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Gotheridge H, Eccles FJR, Murray C, Henderson R, Simpson J. A systematic review of the factors associated with the psychological wellbeing of people with Parkinson's in the COVID-19 pandemic. Disabil Rehabil 2024:1-12. [PMID: 39258822 DOI: 10.1080/09638288.2024.2395460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 07/21/2024] [Accepted: 08/19/2024] [Indexed: 09/12/2024]
Abstract
PURPOSE The lockdown and social distancing measures introduced as a result of the COVID-19 pandemic impacted the ability of people with Parkinson's to engage in normal health management practices. This led to documented reductions in psychological wellbeing. The aim of the present review was to identify factors associated with the psychological wellbeing of people with Parkinson's during the acute stage of the pandemic. MATERIALS AND METHODS Five academic databases (PsycINFO, MEDLINE, Embase, CINAHL, and Web of Science) were searched and 23 articles were identified using pre-defined inclusion and exclusion criteria. The findings are stratified by risk factor and analysed using a narrative synthesis. RESULTS Worsening of motor symptoms, poor motor-related daily living experiences and motor symptoms during "off time" (when symptom suppressing medication has worn off) as well as less physical activity emerged as the most consistent risk factors of worsened or poorer psychological wellbeing. A deviation from pre-pandemic risk factors was identified, with age and gender not identified as consistent risk factors. CONCLUSIONS The implications of this review are not limited to preparing for future pandemics but can also be applied to more common concerns with comparable contextual characteristics such as yearly flu outbreaks, social isolation, and economic uncertainty.
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Affiliation(s)
- H Gotheridge
- Division of Health Research, Lancaster University, Lancaster, UK
| | - F J R Eccles
- Division of Health Research, Lancaster University, Lancaster, UK
| | - C Murray
- Division of Health Research, Lancaster University, Lancaster, UK
| | - R Henderson
- Division of Health Research, Lancaster University, Lancaster, UK
| | - J Simpson
- Division of Health Research, Lancaster University, Lancaster, UK
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Jones J, Nielson SA, Trout J, Tanner JJ, Bowers D, Kay DB. Multiple sleep disturbances are associated with apathy in individuals with Parkinson's disease. Heliyon 2024; 10:e35293. [PMID: 39170267 PMCID: PMC11336585 DOI: 10.1016/j.heliyon.2024.e35293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 07/23/2024] [Accepted: 07/25/2024] [Indexed: 08/23/2024] Open
Abstract
Background Parkinson's disease (PD) is associated with both sleep disturbances and apathy, and within PD, apathy has been associated with REM behavior disorder and excessive daytime sleepiness. Whether other forms of sleep disturbance are similarly associated with apathy in PD remains unclear. This study explored associations between a broad array of sleep disturbances and apathy in 50 individuals with idiopathic PD (PD) and 48 matched controls (MC). Methods Participants were adults aged 53-80 (Mdn = 67), 23 % female, and 96 % white. Sleep disturbances were measured with various questionnaires (ISI, PSQI, PROMIS-SD, ESS, PROMIS-SRI, RBDSQ). Mood was measured with the STAI and BDI-II. Apathy was evaluated using the Apathy Scale (AS). Spearman correlations and regression analyses were performed between measures of sleep disturbance and AS in the total sample and each group. Group correlations were compared using 2-sample Fisher's z test. Results The AS total score significantly correlated with PROMIS-SRI in the total sample and multiple measures of sleep disturbance in the PD group. The apathy subscales were each significantly correlated with sleep disturbance measures in the total sample, MC, and PD groups. The correlations between several sleep and apathy values were significantly stronger in the PD group than MC. When accounting for anxiety and depression most differences were no longer significant, only the PROMIS-SRI was significantly predictive of the behavioral apathy sub score. Discussion Evidence supports an association between sleep disturbances and apathy in individuals with PD. Specifically, insomnia severity, poor sleep quality, and daytime sleepiness were uniquely associated with apathy in this group. We did not find these associations in the matched control group. Anxiety and depression are likely involved in the association between sleep and apathy in PD. Experimental studies that manipulate or improve sleep may further elucidate the mechanisms underlying the association between sleep disturbance and apathy in PD.
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Affiliation(s)
- Jolynn Jones
- Brigham Young University, Department of Psychology, USA
| | | | - Jonathan Trout
- University of Texas Health San Antonio Long School of Medicine, USA
| | - Jared J. Tanner
- University of Florida, Department of Clinical and Health Psychology, USA
| | - Dawn Bowers
- University of Florida, Department of Clinical and Health Psychology, USA
| | - Daniel B. Kay
- Brigham Young University, Department of Psychology, USA
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Kalbe E, Folkerts AK, Witt K, Buhmann C, Liepelt-Scarfone I. German Society of Neurology guidelines for the diagnosis and treatment of cognitive impairment and affective disorders in people with Parkinson's disease: new spotlights on diagnostic procedures and non-pharmacological interventions. J Neurol 2024:10.1007/s00415-024-12503-0. [PMID: 39120709 DOI: 10.1007/s00415-024-12503-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 06/03/2024] [Accepted: 06/07/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND AND OBJECTIVE Cognitive impairment and dementia as well as affective disorders are common and debilitating syndromes that develop in people with Parkinson's disease (PwPD). The authors summarized recommendations for the 2023 updated German guidelines on "Parkinson's disease" from the German Neurological Society (DGN), focusing on the diagnosis and treatment of these disorders. METHODS The recommendations were based on literature reviews, other relevant guidelines, and expert opinions. RESULTS Measurements to assess cognitive and affective states were reviewed for psychometric properties, use in routine clinical practice, and availability in German. To improve mild cognitive impairment, cognitive training and physical aerobic training are recommended. To treat Parkinson's disease (PD)-related dementia, cognitive stimulation (as a non-pharmacological intervention) and acetylcholinesterase inhibitors (AChEIs, i.e., rivastigmine) are recommended. Cognitive behavioral therapy is recommended to treat depression, anxiety, and fear of progression. Physical interventions are recommended to treat depression, fatigue, and apathy. Optimized dopaminergic treatment is the first-line pharmacological strategy recommended to manage depression, apathy, anhedonia, fatigue, and mood swings. Major depression can be additionally treated using venlafaxine or desipramine, while moderate depression can be treated pharmacologically according to its clinical phenotype (psychomotor retardation or agitation) and comorbidities (e.g., sleep disturbances, pain). Venlafaxine and nortriptyline can be used to treat anhedonia, while citalopram can be used for anxiety. CONCLUSIONS In addition to the updated pharmacological treatment options, new insights into recommendations for standardized diagnostics and non-pharmacological interventions were provided for the German health care system. However, more studies are needed to explore the full potential of non-pharmacological interventions to treat and prevent cognitive impairment and affective disorders.
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Affiliation(s)
- Elke Kalbe
- Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - Ann-Kristin Folkerts
- Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Karsten Witt
- Department of Neurology, School of Medicine and Health Science, Carl Von Ossietzky University of Oldenburg, Oldenburg, Germany
- Research Center of Neurosensory Science, Carl Von Ossietzky University of Oldenburg, Oldenburg, Germany
- Department of Neurology, Evangelical Hospital, Oldenburg, Germany
| | - Carsten Buhmann
- Department of Neurology, University Clinic Eppendorf, Hamburg, Germany
| | - Inga Liepelt-Scarfone
- Hertie Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, Eberhard Karls Universität Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
- IB-Hochschule, Stuttgart, Germany
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Lockwood PL, Cutler J, Drew D, Abdurahman A, Jeyaretna DS, Apps MAJ, Husain M, Manohar SG. Human ventromedial prefrontal cortex is necessary for prosocial motivation. Nat Hum Behav 2024; 8:1403-1416. [PMID: 38802539 PMCID: PMC11272586 DOI: 10.1038/s41562-024-01899-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 04/23/2024] [Indexed: 05/29/2024]
Abstract
Ventromedial prefrontal cortex (vmPFC) is vital for decision-making. Functional neuroimaging links vmPFC to processing rewards and effort, while parallel work suggests vmPFC involvement in prosocial behaviour. However, the necessity of vmPFC for these functions is unknown. Patients with rare focal vmPFC lesions (n = 25), patients with lesions elsewhere (n = 15) and healthy controls (n = 40) chose between rest and exerting effort to earn rewards for themselves or another person. vmPFC damage decreased prosociality across behavioural and computational measures. vmPFC patients earned less, discounted rewards by effort more, and exerted less force when another person benefited, compared to both control groups. Voxel-based lesion mapping revealed dissociations between vmPFC subregions. While medial damage led to antisocial behaviour, lateral damage increased prosocial behaviour relative to patients with damage elsewhere. vmPFC patients also showed reduced effort sensitivity overall, but reward sensitivity was limited to specific subregions. These results reveal multiple causal contributions of vmPFC to prosocial behaviour, effort and reward.
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Affiliation(s)
- Patricia L Lockwood
- Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham, UK.
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK.
- Department of Experimental Psychology, University of Oxford, Oxford, UK.
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK.
| | - Jo Cutler
- Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham, UK.
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK.
- Department of Experimental Psychology, University of Oxford, Oxford, UK.
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK.
| | - Daniel Drew
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Ayat Abdurahman
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - Deva Sanjeeva Jeyaretna
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Department of Neurology, John Radcliffe Hospital, Oxford, UK
| | - Matthew A J Apps
- Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham, UK
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
| | - Masud Husain
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Department of Neurology, John Radcliffe Hospital, Oxford, UK
| | - Sanjay G Manohar
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Department of Neurology, John Radcliffe Hospital, Oxford, UK
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5
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Le Heron C, Horne KL, MacAskill MR, Livingstone L, Melzer TR, Myall D, Pitcher T, Dalrymple-Alford J, Anderson T, Harrison S. Cross-Sectional and Longitudinal Association of Clinical and Neurocognitive Factors With Apathy in Patients With Parkinson Disease. Neurology 2024; 102:e209301. [PMID: 38830182 DOI: 10.1212/wnl.0000000000209301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND AND OBJECTIVES A robust understanding of the natural history of apathy in Parkinson disease (PD) is foundational for developing effective clinical management tools. However, large longitudinal studies are lacking while the literature is inconsistent about even cross-sectional associations. We aimed to determine the longitudinal predictors of apathy development in a large cohort of people with PD and its cross-sectional associations and trajectories over time, using sophisticated Bayesian modeling techniques. METHODS People with PD followed up in the longitudinal New Zealand Parkinson's progression project were included. Apathy was defined using the neuropsychiatric inventory subscale ≥4, and analyses were also repeated using a less stringent cutoff of ≥1. Both MoCA and comprehensive neuropsychological testing were used as appropriate to the model. Depression was assessed using the hospital anxiety and depression scale. Cross-sectional Bayesian regressions were conducted, and a multistate predictive model was used to identify factors that predict the initial onset of apathy in nonapathetic PD, while also accounting for the competing risk of death. The relationship between apathy presence and mortality was also investigated. RESULTS Three hundred forty-six people with PD followed up for up to 14 years across a total of 1,392 sessions were included. Apathy occurrence did not vary significantly across the disease course (disease duration odds ratio [OR] = 0.55, [95% CI 0.28-1.12], affecting approximately 11% or 22% of people at any time depending on the NPI cutoff used. Its presence was associated with a significantly higher risk of death after controlling for all other factors (hazard ratio [HR] = 2.92 [1.50-5.66]). Lower cognition, higher depression levels, and greater motor severity predicted apathy development in those without motivational deficits (HR [cognition] = 0.66 [0.48-0.90], HR [depression] = 1.45 [1.04-2.02], HR [motor severity] = 1.37 [1.01-1.86]). Cognition and depression were also associated with apathy cross-sectionally, along with male sex and possibly lower dopaminergic therapy level, but apathy still occurred across the full spectrum of each variable (OR [cognition] = 0.58 [0.44-0.76], OR [depression] = 1.43 [1.04-1.97], OR [female sex] = 0.45 [0.22-0.92], and OR [levodopa equivalent dose] = 0.78 [0.59-1.04]. DISCUSSION Apathy occurs across the PD time course and is associated with higher mortality. Depressive symptoms and cognitive impairment in particular predict its future development in those with normal motivation.
