, Ortelli P, Carter A, Ferrazzoli D, Dissanayaka NN, Evans A, Chye Y, Lorenzetti V, Frazzitta G, Yücel M. Motivational and myopic mechanisms underlying dopamine medication-induced impulsive-compulsive behaviors in Parkinson's disease. Front Behav Neurosci 2023; 16:949406. [PMID: 36744102 PMCID: PMC9889554 DOI: 10.3389/fnbeh.2022.949406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 12/27/2022] [Indexed: 01/20/2023] Open
Abstract
Introduction Dopaminergic medications can trigger impulsive-compulsive behaviors (ICBs) in pre-disposed patients with Parkinson's disease (PD), but what this implies on a neurocognitive level is unclear. Previous findings highlighted potentially exacerbated incentive motivation (willingness to work for rewards) and choice impulsivity (preferring smaller, immediate rewards over larger, delayed rewards) in PD patients with ICBs (PD + ICBs). Methods To deeply understand this evidence, we studied 24 PD + ICBs and 28 PD patients without ICBs (PD-ICBs). First of all, patients underwent the assessment of impulsivity traits, mood, anxiety, and addiction condition. We further administered robust objective and subjective measures of specific aspects of motivation. Finally, we explored whether these processes might link to any heightened antisocial behavior (aggression and risky driving) in PD + ICBs. Results High levels of positive urgency trait characterized PD + ICBs. They choose to exert more effort for rewards under the conditions of low and medium reward probability and as reward magnitude increases. Findings on choice impulsivity show a great tendency to delay discounting in PD + ICBs, other than a high correlation between delay and probability discounting. In addition, we found what appears to be the first evidence of heightened reactive aggression in PD patients with ICBs. Exacerbated incentive motivation and delay discounting trended toward positively predicting reactive aggression in PD + ICBs. Discussion Our promising results suggest that there might be immense value in future large-scale studies adopting a transdiagnostic neurocognitive endophenotype approach to understanding and predicting the addictive and aggressive behaviors that can arise from dopaminergic medication in PD.
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Affiliation(s)
- Andrew Dawson
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, VIC, Australia
| | - Paola Ortelli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Vipiteno-Sterzing, Italy,Department of Movement Disorders and Brain Injury Rehabilitation, “Moriggia-Pelascini” Hospital, Como, Italy,*Correspondence: Paola Ortelli ✉
| | - Adrian Carter
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, VIC, Australia
| | - Davide Ferrazzoli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Vipiteno-Sterzing, Italy,Department of Movement Disorders and Brain Injury Rehabilitation, “Moriggia-Pelascini” Hospital, Como, Italy
| | - Nadeeka N. Dissanayaka
- Faculty of Medicine, University of Queensland Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia,Department of Neurology, Royal Brisbane and Women's Hospital, Herston, QLD, Australia,School of Psychology, The University of Queensland, St. Lucia, QLD, Australia
| | - Andrew Evans
- Department of Movement Disorders, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Yann Chye
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, VIC, Australia
| | | | | | - Murat Yücel
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, VIC, Australia
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10
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Pourzinal D, Yang J, Lawson RA, McMahon KL, Byrne GJ, Dissanayaka NN. Systematic review of data-driven cognitive subtypes in Parkinson disease. Eur J Neurol 2022; 29:3395-3417. [PMID: 35781745 PMCID: PMC9796227 DOI: 10.1111/ene.15481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 06/30/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE Recent application of the mild cognitive impairment concept to Parkinson disease (PD) has proven valuable in identifying patients at risk of dementia. However, it has sparked controversy regarding the existence of cognitive subtypes. The present review evaluates the current literature pertaining to data-driven subtypes of cognition in PD. METHODS Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, systematic literature searches for peer-reviewed articles on the topic of cognitive subtyping in PD were performed. RESULTS Twenty-two relevant articles were identified in the systematic search. Subtype structures showed either a spectrum of severity or specific domains of impairment. Domain-specific subtypes included amnestic/nonamnestic, memory/executive, and frontal/posterior dichotomies, as well as more complex structures with less definitive groupings. Preliminary longitudinal evidence showed some differences in cognitive progression among subtypes. Neuroimaging evidence provided insight into distinct patterns of brain alterations among subtypes. CONCLUSIONS Recurring phenotypes in the literature suggest strong clinical relevance of certain cognitive subtypes in PD. Although the current literature is limited, it raises critical questions about the utility of data-driven methods in cognitive research. The results encourage further integration of neuroimaging research to define the latent neural mechanisms behind divergent subtypes. Although there is no consensus, there appears to be growing consistency and inherent value in identifying cognitive subtypes in PD.
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Affiliation(s)
- Dana Pourzinal
- Faculty of MedicineUniversity of Queensland Centre for Clinical ResearchHerstonQueenslandAustralia
| | - Jihyun Yang
- Faculty of MedicineUniversity of Queensland Centre for Clinical ResearchHerstonQueenslandAustralia
| | - Rachael A. Lawson
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle Upon TyneUK
| | - Katie L. McMahon
- School of Clinical Sciences, Faculty of HealthQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Gerard J. Byrne
- Faculty of MedicineUniversity of Queensland Centre for Clinical ResearchHerstonQueenslandAustralia,Mental Health Service, Royal Brisbane and Women's HospitalHerstonQueenslandAustralia
| | - Nadeeka N. Dissanayaka
- Faculty of MedicineUniversity of Queensland Centre for Clinical ResearchHerstonQueenslandAustralia,School of PsychologyUniversity of QueenslandSt LuciaQueenslandAustralia,Department of NeurologyRoyal Brisbane and Women's HospitalHerstonQueenslandAustralia
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11
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Dissanayaka NN, Forbes EJ, Perepezko K, Leentjens AFG, Dobkin RD, Dujardin K, Pontone GM. Phenomenology of Atypical Anxiety Disorders in Parkinson's Disease: A Systematic Review. Am J Geriatr Psychiatry 2022; 30:1026-1050. [PMID: 35305884 DOI: 10.1016/j.jagp.2022.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 02/03/2022] [Accepted: 02/10/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Anxiety is a prominent concern in Parkinson's disease (PD) that negatively impacts quality of life, increases functional disability, and complicates clinical management. Atypical presentations of anxiety are under-recognized and inadequately treated in patients with PD, compromising global PD care. METHODS This systematic review focuses on the prevalence, symptomology and clinical correlates of atypical presentations of PD-related anxiety following PRISMA guidelines. RESULTS Of the 60 studies meeting inclusion criteria, 14 focused on 'Anxiety Not Otherwise Specified (NOS)' or equivalent, 31 reported on fluctuating anxiety symptoms, and 22 reported on 'Fear of Falling (FOF)'. Anxiety NOS accounted for a weighted mean prevalence of 14.9%, fluctuating anxiety for 34.19%, and FOF for 51.5%. These latter two exceeded the average reported overall prevalence rate of 31% for anxiety disorders in PD. We identified a diverse array of anxiety symptoms related to motor and non-motor symptoms of PD, to complications of PD medication (such as "on" and "off" fluctuations, or both), and, to a lesser extent, to cognitive symptoms. CONCLUSION Atypical anxiety is common, clinically relevant, and heterogeneous in nature. A better understanding of the phenomenology, clinical course, and pathophysiology of varied forms of atypical anxiety in PD is needed to improve recognition, advance therapeutic development and ultimately optimize quality of life in PD.
