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González-Usigli HA, Ortiz GG, Charles-Niño C, Mireles-Ramírez MA, Pacheco-Moisés FP, Torres-Mendoza BMDG, Hernández-Cruz JDJ, Delgado-Lara DLDC, Ramírez-Jirano LJ. Neurocognitive Psychiatric and Neuropsychological Alterations in Parkinson's Disease: A Basic and Clinical Approach. Brain Sci 2023; 13:508. [PMID: 36979318 PMCID: PMC10046896 DOI: 10.3390/brainsci13030508] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/07/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
The main histopathological hallmarks of Parkinson's disease (PD) are the degeneration of the dopaminergic neurons of the substantia nigra pars compacta and the loss of neuromelanin as a consequence of decreased dopamine synthesis. The destruction of the striatal dopaminergic pathway and blocking of striatal dopamine receptors cause motor deficits in humans and experimental animal models induced by some environmental agents. In addition, neuropsychiatric symptoms such as mood and anxiety disorders, hallucinations, psychosis, cognitive impairment, and dementia are common in PD. These alterations may precede the appearance of motor symptoms and are correlated with neurochemical and structural changes in the brain. This paper reviews the most crucial pathophysiology of neuropsychiatric alterations in PD. It is worth noting that PD patients have global task learning deficits, and cognitive functions are compromised in a way is associated with hypoactivation within the striatum, anterior cingulate cortex, and inferior frontal sulcus regions. An appropriate and extensive neuropsychological screening battery in PD must accurately assess at least five cognitive domains with some tests for each cognitive domain. This neuropsychological screening should consider the pathophysiological and clinical heterogeneity of cognitive dysfunction in PD.
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Affiliation(s)
- Héctor Alberto González-Usigli
- Department of Neurology, Clinic of Movements Disorders, High Specialty Medical Unit, Western National Medical Center of the Mexican Institute of Social Security, Guadalajara 44340, Mexico
| | - Genaro Gabriel Ortiz
- Department of Neurology, Clinic of Movements Disorders, High Specialty Medical Unit, Western National Medical Center of the Mexican Institute of Social Security, Guadalajara 44340, Mexico
- Department of Philosophical and Methodological Disciplines, University Center of Health Sciences, University of Guadalajara, Guadalajara 44340, Mexico
| | - Claudia Charles-Niño
- Department of Microbiology, University Center of Health Sciences, University of Guadalajara, Guadalajara 44340, Mexico
| | - Mario Alberto Mireles-Ramírez
- Department of Neurology, Clinic of Movements Disorders, High Specialty Medical Unit, Western National Medical Center of the Mexican Institute of Social Security, Guadalajara 44340, Mexico
| | - Fermín Paul Pacheco-Moisés
- Department of Chemistry, University Center of Exact Sciences and Engineering, University of Guadalajara, Guadalajara 44430, Mexico
| | - Blanca Miriam de Guadalupe Torres-Mendoza
- Department of Philosophical and Methodological Disciplines, University Center of Health Sciences, University of Guadalajara, Guadalajara 44340, Mexico
- Division of Neurosciences, Western Biomedical Research Center, Mexican Institute of Social Security, Guadalajara 44340, Mexico
| | - José de Jesús Hernández-Cruz
- Department of Philosophical and Methodological Disciplines, University Center of Health Sciences, University of Guadalajara, Guadalajara 44340, Mexico
| | | | - Luis Javier Ramírez-Jirano
- Division of Neurosciences, Western Biomedical Research Center, Mexican Institute of Social Security, Guadalajara 44340, Mexico
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Coutinho AM, Ghilardi MG, Campos ACP, Etchebehere E, Fonoff FC, Cury RG, Pagano RL, Martinez RCR, Fonoff ET. Does TRODAT-1 SPECT Uptake Correlate with Cerebrospinal Fluid α-Synuclein Levels in Mid-Stage Parkinson's Disease? Biomedicines 2023; 11:biomedicines11020296. [PMID: 36830833 PMCID: PMC9952987 DOI: 10.3390/biomedicines11020296] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/06/2023] [Accepted: 01/11/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Parkinson's disease (PD) is characterized by a progressive loss of nigrostriatal dopaminergic neurons with impaired motor and non-motor symptoms. It has been suggested that motor asymmetry could be caused due to an imbalance in dopamine levels, as visualized by dopamine transporter single emission computed tomography test (DAT-SPECT), which might be related to indirect measures of neurodegeneration, evaluated by the Montreal Cognitive Assessment (MOCA) and α-synuclein levels in the cerebrospinal fluid (CSF). Therefore, this study aimed to understand the correlation between disease laterality, DAT-SPECT, cognition, and α-synuclein levels in PD. METHODS A total of 28 patients in the moderate-advanced stage of PD were subjected to neurological evaluation, TRODAT-1-SPECT/CT imaging, MOCA, and quantification of the levels of α-synuclein. RESULTS We found that α-synuclein in the CSF was correlated with global cognition (positive correlation, r2 = 0.3, p = 0.05) and DAT-SPECT concentration in the putamen (positive correlation, r2 = 0.4, p = 0.005), and striatum (positive correlation, r2 = 0.2, p = 0.03), thus working as a neurodegenerative biomarker. No other correlations were found between DAT-SPECT, CSF α-synuclein, and cognition, thus suggesting that they may be lost with disease progression. CONCLUSIONS Our data highlight the importance of understanding the dysfunction of the dopaminergic system in the basal ganglia and its complex interactions in modulating cognition.
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Affiliation(s)
- Artur M. Coutinho
- Division of Neuroscience, Hospital Sírio-Libanês, Sao Paulo 01308-060, SP, Brazil
- Laboratory of Nuclear Medicine (LIM 43), Department of Radiology and Oncology, Faculdade de Medicina (FMUSP), Universidade de Sao Paulo, Sao Paulo 05403-010, SP, Brazil
- Division of Nuclear Medicine and PET/CT, Hospital Sírio-Libanês, Sao Paulo 01308-050, SP, Brazil
| | - Maria Gabriela Ghilardi
- Department of Neurology, Faculdade de Medicina (FMUSP), Universidade de Sao Paulo, Sao Paulo 05403-010, SP, Brazil
| | | | - Elba Etchebehere
- Division of Nuclear Medicine, University of Campinas (UNICAMP), Campinas 13083-888, SP, Brazil
| | - Fernanda C. Fonoff
- Department of Neurology, Faculdade de Medicina (FMUSP), Universidade de Sao Paulo, Sao Paulo 05403-010, SP, Brazil
| | - Rubens G. Cury
- Department of Neurology, Faculdade de Medicina (FMUSP), Universidade de Sao Paulo, Sao Paulo 05403-010, SP, Brazil
| | - Rosana L. Pagano
- Division of Neuroscience, Hospital Sírio-Libanês, Sao Paulo 01308-060, SP, Brazil
| | - Raquel C. R. Martinez
- Division of Neuroscience, Hospital Sírio-Libanês, Sao Paulo 01308-060, SP, Brazil
- LIM/23—Institute of Psychiatry, Faculdade de Medicina (FMUSP), Universidade de Sao Paulo, Sao Paulo 05403-903, SP, Brazil
- Correspondence:
| | - Erich T. Fonoff
- Division of Neuroscience, Hospital Sírio-Libanês, Sao Paulo 01308-060, SP, Brazil
- Department of Neurology, Faculdade de Medicina (FMUSP), Universidade de Sao Paulo, Sao Paulo 05403-010, SP, Brazil
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Steinbach MJ, Campbell RW, DeVore BB, Harrison DW. Laterality in Parkinson's disease: A neuropsychological review. APPLIED NEUROPSYCHOLOGY. ADULT 2023; 30:126-140. [PMID: 33844619 DOI: 10.1080/23279095.2021.1907392] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Laterality of motor symptom onset in Parkinson's disease is both well-known and under-appreciated. Treatment of disorders that have asymmetric pathological features, such as stroke and epilepsy, demonstrate the importance of incorporating hemispheric lateralization and specialization into therapy and care planning. These practices could theoretically extend to Parkinson's disease, providing increased diagnostic accuracy and improved treatment outcomes. Additionally, while motor symptoms have generally received the majority of attention, non-motor features (e.g., autonomic dysfunction) also decrease quality of life and are influenced by asymmetrical neurodegeneration. Due to the laterality of cognitive and behavioral processes in the two brain hemispheres, analysis of hemibody side of onset can potentially give insight into expected symptom profile of the patient and allow for increased predictive accuracy of disease progression and outcome, thus opening the door to personalized and improved therapy in treating Parkinson's disease patients. This review discusses motor and non-motor symptoms (namely autonomic, sensory, emotional, and cognitive dysfunction) of Parkinson's disease in respect to hemispheric lateralization from a theoretical perspective in hopes of providing a framework for future research and personalized treatment.
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Biomarkers and non-motor symptoms as a function of motor symptom asymmetry in early Parkinson's disease. Neuropsychologia 2022; 177:108419. [PMID: 36375651 DOI: 10.1016/j.neuropsychologia.2022.108419] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 10/19/2022] [Accepted: 11/06/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The longitudinal trajectories of cognitive-neuropsychiatric symptoms from the early stages of Parkinson's disease, as a function of motor symptom asymmetry at the onset of the disease, remain to be fully explored. Moreover, the relationship to biomarkers warrants further investigation. METHODOLOGY Non-motor and biospecimen data from 413 patients with Parkinson's disease, dissociating predominantly left-sided motor symptoms patients (n = 179), predominantly right-sided motor symptoms patients (n = 234), and matched healthy controls (n = 196), were extracted from the Parkinson's Progression Marker Initiative database during a 3-Year follow-up. Non-parametric and conservative corrections for multivariate comparisons were carried out on neuropsychiatric and biomarker data. RESULTS A decline for global cognitive efficiency scores in predominantly right-sided motor symptoms patients was observed, whereas depressive and anxiety symptoms were greater overtime for predominantly left-sided motor symptoms patients. Biomarker analysis revealed that predominantly right-sided patients expressed decreased levels of total-tau and phospho-tau over time, while left-sided patients didn't differ from healthy controls. CONCLUSION From the early course of the disease, the existence of different clinical phenotypes is proposed, associated to emerging evidences of distinct pathological pathways and a left-hemispheric vulnerability for cognitive decline.