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Affiliation(s)
- Campbell Le Heron
- From the Department of Medicine (C.L.H., M.R.M., T.R.M., T.P., J.D.-A., T.A., S.H.), University of Otago, Christchurch; New Zealand Brain Research Institute (C.L.H., K.-L.H., M.R.M., L.L., T.R.M., D.M., T.P., J.D.-A., T.A.), Christchurch; Department of Neurology (C.L.H., T.A.), Christchurch Hospital; and Department of Psychology (C.L.H., J.D.-A.), Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Kyla-Louise Horne
- From the Department of Medicine (C.L.H., M.R.M., T.R.M., T.P., J.D.-A., T.A., S.H.), University of Otago, Christchurch; New Zealand Brain Research Institute (C.L.H., K.-L.H., M.R.M., L.L., T.R.M., D.M., T.P., J.D.-A., T.A.), Christchurch; Department of Neurology (C.L.H., T.A.), Christchurch Hospital; and Department of Psychology (C.L.H., J.D.-A.), Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Michael R MacAskill
- From the Department of Medicine (C.L.H., M.R.M., T.R.M., T.P., J.D.-A., T.A., S.H.), University of Otago, Christchurch; New Zealand Brain Research Institute (C.L.H., K.-L.H., M.R.M., L.L., T.R.M., D.M., T.P., J.D.-A., T.A.), Christchurch; Department of Neurology (C.L.H., T.A.), Christchurch Hospital; and Department of Psychology (C.L.H., J.D.-A.), Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Leslie Livingstone
- From the Department of Medicine (C.L.H., M.R.M., T.R.M., T.P., J.D.-A., T.A., S.H.), University of Otago, Christchurch; New Zealand Brain Research Institute (C.L.H., K.-L.H., M.R.M., L.L., T.R.M., D.M., T.P., J.D.-A., T.A.), Christchurch; Department of Neurology (C.L.H., T.A.), Christchurch Hospital; and Department of Psychology (C.L.H., J.D.-A.), Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Tracy R Melzer
- From the Department of Medicine (C.L.H., M.R.M., T.R.M., T.P., J.D.-A., T.A., S.H.), University of Otago, Christchurch; New Zealand Brain Research Institute (C.L.H., K.-L.H., M.R.M., L.L., T.R.M., D.M., T.P., J.D.-A., T.A.), Christchurch; Department of Neurology (C.L.H., T.A.), Christchurch Hospital; and Department of Psychology (C.L.H., J.D.-A.), Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Daniel Myall
- From the Department of Medicine (C.L.H., M.R.M., T.R.M., T.P., J.D.-A., T.A., S.H.), University of Otago, Christchurch; New Zealand Brain Research Institute (C.L.H., K.-L.H., M.R.M., L.L., T.R.M., D.M., T.P., J.D.-A., T.A.), Christchurch; Department of Neurology (C.L.H., T.A.), Christchurch Hospital; and Department of Psychology (C.L.H., J.D.-A.), Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Toni Pitcher
- From the Department of Medicine (C.L.H., M.R.M., T.R.M., T.P., J.D.-A., T.A., S.H.), University of Otago, Christchurch; New Zealand Brain Research Institute (C.L.H., K.-L.H., M.R.M., L.L., T.R.M., D.M., T.P., J.D.-A., T.A.), Christchurch; Department of Neurology (C.L.H., T.A.), Christchurch Hospital; and Department of Psychology (C.L.H., J.D.-A.), Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - John Dalrymple-Alford
- From the Department of Medicine (C.L.H., M.R.M., T.R.M., T.P., J.D.-A., T.A., S.H.), University of Otago, Christchurch; New Zealand Brain Research Institute (C.L.H., K.-L.H., M.R.M., L.L., T.R.M., D.M., T.P., J.D.-A., T.A.), Christchurch; Department of Neurology (C.L.H., T.A.), Christchurch Hospital; and Department of Psychology (C.L.H., J.D.-A.), Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Tim Anderson
- From the Department of Medicine (C.L.H., M.R.M., T.R.M., T.P., J.D.-A., T.A., S.H.), University of Otago, Christchurch; New Zealand Brain Research Institute (C.L.H., K.-L.H., M.R.M., L.L., T.R.M., D.M., T.P., J.D.-A., T.A.), Christchurch; Department of Neurology (C.L.H., T.A.), Christchurch Hospital; and Department of Psychology (C.L.H., J.D.-A.), Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Samuel Harrison
- From the Department of Medicine (C.L.H., M.R.M., T.R.M., T.P., J.D.-A., T.A., S.H.), University of Otago, Christchurch; New Zealand Brain Research Institute (C.L.H., K.-L.H., M.R.M., L.L., T.R.M., D.M., T.P., J.D.-A., T.A.), Christchurch; Department of Neurology (C.L.H., T.A.), Christchurch Hospital; and Department of Psychology (C.L.H., J.D.-A.), Speech and Hearing, University of Canterbury, Christchurch, New Zealand
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Xeni F, Marangoni C, Jackson MG. Validation of a non-food or water motivated effort-based foraging task as a measure of motivational state in male mice. Neuropsychopharmacology 2024:10.1038/s41386-024-01899-y. [PMID: 38898205 DOI: 10.1038/s41386-024-01899-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 05/06/2024] [Accepted: 06/03/2024] [Indexed: 06/21/2024]
Abstract
Disorders of motivation such as apathy syndrome are highly prevalent across neurological disorders but do not yet have an agreed treatment approach. The use of translational behavioural models can provide a route through which to meaningfully screen novel drug targets. Methods that utilise food deprivation in contrived environments may lack the sensitivity to detect deficits in self-initiated behaviour, and may have limited translation to normal behaviour. Animals monitored in more naturalistic environments may display more ethologically-relevant behaviours of greater translational value. Here, we aimed to validate a novel, non-food or water motivated effort-based foraging task as a measure of motivational state in mice. In this task, the mouse can freely choose to exert effort to forage nesting material and shuttle it back to a safe and enclosed environment. The amount of nesting material foraged is used as a readout of motivational state. Acute dopaminergic modulation with haloperidol, amphetamine and methylphenidate, and two phenotypic models known to induce motivational deficits (healthy ageing and chronic administration of corticosterone) were used to validate this task. Consistent with other effort-based decision-making tasks we find that foraging behaviour is sensitive to acute modulation of dopaminergic transmission. We find that both phenotypic models induce differing deficits in various aspects of foraging behaviour suggesting that the task may be used to parse different behavioural profiles from distinct disease phenotypes. Thus, without requiring extended training periods or physiological deprivation, this task may represent a refined and translational preclinical measure of motivation.
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Affiliation(s)
- Foteini Xeni
- School of Physiology, Pharmacology and Neuroscience, Biomedical Sciences Building, University of Bristol, BS8 1TD, Bristol, UK
| | - Caterina Marangoni
- School of Physiology, Pharmacology and Neuroscience, Biomedical Sciences Building, University of Bristol, BS8 1TD, Bristol, UK
| | - Megan G Jackson
- School of Physiology, Pharmacology and Neuroscience, Biomedical Sciences Building, University of Bristol, BS8 1TD, Bristol, UK.
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7
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Wandell CJ, Torres K. Exploring the utility of process scores in elucidating the role of cognitive and affective factors that influence verbal fluency performance in Parkinson's disease. APPLIED NEUROPSYCHOLOGY. ADULT 2024:1-12. [PMID: 38828539 DOI: 10.1080/23279095.2024.2359446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
OBJECTIVES Cognitive and affective factors have been implicated in verbal fluency (VF) performance in Parkinson's disease (PD). This exploratory study aimed to investigate the relationships between cognitive and affective variables on traditional ("core") and "process" (error and interval) scores of VF and elucidate unique information these scores may provide regarding mechanisms underlying VF. METHODS Sixty-two PD patients without dementia completed clinical neuropsychological examinations consisting of attention, processing speed, language, executive functioning, visuospatial, memory, and mood measures. Hierarchical regression and negative binomial regression analyses were used to evaluate relationships between outcome and predictor variables. RESULTS Generativity results revealed that processing speed and working memory explained up to 34% of the variance of total letter fluency responses (p = <.001) and processing speed explained 24% of the variance for total semantic fluency (p = .003). For category switching generativity, only age predicted 20% of the variance (p = .01). Two executive functioning measures were negatively associated with error production over the duration (b = -.055, p = .028; b = -.062, p = .004) and final 45-second interval (b = -.072, p = .003; b = -.044, p = .033) of the category switching task. In the initial 15-second task interval, a positive predictive relationship between error production and indifference apathy (b = .616, p = .044) was demonstrated. CONCLUSIONS Findings demonstrate the potential utility of "process" scores in detecting subtle cognitive impairment in Parkinson's disease patients without dementia and tentatively evidence the role of indifference apathy in task initiation.