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Affiliation(s)
- Nadeeka N Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine (NND, EJF), The University of Queensland, Brisbane, Australia; School of Psychology (NND, EJF), University of Queensland, Brisbane, Australia; Department of Neurology (NND), Royal Brisbane & Women's Hospital, Brisbane, Australia.
| | - Elana J Forbes
- UQ Centre for Clinical Research, Faculty of Medicine (NND, EJF), The University of Queensland, Brisbane, Australia; School of Psychology (NND, EJF), University of Queensland, Brisbane, Australia
| | - Kate Perepezko
- Department of Mental Health (KP), Johns Hopkins University Blomberg School of Public Health, Baltimore, USA
| | - Albert F G Leentjens
- Department of Psychiatry (AFGL), Maastricht University Medical Center, Maastricht, the Netherlands
| | - Roseanne D Dobkin
- Department of Psychiatry (RDD), Rutgers University, Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
| | - Kathy Dujardin
- Department of Neurology and Movement Disorders (KD), University Lille, Lille, France
| | - Gregory M Pontone
- Department of Psychiatry and Behavioral Sciences (GMP), Johns Hopkins University School of Medicine, Baltimore, USA; Department of Neurology (GMP), Johns Hopkins University School of Medicine, Baltimore, USA
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12
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Pacas Fronza G, Liddle J, Mitchell LK, Byrne GJ, Pachana NA, Dissanayaka NN. Phenomenology of anxiety in people living with mild to moderate dementia: A conceptual meta-ethnographic review. Dementia (London) 2022; 21:2677-2699. [PMID: 36018575 DOI: 10.1177/14713012221123706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This conceptual review aims to integrate findings from published qualitative studies focusing on individual experiences of people living with dementia to generate a better understanding and conceptualisation of anxiety in dementia, including its subclinical manifestations. The review aims to inform the clinical practice to facilitate the development of targeted psychological interventions and provision of holistic support to people living with dementia. DESIGN The review was conducted according to the guide for reporting meta-ethnographic qualitative syntheses eMERGe and the PRISMA guidelines. RESULTS The search yielded a total of 2947 studies, out of which 13 were included in the final qualitative synthesis. The interpretive synthesis identified common experiences of people living with mild to moderate dementia, characterised by clusters of themes around worry, emotional experiences, and behavioural reactions in response to the diagnosis of dementia and its symptoms. These represent the components of a conceptual framework of anxiety in mild to moderate dementia, where anxiety is triggered by negative appraisals of living with an irreversible neurodegenerative disease. Stemming from these appraisals of dementia progression and its impact on the person's overall future, the content of worrisome thoughts and concerns include the loss of self and identity, losing independence and the ability to perform previous activities, concerns about being a burden to loved ones, and worry about the impact on interpersonal relationships. CONCLUSION This conceptualisation of anxiety in dementia, including its subclinical manifestations facilitates the development of psychological interventions and provision of holistic support to people living with dementia.
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Affiliation(s)
- Gabriela Pacas Fronza
- UQ Centre for Clinical Research, Faculty of Medicine, 1974The University of Queensland, Herston, Brisbane, QLD, Australia
| | - Jacki Liddle
- School of Information Technology and Electrical Engineering, 1974The University of Queensland, St Lucia, Brisbane, QLD, Australia
| | - Leander K Mitchell
- School of Psychology, 1974The University of Queensland, St Lucia, Brisbane, QLD, Australia
| | - Gerard J Byrne
- UQ Centre for Clinical Research, Faculty of Medicine, 1974The University of Queensland, Herston, Brisbane, QLD, Australia.,Mental Health Service, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, Australia
| | - Nancy A Pachana
- School of Psychology, 1974The University of Queensland, St Lucia, Brisbane, QLD, Australia.,School of Business, 1974The University of Queensland, St Lucia, Brisbane, QLD, Australia
| | - Nadeeka N Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine, 1974The University of Queensland, Herston, Brisbane, QLD, Australia.,School of Psychology, 1974The University of Queensland, St Lucia, Brisbane, QLD, Australia.,Department of Neurology, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, Australia
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13
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Yang J, McMahon KL, Copland DA, Pourzinal D, Byrne GJ, Angwin AJ, O'Sullivan JD, Dissanayaka NN. Semantic fluency deficits and associated brain activity in Parkinson's disease with mild cognitive impairment. Brain Imaging Behav 2022; 16:2445-2456. [PMID: 35841523 DOI: 10.1007/s11682-022-00698-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 06/03/2022] [Accepted: 06/06/2022] [Indexed: 11/26/2022]
Abstract
People living with Parkinson's disease (PD) with poor verbal fluency have an increased risk of developing dementia. This study examines the neural mechanisms underpinning semantic fluency deficits in patients with PD with mild cognitive impairment (PD-MCI) compared to those without MCI (PD-NC) and control participants without PD (non-PD). Thirty-seven (37) participants with PD completed a cognitive assessment battery to identify MCI (13 PD-MCI). Twenty sex- and age-matched non-PD patients also participated. Participants were scanned (3T Siemens PRISMA) while performing semantic fluency, semantic switching, and automatic speech tasks. The number of responses and fMRI data for semantic generation and semantic switching were analyzed. Participants also completed a series of verbal fluency tests outside the scanner, including letter fluency. Participants with PD-MCI performed significantly worse than PD-NC and non-PD participants during semantic fluency and semantic switching tasks. PD-MCI patients showed greater activity in the right angular gyrus than PD-NC and non-PD patients during semantic switching. Increased right angular activity correlated with worse verbal fluency performance outside the scanner. Our study showed that the PD-MCI group performed worse on semantic fluency than either the PD-NC or non-PD groups. Increased right angular gyrus activity in participants with PD-MCI during semantic switching suggests early compensatory mechanisms, predicting the risk of future dementia in PD.
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Affiliation(s)
- Jihyun Yang
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Katie L McMahon
- School of Clinical Sciences and Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Queensland, Australia
| | - David A Copland
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- School of Health & Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Dana Pourzinal
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Gerard J Byrne
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- Mental Health Service, Royal Brisbane & Women's Hospital, Herston, Queensland, Australia
| | - Anthony J Angwin
- School of Health & Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - John D O'Sullivan
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- Department of Neurology, Royal Brisbane & Women's Hospital, Herston Queensland, Australia
| | - Nadeeka N Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia.
- Department of Neurology, Royal Brisbane & Women's Hospital, Herston Queensland, Australia.
- School of Psychology, The University of Queensland, St Lucia, Queensland, Australia.
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14
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Brimelow RE, Amalathas A, Beattie E, Byrne G, Dissanayaka NN. The Use of Balanced Scorecards in Mental Health Services: an Integrative Review and Thematic Analysis. J Behav Health Serv Res 2022; 50:128-146. [PMID: 35835954 PMCID: PMC9282827 DOI: 10.1007/s11414-022-09806-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2022] [Indexed: 11/18/2022]
Abstract
Performance management of mental health services (MHS) through quality reporting of strategic indicators and goals is essential to improve efficiency and quality of care. One such method is the balanced scorecard (BSC). This integrative review of peer-reviewed and industry implemented BSCs in MHS aims to inform future development of a more comprehensive mental health–focused benchmarking tool. A two-part systematic literature search consisted of peer-reviewed published literature on MHS specific BSCs utilising the PRISMA guidelines in addition to industry published BSCs available online. A total of 17 unique BSCs were identified. A total of 434 indicators were subject to thematic analysis identifying 11 key themes: prevalence, accessibility, services provided, clinical outcomes, client satisfaction, client involvement, staff motivation, staffing levels, governance and compliance, development, and costs and revenue. These themes represented the measures that MHS believed measured key performance criteria in alignment with their organisational objectives.