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Siokas V, Liampas I, Lyketsos CG, Dardiotis E. Association between Motor Signs and Cognitive Performance in Cognitively Unimpaired Older Adults: A Cross-Sectional Study Using the NACC Database. Brain Sci 2022; 12:1365. [PMID: 36291299 PMCID: PMC9599814 DOI: 10.3390/brainsci12101365] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 11/16/2022] Open
Abstract
Aiming to examine whether specific motor signs are associated with worse performance in specific cognitive domains among cognitively unimpaired (CU) individuals, we performed a cross-sectional analysis of data from the baseline evaluations of older, CU participants from the National Alzheimer's Coordinating Center (NACC) Uniform Data Set. In total, 8149 CU (≥60 years) participants were included. Of these, 905 individuals scored ≥ 2 on at least one of the motor domains of the Unified Parkinson's Disease Rating Scale part III (UPDRSIII). Cognitively impaired individuals, participants with psychiatric disorders and/or under treatment with antipsychotic, anxiolytic, sedative or hypnotic agents were excluded. Nine motor signs were examined: hypophonia, masked facies, resting tremor, action/postural tremor, rigidity, bradykinesia, impaired chair rise, impaired posture/gait and postural instability. Their association with performance on episodic memory, semantic memory, language, attention, processing speed or executive function was assessed using crude and adjusted linear regression models. Individuals with impaired chair rise had worse episodic memory, semantic memory, processing speed and executive function, while those with bradykinesia had worse language, processing speed and executive function. Sensitivity analyses, by excluding participants with cerebrovascular disease or PD, or other Parkinsonism, produced similar results with the exception of the relationship between bradykinesia and language performance.
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Affiliation(s)
- Vasileios Siokas
- Department of Neurology, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41100 Larissa, Greece
| | - Ioannis Liampas
- Department of Neurology, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41100 Larissa, Greece
| | - Constantine G. Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Efthimios Dardiotis
- Department of Neurology, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41100 Larissa, Greece
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
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Chen J, Jiang X, Wu J, Wu H, Zhou C, Guo T, Bai X, Liu X, Wen J, Cao Z, Gu L, Yang W, Pu J, Guan X, Xu X, Zhang B, Zhang M. Gray and white matter alterations in different predominant side and type of motor symptom in Parkinson's disease. CNS Neurosci Ther 2022; 28:1372-1379. [PMID: 35673762 PMCID: PMC9344082 DOI: 10.1111/cns.13877] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/12/2022] [Accepted: 05/20/2022] [Indexed: 11/29/2022] Open
Abstract
Background Parkinson's disease (PD) is highly heterogeneous reflected by different affected side of body and type of motor symptom. We aim to explore clinical characteristics and underlying brain structure alterations in PD with different predominant sides and motor types. Methods We recruited 161 PD patients and 50 healthy controls (HC). Patients were classified into four subtypes according to their predominant side and motor type: left akinetic/rigid‐dominant (LAR), left tremor‐dominant (LTD), right akinetic/rigid‐dominant (RAR), and right tremor‐dominant (RTD). All participants assessed motor and cognitive performances, then underwent T1‐weighted and diffusion tensor imaging scanning. A general linear model was used to compare neuroimaging parameters among five groups. Results Among four PD subtypes, patients of LAR subtype experienced the worst motor impairment, and only this subtype showed worse cognitive performance compared with HC. Compared with HC and other subtypes, LAR subtype showed a significant reduction in cortical thickness of the right caudal‐anterior‐cingulate gyrus and fractional anisotropy of the right cingulum bundle. Conclusions We demonstrated that LAR subtype had the worst clinical performance, which the severer damage in the right cingulate region might be the underlying mechanism. This study underscores the importance of classifying PD subtypes based on both the side and type of motor symptom for clinical intervention and research to optimize behavioral outcomes in the future.
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Affiliation(s)
- Jingwen Chen
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University of Medicine, Hangzhou, China
| | - Xianchen Jiang
- Quzhou Center for Disease Control and Prevention, Quzhou, China
| | - Jingjing Wu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University of Medicine, Hangzhou, China
| | - Haoting Wu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University of Medicine, Hangzhou, China
| | - Cheng Zhou
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University of Medicine, Hangzhou, China
| | - Tao Guo
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University of Medicine, Hangzhou, China
| | - Xueqin Bai
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University of Medicine, Hangzhou, China
| | - Xiaocao Liu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University of Medicine, Hangzhou, China
| | - Jiaqi Wen
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University of Medicine, Hangzhou, China
| | - Zhengye Cao
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University of Medicine, Hangzhou, China
| | - Luyan Gu
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University of Medicine, Hangzhou, China
| | - Wenyi Yang
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University of Medicine, Hangzhou, China
| | - Jiali Pu
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University of Medicine, Hangzhou, China
| | - Xiaojun Guan
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University of Medicine, Hangzhou, China
| | - Xiaojun Xu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University of Medicine, Hangzhou, China
| | - Baorong Zhang
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University of Medicine, Hangzhou, China
| | - Minming Zhang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University of Medicine, Hangzhou, China
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Normal-sized basal ganglia perivascular space related to motor phenotype in Parkinson freezers. Aging (Albany NY) 2021; 13:18912-18923. [PMID: 34314380 PMCID: PMC8351731 DOI: 10.18632/aging.203343] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 07/02/2021] [Indexed: 11/25/2022]
Abstract
Changes in basal ganglia (BG) perivascular spaces (PVSs) are related to motor and cognitive behaviors in Parkinson’s disease (PD). However, the correlation between the initial motor phenotype and PVSs distribution/burden in PD freezing of gait (FOG) remains unclear. In addition, the normal-sized PVSs (nPVSs) have not been well-studied. With high-resolution 7T-MRI, we studied nPVSs burden in BG, thalamus, midbrain and centrum semiovale. The numbers and volume of nPVSs were assessed in 10 healthy controls, 10 PD patients without FOG, 20 with FOG [10 tremor dominant (TD), 10 non-TD subtype]. Correlation analyses were further performed in relation to clinical parameters. In this proof of concept study, we found that the nPVS burden of bilateral and right BG were significantly higher in freezers. A negative correlation existed between the tremor score and BG-nPVSs count. A positive correlation existed between the levodopa equivalent daily dose and BG-nPVSs count. The nPVS burden correlated with the progression to FOG in PD, but the distribution and burden of nPVS differ in TD vs. non-TD subtypes. High resolution 7T-MRI is a sensitive and reliable tool to evaluate BG-nPVS, and may be a useful imaging marker for predicting gait impairment that may evolve into FOG in PD.
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Mylius V, Möller JC, Bohlhalter S, Ciampi de Andrade D, Perez Lloret S. Diagnosis and Management of Pain in Parkinson's Disease: A New Approach. Drugs Aging 2021; 38:559-577. [PMID: 34224103 DOI: 10.1007/s40266-021-00867-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 12/27/2022]
Abstract
Pain is a frequent and disabling non-motor feature of Parkinson's disease (PD). The recently proposed PD Pain Classification System (PD-PCS) allows for an association of pain with PD to be determined before being allocated to the main pain mechanism (i.e. nociceptive, neuropathic, and nociplastic). In this article, previous studies on treatments for pain in PD are summarized according to the pain mechanisms. A mechanistic approach to treatment is discussed. We suggest that the first step should be optimizing dopaminergic therapy before other therapy is started. When these treatments remain unsuccessful, further causes of pain must be considered. The role of drugs, invasive treatments, and physiotherapeutic interventions are discussed with a focus on older PD patients and considering polypharmacy, altered pharmacokinetics, and comorbidities.
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Affiliation(s)
- Veit Mylius
- Department of Neurology, Center for Neurorehabilitation, 7317, Valens, Switzerland. .,Department of Neurology, Philipps University, Marburg, Germany. .,Department of Neurology, Kantonsspital, St. Gallen, Switzerland.
| | - Jens Carsten Möller
- Department of Neurology, Philipps University, Marburg, Germany.,Parkinson Center, Center for Neurological Rehabilitation, Zihlschlacht, Switzerland
| | - Stephan Bohlhalter
- Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland.,Department of Neurology, University of Zurich, Zurich, Switzerland
| | - Daniel Ciampi de Andrade
- Centro de Dor, Departamento de Neurologia da Faculdade de Medicina da, Universidade de Sao Paulo, Sao Paulo, Brazil.,Instituto do Cancer de Sao Paulo, Octavio Frias de Oliveira, Sao Paulo, Brazil.,Hospital das Clinicas, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Santiago Perez Lloret
- LIM 62, Biomedical Research Center (CAECIHS-UAI), National Research Council (CONICET), Buenos Aires, Argentina.,Facultad de Ciencias Médicas, Pontificia Universidad Católica Argentina, Buenos Aires, Argentina.,Departamento de Fisiología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
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Cuesta MJ, Lecumberri P, Moreno-Izco L, López-Ilundain JM, Ribeiro M, Cabada T, Lorente-Omeñaca R, de Erausquin G, García-Martí G, Sanjuan J, Sánchez-Torres AM, Gómez M, Peralta V. Motor abnormalities and basal ganglia in first-episode psychosis (FEP). Psychol Med 2021; 51:1625-1636. [PMID: 32114994 DOI: 10.1017/s0033291720000343] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Motor abnormalities (MAs) are the primary manifestations of schizophrenia. However, the extent to which MAs are related to alterations of subcortical structures remains understudied. METHODS We aimed to investigate the associations of MAs and basal ganglia abnormalities in first-episode psychosis (FEP) and healthy controls. Magnetic resonance imaging was performed on 48 right-handed FEP and 23 age-, gender-, handedness-, and educational attainment-matched controls, to obtain basal ganglia shape analysis, diffusion tensor imaging techniques (fractional anisotropy and mean diffusivity), and relaxometry (R2*) to estimate iron load. A comprehensive motor battery was applied including the assessment of parkinsonism, catatonic signs, and neurological soft signs (NSS). A fully automated model-based segmentation algorithm on 1.5T MRI anatomical images and accurate corregistration of diffusion and T2* volumes and R2* was used. RESULTS FEP patients showed significant local atrophic changes in left globus pallidus nucleus regarding controls. Hypertrophic changes in left-side caudate were associated with higher scores in sensory integration, and in right accumbens with tremor subscale. FEP patients showed lower fractional anisotropy measures than controls but no significant differences regarding mean diffusivity and iron load of basal ganglia. However, iron load in left basal ganglia and right accumbens correlated significantly with higher extrapyramidal and motor coordination signs in FEP patients. CONCLUSIONS Taken together, iron load in left basal ganglia may have a role in the emergence of extrapyramidal signs and NSS of FEP patients and in consequence in the pathophysiology of psychosis.