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Affiliation(s)
- Catie J Wandell
- Veterans Afffairs Puget Sound Healthcare System, Seattle, WA, USA
| | - Karen Torres
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA
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8
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Jackson MG, Lightman SL, Robinson ESJ. Characterisation of behaviours relevant to apathy syndrome in the aged male rat. Behav Brain Res 2024; 466:114977. [PMID: 38570074 DOI: 10.1016/j.bbr.2024.114977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/22/2024] [Accepted: 03/29/2024] [Indexed: 04/05/2024]
Abstract
Apathy is a complex psychiatric syndrome characterised by motivational deficit, emotional blunting and cognitive changes. It occurs alongside a broad range of neurological disorders, but also occurs in otherwise healthy ageing. Despite its clinical prevalence, apathy does not yet have a designated treatment strategy. Generation of a translational animal model of apathy syndrome would facilitate the development of novel treatments. Given the multidimensional nature of apathy, a model cannot be achieved with a single behavioural test. Using a battery of behavioural tests we investigated whether aged rats exhibit behavioural deficits across different domains relevant to apathy. Using the effort for reward and progressive ratio tasks we found that aged male rats (21-27 months) show intact reward motivation. Using the novelty supressed feeding test and position-based object exploration we found aged rats showed increased anxiety-like behaviour inconsistent with emotional blunting. The sucrose preference test and reward learning assay showed intact reward sensitivity and reward-related cognition in aged rats. However, using a bowl-digging version of the probabilistic reversal learning task, we found a deficit in cognitive flexibility in aged rats that did not translate across to a touchscreen version of the task. While these data reveal important changes in cognitive flexibility and anxiety associated with ageing, aged rats do not show deficits across other behavioural domains relevant to apathy. This suggests that aged rats are not a suitable model for age-related apathy syndrome. These findings contrast with previous work in mice, revealing important species differences in behaviours relevant to apathy syndrome in ageing.
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Affiliation(s)
- Megan G Jackson
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK.
| | - Stafford L Lightman
- Bristol Medical School: Translational Health Sciences, University of Bristol, Bristol, UK
| | - Emma S J Robinson
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
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9
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Schade RN, Etheridge CB, Kenney LE, Ratajska AM, Rodriguez K, Lopez FV, Gertler J, Ray A, Santos L, Hess C, Bowers D. Greater Apathy Associated With Selective Serotonin Reuptake Inhibitor Use in Parkinson's Disease. J Geriatr Psychiatry Neurol 2024:8919887241254471. [PMID: 38780969 DOI: 10.1177/08919887241254471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
OBJECTIVE Apathy, a motivational disorder, is common in Parkinson's disease (PD) and often misdiagnosed as depression. Use of selective serotonin reuptake inhibitors (SSRIs) has been associated with increased apathy in adolescents and adults with depression. Based on observations that serotonin may downregulate dopaminergic systems, we examined the relationship between apathy and SSRI use in individuals with PD. METHODS Medications, mood/motivation scales, and clinical data were collected from a convenience sample of 400 individuals with PD. Depression and apathy were measured using the Beck Depression Inventory-II (BDI-Il) and the Apathy Scale (AS). Antidepressant medications were grouped by mechanism type. RESULTS Of the 400 PD patients, 26% were on SSRIs. On standard mood/motivation scales, 38% of the sample exceeded clinical cut-offs for apathy and 28% for depression. Results of hierarchical regression analyses revealed that SSRIs were the only antidepressant that were significantly associated with higher apathy scores (β = .1, P = .02). Less education (β = -.1, P = .01) worse cognition (β = -.1, P = .01), and greater depressive symptoms (β = .5, P < .001) were also significant predictors of apathy. CONCLUSION These findings suggest that use of SSRIs, but not other antidepressants, is associated with greater apathy in PD. Given the interactive relationship between serotonin and dopamine, the current findings highlight the importance of considering apathy when determining which antidepressants to prescribe to individuals with PD. Similarly, switching a SSRI for an alternative antidepressant in individuals with PD who are apathetic may be a potential treatment for apathy that needs further study.
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Affiliation(s)
- Rachel N Schade
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Connor B Etheridge
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Lauren E Kenney
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Adrianna M Ratajska
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Katie Rodriguez
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Francesca V Lopez
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Joshua Gertler
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Alyssa Ray
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Lauren Santos
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Christopher Hess
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, USA
| | - Dawn Bowers
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, USA
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10
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Scott BM, Eisinger RS, Mara R, Rana AN, Thompson S, Okun MS, Gunduz A, Bowers D. Co-Occurrence of Apathy and Impulse Control Disorders in Parkinson Disease: Variation across Multiple Measures. Arch Clin Neuropsychol 2024:acae036. [PMID: 38704737 DOI: 10.1093/arclin/acae036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/21/2024] [Accepted: 04/17/2024] [Indexed: 05/07/2024] Open
Abstract
OBJECTIVE To determine if the co-occurrence of apathy and impulse control disorders (ICDs) in Parkinson disease is dependent on instrument selection and assess the concurrent validity of three motivation measures by examining interrelationships between them. METHOD Ninety-seven cognitively normal individuals with idiopathic Parkinson disease (PD) completed the Questionnaire for Impulsive-Compulsive Disorders in Parkinson Disease-Rating Scale (QUIP-RS) and three apathy measures: the Apathy Scale, Lille Apathy Rating Scale, and Item 4 of the Movement Disorder Society-Unified Parkinson Disease Rating Scale. RESULTS Fifty (51.5%) participants were classified as apathetic on at least one measure, and only four individuals (4.3%) obtained clinically elevated scores on all three measures. The co-occurrence of apathy and ICD varied across measures. CONCLUSIONS We observed a co-occurrence of apathy and ICDs in PD patients with each apathy instrument; however, limited concurrent validity exists across measures. This is important for future investigations into shared pathophysiology and the design of future clinical trials aimed at improving the early detection and treatment of these debilitating syndromes.
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Affiliation(s)
- Bonnie M Scott
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, TX, USA
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Robert S Eisinger
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Roshan Mara
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Amtul-Noor Rana
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Sable Thompson
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Michael S Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Aysegul Gunduz
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
- J. Crayton Pruitt Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Dawn Bowers
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
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11
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Doskas T, Vadikolias K, Ntoskas K, Vavougios GD, Tsiptsios D, Stamati P, Liampas I, Siokas V, Messinis L, Nasios G, Dardiotis E. Neurocognitive Impairment and Social Cognition in Parkinson's Disease Patients. Neurol Int 2024; 16:432-449. [PMID: 38668129 PMCID: PMC11054167 DOI: 10.3390/neurolint16020032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/06/2024] [Accepted: 04/11/2024] [Indexed: 04/29/2024] Open
Abstract
In addition to motor symptoms, neurocognitive impairment (NCI) affects patients with prodromal Parkinson's disease (PD). NCI in PD ranges from subjective cognitive complaints to dementia. The purpose of this review is to present the available evidence of NCI in PD and highlight the heterogeneity of NCI phenotypes as well as the range of factors that contribute to NCI onset and progression. A review of publications related to NCI in PD up to March 2023 was performed using PubMed/Medline. There is an interconnection between the neurocognitive and motor symptoms of the disease, suggesting a common underlying pathophysiology as well as an interconnection between NCI and non-motor symptoms, such as mood disorders, which may contribute to confounding NCI. Motor and non-motor symptom evaluation could be used prognostically for NCI onset and progression in combination with imaging, laboratory, and genetic data. Additionally, the implications of NCI on the social cognition of afflicted patients warrant its prompt management. The etiology of NCI onset and its progression in PD is multifactorial and its effects are equally grave as the motor effects. This review highlights the importance of the prompt identification of subjective cognitive complaints in PD patients and NCI management.
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Affiliation(s)
- Triantafyllos Doskas
- Department of Neurology, Athens Naval Hospital, 11521 Athens, Greece;
- Department of Neurology, General University Hospital of Alexandroupoli, 68100 Alexandroupoli, Greece; (K.V.); (D.T.)
| | - Konstantinos Vadikolias
- Department of Neurology, General University Hospital of Alexandroupoli, 68100 Alexandroupoli, Greece; (K.V.); (D.T.)
| | | | - George D. Vavougios
- Department of Neurology, Athens Naval Hospital, 11521 Athens, Greece;
- Department of Neurology, Faculty of Medicine, University of Cyprus, 1678 Lefkosia, Cyprus
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larissa, Greece
| | - Dimitrios Tsiptsios
- Department of Neurology, General University Hospital of Alexandroupoli, 68100 Alexandroupoli, Greece; (K.V.); (D.T.)
| | - Polyxeni Stamati
- Department of Neurology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece; (P.S.); (I.L.); (V.S.); (E.D.)
| | - Ioannis Liampas
- Department of Neurology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece; (P.S.); (I.L.); (V.S.); (E.D.)
| | - Vasileios Siokas
- Department of Neurology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece; (P.S.); (I.L.); (V.S.); (E.D.)
| | - Lambros Messinis
- School of Psychology, Laboratory of Neuropsychology and Behavioural Neuroscience, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Grigorios Nasios
- Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, 45500 Ioannina, Greece;
| | - Efthimios Dardiotis
- Department of Neurology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece; (P.S.); (I.L.); (V.S.); (E.D.)
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12
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Zhang Y, Zhu XB, Gan J, Song L, Qi C, Wu N, Wan Y, Hou M, Liu Z. Impulse control behaviors and apathy commonly co-occur in de novo Parkinson's disease and predict the incidence of levodopa-induced dyskinesia. J Affect Disord 2024; 351:895-903. [PMID: 38342317 DOI: 10.1016/j.jad.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 01/24/2024] [Accepted: 02/06/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVE Impulse control behaviors (ICBs) and apathy are believed to represent opposite motivational expressions of the same behavioral spectrum involving hypo- and hyperdopaminergic status, but this has been recently debated. Our study aims to estimate the co-occurrence of ICBs and apathy in early Parkinson's disease (PD) and to determine whether this complex neuropsychiatric condition is an important marker of PD prognoses. METHODS Neuropsychiatric symptoms, clinical data, neuroimaging results, and demographic data from de novo PD patients were obtained from the Parkinson's Progression Markers Initiative, a prospective, multicenter, observational cohort. The clinical characteristics of ICBs co-occurring with apathy and their prevalence were analyzed. We compared the prognoses of the different groups during the 8-year follow-up. Multivariate Cox regression analysis was conducted to predict the development of levodopa-induced dyskinesia (LID) using baseline neuropsychiatric symptoms. RESULTS A total of 422 PD patients and 195 healthy controls (HCs) were included. In brief, 87 (20.6 %) de novo PD patients and 37 (19.0 %) HCs had ICBs at baseline. Among them, 23 (26.4 %) de novo PD patients and 3 (8.1 %) HCs had clinical symptoms of both ICBs and apathy. The ICBs and apathy group had more severe non-motor symptoms than the isolated ICBs group. Cox regression analysis demonstrated that the co-occurrence of ICBs and apathy was a risk factor for LID development (HR 2.229, 95 % CI 1.209 to 4.110, p = 0.010). CONCLUSIONS Co-occurrence of ICBs and apathy is common in patients with early PD and may help to identify the risk of LID development.