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Affiliation(s)
- Rachel E Brimelow
- The University of Queensland Centre for Clinical Research, Herston, QLD, 4029, Australia
| | - Aneline Amalathas
- The University of Queensland-Ochsner Clinical School, Brisbane, Australia.,Ochsner Clinical School, The University of Queensland, New Orleans, LA, USA
| | - Elizabeth Beattie
- Faculty of Health, School of Nursing, Queensland University of Technology, Kelvin Grove, QLD, 4059, Australia.,Institute of Health and Biomedical Innovation, Kelvin Grove, QLD, 4059, Australia
| | - Gerard Byrne
- The University of Queensland Centre for Clinical Research, Herston, QLD, 4029, Australia
| | - Nadeeka N Dissanayaka
- The University of Queensland Centre for Clinical Research, Herston, QLD, 4029, Australia. .,Mental Health Service, Royal Brisbane & Woman's Hospital, Herston, QLD, 4029, Australia. .,Faculty of Health and Behavioural Sciences, The University of Queensland School of Psychology, St Lucia, QLD, 4072, Australia. .,Department of Neurology, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.
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15
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Abstract
OBJECTIVES Decline in language and cognitive functioning often deprives people living with moderate-to-severe dementia of self-reporting their quality of life (QoL) on the written and verbal formats of questionnaires. This systematic review aimed to evaluate the effectiveness of pictorial tools as an alternative method for enabling people living with dementia to self-report their QoL. METHODS PubMed, PsycINFO, CINAHL, and EMBASE were searched. Primary research studies reporting on information elicitation from people living with dementia through pictures were deemed eligible. Six studies satisfied the inclusion criteria. Methodological quality of the studies was evaluated through Downs and Black checklist. Data was extracted according to population, intervention, comparator, and outcomes (PICO) and results were summarized and supplemented by narrative synthesis. RESULTS Compared to usual communication methods, pictorial tools were found to have a superior effect on comprehension of conversations and decision-making abilities, minimal effect on preference consistency, and an undeterminable effect on discourse features. CONCLUSIONS There is consistent evidence that pictures enhance comprehension and might facilitate decision-making abilities. CLINICAL IMPLICATIONS QoL information can be elicited more effectively through pictorial tools. Future studies warrant development of pictorial versions of standardized QoL tools which will assist the inclusion of people living with severe dementia.
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Affiliation(s)
- Muhammad Haroon
- Centre for Health Services Research, Faculty of Medicine, the University of Queensland, Brisbane, Australia
| | - Nadeeka N Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine, the University of Queensland, Brisbane, Australia.,School of Psychology, the University of Queensland, Brisbane, Australia.,Department of Neurology, Royal Brisbane & Women's Hospital, Brisbane, Australia
| | - Anthony J Angwin
- School of Health and Rehabilitation Sciences, the University of Queensland, Brisbane, Australia
| | - Tracy Comans
- Centre for Health Services Research, Faculty of Medicine, the University of Queensland, Brisbane, Australia
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16
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Thangavelu K, Hayward JA, Pachana NA, Byrne GJ, Mitchell LK, Wallis GM, Au TR, Dissanayaka NN. Designing Virtual Reality Assisted Psychotherapy for Anxiety in Older Adults Living with Parkinson's Disease: Integrating Literature for Scoping. Clin Gerontol 2022; 45:235-251. [PMID: 31903862 DOI: 10.1080/07317115.2019.1709597] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objective: This review integrates literature to discuss the potential use of virtual reality (VR) in treatment of anxiety in Parkinson's disease (PD) and inform next steps.Methods: A systematic search was performed to identify studies of VR use in PD, using four databases. Data were reported in accordance to the Preferred Reporting Items for Systematic reviews and Meta-Analyzes extension for Scoping Reviews (PRISMA-ScR).Results: Thirty-two studies met the inclusion criteria with four VR studies from the same study group directly assessing the effects of anxiety on motor symptoms in PD. Primary studies implementing a VR protocol in PD identified focus areas of understanding and alleviating freezing of gait (FOG), balance training, and cognitive and motor rehabilitation, and informed design considerations.Conclusion: VR in PD studies suggested established feasibility. With appropriate design considerations, a VR based protocol could improve anxiety outcomes in PD.Clinical implications: VR in PD provides control of a patient's field of view, which can be exploited to induce specific responses, provide visual feedback, analysis of patient actions, and introduce safe challenges in the context of training. VR assisted Cognitive Behavioral Therapy (CBT) tailored to suit subtypes of anxiety disorders in PD have the potential to improve the efficacy and effectiveness of psychotherapy in PD.
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Affiliation(s)
- Karthick Thangavelu
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Joshua A Hayward
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Nancy A Pachana
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Gerard J Byrne
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Mental Health Service, Royal Brisbane & Woman's Hospital, Brisbane, Australia
| | | | - Guy M Wallis
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Australia
| | - Tiffany R Au
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Nadeeka N Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,School of Psychology, The University of Queensland, Brisbane, Australia.,Department of Neurology, Royal Brisbane & Woman's Hospital, Brisbane, Australia
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17
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Perepezko K, Naaz F, Wagandt C, Dissanayaka NN, Mari Z, Nanavati J, Bakker A, Pontone GM. Anxiety in Parkinson's Disease: A Systematic Review of Neuroimaging Studies. J Neuropsychiatry Clin Neurosci 2021; 33:280-294. [PMID: 34280319 DOI: 10.1176/appi.neuropsych.20110272] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The mechanisms and neuronal networks associated with anxiety in Parkinson's disease (PD) are incompletely understood. One of the best tools for investigating both component function and neuronal networks associated with psychiatric symptoms is functional MRI (fMRI). Unlike structural scans, functional scans, whether task-based or resting-state, are more likely to be clinically relevant and sensitive to changes related to treatment. The investigators provide a comprehensive review of and present results for imaging studies of anxiety in PD. METHODS A systematic review of the literature on fMRI and anxiety in PD was conducted, and the quality of all included studies was simultaneously assessed. Eighteen studies were included: 15 studies assessed anxiety directly, and three evaluated emotional processing. Imaging methodology and behavioral assessments varied across studies, preventing direct comparison of results in most cases. RESULTS There was a convergence in findings across methods, implicating involvement of the amygdala, caudate, and putamen in association with anxiety in PD. For both task-based activation and resting-state connectivity, dopamine medication status was associated with differences in activation and behavioral function. CONCLUSIONS Although there is little consensus in the current fMRI literature studying anxiety in PD, these results suggest an overlap between structures classically involved in the brain's fear circuit (particularly the amygdala) and the alterations in the nigro-striatal system (e.g., the caudate and putamen and on-off dopamine findings) related to PD and its dopaminergic treatments.