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Affiliation(s)
- Manuel J Cuesta
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Pablo Lecumberri
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Movalsys S. L., NavarraBiomed, Pamplona, Spain
| | - Lucia Moreno-Izco
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Jose M López-Ilundain
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - María Ribeiro
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Teresa Cabada
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Department of Neuroradiology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Ruth Lorente-Omeñaca
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Gabriel de Erausquin
- Zachry Foundation, The Glenn Biggs Institute of Alzheimer's & Neurodegenerative Disorders, UT Heath San Antonio, Texas, USA
| | - Gracian García-Martí
- Radiology Department, CIBERSAM, Valencia, España, Quirón Salud Hospital, Valencia, España
| | - Julio Sanjuan
- Research Institute of Clinic University Hospital of Valencia (INCLIVA), Valencia, Spain
- CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain
- Department of Psychiatric, University of Valencia School of Medicine, Valencia, Spain
| | - Ana M Sánchez-Torres
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Marisol Gómez
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Movalsys S. L., NavarraBiomed, Pamplona, Spain
- Department of Statistics, Computer Science and Mathematics, Universidad Pública de Navarra (UPNA), Pamplona, Spain
| | - Victor Peralta
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
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Wagner D, Eslinger PJ, Sterling NW, Du G, Lee EY, Styner M, Lewis MM, Huang X. Lexical-semantic search related to side of onset and putamen volume in Parkinson's disease. BRAIN AND LANGUAGE 2020; 209:104841. [PMID: 32818719 PMCID: PMC8189666 DOI: 10.1016/j.bandl.2020.104841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 06/11/2023]
Abstract
Parkinson's disease (PD) is characterized by dopaminergic cell loss and reduced striatal volume. Prior studies have demonstrated striatal involvement in access to lexical-semantic knowledge and damage to this structure may be evident in the lexical properties of responses. Semantic fluency task responses from early stage, non-demented PD participants with right (PD-R) or left (PD-L) lateralizing symptoms were compared to matched controls on lexical properties (word frequency, age of acquisition) and correlated with striatal volumes segmented from T1-weighted brain MR images. PD-R participants produced semantic fluency responses of a lower age of acquisition than PD-L and control participants (p < 0.05). PD-R age of acquisition responses correlated positively with putamen volume (p < 0.05), while age of acquisition of responses correlated negatively with caudate volume in controls (p < 0.05). Findings provide evidence for a role of the striatum in lexical-semantic access and qualitative changes in lexical access in select PD patients.
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Affiliation(s)
- Daymond Wagner
- Departments of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, United States.
| | - Paul J Eslinger
- Departments of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, United States; Departments of Neural and Behavioral Sciences, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, United States; Departments of Radiology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, United States.
| | - Nicholas W Sterling
- Departments of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, United States.
| | - Guangwei Du
- Departments of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, United States.
| | - Eun-Young Lee
- Departments of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, United States.
| | - Martin Styner
- Departments of Psychiatry, University of North Carolina-Chapel Hill, Chapel Hill, NC 27599, United States; Departments of Computer Science, University of North Carolina-Chapel Hill, Chapel Hill, NC 27599, United States.
| | - Mechelle M Lewis
- Departments of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, United States; Departments of Pharmacology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, United States.
| | - Xuemei Huang
- Departments of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, United States; Departments of Pharmacology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, United States; Departments of Neurosurgery, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, United States; Departments of Kinesiology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, United States.
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Determination of Parkinson Disease Laterality After Deep Brain Stimulation Using 123I FP-CIT SPECT. Clin Nucl Med 2020; 45:e178-e184. [DOI: 10.1097/rlu.0000000000002955] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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12
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Optical coherence tomography and cognitive dysfunction in Parkinson disease. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2019. [DOI: 10.1186/s41983-019-0097-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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13
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Hogue O, Fernandez HH, Floden DP. Predicting early cognitive decline in newly-diagnosed Parkinson's patients: A practical model. Parkinsonism Relat Disord 2018; 56:70-75. [PMID: 29936131 DOI: 10.1016/j.parkreldis.2018.06.031] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 06/11/2018] [Accepted: 06/18/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To create a multivariable model to predict early cognitive decline among de novo patients with Parkinson's disease, using brief, inexpensive assessments that are easily incorporated into clinical flow. METHODS Data for 351 drug-naïve patients diagnosed with idiopathic Parkinson's disease were obtained from the Parkinson's Progression Markers Initiative. Baseline demographic, disease history, motor, and non-motor features were considered as candidate predictors. Best subsets selection was used to determine the multivariable baseline symptom profile that most accurately predicted individual cognitive decline within three years. RESULTS Eleven per cent of the sample experienced cognitive decline. The final logistic regression model predicting decline included five baseline variables: verbal memory retention, right-sided bradykinesia, years of education, subjective report of cognitive impairment, and REM behavior disorder. Model discrimination was good (optimism-adjusted concordance index = .749). The associated nomogram provides a tool to determine individual patient risk of meaningful cognitive change in the early stages of the disease. CONCLUSIONS Through the consideration of easily-implemented or routinely-gathered assessments, we have identified a multidimensional baseline profile and created a convenient, inexpensive tool to predict cognitive decline in the earliest stages of Parkinson's disease. The use of this tool would generate prediction at the individual level, allowing clinicians to tailor medical management for each patient and identify at-risk patients for clinical trials aimed at disease modifying therapies.
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Affiliation(s)
- Olivia Hogue
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
| | - Hubert H Fernandez
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
| | - Darlene P Floden
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA; Department of Psychiatry and Psychology, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
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14
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Oh SW, Shin NY, Choi JY, Lee SK, Bang MR. Altered White Matter Integrity in Human Immunodeficiency Virus-Associated Neurocognitive Disorder: A Tract-Based Spatial Statistics Study. Korean J Radiol 2018; 19:431-442. [PMID: 29713221 PMCID: PMC5904470 DOI: 10.3348/kjr.2018.19.3.431] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 09/28/2017] [Indexed: 01/26/2023] Open
Abstract
Objective Human immunodeficiency virus (HIV) infection has been known to damage the microstructural integrity of white matter (WM). However, only a few studies have assessed the brain regions in HIV-associated neurocognitive disorders (HAND) with diffusion tensor imaging (DTI). Therefore, we sought to compare the DTI data between HIV patients with and without HAND using tract-based spatial statistics (TBSS). Materials and Methods Twenty-two HIV-infected patients (10 with HAND and 12 without HAND) and 11 healthy controls (HC) were enrolled in this study. A whole-brain analysis of fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity was performed with TBSS and a subsequent 20 tract-specific region-of-interest (ROI)-based analysis to localize and compare altered WM integrity in all group contrasts. Results Compared with HC, patients with HAND showed decreased FA in the right frontoparietal WM including the upper corticospinal tract (CST) and increased MD and RD in the bilateral frontoparietal WM, corpus callosum, bilateral CSTs and bilateral cerebellar peduncles. The DTI values did not significantly differ between HIV patients with and without HAND or between HIV patients without HAND and HC. In the ROI-based analysis, decreased FA was observed in the right superior longitudinal fasciculus and was significantly correlated with decreased information processing speed, memory, executive function, and fine motor function in HIV patients. Conclusion These results suggest that altered integrity of the frontoparietal WM contributes to cognitive dysfunction in HIV patients.
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Affiliation(s)
- Se Won Oh
- Department of Radiology, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Korea
| | - Na-Young Shin
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Jun Yong Choi
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Seung-Koo Lee
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Mi Rim Bang
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
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15
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Dahdal P, Meyer A, Chaturvedi M, Nowak K, Roesch AD, Fuhr P, Gschwandtner U. Fine Motor Function Skills in Patients with Parkinson Disease with and without Mild Cognitive Impairment. Dement Geriatr Cogn Disord 2018; 42:127-134. [PMID: 27643700 DOI: 10.1159/000448751] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/22/2016] [Indexed: 11/19/2022] Open
Abstract
AIMS The objective of this study was to investigate the relation between impaired fine motor skills in Parkinson disease (PD) patients and their cognitive status, and to determine whether fine motor skills are more impaired in PD patients with mild cognitive impairment (MCI) than in non-MCI patients. METHODS Twenty PD MCI and 31 PD non-MCI patients (mean age 66.7 years, range 50-84, 36 males/15 females), all right-handed, took part in a motor performance test battery. Steadiness, precision, dexterity, velocity of arm-hand movements, and velocity of wrist-finger movements were measured and compared across groups and analyzed for confounders (age, sex, education, severity of motor symptoms, and disease duration). Statistical analysis included t tests corrected for multiple testing, and a linear regression with stepwise elimination procedure was used to select significant predictors for fine motor function. RESULTS PD MCI patients performed significantly worse in precision (p < 0.05), dexterity (p < 0.05), and velocity (arm-hand movements; p < 0.05) compared to PD non-MCI patients. The fine motor function skills were confounded by age. CONCLUSIONS Fine motor skills in PD MCI patients are impaired compared to PD non-MCI patients. Investigating the relation between the fine motor performance and MCI in PD might be a relevant subject for future research.