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Affiliation(s)
- Yu Zhang
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kong jiang Road, Shanghai 200092, People's Republic of China
| | - Xiao Bo Zhu
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kong jiang Road, Shanghai 200092, People's Republic of China; Department of Neurology, QingPu Branch of Zhongshan Hospital Affiliated to Fudan University, 1158 Gong yuan East Road, Shanghai 201700, People's Republic of China
| | - Jing Gan
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kong jiang Road, Shanghai 200092, People's Republic of China
| | - Lu Song
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kong jiang Road, Shanghai 200092, People's Republic of China
| | - Chen Qi
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kong jiang Road, Shanghai 200092, People's Republic of China
| | - Na Wu
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kong jiang Road, Shanghai 200092, People's Republic of China
| | - Ying Wan
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kong jiang Road, Shanghai 200092, People's Republic of China
| | - Miaomiao Hou
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kong jiang Road, Shanghai 200092, People's Republic of China
| | - Zhenguo Liu
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kong jiang Road, Shanghai 200092, People's Republic of China.
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13
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Maher S, Donlon E, Mullane G, Walsh R, Lynch T, Fearon C. Treatment of Apathy in Parkinson's Disease and Implications for Underlying Pathophysiology. J Clin Med 2024; 13:2216. [PMID: 38673489 PMCID: PMC11051068 DOI: 10.3390/jcm13082216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 03/28/2024] [Accepted: 04/05/2024] [Indexed: 04/28/2024] Open
Abstract
Apathy is a prevalent and highly debilitating non-motor symptom of Parkinson's disease (PD) that is often overlooked in clinical practice due to its subtle nature. This review aims to provide a comprehensive overview of the current evidence for the treatment of apathy in PD, highlighting recent advancements and emerging therapeutic avenues. In this review, we analyse a diverse array of treatment strategies for apathy in PD, including pharmacological interventions, non-pharmacological approaches, and emerging neuromodulation techniques. We evaluate the efficacy, safety, and limitations of established pharmacotherapies, such as dopaminergic agents, antidepressants, and cognitive enhancers. Additionally, we examine the promising role of non-pharmacological interventions, encompassing psychotherapies and behavioural interventions, in ameliorating apathetic symptoms. Furthermore, this review explores the effects of neuromodulation techniques on apathy, including the modulation of apathy via deep brain stimulation and emerging data on the potential influence of transcranial magnetic stimulation (TMS) on apathy in PD. Ultimately, a deeper understanding of effective treatment strategies for apathy has the potential to significantly improve the quality of life and overall well-being of individuals living with PD.
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Affiliation(s)
- Senan Maher
- Dublin Neurological Institute, Mater Misericordiae Hospital, D07 W7XF Dublin, Ireland
| | - Eoghan Donlon
- Dublin Neurological Institute, Mater Misericordiae Hospital, D07 W7XF Dublin, Ireland
| | - Gerard Mullane
- Dublin Neurological Institute, Mater Misericordiae Hospital, D07 W7XF Dublin, Ireland
| | - Richard Walsh
- Dublin Neurological Institute, Mater Misericordiae Hospital, D07 W7XF Dublin, Ireland
- Academic Unit of Neurology, School of Medicine, Trinity College Dublin, D02 R590 Dublin, Ireland
| | - Tim Lynch
- Dublin Neurological Institute, Mater Misericordiae Hospital, D07 W7XF Dublin, Ireland
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Conor Fearon
- Dublin Neurological Institute, Mater Misericordiae Hospital, D07 W7XF Dublin, Ireland
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
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14
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Gilmour W, Mackenzie G, Feile M, Tayler-Grint L, Suveges S, Macfarlane JA, Macleod AD, Marshall V, Grunwald IQ, Steele JD, Gilbertson T. Impaired value-based decision-making in Parkinson's disease apathy. Brain 2024; 147:1362-1376. [PMID: 38305691 PMCID: PMC10994558 DOI: 10.1093/brain/awae025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 12/07/2023] [Accepted: 01/13/2024] [Indexed: 02/03/2024] Open
Abstract
Apathy is a common and disabling complication of Parkinson's disease characterized by reduced goal-directed behaviour. Several studies have reported dysfunction within prefrontal cortical regions and projections from brainstem nuclei whose neuromodulators include dopamine, serotonin and noradrenaline. Work in animal and human neuroscience have confirmed contributions of these neuromodulators on aspects of motivated decision-making. Specifically, these neuromodulators have overlapping contributions to encoding the value of decisions, and influence whether to explore alternative courses of action or persist in an existing strategy to achieve a rewarding goal. Building upon this work, we hypothesized that apathy in Parkinson's disease should be associated with an impairment in value-based learning. Using a four-armed restless bandit reinforcement learning task, we studied decision-making in 75 volunteers; 53 patients with Parkinson's disease, with and without clinical apathy, and 22 age-matched healthy control subjects. Patients with apathy exhibited impaired ability to choose the highest value bandit. Task performance predicted an individual patient's apathy severity measured using the Lille Apathy Rating Scale (R = -0.46, P < 0.001). Computational modelling of the patient's choices confirmed the apathy group made decisions that were indifferent to the learnt value of the options, consistent with previous reports of reward insensitivity. Further analysis demonstrated a shift away from exploiting the highest value option and a reduction in perseveration, which also correlated with apathy scores (R = -0.5, P < 0.001). We went on to acquire functional MRI in 59 volunteers; a group of 19 patients with and 20 without apathy and 20 age-matched controls performing the Restless Bandit Task. Analysis of the functional MRI signal at the point of reward feedback confirmed diminished signal within ventromedial prefrontal cortex in Parkinson's disease, which was more marked in apathy, but not predictive of their individual apathy severity. Using a model-based categorization of choice type, decisions to explore lower value bandits in the apathy group activated prefrontal cortex to a similar degree to the age-matched controls. In contrast, Parkinson's patients without apathy demonstrated significantly increased activation across a distributed thalamo-cortical network. Enhanced activity in the thalamus predicted individual apathy severity across both patient groups and exhibited functional connectivity with dorsal anterior cingulate cortex and anterior insula. Given that task performance in patients without apathy was no different to the age-matched control subjects, we interpret the recruitment of this network as a possible compensatory mechanism, which compensates against symptomatic manifestation of apathy in Parkinson's disease.
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Affiliation(s)
- William Gilmour
- Division of Imaging Science and Technology, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
- Department of Neurology, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
| | - Graeme Mackenzie
- Division of Imaging Science and Technology, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
- Department of Neurology, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
| | - Mathias Feile
- Rehabilitation Psychiatry, Murray Royal Hospital, Perth PH2 7BH, UK
| | | | - Szabolcs Suveges
- Division of Imaging Science and Technology, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Jennifer A Macfarlane
- Division of Imaging Science and Technology, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
- Medical Physics, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
- SINAPSE, University of Glasgow, Imaging Centre of Excellence, Level 2, Queen Elizabeth University Hospital, Glasgow G51 4TF, Scotland, UK
| | - Angus D Macleod
- Institute of Applied Health Sciences, School of Medicine, University of Aberdeen, Foresterhill, Aberdeen AB24 2ZD, UK
- Department of Neurology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB24 2ZD, UK
| | - Vicky Marshall
- Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK
| | - Iris Q Grunwald
- Division of Imaging Science and Technology, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - J Douglas Steele
- Division of Imaging Science and Technology, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Tom Gilbertson
- Division of Imaging Science and Technology, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
- Department of Neurology, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
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15
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Mombelli S, Ricordeau F, Gillard L, Lecca R, Vidal T, Pereira B, Beudin P, Vitello N, Bastuji H, Peter-Derex L, Fantini ML. Psychobehavioural profile in narcolepsy type 1 with and without REM sleep behaviour disorder. J Sleep Res 2024; 33:e13925. [PMID: 37222001 DOI: 10.1111/jsr.13925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 05/25/2023]
Abstract
REM sleep behaviour disorder (RBD) is common in narcolepsy type 1 (NT1). Abnormalities in the reward system have been observed in NT1, possibly related to impaired orexin projections towards the mesolimbic reward system, but also in RBD when associated with Parkinson's disease. Our study aimed to explore the psychobehavioural profile of NT1 patients with and without RBD compared with healthy controls (HC). Forty patients with NT1 were compared with 20 sex- and age-matched HC. All patients with NT1 underwent a video-polysomnography including a measure of REM sleep without atonia (RSWA). The following neuropsychobehavioural variables were assessed: apathy, impulsivity, depression, cognition, subjective and objective attention, sensation-seeking, and behavioural addictions. The patient population included 22 patients with NT1-RBD and 18 patients with NT1-noRBD. Compared with the healthy controls, patients with NT1 had higher scores of apathy, impulsivity, and depression; a lower score on global cognition, and poorer self-perceived attention. No differences were found between patients with NT1 with and without RBD in all neuropsychological variables, except for impaired objective attention in patients with NT1-RBD. In patients with NT1, a positive correlation was observed between RSWA and both apathy and impulsivity subscale. Moreover, in patients with NT1-RBD, RSWA was positively correlated with depression. Patients with NT1 showed higher depression, apathy, and impulsivity compared with controls. These measures correlate with the severity of RSWA, suggesting a transdiagnostic association between RBD and abnormalities of the reward system at least for patients with NT1.