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Affiliation(s)
- Kate Perepezko
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Perepezko, Bakker); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine (Naaz, Wagandt, Nanavati, Bakker, Pontone); University of Queensland Centre for Clinical Research, Faculty of Medicine, Brisbane, Australia (Dissanayaka); School of Psychology, University of Queensland (Dissanayaka); Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Australia (Dissanayaka); Department of Neurology, Johns Hopkins University School of Medicine (Mari, Bakker, Pontone); and Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas (Mari)
| | - Farah Naaz
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Perepezko, Bakker); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine (Naaz, Wagandt, Nanavati, Bakker, Pontone); University of Queensland Centre for Clinical Research, Faculty of Medicine, Brisbane, Australia (Dissanayaka); School of Psychology, University of Queensland (Dissanayaka); Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Australia (Dissanayaka); Department of Neurology, Johns Hopkins University School of Medicine (Mari, Bakker, Pontone); and Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas (Mari)
| | - Carrie Wagandt
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Perepezko, Bakker); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine (Naaz, Wagandt, Nanavati, Bakker, Pontone); University of Queensland Centre for Clinical Research, Faculty of Medicine, Brisbane, Australia (Dissanayaka); School of Psychology, University of Queensland (Dissanayaka); Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Australia (Dissanayaka); Department of Neurology, Johns Hopkins University School of Medicine (Mari, Bakker, Pontone); and Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas (Mari)
| | - Nadeeka N Dissanayaka
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Perepezko, Bakker); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine (Naaz, Wagandt, Nanavati, Bakker, Pontone); University of Queensland Centre for Clinical Research, Faculty of Medicine, Brisbane, Australia (Dissanayaka); School of Psychology, University of Queensland (Dissanayaka); Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Australia (Dissanayaka); Department of Neurology, Johns Hopkins University School of Medicine (Mari, Bakker, Pontone); and Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas (Mari)
| | - Zoltan Mari
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Perepezko, Bakker); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine (Naaz, Wagandt, Nanavati, Bakker, Pontone); University of Queensland Centre for Clinical Research, Faculty of Medicine, Brisbane, Australia (Dissanayaka); School of Psychology, University of Queensland (Dissanayaka); Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Australia (Dissanayaka); Department of Neurology, Johns Hopkins University School of Medicine (Mari, Bakker, Pontone); and Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas (Mari)
| | - Julie Nanavati
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Perepezko, Bakker); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine (Naaz, Wagandt, Nanavati, Bakker, Pontone); University of Queensland Centre for Clinical Research, Faculty of Medicine, Brisbane, Australia (Dissanayaka); School of Psychology, University of Queensland (Dissanayaka); Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Australia (Dissanayaka); Department of Neurology, Johns Hopkins University School of Medicine (Mari, Bakker, Pontone); and Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas (Mari)
| | - Arnold Bakker
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Perepezko, Bakker); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine (Naaz, Wagandt, Nanavati, Bakker, Pontone); University of Queensland Centre for Clinical Research, Faculty of Medicine, Brisbane, Australia (Dissanayaka); School of Psychology, University of Queensland (Dissanayaka); Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Australia (Dissanayaka); Department of Neurology, Johns Hopkins University School of Medicine (Mari, Bakker, Pontone); and Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas (Mari)
| | - Gregory M Pontone
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Perepezko, Bakker); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine (Naaz, Wagandt, Nanavati, Bakker, Pontone); University of Queensland Centre for Clinical Research, Faculty of Medicine, Brisbane, Australia (Dissanayaka); School of Psychology, University of Queensland (Dissanayaka); Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Australia (Dissanayaka); Department of Neurology, Johns Hopkins University School of Medicine (Mari, Bakker, Pontone); and Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas (Mari)
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18
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Mosley PE, Robinson K, Dissanayaka NN, Coyne T, Silburn P, Marsh R, Pye D. A Pilot Trial of Cognitive Behavioral Therapy for Caregivers After Deep Brain Stimulation for Parkinson's Disease. J Geriatr Psychiatry Neurol 2021; 34:454-465. [PMID: 32400266 DOI: 10.1177/0891988720924720] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Subthalamic deep brain stimulation for Parkinson's disease may not ameliorate burden among caregivers. An 8-session, manualized program of cognitive-behavioral therapy (CBT) was delivered to a pilot sample of 10 caregivers (6 females, mean age: 60, age range: 34-79). Primary outcome measures were caregiver burden (Zarit Burden Interview) and caregiver quality of life (Parkinson's Disease Questionnaire-Carer). Secondary outcome measures comprised ratings of depression and anxiety in the caregiver, in addition to relationship quality. Caregiver burden (t = 2.91 P = .017) and caregiver anxiety (t = 2.82 P = .020) symptoms were significantly reduced at completion of the program, and these benefits were maintained 3 months later. Caregiver quality of life had significantly improved by the end of the intervention (t = 3.02 P = .015), but this effect was not sustained after 3 months. The longitudinal influence of participation in the program on caregiver burden was confirmed in a linear, mixed-effects model, χ2 (3) = 15.1, P = .0017). The intervention was well received by participants, and qualitative feedback was obtained. These results indicate that caregiver burden is modifiable in this cohort with a short course of CBT, that benefits are maintained after termination of the program, and that psychological treatment is acceptable to participants. Larger, controlled trials are justified.
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Affiliation(s)
- Philip E Mosley
- Systems Neuroscience Group, 56362QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,Neurosciences Queensland, St Andrew's War Memorial Hospital, Spring Hill, Queensland, Australia.,171919Queensland Brain Institute, University of Queensland, St Lucia, Queensland, Australia.,Faculty of Medicine, 171919University of Queensland, Herston, Queensland, Australia
| | - Katherine Robinson
- Systems Neuroscience Group, 56362QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Nadeeka N Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Herston, Queensland, Australia.,310748School of Psychology, St Lucia, University of Queensland, Brisbane, Australia.,Department of Neurology, 3883Royal Brisbane & Women's Hospital, Herston, Queensland, Australia
| | - Terry Coyne
- 171919Queensland Brain Institute, University of Queensland, St Lucia, Queensland, Australia.,Brizbrain and Spine, The Wesley Hospital, Auchenflower, Queensland, Australia
| | - Peter Silburn
- Neurosciences Queensland, St Andrew's War Memorial Hospital, Spring Hill, Queensland, Australia.,171919Queensland Brain Institute, University of Queensland, St Lucia, Queensland, Australia
| | - Rodney Marsh
- Neurosciences Queensland, St Andrew's War Memorial Hospital, Spring Hill, Queensland, Australia.,Department of Psychiatry, 3883Royal Brisbane & Women's Hospital, Herston, Queensland, Australia
| | - Deidre Pye
- 310748School of Psychology, St Lucia, University of Queensland, Brisbane, Australia
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19
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Brimelow RE, Thangavelu K, Beattie R, Dissanayaka NN. Feasibility of Group-Based Multiple Virtual Reality Sessions to Reduce Behavioral and Psychological Symptoms in Persons Living in Residential Aged Care. J Am Med Dir Assoc 2021; 23:831-837.e2. [PMID: 34454923 DOI: 10.1016/j.jamda.2021.07.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 07/07/2021] [Accepted: 07/18/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To assess the feasibility of using group-based fully immersive virtual reality (VR) across multiple sessions to reduce behavioral and psychological symptoms (BPSs), including depression, anxiety, and agitated behaviors, in cognitively diverse aged care residents. DESIGN A 6-session feasibility trial was conducted within a residential aged care facility using convenience sampling to recruit N = 25 residents of varying cognitive capacity. Groups of 5 residents viewed 360-degree videos on a wireless head-mounted display to provide fully immersive VR experiences. SETTING AND PARTICIPANTS Half of the participants recruited from the 160-bed facility had a diagnosis of dementia (48%), whereas assessment with the Psychogeriatric Assessment Scale for cognitive impairment revealed that 64% experienced cognitive impairment (mild 20%, moderate 16%, and severe 28%). Additionally, 32% of participants had an existing anxiety or depression diagnosis. MEASURES The Cornell Scale for Depression in Dementia, Generalized Anxiety Disorder 7-item, and Cohen Mansfield Agitation Inventory-Short were used to assess changes in persisting BPS pre- to postintervention period. The Person-Environment Apathy Rating apathy subscale, Observed Emotions Rating Scale, and a visual analog scale (Smileometer) were used to assess immediate mood responses from residents at every VR session. VR tolerability and resident feedback was also recorded. RESULTS Pleasure (z = -5.892, P < .001) and general alertness (z = -2.455, P = .014) of participants improved at VR sessions, whereas apathy diminished (z = -5.275, P < .001). Compared to baseline, post-intervention depression was significantly lowered (z = -2.60, P = .009), whereas agitation increased (z = -2.98, P = .003). No significant changes in anxiety were observed. The quality of 360-degree videos and the device used did not induce any major VR-related negative side effects. CONCLUSIONS AND IMPLICATIONS Overall group-based VR reduced depressive symptoms and apathy, and induced a positive emotional response in most residents, with few observed side effects. Results indicate feasibility of group-based VR technological innovation within RAC.