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Affiliation(s)
- Philippe Dahdal
- Department of Neurology, University Hospital Basel, Basel, Switzerland
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Chung SJ, Shin JH, Cho KH, Lee Y, Sohn YH, Seong JK, Lee PH. Subcortical shape analysis of progressive mild cognitive impairment in Parkinson's disease. Mov Disord 2017; 32:1447-1456. [PMID: 28737237 DOI: 10.1002/mds.27106] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 06/19/2017] [Accepted: 06/23/2017] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Cortical neural correlates of ongoing cognitive decline in Parkinson's disease (PD) have been suggested; however, the role of subcortical structures in longitudinal change of cognitive dysfunction in PD has not been fully investigated. Here, we used automatic analysis to explore subcortical brain structures in patients with PD with mild cognitive impairment that converts into PD with dementia. METHODS One hundred eighty-two patients with PD with mild cognitive impairment were classified as PD with mild cognitive impairment converters (n = 74) or nonconverters (n = 108), depending on whether they were subsequently diagnosed with dementia in PD. We used surface-based analysis to compare atrophic changes of subcortical brain structures between PD with mild cognitive impairment converters and nonconverters. RESULTS PD with mild cognitive impairment converters had lower cognitive composite scores in the attention and frontal executive domains than did nonconverters. Subcortical shape analysis revealed that PD with mild cognitive impairment converters had smaller local shape volumes than did nonconverters in the bilateral thalamus, right caudate, and right hippocampus. Logistic regression analysis showed that local shape volumes in the bilateral thalamus and right caudate were significant independent predictors of PD with mild cognitive impairment converters. In the PD with mild cognitive impairment converter group, thalamic local shape volume was associated with semantic fluency and attentional composite score. CONCLUSIONS The present data suggest that the local shape volumes of deep subcortical structures, especially in the caudate and thalamus, may serve as important predictors of the development of dementia in patients with PD. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Su Jin Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Department of Neurology, Myongji Hospital, Goyang, South Korea
| | - Jeong-Hyeon Shin
- Department of Bio-convergence Engineering, Korea University, Seoul, South Korea
| | - Kyoo Ho Cho
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Yoonju Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Joon-Kyung Seong
- Department of Bio-convergence Engineering, Korea University, Seoul, South Korea.,School of Biomedical Engineering, Korea University, Seoul, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea
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17
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Tanner JJ, Levy SA, Schwab NA, Hizel LP, Nguyen PT, Okun MS, Price CC. Marked brain asymmetry with intact cognitive functioning in idiopathic Parkinson's disease: a longitudinal analysis. Clin Neuropsychol 2017; 31:654-675. [PMID: 27813459 PMCID: PMC5334434 DOI: 10.1080/13854046.2016.1251973] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 10/18/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE A 71-year-old (MN) with an 11-year history of left onset tremor diagnosed as Parkinson's disease (PD) completed longitudinal brain magnetic resonance imaging (MRI) and neuropsychological testing. MRI scans showed an asymmetric caudate nucleus (right < left volume). We describe this asymmetry at baseline and the progression over time relative to other subcortical gray, frontal white matter, and cortical gray matter regions of interest. Isolated structural changes are compared to MN's cognitive profiles. METHOD MN completed yearly MRIs and neuropsychological assessments. For comparison, left onset PD (n = 15) and non-PD (n = 43) peers completed the same baseline protocol. All MRI scans were processed with FreeSurfer and the FMRIB Software Library to analyze gray matter structures and frontal fractional anisotropy (FA) metrics. Processing speed, working memory, language, verbal memory, abstract reasoning, visuospatial, and motor functions were examined using reliable change methods. RESULTS At baseline, MN had striatal volume and frontal lobe thickness asymmetry relative to peers with mild prefrontal white matter FA asymmetry. Over time only MN's right caudate nucleus showed accelerated atrophy. Cognitively, MN had slowed psychomotor speed and visuospatial-linked deficits with mild visuospatial working memory declines longitudinally. CONCLUSIONS This is a unique report using normative neuroimaging and neuropsychology to describe an individual diagnosed with PD who had striking striatal asymmetry followed secondarily by cortical thickness asymmetry and possible frontal white matter asymmetry. His decline and variability in visual working memory could be linked to ongoing atrophy of his right caudate nucleus.
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Affiliation(s)
- Jared J Tanner
- a Department of Clinical and Health Psychology , University of Florida , Gainesville , FL , USA
- b Center for Movement Disorders and Neurorestoration , University of Florida , Gainesville , FL , USA
| | - Shellie-Anne Levy
- a Department of Clinical and Health Psychology , University of Florida , Gainesville , FL , USA
- b Center for Movement Disorders and Neurorestoration , University of Florida , Gainesville , FL , USA
| | - Nadine A Schwab
- a Department of Clinical and Health Psychology , University of Florida , Gainesville , FL , USA
- b Center for Movement Disorders and Neurorestoration , University of Florida , Gainesville , FL , USA
| | - Loren P Hizel
- a Department of Clinical and Health Psychology , University of Florida , Gainesville , FL , USA
- b Center for Movement Disorders and Neurorestoration , University of Florida , Gainesville , FL , USA
| | - Peter T Nguyen
- a Department of Clinical and Health Psychology , University of Florida , Gainesville , FL , USA
- b Center for Movement Disorders and Neurorestoration , University of Florida , Gainesville , FL , USA
| | - Michael S Okun
- a Department of Clinical and Health Psychology , University of Florida , Gainesville , FL , USA
- b Center for Movement Disorders and Neurorestoration , University of Florida , Gainesville , FL , USA
| | - Catherine C Price
- a Department of Clinical and Health Psychology , University of Florida , Gainesville , FL , USA
- b Center for Movement Disorders and Neurorestoration , University of Florida , Gainesville , FL , USA
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18
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Horowitz M, Elstein D, Zimran A, Goker-Alpan O. New Directions in Gaucher Disease. Hum Mutat 2016; 37:1121-1136. [DOI: 10.1002/humu.23056] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 07/20/2016] [Indexed: 12/17/2022]
Affiliation(s)
- Mia Horowitz
- Department of Cell Research and Immunology, Faculty of Life Sciences; Tel Aviv University; Ramat Aviv Israel
| | - Deborah Elstein
- Gaucher Clinic; Shaare Zedek Medical Center; Jerusalem Israel
| | - Ari Zimran
- Gaucher Clinic; Shaare Zedek Medical Center; Jerusalem Israel
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19
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Lahr J, Pereira MP, Pelicioni PHS, De Morais LC, Gobbi LTB. PARKINSON'S DISEASE PATIENTS WITH DOMINANT HEMIBODY AFFECTED BY THE DISEASE RELY MORE ON VISION TO MAINTAIN UPRIGHT POSTURAL CONTROL. Percept Mot Skills 2015; 121:923-34. [PMID: 26654986 DOI: 10.2466/15.pms.121c26x0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study assesses the association between disease onset side (dominant or non-dominant) and vision on postural control of Parkinson's disease patients. Patient volunteers composed two groups, according to the onset side affected: Dominant group (n=9; M age=66.1 yr., SD=7.2; 6 women, 3 men) and Non-dominant group (n=9; M age=67.4 yr., SD=6.4; 6 women, 3 men). The groups' postural control was assessed by posturography during quiet upright stance in two conditions, Eyes open and Eyes closed. Two-way analyses of variance (ANOVAs; group×condition) with repeated measures for the second factor assessed the differences associated with affected hemibody and vision on postural control. Analyses indicated that patients with the dominant side affected also presented significantly greater variation in center of pressure than those with the non-dominant side affected, mainly in the Eyes closed condition. The results demonstrate a higher reliance on vision in the dominant side, possibly to compensate somatosensory system impairments. These results also highlight the importance of analyzing the hemibody affected by the disease when postural control is assessed in this population.
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Seichepine DR, Neargarder S, Davidsdottir S, Reynolds GO, Cronin-Golomb A. Side and type of initial motor symptom influences visuospatial functioning in Parkinson's disease. JOURNAL OF PARKINSONS DISEASE 2015; 5:75-83. [PMID: 25311203 DOI: 10.3233/jpd-140365] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND/OBJECTIVES Visuospatial problems are common in Parkinson's disease (PD) and likely stem from dysfunction in dopaminergic pathways and consequent disruption of cortical functioning. Characterizing the motor symptoms at disease onset provides a method of observing how dysfunction in these pathways influences visuospatial cognition. We examined two types of motor characteristics: Body side (left or right) and type of initial symptom (tremor or symptom other than tremor). METHODS 31 non-demented patients with PD, 16 with left-side onset (LPD) and 15 with right-side onset (RPD), as well as 17 healthy control participants (HC). The PD group was also divided by type of initial motor symptom, 15 having tremor as the initial symptom and 16 having an initial symptom other than tremor. Visuospatial function was assessed with the Clock Drawing Test. RESULTS Of the four Clock Drawing scoring methods used, the Rouleau method showed sensitivity to subgroup differences. As predicted, the LPD and non-tremor subgroups, but not the other subgroups, performed more poorly than the HC group. CONCLUSION The findings provide further evidence for differences in cognition between these subtypes of PD and highlight the importance of considering disease subtypes when examining cognition.