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Affiliation(s)
- Samantha Mombelli
- Sleep and EEG, Neurophysiology Unit, Neurology Department, University Hospital and UMR 6602-Université Clermont Auvergne, CNRS, Institute Pascal, Clermont-Ferrand, France
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - François Ricordeau
- Sleep and EEG, Neurophysiology Unit, Neurology Department, University Hospital and UMR 6602-Université Clermont Auvergne, CNRS, Institute Pascal, Clermont-Ferrand, France
- Center for Sleep Medicine and Respiratory Diseases, Lyon University Hospital, Lyon 1 University, Lyon, France
| | - Léa Gillard
- Sleep and EEG, Neurophysiology Unit, Neurology Department, University Hospital and UMR 6602-Université Clermont Auvergne, CNRS, Institute Pascal, Clermont-Ferrand, France
| | - Rosa Lecca
- Sleep and EEG, Neurophysiology Unit, Neurology Department, University Hospital and UMR 6602-Université Clermont Auvergne, CNRS, Institute Pascal, Clermont-Ferrand, France
- Sleep Disorder Research Center, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Tiphaine Vidal
- CMRR, Neurology Department, University Hospital - Université Clermont Auvergne, CNRS, Institute Pascal, Clermont-Ferrand, France
| | - Bruno Pereira
- Clinical Research and Innovation Direction, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Patricia Beudin
- Sleep and EEG, Neurophysiology Unit, Neurology Department, University Hospital and UMR 6602-Université Clermont Auvergne, CNRS, Institute Pascal, Clermont-Ferrand, France
| | - Nicolas Vitello
- Biostatistics Unit (DRCI) CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Helene Bastuji
- Center for Sleep Medicine and Respiratory Diseases, Lyon University Hospital, Lyon 1 University, Lyon, France
- Lyon Neuroscience Research Center, CNRS UMR 5292, INSERM U1028 - Neuropain Team, Lyon, France
| | - Laure Peter-Derex
- Center for Sleep Medicine and Respiratory Diseases, Lyon University Hospital, Lyon 1 University, Lyon, France
- Lyon Neuroscience Research Center, CNRS UMR 5292, INSERM U1028 - PAM Team, Lyon, France
| | - Maria Livia Fantini
- Sleep and EEG, Neurophysiology Unit, Neurology Department, University Hospital and UMR 6602-Université Clermont Auvergne, CNRS, Institute Pascal, Clermont-Ferrand, France
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16
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Ge S, Liu J, Jia Y, Li Z, Wang J, Wang M. Topological alteration of the brain structural network in Parkinson's disease with apathy. Brain Res Bull 2024; 208:110899. [PMID: 38340778 DOI: 10.1016/j.brainresbull.2024.110899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/05/2023] [Accepted: 02/07/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Apathy is a common neuropsychiatric manifestations in Parkinson's disease (PD), but neural network mechanisms still remain elusive. We aim to investigate the topological alteration of the brain structural network in PD with apathy. METHOD In the present study, a total of 47 apathetic PD (aPD) patients, 37 non-apathetic PD (naPD) patients, and 40 healthy controls (HCs) were enrolled. Diffusion tensor imaging (DTI) in conjunction with graph-theoretic approaches were used to explore the alterations of topological properties of the WM structural network arising from apathy in PD. One-way analysis of covariance and post hoc analyses were performed to explore differences among the three groups. Correlations were ascertained to examine relationships between the Starkstein Apathy Scale (AS) scores and significantly different network metrics among the three groups. RESULTS Both aPD and naPD patients remained small-world topology. However, compared with the naPD patients, aPD patients showed increased clustering coefficient (Cp) at the global level. At the regional level, aPD exhibited decreased nodal properties, mainly in the right dorsolateral prefrontal cortex (DLPFC), the right caudate nucleus (CAU), the right hippocampus, and the right superior parietal gyrus. Further, AS scores were negatively correlated with degree centrality of the right DLPFC (r = -0.254, p = 0.020) and the right CAU ( r = -0.357, p = 0.001) in the pooled patients with PD. CONCLUSIONS The findings suggested that apathy in PD presented relatively optimized global topological properties of the brain structural network and disrupted topological organization of the regional network, particularly involving the fronto-striatal-limbic circuits. The altered topological properties of abnormal brain regions might be used to understand the physiopathologic mechanism of the neural network in aPD patients.
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Affiliation(s)
- Shaoyun Ge
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Jun Liu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yongfeng Jia
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Zihan Li
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Jianwei Wang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
| | - Min Wang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
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17
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Zhu X, Gan J, Wu N, Zhang Y, Liu Z. The simultaneous presence of demoralization, apathy, and depression has a detrimental impact on both cognitive function and motor symptoms in Parkinson's disease patients. Front Psychiatry 2024; 15:1345280. [PMID: 38404468 PMCID: PMC10884111 DOI: 10.3389/fpsyt.2024.1345280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/25/2024] [Indexed: 02/27/2024] Open
Abstract
Objective Parkinson's disease (PD) is marked not only by motor symptoms but also by neuropsychiatric manifestations, including demoralization, apathy, and depression. Understanding the clinical distribution and characteristics of these co-occurring symptoms is crucial for improving quality of life of PD patients. Methods This study enrolled 195 Chinese PD patients from Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine. The study involved analyzing the clinical characteristics related to the simultaneous presence of demoralization, apathy, and depression in PD patients. Linear regression was employed to elucidate the linear trend between the quantity of negative neuropsychiatric symptoms and cognitive function, as well as motor symptoms and motor complications. SPSS mediation models were utilized to investigate whether the severity of cognitive function mediated the connection between multiple negative neuropsychiatric symptoms and motor symptoms. Results Among PD patients, a notable 57.5% experience the presence of multiple concurrent negative neuropsychiatric symptoms. Our investigation unveiled a correlation where patients with more negative neuropsychiatric symptoms displayed heightened cognitive impairment (P=0.048) and more severe motor symptoms (P=0.024), following a linear trend with increasing symptom numbers. Additionally, cognitive impairment played a partial mediating role in the impact of multiple negative neuropsychiatric symptoms on motor symptoms (β=0.747; 95% bootstrap confidence interval: 0.195 to 1.532). Conclusions The co-occurrence of these negative neuropsychiatric symptoms has the potential to worsen cognitive function and motor symptoms in PD patients. Moreover, cognitive impairment was identified as playing a partial mediating role in the relationship between multiple negative neuropsychiatric symptoms and motor symptoms.
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Affiliation(s)
- Xiaobo Zhu
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Neurology, QingPu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Jing Gan
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Na Wu
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Zhang
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhenguo Liu
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Voorend CGN, van Buren M, Berkhout-Byrne NC, Kerckhoffs APM, van Oevelen M, Gussekloo J, Richard E, Bos WJW, Mooijaart SP. Apathy Symptoms, Physical and Cognitive Function, Health-Related Quality of Life, and Mortality in Older Patients With CKD: A Longitudinal Observational Study. Am J Kidney Dis 2024; 83:162-172.e1. [PMID: 37741610 DOI: 10.1053/j.ajkd.2023.07.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 07/14/2023] [Accepted: 07/24/2023] [Indexed: 09/25/2023]
Abstract
RATIONALE & OBJECTIVE Apathy reflects diminished motivation, goal-directed behavior, and emotions, as well as less engagement in social interactions. Apathy overlaps with depression and is associated with cognitive decline. In the older individuals with chronic kidney disease (CKD), both depression and cognitive impairments are common, but apathy symptoms have been underreported. We investigated the occurrence of apathy symptoms and their associations with physical and cognitive functioning, health-related quality of life (HRQoL), and mortality in older patients with CKD. STUDY DESIGN Prospective observational cohort study. SETTING & PARTICIPANTS 180 outpatients aged≥65 years with estimated glomerular filtration rate≤20mL/min/1.73m2 from 5 Dutch nephrology centers. EXPOSURE Apathy symptoms at baseline were considered present when a Geriatric Depression Scale's 3-item apathy subscale score was≥2 points. OUTCOME Physical and cognitive functioning, HRQoL (assessed in annual geriatric assessments), and 4-year mortality. ANALYTICAL APPROACH Linear regression for cross-sectional associations, linear regression models for longitudinal associations, and Cox regression models for mortality over 4 years of observation. RESULTS Apathy symptoms were present in 64 patients (36%; 67% men; median age 75.5 years), of whom 32 (50%) had no depressive symptoms. At baseline, the presence of apathy symptoms was associated with significantly more frailty, more functional dependence, less physical capacity, lower visuoconstructive performance, worse delayed recall, and lower HRQoL scores. The presence of apathy symptoms at baseline was also associated with a higher mortality risk (hazard ratio, 2.3 [95% CI, 1.3-4.2], P=0.005 adjusted for age, sex, and high education level), but not with changes in physical and cognitive functioning or HRQoL during the follow-up period. LIMITATIONS Risk of selection bias and residual confounding. CONCLUSIONS Apathy symptoms were highly prevalent and associated with concurrent lower physical and cognitive status, lower HRQoL, and increased mortality. These findings highlight apathy as a potentially important clinical phenotype in older CKD patients. PLAIN-LANGUAGE SUMMARY We observed that older kidney patients often present apathy symptoms, such as less motivation, fewer goal-directed behaviors, fewer emotions, and less social engagement. Prior research has not extensively described apathy in kidney disease. We investigated the link between apathy symptoms and poor outcomes. We measured physical functioning, cognitive functioning, and quality of life. We learned that one-third of our older kidney patients showed symptoms of apathy, only half of whom had symptoms of depression. Patients with apathy symptoms showed lower quality of life and lower physical and cognitive performance. They also had a higher risk of death. These findings highlight the need for awareness of apathy symptoms in older kidney patients.
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Affiliation(s)
- Carlijn G N Voorend
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, the Netherlands.
| | - Marjolijn van Buren
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, the Netherlands; Department of Internal Medicine, Haga Hospital, The Hague, the Netherlands
| | - Noeleen C Berkhout-Byrne
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, the Netherlands
| | - Angèle P M Kerckhoffs
- Department of Internal Medicine and Geriatrics, Jeroen Bosch Hospital, Den Bosch, the Netherlands
| | - Mathijs van Oevelen
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, the Netherlands
| | - Jacobijn Gussekloo
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands; Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Edo Richard
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Willem Jan W Bos
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, the Netherlands; Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Simon P Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
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Costello H, Husain M, Roiser JP. Apathy and Motivation: Biological Basis and Drug Treatment. Annu Rev Pharmacol Toxicol 2024; 64:313-338. [PMID: 37585659 DOI: 10.1146/annurev-pharmtox-022423-014645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Apathy is a disabling syndrome associated with poor functional outcomes that is common across a broad range of neurological and psychiatric conditions. Currently, there are no established therapies specifically for the condition, and safe and effective treatments are urgently needed. Advances in the understanding of motivation and goal-directed behavior in humans and animals have shed light on the cognitive and neurobiological mechanisms contributing to apathy, providing an important foundation for the development of new treatments. Here, we review the cognitive components, neural circuitry, and pharmacology of apathy and motivation, highlighting converging evidence of shared transdiagnostic mechanisms. Though no pharmacological treatments have yet been licensed, we summarize trials of existing and novel compounds to date, identifying several promising candidates for clinical use and avenues of future drug development.
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Affiliation(s)
- Harry Costello
- Institute of Cognitive Neuroscience, University College London, London, United Kingdom;
| | - Masud Husain
- Nuffield Department of Clinical Neurosciences and Department of Experimental Psychology, Oxford University, Oxford, United Kingdom
| | - Jonathan P Roiser
- Institute of Cognitive Neuroscience, University College London, London, United Kingdom;
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Batzu L, Podlewska A, Gibson L, Chaudhuri KR, Aarsland D. A general clinical overview of the non-motor symptoms in Parkinson's disease: Neuropsychiatric symptoms. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2024; 174:59-97. [PMID: 38341232 DOI: 10.1016/bs.irn.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
The heterogeneity of non-motor features observed in people with Parkinson's disease (PD) is often dominated by one or more symptoms belonging to the neuropsychiatric spectrum, such as cognitive impairment, psychosis, depression, anxiety, and apathy. Due to their high prevalence in people with PD (PwP) and their occurrence in every stage of the disease, from the prodromal to the advanced stage, it is not surprising that PD can be conceptualised as a complex neuropsychiatric disorder. Despite progress in understanding the pathophysiological mechanisms underlying the neuropsychiatric signs and symptoms in PD, and better identification and diagnosis of these symptoms, effective treatments are still a major unmet need. The impact of these symptoms on the quality of life of PwP and caregivers, as well as their contribution to the overall non-motor symptom burden can be greater than that of motor symptoms and require a personalised, holistic approach. In this chapter, we provide a general clinical overview of the major neuropsychiatric symptoms of PD.