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Affiliation(s)
- Rachel E Brimelow
- UQ Centre for Clinical Research, Royal Brisbane & Women's Hospital, Faculty of Medicine, University of Queensland, Herston, Brisbane, Queensland, Australia
| | - Karthick Thangavelu
- UQ Centre for Clinical Research, Royal Brisbane & Women's Hospital, Faculty of Medicine, University of Queensland, Herston, Brisbane, Queensland, Australia
| | - Romana Beattie
- Wesley Mission Queensland, Chermside, Brisbane, Queensland, Australia
| | - Nadeeka N Dissanayaka
- UQ Centre for Clinical Research, Royal Brisbane & Women's Hospital, Faculty of Medicine, University of Queensland, Herston, Brisbane, Queensland, Australia; Department of Neurology, Royal Brisbane & Women's Hospital, Herston, Brisbane, Queensland, Australia; School of Psychology, University of Queensland, St Lucia, Brisbane, Queensland, Australia.
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Dissanayaka NN, Forbes EJ, Yang JHJ, Pourzinal D, O'Sullivan JD, Mitchell LK, Copland DA, McMahon KL, Byrne GJ. Anxiety disorders are associated with verbal memory impairment in patients with Parkinson's disease without dementia. J Neurol 2021; 269:1600-1609. [PMID: 34347150 DOI: 10.1007/s00415-021-10736-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/25/2021] [Accepted: 07/26/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Preliminary evidence has demonstrated a link between anxiety and memory impairment in Parkinson's disease (PD). This study further investigated this association using the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for anxiety disorders and a standardized cognitive test battery. METHODS A convenience sample of 89 PD patients without dementia was recruited from neurology outpatient clinics. A cross-sectional design was applied. Participants completed two semi-structured interviews. The first interview diagnosed DSM-5 anxiety disorders, unspecified anxiety disorder, and no anxiety. The second interview applied a neurocognitive test battery comprising two tests for each domain. Logistic regression models compared cognitive characteristics associated with anxiety disorders to no anxiety. RESULTS Clinically significant anxiety was associated with immediate verbal memory impairment compared to the no anxiety group (OR, 95% CI 0.52, 0.30-0.89; p = 0.018), controlling for sex and age. The anxiety disorders group demonstrated immediate (OR, 95% CI 0.46, 0.26-0.83; p = 0.010) and delayed (OR, 95% CI 0.63, 0.40-0.99; p = 0.047) verbal memory impairments compared to those without anxiety, controlling for sex and age. This association remained for immediate (OR, 95% CI 0.43, 0.22-0.84; p = 0.013), but not delayed verbal memory impairment (OR, 95% CI 0.65, 0.39-1.06; p = 0.081) when additionally controlling for disease severity, education and levodopa dose. CONCLUSION These findings present first evidence that anxiety disorders are associated with verbal memory impairment in PD and have implications for the management and treatment of anxiety in PD.
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Affiliation(s)
- Nadeeka N Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Building 71/918 Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, 4029, Australia. .,School of Psychology, The University of Queensland, Brisbane, Australia. .,Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Australia.
| | - Elana J Forbes
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Building 71/918 Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, 4029, Australia.,School of Psychology, The University of Queensland, Brisbane, Australia
| | - Ji Hyun J Yang
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Building 71/918 Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, 4029, Australia
| | - Dana Pourzinal
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Building 71/918 Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, 4029, Australia
| | - John D O'Sullivan
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Building 71/918 Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, 4029, Australia.,Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | | | - David A Copland
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Building 71/918 Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, 4029, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Katie L McMahon
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Gerard J Byrne
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Building 71/918 Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, 4029, Australia.,Mental Health Service, Royal Brisbane and Women's Hospital, Brisbane, Australia
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21
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Eeles E, Huang L, Dakin L, Ling C, Dunn E, Fraser J, Dissanayaka NN. Development and validation of an aetiology in delirium diagnostic support tool. Age Ageing 2021; 50:1402-1405. [PMID: 33301574 DOI: 10.1093/ageing/afaa269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 10/15/2020] [Accepted: 11/06/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND recognition of the multifactorial causes of delirium represents a clinical challenge. OBJECTIVES to develop and show proof of principle of a diagnostic support tool (DST) for identification of causes of delirium. METHODS stage 1-development of the aetiology in delirium-diagnostic support tool (AiD-DST); stage 2-validation of the AiD-DST against reference standard diagnosis, based on clinical assessment from two independent consultant geriatricians. RESULTS a series of eight steps AiD-DST were formulated by an expert group to identify possible causes of delirium. Forty inpatients admitted to a general medical unit with a consultant physician/geriatrician diagnosis of delirium were recruited, consented and reviewed against the AiD-DST. Mean age was 85.1 (standard deviation 7.9) years and 26 (65%) of participants were female. Participants had multiple chronic co-morbidities [median Charlson Comorbidity Index 7; interquartile range (IQR 6-9)] and median number of medications was 8 (IQR 6-11.75). Median number of causes of delirium detected on AiD-DST was 3 (IQR 3-4) versus 5 (IQR 3-6) using the reference standard diagnosis, with sensitivity of 88.8% (95% confidence interval, 81.6-93.9%) and specificity of 71.8% (63-79.5%). CONCLUSIONS the aetiology in delirium DST shows promise in the identification of cause(s) in delirium.
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Affiliation(s)
- Eamonn Eeles
- Internal Medicine Services, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Northside Clinical School, School of Medicine, University of Queensland, Brisbane, Australia
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Lisa Huang
- Department of Medicine, Logan Hospital, Brisbane, Queensland, Australia
| | - Lucy Dakin
- Internal Medicine Services, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Northside Clinical School, School of Medicine, University of Queensland, Brisbane, Australia
| | - Carolina Ling
- Internal Medicine Services, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Northside Clinical School, School of Medicine, University of Queensland, Brisbane, Australia
| | - Erin Dunn
- Allied Health, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Jon Fraser
- Metro North IT, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Nadeeka N Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Department of Neurology, Royal Brisbane & Women’s Hospital, Herston Queensland, Australia
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
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22
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Pourzinal D, Yang JHJ, Bakker A, McMahon KL, Byrne GJ, Pontone GM, Mari Z, Dissanayaka NN. Hippocampal correlates of episodic memory in Parkinson's disease: A systematic review of magnetic resonance imaging studies. J Neurosci Res 2021; 99:2097-2116. [PMID: 34075634 DOI: 10.1002/jnr.24863] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/09/2021] [Accepted: 05/11/2021] [Indexed: 12/15/2022]
Abstract
The present review asks whether magnetic resonance imaging (MRI) studies are able to define neural correlates of episodic memory within the hippocampus in Parkinson's disease (PD). Systematic searches were performed in PubMed, Web of Science, Medline, CINAHL, and EMBASE using search terms related to structural and functional MRI (fMRI), the hippocampus, episodic memory, and PD. Risk of bias was assessed for each study using the Newtown-Ottawa Scale. Thirty-nine studies met inclusion criteria; eight fMRI, seven diffusion MRI (dMRI), and 24 structural MRI (14 exploring whole hippocampus and 10 exploring hippocampal subfields). Critical analysis of the literature revealed mixed evidence from functional and dMRI, but stronger evidence from sMRI of the hippocampus as a biomarker for episodic memory impairment in PD. Hippocampal subfield studies most often implicated CA1, CA3/4, and subiculum volume in episodic memory and cognitive decline in PD. Despite differences in imaging methodology, study design, and sample characteristics, MRI studies have helped elucidate an important neural correlate of episodic memory impairment in PD with both clinical and theoretical implications. Natural progression of this work encourages future research on hippocampal subfield function as a potential biomarker of, or therapeutic target for, episodic memory dysfunction in PD.