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Affiliation(s)
- Daniel R Seichepine
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Sandy Neargarder
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA Department of Psychology, Bridgewater State University, Bridgewater, MA, USA
| | | | - Gretchen O Reynolds
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Alice Cronin-Golomb
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
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Classification of symptom-side predominance in idiopathic Parkinson's disease. NPJ PARKINSONS DISEASE 2015; 1:15018. [PMID: 28725686 PMCID: PMC5516555 DOI: 10.1038/npjparkd.2015.18] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 09/01/2015] [Indexed: 02/07/2023]
Abstract
Asymmetry of symptom onset in Parkinson’s disease (PD) is strongly linked to differential diagnosis, progression of disease, and clinical manifestation, suggesting its importance in terms of specifying a therapeutic strategy for each individual patient. To scrutinize the predictive value of this consequential clinical phenomenon as a neuromarker supporting a personalized therapeutic approach, we modeled symptom-side predominance at disease onset based on brain morphology assessed with magnetic resonance (MR) images by utilizing machine learning classification. The integration of multimodal MR imaging data into a multivariate statistical model led to predict left- and right-sided symptom onset with an above-chance accuracy of 96%. By absolute numbers, all but one patient were correctly classified. Interestingly, mainly hippocampal morphology supports this prediction. Considering a different disease formation of this single outlier and the strikingly high classification, this approach proves a reliable predictive model for symptom-side diagnostics in PD. In brief, this work hints toward individualized disease-modifying therapies rather than symptom-alleviating treatments.
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Ham JH, Lee JJ, Kim JS, Lee PH, Sohn YH. Is Dominant-Side Onset Associated With a Better Motor Compensation in Parkinson's Disease? Mov Disord 2015; 30:1921-5. [PMID: 26408124 DOI: 10.1002/mds.26418] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 08/03/2015] [Accepted: 08/04/2015] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Unilateral onset and persistent asymmetry of motor signs are unique features of PD. The dominant hemisphere may have more efficient motor networks with greater neural reserve to cope with pathological changes. Therefore, this study compared dominant-side onset and non-dominant-side onset PD to evaluate whether dominant-side onset patients have greater neural reserve and fewer motor deficits despite similar pathological changes. METHODS We included the data of 157 consecutive, de novo PD patients with documented right-handedness who underwent dopamine transporter PET scans for an initial diagnostic workup. Among them, 118 patients with significant asymmetric motor deficits were selected for the analyses. RESULTS Dominant-side patients (i.e., the majority of motor deficits on the right side) showed significantly fewer motor deficits (i.e., the part III score of the UPDRS) than non-dominant-side patients (18.0 ± 8.1 and 22.9 ± 10.1, respectively; P = 0.005). Other variables, including symptom duration and striatal dopaminergic activities, were similar between the two groups. A general linear model showed that this difference in motor deficits remained statistically significant after controlling for patient age, sex, symptom duration, and striatal dopaminergic activity in the posterior putamen (P = 0.013). CONCLUSION These results suggest that dominant-side patients have greater neural reserve, allowing them to better cope with PD-related pathological changes (i.e., fewer motor deficits despite similar dopamine reduction) compared to non-dominant-side patients.
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Affiliation(s)
- Jee H Ham
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Jae J Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Jae S Kim
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Phil H Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.,Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
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Wang YQ, Tang BS, Yan XX, Chen ZH, Xu Q, Liu ZH, Li K, Wang K, Guo JF. A neurophysiological profile in Parkinson’s disease with mild cognitive impairment and dementia in China. J Clin Neurosci 2015; 22:981-5. [DOI: 10.1016/j.jocn.2014.11.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 11/25/2014] [Indexed: 12/21/2022]
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Schneider JS, Sendek S, Yang C. Relationship between Motor Symptoms, Cognition, and Demographic Characteristics in Treated Mild/Moderate Parkinson's Disease. PLoS One 2015; 10:e0123231. [PMID: 25905783 PMCID: PMC4407885 DOI: 10.1371/journal.pone.0123231] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 03/02/2015] [Indexed: 11/18/2022] Open
Abstract
Background Although Parkinson’s disease (PD) is a progressive neurodegenerative disorder characterized primarily by motor symptoms, PD patients, at all stages of the disease, can experience cognitive dysfunction. However, the relationships between cognitive and motor symptoms and specific demographic characteristics are not well defined, particularly for patients who have progressed to requiring dopaminergic medication. Objective To examine relationships between motor and cognitive symptoms and various demographic factors in mild to moderate, PD patients requiring anti-PD medication. Methods Cognitive function was assessed in 94 subjects with a variety of neuropsychological tests during baseline evaluations as part of an experimental treatment study. Data were analyzed in relation to Unified Parkinson’s Disease Rating Scale motor scores and demographic variables. Results Of the UPDRS subscores analyzed, posture/balance/gait was associated with the highest number of adverse cognitive outcomes followed by speech/facial expression, bradykinesia, and rigidity. No associations were detected between any of the cognitive performance measures and tremor. Motor functioning assessed in the “off” condition correlated primarily with disease duration; neuropsychological performance in general was primarily related to age. Conclusion In PD patients who have advanced to requiring anti-PD therapies, there are salient associations between axial signs and cognitive performance and in particular, with different aspects of visuospatial function suggesting involvement of similar circuits in these functions. Associations between executive functions and bradykinesia also suggest involvement similar circuits in these functions.
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Affiliation(s)
- Jay S. Schneider
- Dept. of Pathology, Anatomy and Cell Biology, Thomas Jefferson University, Philadelphia, PA, United States of America
- * E-mail:
| | - Stephanie Sendek
- Dept. of Pathology, Anatomy and Cell Biology, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Chengwu Yang
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA, United States of America
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Paradoxical effect of dopamine medication on cognition in Parkinson's disease: relationship to side of motor onset. J Int Neuropsychol Soc 2015; 21:259-70. [PMID: 25923830 PMCID: PMC4493897 DOI: 10.1017/s1355617715000181] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Parkinson's disease (PD) is characterized by asymmetric motor symptom onset attributed to greater degeneration of dopamine neurons contralateral to the affected side. However, whether motor asymmetries predict cognitive profiles in PD, and to what extent dopamine influences cognition remains controversial. This study evaluated cognitive variability in PD by measuring differential response to dopamine replacement therapy (DRT) based on hemispheric asymmetries. The influence of DRT on cognition was evaluated in mild PD patients (n = 36) with left or right motor onset symptoms. All subjects were evaluated on neuropsychological measures on and off DRT and compared to controls (n = 42). PD patients were impaired in executive, memory and motor domains irrespective of side of motor onset, although patients with left hemisphere deficit displayed greater cognitive impairment. Patients with right hemisphere deficit responded to DRT with significant improvement in sensorimotor deficits, and with corresponding improvement in attention and verbal memory functions. Conversely, patients with greater left hemisphere dopamine deficiency did not improve in attentional functions and declined in verbal memory recall following DRT. These findings support the presence of extensive mild cognitive deficits in early PD not fully explained by dopamine depletion alone. The paradoxical effects of levodopa on verbal memory were predicted by extent of fine motor impairment and sensorimotor response to levodopa, which reflects extent of dopamine depletion. The findings are discussed with respect to factors influencing variable cognitive profiles in early PD, including hemispheric asymmetries and differential response to levodopa based on dopamine levels predicting amelioration or overdosing.
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26
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Lee EY, Sen S, Eslinger PJ, Wagner D, Kong L, Lewis MM, Du G, Huang X. Side of motor onset is associated with hemisphere-specific memory decline and lateralized gray matter loss in Parkinson's disease. Parkinsonism Relat Disord 2015; 21:465-70. [PMID: 25749355 DOI: 10.1016/j.parkreldis.2015.02.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 01/28/2015] [Accepted: 02/10/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Parkinson's disease (PD) is a neurodegenerative disorder that generally begins with asymmetric motor symptoms that persist over time. This suggests that the dysfunction in the nigrostriatal motor circuit may be lateralized. The present study examined whether the asymmetric motor presentation is associated with hemisphere-specific cognitive decline and lateralized gray matter volume loss. METHODS Data from comprehensive cognitive tests that measured visuospatial and verbal functions and high-resolution T1-weighted magnetic resonance images of the brain were acquired in 23 PD subjects with left-side motor symptom onset (PDL), 23 PD subjects with right-side onset (PDR), and 23 matched Controls. GM volume differences were assessed using voxel-based morphometry (VBM). Cognitive results and VBM were compared among the three groups, and correlation analyses were performed between those cognitive domains and brain areas that showed significant differences. RESULTS PDL subjects had lower performance on visuospatial memory tasks compared to PDR. Furthermore, PDL subjects experienced lateralized GM loss, which was localized predominantly in the right hemisphere contralateral to the side of motor symptom onset. Visuospatial memory performance in PDL was correlated with GM loss in the right middle frontal gyrus and precuneus. CONCLUSION These data suggest that the onset of asymmetric motor symptoms in PD may be associated with hemisphere-specific memory decline and lateralized GM loss, particularly in PDL. This study underscores the importance of classifying PD subgroups based on the side of motor symptom onset for clinical care and research to optimize cognitive outcomes.
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Affiliation(s)
- Eun-Young Lee
- Department of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Suman Sen
- Department of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Paul J Eslinger
- Department of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, USA; Department of Public Health Sciences, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, USA; Department of Radiology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Daymond Wagner
- Department of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Lan Kong
- Department of Public Health Sciences, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Mechelle M Lewis
- Department of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, USA; Department of Pharmacology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Guangwei Du
- Department of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Xuemei Huang
- Department of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, USA; Department of Pharmacology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, USA; Department of Radiology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, USA; Department of Neurosurgery, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, USA; Department of Kinesiology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, USA.