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Affiliation(s)
- Lucia Batzu
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Parkinson's Foundation Centre of Excellence, King's College Hospital, London, United Kingdom
| | - Aleksandra Podlewska
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Parkinson's Foundation Centre of Excellence, King's College Hospital, London, United Kingdom
| | - Lucy Gibson
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - K Ray Chaudhuri
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Parkinson's Foundation Centre of Excellence, King's College Hospital, London, United Kingdom
| | - Dag Aarsland
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Centre for Age-Related Diseases, Stavanger University Hospital, Stavanger, Norway.
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Siciliano M, Tessitore A, Morgante F, Goldman JG, Ricciardi L. Subjective Cognitive Complaints in Parkinson's Disease: A Systematic Review and Meta-Analysis. Mov Disord 2024; 39:17-28. [PMID: 38173220 DOI: 10.1002/mds.29649] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 10/15/2023] [Accepted: 10/17/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Subjective cognitive complaints (SCCs) in Parkinson's disease (PD) are reported frequently, but their prevalence and association with changes on objective testing are not fully known. OBJECTIVE We aimed to determine the prevalence, clinical correlates, and predictive value of SCCs in PD. METHODS We conducted a systematic review and meta-analysis. From 204 abstracts, we selected 31 studies (n = 3441 patients), and from these, identified the prevalence, clinical features, associations with neuropsychiatric symptoms, and predictive values of SCCs in PD. RESULTS The meta-analysis showed an SCC prevalence of 36%. This prevalence, however, was significantly moderated by study heterogeneity regarding female sex, disease severity, levodopa equivalent daily dosage, exclusion from the overall sample of patients with objective cognitive impairment, and measurement instrument. SCC prevalence did not differ between de novo and treated PD patients. SCCs were weakly and negligibly associated with cognitive changes on objective testing in cross-sectional studies. However, in cognitively healthy patients, SCCs had a risk ratio of 2.71 for later cognitive decline over a mean follow-up of 3.16 years. Moreover, SCCs were moderately related to co-occurring symptoms of depression, anxiety, or apathy and were more strongly related to these neuropsychiatric symptoms than objective cognitive functioning. CONCLUSION Our analyses suggest that SCCs in patients with and without objective cognitive impairment are frequent, occurring in more than one third of PD patients. Establishing uniform measurement instruments for identifying PD-related SCCs is critical to understand their implications. Even in cases lacking evidence of objective cognitive impairment and where SCCs might reflect underlying neuropsychiatric symptoms, the possibility of later cognitive deterioration should not be excluded. Therefore, SCCs in PD patients warrant close monitoring for opportunities for targeted and effective interventions. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Mattia Siciliano
- Department of Advanced Medical and Surgical Sciences-MRI Research Center Vanvitelli-FISM, University of Campania "Luigi Vanvitelli", Naples, Italy
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom
| | - Alessandro Tessitore
- Department of Advanced Medical and Surgical Sciences-MRI Research Center Vanvitelli-FISM, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesca Morgante
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom
| | | | - Lucia Ricciardi
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom
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Henning A, Linden M, Muschalla B. Self- and observer ratings of capacity limitations in patients with neurological conditions. BRAIN IMPAIR 2023; 24:586-600. [PMID: 38167355 DOI: 10.1017/brimp.2022.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the self- and observer ratings of capacity limitations in patients with neurological conditions. Research on this topic is relevant for assessing the patients' ability to participate in work and social life and improving collaborative patient-clinician relationships. METHOD The self- and observer ratings of capacity limitations in a sample of N = 245 patients with neurological conditions from a rehabilitation facility were compared and assessed using the short rating of activity limitations and participation restrictions in mental disorders according to the International Classification of Functioning, Disability and Health (Mini-ICF-APP) and the equivalent self-rating questionnaire (Mini-ICF-APP-S). RESULTS Paired-samples t-tests revealed significant differences between the self- and observer ratings for six out of 13 capacity dimensions. On average, the patients rated the capacity dimensions adherence to regulations, planning and structuring of tasks, professional competency and endurance as significantly less limited, in comparison to the observers (small to medium effect sizes). The self-ratings for limitation of contact with others and self-care were only marginally higher than the observer ratings. CONCLUSIONS The findings show that psychological capacity limitations occur in patients with neurological conditions. In clinical practice, limitations in each capacity dimension and discrepancies in patient- and clinician-ratings should be thoroughly assessed. This is especially relevant in patients with neurological conditions who have a potential tendency to underestimate or deny their disability.
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Affiliation(s)
- Anne Henning
- Department of Psychotherapy and Diagnostics, Technische Universität Braunschweig, Braunschweig, Germany
- Brandenburgklinik Berlin-Brandenburg, Bernau bei Berlin, Germany
| | - Michael Linden
- Research Group Psychosomatic Rehabilitation, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Beate Muschalla
- Department of Psychotherapy and Diagnostics, Technische Universität Braunschweig, Braunschweig, Germany
- Brandenburgklinik Berlin-Brandenburg, Bernau bei Berlin, Germany
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Corveleyn X, Corbel C, Fabre R, Zeghari R, Dujardin K, Robert P, Manera V. Validation study of the apathy motivation index in French adults. Front Psychol 2023; 14:1252965. [PMID: 37928593 PMCID: PMC10624122 DOI: 10.3389/fpsyg.2023.1252965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/25/2023] [Indexed: 11/07/2023] Open
Abstract
Objective Apathy is present in many brain disorders, but it is also prevalent to varying degrees in healthy people. While many tools have been developed to assess levels of apathy in pathology, no standardized measure of apathy in healthy people exists. Method Therefore, this study aimed to validate the French version of the Apathy Motivation Index (f-AMI). The results of 729 participants were analyzed using an exploratory factorial analysis. Results Preliminary analyses suggested that the three domains of apathy extracted in the original AMI scale-behavioral activation (BA), social motivation (SM), and emotional sensitivity (ES)-could be found also in the f-AMI. A further exploratory analysis showed that a higher number of factors could be extracted, particularly for women. Specifically, both social and emotional factors could be divided into two sub-factors: (1) social motivation toward strangers or toward an acquaintance and (2) self-directed emotional sensitivity directed toward others. Regarding construct validity, the scores of f-AMI were correlated with the French Dimensional Apathy Scale results. Concerning the divergent validity, emotional sensitivity in apathy is different from depression, anhedonia, and fatigue levels. Conclusion These results suggest that the f-AMI can be used to assess levels of apathy in healthy adults.
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Affiliation(s)
- Xavier Corveleyn
- LAPCOS, Université Côte d'Azur, Nice, France
- MSHS Sud-Est, Maison des Sciences de l'Homme et de la Société Sud-Est, Nice, France
| | - Camille Corbel
- LAPCOS, Université Côte d'Azur, Nice, France
- MSHS Sud-Est, Maison des Sciences de l'Homme et de la Société Sud-Est, Nice, France
| | - Roxane Fabre
- CoBTeK Lab, Université Côte d'Azur, Nice, France
- Département de Santé Publique, Centre Hospitalier Universitaire de Nice (Public Health Department University Hospital of Nice), Nice, France
| | | | - Kathy Dujardin
- CHU Lille, Lille Neurosciences and Cognition, INSERM, Université Lille, Lille, France
| | - Philippe Robert
- CoBTeK Lab, Université Côte d'Azur, Nice, France
- Centre Hospitalier Universitaire de Nice, Centre mémoire CMRR, Nice, France
- Association Innovation Alzheimer, Nice, France
| | - Valeria Manera
- CoBTeK Lab, Université Côte d'Azur, Nice, France
- Centre Hospitalier Universitaire de Nice, Centre mémoire CMRR, Nice, France
- Association Innovation Alzheimer, Nice, France
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24
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Mao C, Zhang Y, Jiang J, Qin R, Ye Q, Zhu X, Wu J. Magnetic Resonance Imaging Biomarkers of Punding in Parkinson's Disease. Brain Sci 2023; 13:1423. [PMID: 37891792 PMCID: PMC10605844 DOI: 10.3390/brainsci13101423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/15/2023] [Accepted: 09/22/2023] [Indexed: 10/29/2023] Open
Abstract
Punding is a rare condition triggered by dopaminergic therapy in Parkinson's disease (PD), characterized by a complex, excessive, repetitive, and purposeless abnormal movement, and its pathogenesis remains unclear. We aimed to assess the brain structure alterations related to punding by using multipametric magnetic resonance imaging (MRI). Thirty-eight PD patients (19 with punding and 19 without punding) from the Parkinson's Progression Marker Initiative (PPMI) were included in this study. Cortical thickness was assessed with FreeSurfer, and the integrity of white matter fiber tracts and network topologies were analyzed by using FMRIB Software Library (FSL) and Pipeline for Analyzing braiN Diffusion imAges (PANDA). PD patients with punding showed a higher apathy score and more severe cortical atrophy in the left superior parietal, right inferior parietal, and right superior frontal gyrus, and worse integrity of the right cingulum cingulate tract compared to those without punding. On the other hand, no significant difference in structural network topologies was detected between the two groups. These data suggest that the specific area of destruction may be an MRI biomarker of punding risk, and these findings may have important implications for understanding the neural mechanisms of punding in PD.
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Affiliation(s)
- Chenglu Mao
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China; (C.M.); (Y.Z.); (J.J.); (R.Q.); (Q.Y.); (X.Z.)
- Department of Neurology, Nanjing Drum Tower Hospital, State Key Laboratory of Pharmaceutical Biotechnology and Institute of Translational Medicine for Brain Critical Diseases, Nanjing University, Nanjing 210008, China
| | - Yang Zhang
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China; (C.M.); (Y.Z.); (J.J.); (R.Q.); (Q.Y.); (X.Z.)
- Department of Neurology, Nanjing Drum Tower Hospital, State Key Laboratory of Pharmaceutical Biotechnology and Institute of Translational Medicine for Brain Critical Diseases, Nanjing University, Nanjing 210008, China
| | - Jialiu Jiang
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China; (C.M.); (Y.Z.); (J.J.); (R.Q.); (Q.Y.); (X.Z.)