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Affiliation(s)
- Dana Pourzinal
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia
| | - Ji Hyun J Yang
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia
| | - Arnold Bakker
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA.,Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Katie L McMahon
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Gerard J Byrne
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia.,Mental Health Service, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia
| | - Gregory M Pontone
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA.,Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Zoltan Mari
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Nadeeka N Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia.,Department of Neurology, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia.,School of Psychology, The University of Queensland, Brisbane, QLD, Australia
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23
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Forbes EJ, Byrne GJ, O'Sullivan JD, Yang J, Marsh R, Dissanayaka NN. Defining Atypical Anxiety in Parkinson's Disease. Mov Disord Clin Pract 2021; 8:571-581. [PMID: 33981790 PMCID: PMC8088112 DOI: 10.1002/mdc3.13193] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 02/14/2021] [Accepted: 02/28/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Anxiety is a major complication in Parkinson's disease (PD). Many PD patients experience clinically significant anxiety not meeting Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) anxiety disorder criteria. This atypical anxiety (anxiety disorder not otherwise specified [NOS]) is often under-recognized and its diagnosis is underdeveloped. OBJECTIVES This study aimed to identify the demographic, psychiatric, and clinical characteristics of anxiety disorder NOS in PD. METHODS A cross-sectional design studied a convenience sample of 184 PD patients without dementia recruited from neurology outpatient clinics. A semi-structured interview using DSM-IV criteria categorized PD patients into current anxiety disorder NOS (n = 28), DSM-IV anxiety disorders (n = 42) or no anxiety (n = 86) groups. Logistic regression modeling identified characteristics associated with the anxiety disorder NOS group compared to DSM-IV anxiety and no anxiety groups. RESULTS The anxiety disorder NOS group was associated with motor complications of PD therapy, episodic, persistent and social anxiety symptoms, depression, non-motor experiences of daily living, poor quality of life, and female sex compared to the no anxiety group. Compared to DSM-IV anxiety, those with anxiety disorder NOS demonstrated greater global cognitive impairment, more severe motor complications of PD therapy, a greater severity and functional impact of dyskinesias, and greater complexity of motor fluctuations. Persistent, episodic, and social anxiety symptoms did not significantly differ between anxiety disorder NOS and DSM-IV anxiety groups. CONCLUSIONS These findings suggest that PD-specific symptoms characterize anxiety in a subgroup of PD patients who do not fulfill DSM-IV criteria for anxiety disorders.
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Affiliation(s)
- Elana J. Forbes
- School of PsychologyUniversity of QueenslandBrisbaneQueenslandAustralia
- UQ Centre for Clinical Research, Faculty of Medicine, University of QueenslandRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | - Gerard J. Byrne
- UQ Centre for Clinical Research, Faculty of Medicine, University of QueenslandRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
- Mental Health ServiceRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | - John D. O'Sullivan
- UQ Centre for Clinical Research, Faculty of Medicine, University of QueenslandRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
- Department of NeurologyRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | - Jihyun Yang
- UQ Centre for Clinical Research, Faculty of Medicine, University of QueenslandRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | - Rodney Marsh
- UQ Centre for Clinical Research, Faculty of Medicine, University of QueenslandRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
- Asia‐Pacific Centre for NeuromodulationUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Nadeeka N. Dissanayaka
- School of PsychologyUniversity of QueenslandBrisbaneQueenslandAustralia
- UQ Centre for Clinical Research, Faculty of Medicine, University of QueenslandRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
- Department of NeurologyRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
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24
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Iyer KK, Au TR, Angwin AJ, Copland DA, Dissanayaka NN. Theta and gamma connectivity is linked with affective and cognitive symptoms in Parkinson's disease. J Affect Disord 2020; 277:875-884. [PMID: 33065829 DOI: 10.1016/j.jad.2020.08.086] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 07/16/2020] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The progression of Parkinson's disease (PD) can often exacerbate symptoms of depression, anxiety, and/or cognitive impairment. In this study, we explore the possibility that multiple brain network responses are associated with symptoms of depression, anxiety and cognitive impairment in PD. This association is likely to provide insights into a single multivariate relationship, where common affective symptoms occurring in PD cohorts are related with alterations to electrophysiological response. METHODS 70 PD patients and 21 healthy age-matched controls (HC) participated in a high-density electroencephalography (EEG) study. Functional connectivity differences between PD and HC groups of oscillatory activity at rest and during completion of an emotion-cognition task were examined to identify key brain oscillatory activities. A canonical correlation analysis (CCA) was applied to identify a putative multivariate relationship between connectivity patterns and affective symptoms in PD groups. RESULTS A CCA analysis identified a single mode of co-variation linking theta and gamma connectivity with affective symptoms in PD groups. Increases in frontotemporal gamma, frontal and parietal theta connectivity were related with increased anxiety and cognitive impairment. Decreases in temporal region theta and frontoparietal gamma connectivity were associated with higher depression ratings and PD patient age. LIMITATIONS This study only reports on optimal dosage of dopaminergic treatment ('on' state) in PD and did not investigate at "off" medication". CONCLUSIONS Theta and gamma connectivity during rest and task-states are linked to affective and cognitive symptoms within fronto-temporo-parietal networks, suggesting a potential assessment avenue for understanding brain-behaviour associations in PD with electrophysiological task paradigms.
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Affiliation(s)
- Kartik K Iyer
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane & Women's Hospital, Herston, QLD 4029, Brisbane, Australia; Clinical Brain Networks group, QIMR Berghofer Medical Research Institute, Australia; School of Health & Rehabilitation Sciences, The University of Queensland, St Lucia, QLD 4067, Brisbane, Australia
| | - Tiffany R Au
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane & Women's Hospital, Herston, QLD 4029, Brisbane, Australia
| | - Anthony J Angwin
- School of Health & Rehabilitation Sciences, The University of Queensland, St Lucia, QLD 4067, Brisbane, Australia
| | - David A Copland
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane & Women's Hospital, Herston, QLD 4029, Brisbane, Australia; School of Health & Rehabilitation Sciences, The University of Queensland, St Lucia, QLD 4067, Brisbane, Australia
| | - Nadeeka N Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane & Women's Hospital, Herston, QLD 4029, Brisbane, Australia; Department of Neurology, Royal Brisbane & Women's Hospital, Herston, QLD 4029, Brisbane, Australia; School of Psychology, The University of Queensland, St Lucia, QLD 4067, Brisbane, Australia.