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27
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Pedrosa DJ, Kahraman D, Schmidt M, Drzezga A, Timmermann L, Eggers C. Parkinson's disease with a predominant right-sided putaminal FP-CIT SPECT deficiency shows stronger decline of asymmetry over time. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.baga.2014.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Sanyal J, Banerjee TK, Rao VR. Dementia and cognitive impairment in patients with Parkinson's disease from India: a 7-year prospective study. Am J Alzheimers Dis Other Demen 2014; 29:630-6. [PMID: 24771763 PMCID: PMC10852774 DOI: 10.1177/1533317514531442] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Depression and cognitive impairment are frequent manifestations in Parkinson's disease (PD). Although a few longitudinal studies have reported on depression and dementia in PD, there is a yet a lack of such studies in India. This 7-year longitudinal study is a hospital-based prospective case (n = 250)-control (n = 280) study. In all, 36.8% had PD with no cognitive impairment (PD-Normal), 27.2% of the patients with PD were affected by dementia (PDD), and 36% of the remaining patients with PD had mild cognitive impairment (PD-MCI) at baseline. After 7 years of evaluation, 32 new patients, 12 patients from the PD-MCI group and 9 patients from the PD-Normal group, were diagnosed with dementia. The 7-year prevalence rate for dementia was estimated to be 49.28%. In the Indian population, an early onset of dementia is noted among patients with PD, with the age of onset being less than 55 years. Patients with early-onset PDD showed depression symptoms that differed significantly from the controls of the same age-group. There was a major difference in verbal fluency, word list recall, constructional praxis and recall, word list recognition, abridged Boston Naming Test, word list memory with repetition, and Mini-Mental State Examination between PD-MCI and PDD groups. Hallucinations before baseline (odds ratio [OR] = 4.427, 95% confidence interval [CI] = 2.122-9.373), akinetic/tremor dominancy (OR = 0.380, 95%CI = 0.149-0.953), and asymmetrical disease onset (OR = 0.3285, 95%CI = 0.1576-0.685) can be considered as risk factors for patients with dementia. Patients with early-onset PD might be more prone to complex depression and dementia. As the disease progresses, akinetic-dominant PD, early hallucinations, and asymmetrical disease onset are the potential risk factors for the development of dementia in patients with PD.
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Affiliation(s)
- Jaya Sanyal
- Department of Anthropology, University of Delhi, New Delhi-110007, India
| | - Tapas Kumar Banerjee
- Department of Neurology, National Neurosciences Centre, Kolkata, West Bengal, India
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29
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Dirnberger G, Jahanshahi M. Executive dysfunction in Parkinson's disease: a review. J Neuropsychol 2014; 7:193-224. [PMID: 24007368 DOI: 10.1111/jnp.12028] [Citation(s) in RCA: 324] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 06/30/2013] [Indexed: 12/17/2022]
Abstract
Executive dysfunction can be present from the early stages of Parkinson's disease (PD). It is characterized by deficits in internal control of attention, set shifting, planning, inhibitory control, dual task performance, and on a range of decision-making and social cognition tasks. Treatment with dopaminergic medication has variable effects on executive deficits, improving some, leaving some unchanged, and worsening others. In this review, we start by defining the specific nature of executive dysfunction in PD and describe suitable neuropsychological tests. We then discuss how executive deficits relate to pathology in specific territories of the basal ganglia, consider the impact of dopaminergic treatment on executive function (EF) in this context, and review the changes in EFs with disease progression. In later sections, we summarize correlates of executive dysfunction in PD with motor performance (e.g., postural instability, freezing of gait) and a variety of psychiatric (e.g., depression, apathy) and other clinical symptoms, and finally discuss the implications of these for the patients' daily life.
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Affiliation(s)
- Georg Dirnberger
- Department of Clinical Neuroscience and Preventive Medicine, Danube University, Krems, Austria.
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30
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Bezdicek O, Nikolai T, Hoskovcová M, Štochl J, Brožová H, Dušek P, Zárubová K, Jech R, Růžička E. Grooved Pegboard Predicates More of Cognitive Than Motor Involvement in Parkinson’s Disease. Assessment 2014; 21:723-30. [DOI: 10.1177/1073191114524271] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Grooved Pegboard Test (GPT) was conceived as a test of manual dexterity, upper-limb motor speed, and hand–eye coordination. The aim of our study was to test the componential structure of the GPT on an archetypal model of motor impairment, Parkinson’s disease (PD). A total of 45 PD patients (33 males, 12 females; age M = 67, range = 49-81; PD duration M = 10, range = 6-20 years; H/Y stage 2, range = 2-3) and 20 age- and education-matched controls (14 males, 6 females; age M = 66, range = 48-80) were included. All participants were investigated using the GPT, Short Falls Efficacy Scale–International, Frontal Assessment Battery (FAB), Montreal Cognitive Assessment (MoCA), and Non-Motor Symptom Scale. Patients were followed for 6 months, using fall diaries and monthly phone calls to define PD fallers (falls ≥ 1; n = 27) and PD nonfallers (falls = 0; n = 18). Using structural equation modeling, the GPT predicted performance on the MoCA ( p < .001), but not on the FAB ( p = .29). In conclusion, analysis of the structure of the GPT provided evidence about important cognitive features, in addition to the motor component of this test in PD.
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Affiliation(s)
| | - Tomáš Nikolai
- Charles University in Prague, Prague, Czech Republic
| | | | - Jan Štochl
- Charles University in Prague, Prague, Czech Republic
- University of Cambridge, Cambridge, UK
| | - Hana Brožová
- Charles University in Prague, Prague, Czech Republic
| | - Petr Dušek
- Charles University in Prague, Prague, Czech Republic
| | | | - Robert Jech
- Charles University in Prague, Prague, Czech Republic
| | - Evžen Růžička
- Charles University in Prague, Prague, Czech Republic
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31
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Jaywant A, Musto G, Neargarder S, Stavitsky Gilbert K, Cronin-Golomb A. The effect of Parkinson's disease subgroups on verbal and nonverbal fluency. J Clin Exp Neuropsychol 2014; 36:278-89. [PMID: 24533593 DOI: 10.1080/13803395.2014.889089] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Parkinson's disease (PD) leads to deficits in executive function, including verbal and nonverbal fluency, as a result of compromised frontostriatal circuits. It is unknown whether deficits in verbal and nonverbal fluency in PD are driven by certain subgroups of patients, or how strategy use may facilitate performance. PARTICIPANTS Sixty-five nondemented individuals with PD, including 36 with right-body onset (RPD; 20 with tremor as their initial symptom, 16 nontremor) and 29 with left-body onset (LPD; 14 with tremor as their initial symptom, 15 nontremor), and 52 normal control participants (NC) took part in the study. MEASUREMENTS Verbal fluency was assessed using the FAS and Animals tests. Nonverbal fluency was assessed using the Ruff Figural Fluency Test. RESULTS Both RPD and LPD were impaired in generating words and in using clustering and switching strategies on phonemic verbal fluency, whereas different patterns of impairment were found on nonverbal fluency depending on the interaction of side of onset and initial motor symptom (tremor vs. nontremor). Strategy use correlated with number of correct responses on verbal fluency in LPD, RPD, and NC. By contrast, on nonverbal fluency, strategy use correlated with correct responses for RPD and LPD, but not for NC. CONCLUSION Our findings demonstrate the importance of considering subgroups in PD and analyzing subcomponents of verbal and nonverbal fluency (correct responses, errors, and strategies), which may depend differently on the integrity of dorsolateral prefrontal cortex, inferior frontal cortex, and anterior cingulate cortex.
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Affiliation(s)
- Abhishek Jaywant
- a Department of Psychological and Brain Sciences , Boston University , Boston , MA , USA
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32
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Baumann CR, Held U, Valko PO, Wienecke M, Waldvogel D. Body side and predominant motor features at the onset of Parkinson's disease are linked to motor and nonmotor progression. Mov Disord 2013; 29:207-13. [PMID: 24105646 DOI: 10.1002/mds.25650] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 07/12/2013] [Accepted: 07/25/2013] [Indexed: 11/08/2022] Open
Abstract
Patients with Parkinson's disease most often have asymmetric motor features at onset, and specific motor signs (ie, tremor versus bradykinesia and rigidity) frequently characterize the first few years of disease evolution. Some previous clinical evidence has suggested that body side and a predominance of motor manifestations at disease onset are linked to long-term evolution and disease progression. We prospectively analyzed 206 patients with Parkinson's disease according to the most affected side and predominant motor signs at onset. Patients were divided into left-side rigid-akinetic (n = 71), right-side rigid-akinetic (n = 59), left-side tremor (n = 41), and right-side tremor (n = 35) subgroups. These subgroups were compared in terms of motor and cognitive functions, mean motor deterioration per year (calculated as the motor score divided by disease duration), total equivalent doses of dopaminergic drugs, and the presence of hallucinations and rapid eye movement sleep behavior disorder. Disease duration was similar in all groups. Motor fluctuations were more likely to occur in rigid-akinetic patients. In a multiple model analysis adjusted for potential confounders, faster disease progression was associated with right-side (P = 0.045) and rigid-akinetic onset (P = 0.001). With respect to nonmotor symptoms, the rigid-akinetic type was associated with increased risk of cognitive decline (P = 0.004) compared with the tremor type. A trend was noticed toward an increased risk of developing visual hallucinations in rigid-akinetic patients and toward an increased frequency of rapid eye movement sleep behavior disorder in those who had left-sided onset of symptoms. Our findings corroborate that body side and type of motor signs at the time of diagnosis affect the evolution of motor severity and may also have an impact on some nonmotor manifestations.