- Department of Neurology, Nanjing Drum Tower Hospital, State Key Laboratory of Pharmaceutical Biotechnology and Institute of Translational Medicine for Brain Critical Diseases, Nanjing University, Nanjing 210008, China
| | - Ruomeng Qin
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China; (C.M.); (Y.Z.); (J.J.); (R.Q.); (Q.Y.); (X.Z.)
- Department of Neurology, Nanjing Drum Tower Hospital, State Key Laboratory of Pharmaceutical Biotechnology and Institute of Translational Medicine for Brain Critical Diseases, Nanjing University, Nanjing 210008, China
| | - Qing Ye
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China; (C.M.); (Y.Z.); (J.J.); (R.Q.); (Q.Y.); (X.Z.)
- Department of Neurology, Nanjing Drum Tower Hospital, State Key Laboratory of Pharmaceutical Biotechnology and Institute of Translational Medicine for Brain Critical Diseases, Nanjing University, Nanjing 210008, China
| | - Xiaolei Zhu
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China; (C.M.); (Y.Z.); (J.J.); (R.Q.); (Q.Y.); (X.Z.)
- Department of Neurology, Nanjing Drum Tower Hospital, State Key Laboratory of Pharmaceutical Biotechnology and Institute of Translational Medicine for Brain Critical Diseases, Nanjing University, Nanjing 210008, China
| | - Jiayong Wu
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China; (C.M.); (Y.Z.); (J.J.); (R.Q.); (Q.Y.); (X.Z.)
- Department of Neurology, Nanjing Drum Tower Hospital, State Key Laboratory of Pharmaceutical Biotechnology and Institute of Translational Medicine for Brain Critical Diseases, Nanjing University, Nanjing 210008, China
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Leavy B, Sedhed J, Kalbe E, Åkesson E, Franzén E, Johansson H. Design of the STEPS trial: a phase II randomized controlled trial evaluating eHealth-supported motor-cognitive home training for Parkinson's disease. BMC Neurol 2023; 23:356. [PMID: 37794320 PMCID: PMC10548709 DOI: 10.1186/s12883-023-03389-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 09/12/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Electronic health (eHealth) technology offers the potential to support and motivate physical activity for symptom management in Parkinson's disease (PD). It is also recommended that motor exercise in PD be complemented with cognitive training aimed at attentional or executive functions. This paper describes the protocol for a double-blind randomized controlled trial to evaluate the effects of motor-cognitive training in the home environment, supported by eHealth. METHODS/DESIGN The Support for home Training using Ehealth in Parkinsons diseaSe (STEPS) is a double-blind single center randomized controlled trial. Two parallel groups will include in total 120 participants with mild to moderate PD who will receive either (i) the intervention (a progressive 10-week individualized motor-cognitive eHealth training with cognitive behavioral elements to increase physical activity levels) or (ii) an active control group (an individualized 10-week paper-based home exercise program). The active control group will not receive motor-cognitive exercises or cognitive behavioral approaches to increase physical activity level. The primary outcome is walking capacity assessed by the six-minute walk test (6MWT). Secondary outcomes will include gait performance during single and dual task conditions, gait speed, functional mobility and lower limb strength, balance, physical activity behavior and a range of patient reported outcome measures relevant in PD. DISCUSSION The STEPS trial will answer the question whether 10 weeks of eHealth supported motor-cognitive exercise in the home environment can improve walking capacity in PD when compared to a standard paper exercise program. Findings from this study will also strengthen the evidence concerning the efficacy of PD-specific eHealth interventions with a view meeting future health care demands by addressing issues of inaccessibility to specialized neurological rehabilitation in PD. TRIAL REGISTRATION ClinicalTrials.gov August 2022, NCT05510739.
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Affiliation(s)
- Breiffni Leavy
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden.
- Stockholm Sjukhem Foundation, Research and development unit, Stockholm, Sweden.
| | - Jenny Sedhed
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
- Stockholm Sjukhem Foundation, Research and development unit, Stockholm, Sweden
| | - Elke Kalbe
- Medical Psychology | Neuropsychology and Gender Studies & Centre for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Elisabet Åkesson
- Stockholm Sjukhem Foundation, Research and development unit, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Erika Franzén
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
- Stockholm Sjukhem Foundation, Research and development unit, Stockholm, Sweden
- Theme Womens Health and Allied Health Professionals, Medical unit Occupational Therapy and Physical Therapy, Karolinska University Hospital, Stockholm, Sweden
| | - Hanna Johansson
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
- Stockholm Sjukhem Foundation, Research and development unit, Stockholm, Sweden
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26
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Costello H, Yamamori Y, Reeves S, Schrag AE, Howard R, Roiser JP. Longitudinal decline in striatal dopamine transporter binding in Parkinson's disease: associations with apathy and anhedonia. J Neurol Neurosurg Psychiatry 2023; 94:863-870. [PMID: 37221053 PMCID: PMC10511995 DOI: 10.1136/jnnp-2022-330790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 04/22/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Motivational symptoms such as apathy and anhedonia are common in Parkinson's disease (PD), respond poorly to treatment, and are hypothesised to share underlying neural mechanisms. Striatal dopaminergic dysfunction is considered central to motivational symptoms in PD but the association has never been examined longitudinally. We investigated whether progression of dopaminergic dysfunction was associated with emergent apathy and anhedonia symptoms in PD. METHODS Longitudinal cohort study of 412 newly diagnosed patients with PD followed over 5 years as part of the Parkinson's Progression Markers Initiative cohort.Apathy and anhedonia were measured using a composite score derived from relevant items of the 15-item Geriatric Depression Scale (GDS-15) and part I of the MDS-Unified Parkinson's Disease Rating Scale. Dopaminergic neurodegeneration was measured using repeated striatal dopamine transporter (DAT) imaging. RESULTS Linear mixed-effects modelling across all contemporaneous data points identified a significant negative relationship between striatal DAT specific binding ratio (SBR) and apathy/anhedonia symptoms, which emerged as PD progressed (interaction:β=-0.09, 95% CI (-0.15 to -0.03), p=0.002). Appearance and subsequent worsening of apathy/anhedonia symptoms began on average 2 years after diagnosis and below a threshold striatal DAT SBR level. The interaction between striatal DAT SBR and time was specific to apathy/anhedonia symptoms, with no evidence of a similar interaction for general depressive symptoms from the GDS-15 (excluding apathy/anhedonia items) (β=-0.06, 95% CI (-0.13 to 0.01)) or motor symptoms (β=0.20, 95% CI (-0.25 to 0.65)). CONCLUSIONS Our findings support a central role for dopaminergic dysfunction in motivational symptoms in PD. Striatal DAT imaging may be a useful indicator of apathy/anhedonia risk that could inform intervention strategies.
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Affiliation(s)
- Harry Costello
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Yumeya Yamamori
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Suzanne Reeves
- Division of Psychiatry, University College London, London, UK
| | | | - Robert Howard
- Division of Psychiatry, University College London, London, UK
| | - Jonathan P Roiser
- Institute of Cognitive Neuroscience, University College London, London, UK
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Pourzinal D, Yang J, Sivakumaran K, McMahon KL, Mitchell L, O'Sullivan JD, Byrne GJ, Dissanayaka NN. Longitudinal follow up of data-driven cognitive subtypes in Parkinson's disease. Brain Behav 2023; 13:e3218. [PMID: 37574595 PMCID: PMC10570472 DOI: 10.1002/brb3.3218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/26/2023] [Accepted: 07/31/2023] [Indexed: 08/15/2023] Open
Abstract
AIM The dual syndrome hypothesis proposes that there are two cognitive subtypes in Parkinson's disease (PD): a frontal subtype with executive/attention impairment and gradual cognitive decline, and a posterior-cortical subtype with memory/visuospatial deficits and rapid cognitive decline. We aimed to compare the rate of global cognitive decline between subtypes derived using data-driven methods and explore their longitudinal performance within specific cognitive domains to better understand the prognosis of each subtype. METHOD Frontal, posterior-cortical, globally impaired, and cognitively intact PD subtypes were identified at baseline using k-means clustering (N = 85), and 29 participants (34%) returned for follow-up assessments on average 4.87 years from baseline. Linear mixed effects models compared progression of subtypes on global cognition; psychological symptoms; parkinsonism; and the memory, attention, executive, language, and visuospatial cognitive domains. RESULTS The frontal subtype was lost to attrition. While rate of change in parkinsonism, anxiety, and apathy differed between subtypes, there was no difference in the rate of global cognitive decline. However, the posterior-cortical subtype declined most rapidly in verbal memory, card sorting, trail making, and judgement of line orientation (JLO), while the cognitively intact group declined most rapidly on verbal memory and semantic fluency. The globally impaired subtype declined most rapidly in JLO, although this should be interpreted with caution due to high attrition. CONCLUSION Despite limited sample size, the present study supports the differential progression of the posterior-cortical subtype compared to cognitively intact and globally impaired PD. These results encourage further, large-scale longitudinal investigations of cognitive subtypes in PD.
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Affiliation(s)
- Dana Pourzinal
- Faculty of MedicineThe University of Queensland Centre for Clinical ResearchHerstonQLDAustralia
| | - Jihyun Yang
- Faculty of MedicineThe University of Queensland Centre for Clinical ResearchHerstonQLDAustralia
| | - Kumareshan Sivakumaran
- Faculty of MedicineThe University of Queensland Centre for Clinical ResearchHerstonQLDAustralia
| | - Katie L. McMahon
- School of Clinical Sciences, Faculty of HealthQueensland University of TechnologyBrisbaneQLDAustralia
| | - Leander Mitchell
- School of PsychologyThe University of QueenslandSt. LuciaAustralia
| | - John D. O'Sullivan
- Faculty of MedicineThe University of Queensland Centre for Clinical ResearchHerstonQLDAustralia
- Department of NeurologyRoyal Brisbane and Women's HospitalHerstonQLDAustralia
| | - Gerard J. Byrne
- Faculty of MedicineThe University of Queensland Centre for Clinical ResearchHerstonQLDAustralia
- Mental Health ServiceRoyal Brisbane and Women's HospitalHerstonQLDAustralia
| | - Nadeeka N. Dissanayaka
- Faculty of MedicineThe University of Queensland Centre for Clinical ResearchHerstonQLDAustralia
- School of PsychologyThe University of QueenslandSt. LuciaAustralia
- Department of NeurologyRoyal Brisbane and Women's HospitalHerstonQLDAustralia
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Ricciardi L, Apps M, Little S. Uncovering the neurophysiology of mood, motivation and behavioral symptoms in Parkinson's disease through intracranial recordings. NPJ Parkinsons Dis 2023; 9:136. [PMID: 37735477 PMCID: PMC10514046 DOI: 10.1038/s41531-023-00567-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 08/07/2023] [Indexed: 09/23/2023] Open
Abstract
Neuropsychiatric mood and motivation symptoms (depression, anxiety, apathy, impulse control disorders) in Parkinson's disease (PD) are highly disabling, difficult to treat and exacerbated by current medications and deep brain stimulation therapies. High-resolution intracranial recording techniques have the potential to undercover the network dysfunction and cognitive processes that drive these symptoms, towards a principled re-tuning of circuits. We highlight intracranial recording as a valuable tool for mapping and desegregating neural networks and their contribution to mood, motivation and behavioral symptoms, via the ability to dissect multiplexed overlapping spatial and temporal neural components. This technique can be powerfully combined with behavioral paradigms and emerging computational techniques to model underlying latent behavioral states. We review the literature of intracranial recording studies investigating mood, motivation and behavioral symptomatology with reference to 1) emotional processing, 2) executive control 3) subjective valuation (reward & cost evaluation) 4) motor control and 5) learning and updating. This reveals associations between different frequency specific network activities and underlying cognitive processes of reward decision making and action control. If validated, these signals represent potential computational biomarkers of motivational and behavioural states and could lead to principled therapy development for mood, motivation and behavioral symptoms in PD.