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25
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Pourzinal D, Yang JHJ, Byrne GJ, O'Sullivan JD, Mitchell L, McMahon KL, Copland DA, Dissanayaka NN. Identifying subtypes of mild cognitive impairment in Parkinson's disease using cluster analysis. J Neurol 2020; 267:3213-3222. [PMID: 32535681 DOI: 10.1007/s00415-020-09977-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/01/2020] [Accepted: 06/04/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The concept of Mild Cognitive Impairment (MCI) in Parkinson's disease (PD) has shown the potential for identifying at-risk dementia patients. Identifying subtypes of MCI is likely to assist therapeutic discoveries and better clinical management of patients with PD (PWP). Recent cluster-based approaches have demonstrated dominance in memory and executive impairment in PD. The present study will further explore the role of memory and executive impairment and associated clinical features in non-demented PWP. METHOD A K-means cluster analysis was performed on ten "frontal" and "posterior" cognitive variables derived from a dataset of 85 non-demented PWP. The resulting cluster structure was chosen based on quantitative, qualitative, theoretical, and clinical validity. Cluster profiles were then created through statistical analysis of cognitive and clinical/demographic variables. A descriptive analysis of each cluster's performance on a comprehensive PD-MCI diagnostic battery was also explored. RESULTS The resulting cluster structure revealed four distinct cognitive phenotypes: (1) frontal-dominant impairment; (2) posterior-cortical-dominant impairment; (3) global impairment, and (4) cognitively intact. Demographic profiling revealed significant differences in the age, gender split, global cognitive ability, and motor symptoms between these clusters. However, there were no significant differences between the clusters on measures of depression, apathy, and anxiety. CONCLUSION These results validate the existence of distinct cognitive phenotypes within PD-MCI and encourage future research into their clinical trajectory and neuroimaging correlates.
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Affiliation(s)
- Dana Pourzinal
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital, Building 71/918, Herston, Brisbane, QLD, 4029, Australia
- School of Psychology, The University of Queensland, St Lucia, Brisbane, QLD, 4067, Australia
| | - Ji Hyun J Yang
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital, Building 71/918, Herston, Brisbane, QLD, 4029, Australia
| | - Gerard J Byrne
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital, Building 71/918, Herston, Brisbane, QLD, 4029, Australia
- Mental Health Service, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, 4029, Australia
| | - John D O'Sullivan
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital, Building 71/918, Herston, Brisbane, QLD, 4029, Australia
- Department of Neurology, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, 4029, Australia
| | - Leander Mitchell
- School of Psychology, The University of Queensland, St Lucia, Brisbane, QLD, 4067, Australia
| | - Katie L McMahon
- School of Clinical Sciences and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, 4000, Australia
| | - David A Copland
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital, Building 71/918, Herston, Brisbane, QLD, 4029, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Brisbane, QLD, 4067, Australia
| | - Nadeeka N Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital, Building 71/918, Herston, Brisbane, QLD, 4029, Australia.
- School of Psychology, The University of Queensland, St Lucia, Brisbane, QLD, 4067, Australia.
- Department of Neurology, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, 4029, Australia.
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Moreno A, Wall KJ, Thangavelu K, Craven L, Ward E, Dissanayaka NN. A systematic review of the use of virtual reality and its effects on cognition in individuals with neurocognitive disorders. Alzheimers Dement (N Y) 2019; 5:834-850. [PMID: 31799368 PMCID: PMC6881602 DOI: 10.1016/j.trci.2019.09.016] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Virtual reality (VR) interventions are increasingly used in individuals with brain injuries. The objective of this study was to determine the effects of VR on overall cognitive functioning in individuals with neurocognitive disorders (NCDs). Methods Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review of the published literature on immersive and nonimmersive VR technologies targeting cognition in minor and major NCDs was conducted: (PROSPERO registration number: CRD42019121953). Results A total of 22 studies were included in the review, for an aggregated sample of 564 individuals with NCDs. Most of the studies were conducted on patients who had stroke (27.3%), followed by mild cognitive impairment (22.7%) and Alzheimer's disease (13.6%). VR interventions used for cognitive rehabilitation suggested to improve cognition (e.g. memory, dual tasking, and visual attention), and secondarily to psychological functioning (e.g. reduction of anxiety, higher levels of well-being, and increased use of coping strategies). Conclusion VR interventions are useful to improve cognition and psychological symptoms in NCDs.
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Affiliation(s)
- Alexander Moreno
- Department of Psychology, Université de Montréal, Quebec, Canada.,Centre for Interdisciplinary Research in Rehabilitation (CRIR) - Notre-Dame Hospital, CIUSSS Centre-Sud-de-l'Île-de-Montréal (CCSMTL), Montreal, Quebec, Canada
| | - Kylie Janine Wall
- Faculty of Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia.,Faculty of Health, School of Psychology and Counselling, Queensland University of Technology, Queensland, Australia.,QSpectral Systems Pty Ltd, Queensland, Australia
| | - Karthick Thangavelu
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Queensland, Australia
| | - Lucas Craven
- Department of Psychology, Western Colorado University, Gunnison, Colorado, USA
| | - Emma Ward
- Faculty of Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia.,Faculty of Health, School of Psychology and Counselling, Queensland University of Technology, Queensland, Australia.,QSpectral Systems Pty Ltd, Queensland, Australia
| | - Nadeeka N Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Queensland, Australia.,School of Psychology, The University of Queensland, Queensland, Australia.,Department of Neurology, Royal Brisbane & Woman's Hospital, Queensland, Australia
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Walker N, Dissanayaka NN, Scott T, Manchha A, Pachana NA. Shaping attitudes: The association between prior contact with residential aged care and resistance to enter residential aged care. Int J Older People Nurs 2019; 14:e12268. [PMID: 31486587 DOI: 10.1111/opn.12268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/08/2019] [Accepted: 07/24/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND The ageing population is increasing, and negative attitudes towards older people are all too common and largely overlooked. However, little research has examined how ageist, prejudice, and discrimination, that often occur in healthcare settings, impact the community's perceptions of entering Residential Aged Care (RAC) in the future. In particular, studies have not investigated how contact with RAC influences individuals' attitudes towards RAC facilities, residents and staff. This study is the first to examine individuals' resistance towards living in RAC using the contact hypothesis, a theory of prejudice reduction. AIMS To explore how positive or negative contact with RAC residents and staff impacts individuals' behavioural intentions towards entering RAC in the future. To examine whether perceptions of trust, independence and RAC staff mediate the relationship between contact and behavioural intentions towards entering RAC in the future. DESIGN A cross-sectional survey design. METHOD Data were collected via online surveys using contact (positive or negative), trust, independence, perceptions of RAC staff and resistance levels (mild refusal or extreme refusal) measures. Participants (n = 373) from Australia and USA were recruited using social media, word of mouth and Amazons Mechanical Turk. FINDINGS Individuals who experienced negative contact with RAC residents and staff were more likely to report intense resistance to RAC, "I would rather die than enter RAC". Whereas, positive contact with RAC residents and staff was associated with reductions in the adverse appraisal of RAC staff; a diminished perception that individuals lost their independence, and an increased trust in RAC residents, facilities and staff. Participants from USA reported greater levels of resistance towards RAC in comparison with participants from Australia. This study demonstrates how interactions with RAC residents, facilities and staff are critical in shaping attitudes towards RAC. IMPLICATIONS FOR PRACTICE It is recommended that the public are exposed to opportunities where they can experience positive contact with RAC. RAC facilities can promote interaction between the public and RAC residents through encouraging participation in community partnership programs/intergenerational programs.