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Retailleau A, Dejean C, Fourneaux B, Leinekugel X, Boraud T. Why am I lost without dopamine? Effects of 6-OHDA lesion on the encoding of reward and decision process in CA3. Neurobiol Dis 2013; 59:151-64. [PMID: 23911573 DOI: 10.1016/j.nbd.2013.07.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 06/24/2013] [Accepted: 07/24/2013] [Indexed: 11/28/2022] Open
Abstract
There is growing evidence that Parkinson's disease, generally characterized by motor symptoms, also causes cognitive impairment such as spatial disorientation. The hippocampus is a critical structure for spatial navigation and receives sparse but comprehensive dopamine (DA) innervation. DA loss is known to be the cause of Parkinson's disease and therefore it has been hypothesized that the associated spatial disorientation could result from hippocampal dysfunction. Because DA is involved in the prediction of reward expectation, it is possible to infer that spatial disorientation in DA depleted subjects results from the loss of the ability to detect the rewarding features within the environment. Amongst hippocampal formation subdivisions, CA3 properties such as the high liability of its place fields make it a serious candidate for interfacing DA reward system and spatial information encoding. We addressed this issue using multiple electrode recordings of CA3 in normal and dopamine depleted rats performing a spatial learning in a Y-maze. Our data confirm that DA is essential to spatial learning as its depletion results in spatial impairments. The present work also shows that CA3 involvement in the detection of spatial feature contextual significance is under DA control. Finally, it also shows that CA3 contributes to the decision making processes of navigation tasks. The data also reveal a lateralization effect of DA depletion underlined by neural correlates.
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Affiliation(s)
- Aude Retailleau
- University of Bordeaux, Institut des Maladies Neurodegeneratives UMR 5293, Bordeaux, France; CNRS, Institut des Maladies Neurodegeneratives UMR 5293, Bordeaux, France
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Fling BW, Cohen RG, Mancini M, Nutt JG, Fair DA, Horak FB. Asymmetric pedunculopontine network connectivity in parkinsonian patients with freezing of gait. ACTA ACUST UNITED AC 2013; 136:2405-18. [PMID: 23824487 DOI: 10.1093/brain/awt172] [Citation(s) in RCA: 187] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Freezing of gait is one of the most debilitating symptoms in Parkinson's disease as it causes falls and reduces mobility and quality of life. The pedunculopontine nucleus is one of the major nuclei of the mesencephalic locomotor region and has neurons related to anticipatory postural adjustments preceding step initiation as well as to the step itself, thus it may be critical for coupling posture and gait to avoid freezing. Because freezing of gait and postural impairments have been related to frontal lesions and frontal dysfunction such as executive function, we hypothesized that freezing is associated with disrupted connectivity between midbrain locomotor regions and medial frontal cortex. We used diffusion tensor imaging to quantify structural connectivity of the pedunculopontine nucleus in patients with Parkinson's disease with freezing of gait, without freezing, and healthy age-matched controls. We also included behavioural tasks to gauge severity of freezing of gait, quantify gait metrics, and assess executive cognitive functions to determine whether between-group differences in executive dysfunction were related to pedunculopontine nucleus structural network connectivity. Using seed regions from the pedunculopontine nucleus, we were able to delineate white matter connections between the spinal cord, cerebellum, pedunculopontine nucleus, subcortical and frontal/prefrontal cortical regions. The current study is the first to demonstrate differences in structural connectivity of the identified locomotor pathway in patients with freezing of gait. We report reduced connectivity of the pedunculopontine nucleus with the cerebellum, thalamus and multiple regions of the frontal cortex. Moreover, these structural differences were observed solely in the right hemisphere of patients with freezing of gait. Finally, we show that the more left hemisphere-lateralized the pedunculopontine nucleus tract volume, the poorer the performance on cognitive tasks requiring the initiation of appropriate actions and/or the inhibition of inappropriate actions, specifically within patients with freezing. These results support the notion that freezing of gait is strongly related to structural deficits in the right hemisphere's locomotor network involving prefrontal cortical areas involved in executive inhibition function.
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Affiliation(s)
- Brett W Fling
- Department of Neurology, School of Medicine, Oregon Health and Science University, Portland, OR 97239, USA
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35
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Yu G, Jang I, Kim L. Voice Handicap Index and Voice-Related Quality of Life in Idiopathic Parkinson's Disease. ACTA ACUST UNITED AC 2013. [DOI: 10.7231/jon.2013.24.2.155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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36
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Haehner A, Tosch C, Wolz M, Klingelhoefer L, Fauser M, Storch A, Reichmann H, Hummel T. Olfactory training in patients with Parkinson's disease. PLoS One 2013; 8:e61680. [PMID: 23613901 PMCID: PMC3629137 DOI: 10.1371/journal.pone.0061680] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 03/13/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Decrease of olfactory function in Parkinson's disease (PD) is a well-investigated fact. Studies indicate that pharmacological treatment of PD fails to restore olfactory function in PD patients. The aim of this investigation was whether patients with PD would benefit from "training" with odors in terms of an improvement of their general olfactory function. It has been hypothesized that olfactory training should produce both an improved sensitivity towards the odors used in the training process and an overall increase of olfactory function. METHODS We recruited 70 subjects with PD and olfactory loss into this single-center, prospective, controlled non-blinded study. Thirty-five patients were assigned to the olfactory training group and 35 subjects to the control group (no training). Olfactory training was performed over a period of 12 weeks while patients exposed themselves twice daily to four odors (phenyl ethyl alcohol: rose, eucalyptol: eucalyptus, citronellal: lemon, and eugenol: cloves). Olfactory testing was performed before and after training using the "Sniffin' Sticks" (thresholds for phenyl ethyl alcohol, tests for odor discrimination, and odor identification) in addition to threshold tests for the odors used in the training process. RESULTS Compared to baseline, trained PD patients experienced a significant increase in their olfactory function, which was observed for the Sniffin' Sticks test score and for thresholds for the odors used in the training process. Olfactory function was unchanged in PD patients who did not perform olfactory training. CONCLUSION The present results indicate that olfactory training may increase olfactory sensitivity in PD patients.
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Affiliation(s)
- Antje Haehner
- Smell & Taste Clinic, Department of Otorhinolaryngology, University of Dresden Medical School, Dresden, Germany.
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Motor symptoms at onset of Parkinson disease and risk for cognitive impairment and depression. Cogn Behav Neurol 2013; 25:115-20. [PMID: 22960435 DOI: 10.1097/wnn.0b013e31826dfd62] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To determine whether side and type of initial motor symptoms in Parkinson disease (PD) predict risk for later development of cognitive impairment or depressive symptoms. METHODS We recruited 124 non-demented patients with PD to participate in a cohort study of cognitive function and depressive symptoms that used validated neuropsychological tests and a depressive symptom inventory. We first reviewed the patients' charts to determine their initial motor symptom and side of onset, and then classified the patients into 4 groups: right-sided onset tremor, right-sided onset bradykinesia/rigidity, left-sided onset tremor, and left-sided onset bradykinesia/rigidity. We excluded patients with bilateral symptom onset. We used analysis of variance on neuropsychological test performance and depressive symptoms to determine whether group classification affected risk of cognitive impairment or depressive symptoms. We controlled our analyses for disease duration and motor severity as measured by the Unified Parkinson Disease Rating Scale Part III motor score. RESULTS There were no differences in any cognitive measure by side and type of initial motor symptoms. The right-sided onset tremor group had the lowest depressive symptom scores, and no patient in any group reported severe depressive symptoms. CONCLUSIONS Our findings suggest that patterns of nigral cell loss correlating to the initial side and type of motor symptoms in PD are not related to the risk of later cognitive impairment. By contrast, patients with right-sided onset of tremor seem to have a lower risk of depressive symptoms than patients with other presentations.
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Erro R, Santangelo G, Picillo M, Vitale C, Amboni M, Longo K, Giordano F, Moccia M, Barone P, Pellecchia MT. Side of onset does not influence cognition in newly diagnosed untreated Parkinson's disease patients. Parkinsonism Relat Disord 2013. [DOI: 10.1016/j.parkreldis.2012.10.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Foster PS, Drago V, Mendez K, Witt JC, Crucian GP, Heilman KM. Mood disturbances and cognitive functioning in Parkinson's disease: The effects of disease duration and side of onset of motor symptoms. J Clin Exp Neuropsychol 2013; 35:71-82. [DOI: 10.1080/13803395.2012.753037] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Unilateral deep brain stimulation surgery in Parkinson's disease improves ipsilateral symptoms regardless of laterality. Parkinsonism Relat Disord 2012; 17:745-8. [PMID: 21856205 DOI: 10.1016/j.parkreldis.2011.07.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Revised: 07/18/2011] [Accepted: 07/24/2011] [Indexed: 01/17/2023]
Abstract
PURPOSE Researchers have consistently observed in right-handed individuals across normal and disease states that the 'dominant' left hemisphere has greater ipsilateral control of the left side than the right hemisphere has over the right. We sought to determine whether this ipsilateral influence of the dominant hemisphere reported in Parkinson's disease extends to treatments such as deep brain stimulation (DBS) and whether it affects outcome. We hypothesised that among Parkinson right-handers, unilateral left DBS would provide greater ipsilateral motor improvement compared with the ipsilateral motor improvement experienced on the right side. SCOPE A total of 73 Parkinson patients who underwent unilateral DBS of the subthalamic nucleus (STN) or globus palidus internus (GPi) participated. Left and right 'composite scores', were computed by separately adding all items on the left and right side from the motor section of the Unified Parkinson Disease Rating Scale. The change in the pre- and 4-month post-implantation score was the primary outcome measure. The mean motor scores improved by 4.96 ± 11.79 points (p < 0.001) post-surgery on the ipsilateral side of the DBS implantation. Regression analyses revealed that the side (left vs. right) and target (STN vs. GPi) did not significantly contribute in the effect of ipsilateral motor improvement (p = 0.3557). CONCLUSION While DBS on the 'dominant' left side failed to exert a greater ipsilateral influence compared with DBS on the non-dominant right side, significant ipsilateral motor improvements were observed after unilateral stimulation regardless of site of implantation and laterality.