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Affiliation(s)
- Nicole Walker
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia.,UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Nadeeka N Dissanayaka
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia.,UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Neurology, Royal Brisbane & Woman's Hospital, Brisbane, Queensland, Australia
| | - Theresa Scott
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia.,Discipline of General Practice, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Asmita Manchha
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Nancy A Pachana
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
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Dawson A, Michael J, Dilkes-Frayne E, Hall W, Dissanayaka NN, Carter A. Capacity, control and responsibility in Parkinson's disease patients with impulse control disorders: Views of neurological and psychiatric experts. Int J Law Psychiatry 2019; 65:101343. [PMID: 29681401 DOI: 10.1016/j.ijlp.2018.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 04/05/2018] [Indexed: 06/08/2023]
Abstract
Dopamine replacement therapy can induce impulse control disorders (ICDs) (e.g., hypersexuality) in susceptible Parkinson's disease patients. ICDs can sometimes result in criminal offending. In a number of past Commonwealth cases, it appears offending ICD patients have been considered to be suffering from 'irresistible impulses' such that their decision-making capacity, behavioural control and responsibility were totally compromised. This contrasts with courts' general scepticism of drug-induced 'compulsion' in cases of addiction-related offending. In one case of explicit ICD-related offending, testimony was limited to three experts and not contested by the prosecution. We explored whether the testimony offered in this particular case, and another similar case, reflects the views of the neurological and psychiatric communities at large. Thematic analysis revealed that neurologists, geriatricians and psychiatrists (n = 11): (a) attributed ICDs to a variety of causes; (b) considered ICD patients' decision-making capacities and behavioural control to be partially, but not totally, compromised; (c) were divided or ambivalent about ICD patients' responsibility; and (d) astutely noted the difficulties inherent in assessing complex constructs such as 'control' and 'responsibility'. We suggest that there is sufficient divergence between our findings and expert testimony from past cases for prosecution teams to engage their own experts in future cases of ICD-related offending.
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Affiliation(s)
- Andrew Dawson
- School of Psychological Sciences, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, Victoria 3168, Australia
| | - Jordie Michael
- School of Psychological Sciences, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, Victoria 3168, Australia
| | - Ella Dilkes-Frayne
- School of Psychological Sciences, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, Victoria 3168, Australia
| | - Wayne Hall
- UQ Centre for Clinical Research, University of Queensland, Herston, Queensland 4029, Australia; Centre for Youth Substance Abuse Research, University of Queensland, Herston 4006, Australia; National Addiction Centre, King's College London, SE5 8BB, UK
| | - Nadeeka N Dissanayaka
- UQ Centre for Clinical Research, University of Queensland, Herston, Queensland 4029, Australia; Department of Neurology, Royal Brisbane & Women's Hospital, Herston, Queensland 4029, Australia; School of Psychology, The University of Queensland, St. Lucia, Queensland 4029, Australia
| | - Adrian Carter
- School of Psychological Sciences, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, Victoria 3168, Australia; UQ Centre for Clinical Research, University of Queensland, Herston, Queensland 4029, Australia.
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Dawson A, Dissanayaka NN, Evans A, Verdejo-Garcia A, Chong TTJ, Frazzitta G, Ferrazzoli D, Ortelli P, Yücel M, Carter A. Neurocognitive correlates of medication-induced addictive behaviours in Parkinson's disease: A systematic review. Eur Neuropsychopharmacol 2018; 28:561-578. [PMID: 29653742 DOI: 10.1016/j.euroneuro.2018.03.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 03/06/2018] [Accepted: 03/22/2018] [Indexed: 12/28/2022]
Abstract
Dopaminergic medication can induce severe addictive behaviours (e.g., pathological gambling) in susceptible Parkinson's disease (PD) patients. It is still unknown which particular neurocognitive processes become exacerbated or dysfunctional in PD patients with addictive behaviours. We sought to systematically review the relevant literature to identity potential neurocognitive correlates of medication-induced addictive behaviours in PD. We framed our review around neurocognitive processes central to four dominant accounts of substance addiction: 'aberrant learning', 'incentive sensitization', 'impulsivity to compulsivity' and 'impaired response inhibition and salience attribution'. Searches of the PubMed and Scopus databases were completed on June 23, 2017. To be included, studies were required to involve: (a) medicated PD patients, without a history of deep brain stimulation, with and without addictive behaviours; (b) a reward-related or decision-making task; and (c) statistical comparison of addictive and non-addictive groups' 'on' medication performance on the task(s). Studies were summarised qualitatively with statistically significant (p<.05) group differences and effect sizes (Cohen's d) highlighted. 35 studies were included. Findings showed that the extant literature is highly heterogeneous. The domains of reward and punishment learning, reflection impulsivity and disadvantageous decision-making exemplify this. More homogeneity exists in domains in which (a) neurocognitive dysfunction is not apparent (motor control, cognitive/attentional flexibility and cognitive control) or (b) typical neurocognitive processes appear exacerbated by medication (reward motivation and choice impulsivity). Future large-scale neurocognitive studies are still required to develop our scientific understanding of addictive behaviours in PD and aid their clinical treatment and prediction.
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Affiliation(s)
- Andrew Dawson
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, Victoria 3800, Australia
| | - Nadeeka N Dissanayaka
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland 4029, Australia; Department of Neurology, Royal Brisbane & Women's Hospital, Herston, Queensland 4029, Australia; School of Psychology, The University of Queensland, St. Lucia, Queensland 4029, Australia
| | - Andrew Evans
- The Royal Melbourne Hospital, Parkville, Victoria 3050, Australia
| | - Antonio Verdejo-Garcia
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, Victoria 3800, Australia
| | - Trevor T J Chong
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, Victoria 3800, Australia
| | - Giuseppe Frazzitta
- Movement Disorders and Brain Injury Rehabilitation, 'Moriggia-Pelascini' Hospital, Gravedona ed Uniti, Como 22015, Italy
| | - Davide Ferrazzoli
- Movement Disorders and Brain Injury Rehabilitation, 'Moriggia-Pelascini' Hospital, Gravedona ed Uniti, Como 22015, Italy
| | - Paola Ortelli
- Movement Disorders and Brain Injury Rehabilitation, 'Moriggia-Pelascini' Hospital, Gravedona ed Uniti, Como 22015, Italy
| | - Murat Yücel
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, Victoria 3800, Australia
| | - Adrian Carter
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, Victoria 3800, Australia; University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland 4029, Australia
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Dissanayaka NN, O'Sullivan JD, Silburn PA, Mellick GD. Assessment methods and factors associated with depression in Parkinson's disease. J Neurol Sci 2011; 310:208-10. [PMID: 21764079 DOI: 10.1016/j.jns.2011.06.031] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 05/25/2011] [Accepted: 06/17/2011] [Indexed: 01/25/2023]
Abstract
Depression is a common problem experienced by patients with Parkinson's disease (PD). Identifying depression in PD is difficult and the determinants of depression in PD are complex and debatable. Here we review our recent studies which have (i) examined the validity of current depression rating scales in PD, (ii) introduced a self-reported and validated strategy to identify a lifetime history of depression in PD, and (iii) investigated genetic and non-genetic factors associated with depression in the context of PD. Our research showed PD-specific cut-off values suitable to use for the Hamilton Depression Scales (HAMD and HDI) and the Geriatric Depression Scale (GDS-15) when dichotomising patients with and without a current depression. Using the GDS-15 specific cut-off scores and a number of self-reported questions that screen for a lifetime history of depression, we developed a novel method to dichotomise PD patients according to current depression or a past history of depression. This method was applied in a large-scale study examining the factors associated with depression in PD. We clarified that the severity of PD is positively related to depression. We also showed that a number of other clinical factors including a longer duration of PD, a younger PD onset age, frequent falls, a history of anxiety disorder and memory problems were associated with depression in PD. In addition to these clinical factors, we observed associations between depression, and lower education levels, a history of smoking and a regular use of non-aspirin bases NSAIDs or analgesics. No associations were found between depression in PD and common genetic variations examined across the serotonin and dopamine transporter genes. Our studies provide a focus for future intervention strategies.
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