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41
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Riederer P, Sian-Hülsmann J. The significance of neuronal lateralisation in Parkinson's disease. J Neural Transm (Vienna) 2012; 119:953-62. [PMID: 22367437 DOI: 10.1007/s00702-012-0775-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 02/04/2012] [Indexed: 12/29/2022]
Abstract
The destruction of the dopaminergic neurons in the substantia nigra (SN) and consequent depletion of striatal dopamine elicits the main movement deficits related to Parkinson's disease (PD). In the early stages of the illness, the motor symptoms are often exhibited asymmetrically. Thus, the onset of PD features starts on either the right or left side. The side of onset appears to determine the prognosis of the disorder and other features, such as right-side tremor dominance has a better prognosis in contrast to left-side dominant bradykinesia-rigidity. In addition, left-side onset of motor features is associated with cognitive decline. Therefore, an intricate relation appears to exist between the side of disease onset and progression/severity and other non-motor symptoms. Unilateral PD in turn corresponds to neuronal nigrostriatal degeneration in the contralateral hemisphere. Indeed positron emission tomography has demonstrated a positive correlation between symptom asymmetry and brain function (Hoorn et al. Parkinsonism Relat Disord 17:58-60, 2011), which corresponds to a unilateral pattern of degeneration. This phenomenon appears to be exclusive to PD. Additionally, the variation in motor symptom(s) dominance exhibited in the disorder conforms to the notion that PD is a spectrum disease with many sub-groups. Thus, clinical and post mortem studies on "lateralisation" may serve as a vital tool in understanding the mechanism(s) eliciting the characteristic destruction of the SN neurons. Additionally, it may be employed as a predictive indicator for the symptomology and prognosis of the illness thus allowing selective treatment strategies targeted at the pronounced hemispheric degeneration.
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Affiliation(s)
- P Riederer
- Clinical Neurochemistry, National Parkinson's Foundation Centre of Excellence Laboratories, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Fuechsleinstrasse 15, Würzburg, Germany.
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Arnott WL, Copland DA, Chenery HJ, Murdoch BE, Silburn PA, Angwin AJ. The influence of dopamine on automatic and controlled semantic activation in Parkinson's disease. PARKINSONS DISEASE 2011; 2011:157072. [PMID: 22135759 PMCID: PMC3216283 DOI: 10.4061/2011/157072] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 09/15/2011] [Accepted: 09/26/2011] [Indexed: 12/04/2022]
Abstract
Two semantic priming
tasks, designed to isolate automatic and
controlled semantic activation, were utilized to
investigate the impact of dopamine depletion on
semantic processing in Parkinson's disease
(PD). Seven people with PD (tested whilst on and
off levodopa medication) and seven healthy
adults participated in the study. The healthy
adult participants demonstrated intact automatic
and controlled semantic activation. Aberrant
controlled semantic activation was observed in
the PD group on levodopa; however, automatic
semantic activation was still evident. In
contrast, automatic semantic activation was not
evident in the PD group off levodopa. These
results further clarify the impact of PD on
semantic processing, demonstrating that dopamine
depletion can cause disturbances in both
automatic and controlled semantic
activation.
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Affiliation(s)
- Wendy L Arnott
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD 4072, Australia
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43
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Cognitive Differences Between Patients with Left-sided and Right-sided Parkinson’s Disease. A Review. Neuropsychol Rev 2011; 21:405-24. [DOI: 10.1007/s11065-011-9182-x] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Accepted: 09/06/2011] [Indexed: 10/17/2022]
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Poletti M, Emre M, Bonuccelli U. Mild cognitive impairment and cognitive reserve in Parkinson’s disease. Parkinsonism Relat Disord 2011; 17:579-86. [DOI: 10.1016/j.parkreldis.2011.03.013] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 03/09/2011] [Accepted: 03/19/2011] [Indexed: 11/30/2022]
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Butler PM, McNamara P, Ghofrani J, Durso R. Disease-associated differences in religious cognition in patients with Parkinson's disease. J Clin Exp Neuropsychol 2011; 33:917-28. [DOI: 10.1080/13803395.2011.575768] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Paul M. Butler
- a Department of Neurology , Boston University School of Medicine , Boston, MA, USA
- b Department of Neurology , VA Boston Healthcare System , Boston, MA, USA
| | - Patrick McNamara
- a Department of Neurology , Boston University School of Medicine , Boston, MA, USA
- b Department of Neurology , VA Boston Healthcare System , Boston, MA, USA
| | - Jessica Ghofrani
- c Department of Neuroscience , College of Arts & Sciences, Boston University , Boston, MA, USA
| | - Raymon Durso
- a Department of Neurology , Boston University School of Medicine , Boston, MA, USA
- b Department of Neurology , VA Boston Healthcare System , Boston, MA, USA
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Foster PS, Drago V, Crucian GP, Sullivan WK, Rhodes RD, Shenal BV, Skoblar B, Skidmore FM, Heilman KM. Anxiety and depression severity are related to right but not left onset Parkinson's disease duration. J Neurol Sci 2011; 305:131-5. [PMID: 21420691 DOI: 10.1016/j.jns.2011.02.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Revised: 01/19/2011] [Accepted: 02/16/2011] [Indexed: 11/15/2022]
Abstract
Depression and anxiety have both been associated with relative left frontal hypoactivation and the motor symptoms of Parkinson's disease typically begin in a lateral or asymmetrical fashion. Hence, PD patients with right hemibody onset may experience heightened depression and anxiety. However, research is mixed regarding whether right or left hemibody onset PD is associated with elevated levels of depression and anxiety. This literature, though, has not considered the potential moderating variable of disease duration. We hypothesized that disease duration would be positively correlated with measures of depression and anxiety in right but not left hemibody onset PD patients. The results indicated that scores on the Geriatric Depression Scale, Beck Depression Inventory-II, and the State Trait Anxiety Scale - State correlated positively with disease duration, but only in the right hemibody onset group of PD patients. Thus, right hemibody onset PD is associated with more severe depressive and anxiety symptoms, but only when disease duration is considered.
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Affiliation(s)
- Paul S Foster
- Middle Tennessee State University, Department of Psychology, 1500 Greenland Drive, Murfreesboro, TN 37132, USA.
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Rodríguez-Violante M, Cervantes-Arriaga A, Villar-Velarde A, Corona T. Relationship between the type and side of motor symptoms with the prevalence of non-motor symptoms in Parkinson's disease. Neurologia 2011; 26:319-24. [PMID: 21315490 DOI: 10.1016/j.nrl.2010.12.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 09/07/2010] [Accepted: 12/01/2010] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION the relationship between laterality and asymmetry of Parkinson's disease and non-motor dysfunction has been studied mainly from the perspective of cognitive functions, and the few studies that have included other symptoms have mixed reports. The relationship between non-motor symptoms and the type of onset of the disease has not been studied in detail. OBJECTIVE to analyse the association between the side and type of motor onset and the prevalence of non-motor symptoms. PATIENTS AND METHODS we included 232 patients diagnosed with Parkinson's disease. Type of onset and the side initially affected were documented. The presence of non-motor symptoms was determined by applying the non-motor symptom questionnaire (NMSQuest). RESULTS when analysing the side of onset and presence of each non-motor symptom explored, statistically significant differences were found in the frequency of hallucinations (P=0.04) and sleep behaviour disorder (P<0.01) in subjects with right side onset. The motor type of onset differences were not statistically significant. CONCLUSIONS subjects with right side onset seem to have a higher risk of having hallucinations and sleep behaviour disorders. These symptoms should be intentionally sought in order to provide treatment and improve the patient's quality of life.
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Affiliation(s)
- M Rodríguez-Violante
- Laboratorio Clínico de Enfermedades Neurodegenerativas, México; Clínica de Movimientos Anormales, México.
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Poletti M, Enrici I, Bonuccelli U, Adenzato M. Theory of Mind in Parkinson's disease. Behav Brain Res 2011; 219:342-50. [PMID: 21238496 DOI: 10.1016/j.bbr.2011.01.010] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Revised: 12/22/2010] [Accepted: 01/06/2011] [Indexed: 10/18/2022]
Abstract
The ability to infer other people's mental states (i.e. Theory of Mind, ToM) is a major topic of interest in various neurological and psychiatric disorders. However, it is only recently that there has been an assessment of cognitive and affective components of ToM ability in neurodegenerative disorders. In this review, we examine studies investigating the ToM ability in Parkinson's disease (PD). Taken together, these studies provide preliminary evidence that ToM difficulties may occur in PD patients. In particular, these difficulties principally involve the cognitive component of ToM in the early stages of the disease. The spatio-temporal progression of dopamine depletion supports the hypothesis that the affective component may only be affected in the advanced stages of the disease. The relationships between executive functioning, dopaminergic therapies, and ToM in PD as well as the relationships between frontostriatal circuits and ToM processing are discussed.
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Relationship between the type and side of motor symptoms with the prevalence of non-motor symptoms in Parkinson's disease. NEUROLOGÍA (ENGLISH EDITION) 2011. [DOI: 10.1016/s2173-5808(11)70076-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Poletti M, Cavedini P, Bonuccelli U. Iowa Gambling Task in Parkinson's Disease. J Clin Exp Neuropsychol 2010; 33:395-409. [PMID: 21140314 DOI: 10.1080/13803395.2010.524150] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Michele Poletti
- a Neurology Unit, Unità Sanitaria Locale of Viareggio , Viareggio, Italy
- b Department of Neuroscience , University of Pisa , Pisa, Italy
| | - Paolo Cavedini
- c Department of Clinical Neurosciences , Villa San Benedetto Hospital, Hermanas Hospitalarias , Albese con Cassano, Italy
| | - Ubaldo Bonuccelli
- a Neurology Unit, Unità Sanitaria Locale of Viareggio , Viareggio, Italy
- b Department of Neuroscience , University of Pisa , Pisa, Italy
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