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Affiliation(s)
- Lucia Ricciardi
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK.
| | - Matthew Apps
- Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham, UK
| | - Simon Little
- Movement Disorders and Neuromodulation Centre, University of California San Francisco, San Francisco, CA, USA
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Martinez-Nunez AE, Soltanian-Zadeh H, Latack K, Ghazi N, Mahajan A. Hyposmia and apathy in early, de novo Parkinson's disease: Lessons from structural brain connectivity. J Neurol Sci 2023; 452:120767. [PMID: 37619327 DOI: 10.1016/j.jns.2023.120767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/08/2023] [Accepted: 08/13/2023] [Indexed: 08/26/2023]
Abstract
INTRODUCTION The neuroanatomical structures implicated in olfactory and emotional processing overlap significantly. Our understanding of the relationship between hyposmia and apathy, common manifestations of early Parkinson's disease (PD), is inadequate. MATERIALS AND METHODS We analyzed data on 40 patients with early de-novo idiopathic PD enrolled within 2 years of motor symptom onset in the Parkinson's Progression Markers Initiative (PPMI) study. To be included in the analysis, patients must have smell dysfunction but no apathy at the baseline visit and had completed a diffusion MRI (dMRI) at the baseline visit and at the 48-month follow-up visit. We used the FMRIB Software Library's diffusion tool kit to measure fractional anisotropy (FA) in six regions of interest on dMRI: bilateral anterior corona radiata, left cingulum, left superior corona radiata, genu and body of the corpus callosum. We compared the FA in each region from the dMRI done at the beginning of the study with the follow up studies at 4 years. RESULTS We found a significant decrease of FA at the bilateral anterior corona radiata, and the genu and body of the corpus callosum comparing baseline scans with follow up images at 4-years after starting the study. CONCLUSION Structural connectivity changes associated with apathy can be seen early in PD patients with smell dysfunction.
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Affiliation(s)
| | - Hamid Soltanian-Zadeh
- Departments of Radiology and Research Administration, Henry Ford Health, Detroit, MI, USA; Control and Intelligent Processing Center of Excellence (CIPCE), School of Electrical and Computer Engineering, University of Tehran, Tehran, Iran
| | - Katie Latack
- Department of Biostatistics, Henry Ford Health, Detroit, MI, USA
| | - Nayereh Ghazi
- Control and Intelligent Processing Center of Excellence (CIPCE), School of Electrical and Computer Engineering, University of Tehran, Tehran, Iran
| | - Abhimanyu Mahajan
- Rush Parkinson's Disease and Movement Disorders Program, Department of Neurological Sciences, Chicago, IL, United States of America.
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Ananthavarathan P, Patel B, Peeros S, Obrocki R, Malek N. Neurological update: non-motor symptoms in atypical parkinsonian syndromes. J Neurol 2023; 270:4558-4578. [PMID: 37316556 PMCID: PMC10421812 DOI: 10.1007/s00415-023-11807-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/31/2023] [Accepted: 06/04/2023] [Indexed: 06/16/2023]
Abstract
Among people with Parkinson's disease (PD), non-motor symptoms (NMS) are a well-recognised cause of significant morbidity and poor quality of life. Yet, it is only more recently that NMS have been recognised to affect the lives of patients with atypical parkinsonian syndromes in a similar fashion. The aim of this article is to highlight and compare the relative prevalence of NMS among patients with atypical parkinsonian syndromes in the published literature, which largely remain underreported and unaddressed in routine clinical practice. All NMS that are recognised to occur in PD are also found to commonly occur in atypical parkinsonian syndromes. In particular, excessive daytime sleepiness is more prevalent among atypical parkinsonian syndromes (94.3%) compared to PD (33.9%) or normal controls (10.5%) (p < 0.001). Urinary dysfunction (not limited to urinary incontinence) is not only found to occur in MSA (79.7%) and PD (79.9%), but has also been reported in nearly half of the patients with PSP (49.3%), DLB (42%) and CBD (53.8%) (p < 0.001). Apathy is significantly more common among the atypical parkinsonian syndromes [PSP (56%), MSA (48%), DLB (44%), CBD (43%)] compared to PD (35%) (p = 0.029). Early recognition and addressing of NMS among atypical parkinsonian syndromes may help improve the holistic patient care provided and may encompass a range of conservative and pharmacotherapeutic treatments to address these symptoms.
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Affiliation(s)
- Piriyankan Ananthavarathan
- Department of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
- Department of Neuroinflammation, Institute of Neurology, University College London, 1st Floor, Russell Square House, 10-12 Russell Square, London, WC1B 5EH, UK.
| | - B Patel
- Department of Neurology, Queen's Hospital, Romford, Essex, UK
| | - S Peeros
- Department of Neurology, Queen's Hospital, Romford, Essex, UK
| | - R Obrocki
- Department of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Department of Neurology, Queen's Hospital, Romford, Essex, UK
| | - N Malek
- Department of Neurology, Queen's Hospital, Romford, Essex, UK
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Horne KS, Ceslis A, Mosley P, Adam R, Robinson GA. The Role of Apathy in Spontaneous Verbal and Nonverbal Behaviors: A Transdiagnostic Pilot Study in Neurodegeneration. Cogn Behav Neurol 2023; 36:178-193. [PMID: 37378480 DOI: 10.1097/wnn.0000000000000345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 02/23/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Apathy, characterized by a quantifiable reduction in motivation or goal-directed behavior, is a multidimensional syndrome that has been observed across many neurodegenerative diseases. OBJECTIVE To develop a novel task measuring spontaneous action initiation (ie, a nonverbal equivalent to spontaneous speech tasks) and to investigate the association between apathy and executive functions such as the voluntary initiation of speech and actions and energization (ie, ability to initiate and sustain a response). METHOD We compared the energization and executive functioning performance of 10 individuals with neurodegenerative disease and clinically significant apathy with that of age-matched healthy controls (HC). We also investigated the association between self-reported scores on the Apathy Evaluation Scale (AES) and performance on energization tasks. RESULTS The individuals with apathy made significantly fewer task-related actions than the HC on the novel spontaneous action task, and their scores on the AES were negatively correlated with spontaneous task-related actions, providing preliminary evidence for the task's construct validity. In addition, the individuals with apathy performed more poorly than the HC on all of the energization tasks, regardless of task type or stimulus modality, suggesting difficulty in sustaining voluntary responding over time. Most of the tasks also correlated negatively with the AES score. However, the individuals with apathy also performed more poorly on some of the executive function tasks, particularly those involving self-monitoring. CONCLUSION Our work presents a novel experimental task for measuring spontaneous action initiation-a key symptom of apathy-and suggests a possible contribution of apathy to neuropsychological deficits such as poor energization.
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Affiliation(s)
- Kristina S Horne
- Queensland Brain Institute, The University of Queensland, Queensland, Australia
| | - Amelia Ceslis
- School of Psychology, The University of Queensland, Queensland, Australia
| | - Philip Mosley
- Queensland Brain Institute, The University of Queensland, Queensland, Australia
- Clinical Brain Networks Group, QIMR Berghofer Medical Research Institute, Queensland, Australia
- Biomedical Informatics Group, Commonwealth Scientific and Industrial Research Organisation, Queensland, Australia
| | - Robert Adam
- University of Queensland Centre for Clinical Research, The University of Queensland, Royal Brisbane & Women's Hospital, Queensland, Australia
| | - Gail A Robinson
- Queensland Brain Institute, The University of Queensland, Queensland, Australia
- School of Psychology, The University of Queensland, Queensland, Australia
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Xu C, Wang F, Huang Q, Lyu D, Wu C, Cao T, Zhao J, Wang M, Zhou N, Yang W, Chen Y, Wei Z, Xie B, Hong W. Association between overt aggression and anhedonia in patients with major depressive disorder during the acute phase. J Psychiatr Res 2023; 165:41-47. [PMID: 37459777 DOI: 10.1016/j.jpsychires.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 07/04/2023] [Accepted: 07/10/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE To explore the factors influencing anhedonia at baseline and use them as confounding factors. To further investigate the correlation between overt aggression and anhedonia during the acute phase of major depressive disorder. METHODS In this eight-week prospective study, 384 major depressive disorder patients were recruited from the outpatient section of Shanghai Mental Health Center from May 1, 2017, to October 30, 2018. Standard treatments were performed with escitalopram or venlafaxine for participants. Depressive symptoms, overt aggression, and anhedonia were assessed using the 17-item Hamilton Rating Scale for Depression, Modified Overt Aggression Scale, and Snaith-Hamilton Pleasure Scale at baseline, and in the 4th and 8th weeks. RESULTS Obsessive-compulsive symptoms and the duration of untreated psychosis were positively associated with aggression (P < 0.05). Patients with aggressive behaviour had worse cognitive impairment and severe anhedonia of pleasurable sensory experiences (P < 0.05). For anhedonia, being female (tau_b = -0.23, P = 0.012) was a protective factor, while number of recurrent, melancholic features, current obsessions, previous combination drug therapies, depressive symptoms, and aggressive behaviour were risk factors (P < 0.05). Social anhedonia related to interests/pastimes, and pleasurable sensory experiences were more severe in major depressive disorder patients with aggressive behaviour in the acute phase (P < 0.05). CONCLUSIONS Anhedonia persisted in major depressive disorder patients with aggressive behaviour after standardized treatment during the acute phase. Being female protected the pleasures from social interaction and sensory experience. However, the number of depressive episodes, melancholic features, current obsessive symptoms, previous combination drug therapies, depressive symptoms, and aggressive behaviour was positively associated with anhedonia.
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Affiliation(s)
- Chuchen Xu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.
| | - Fan Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China. beauty--
| | - Qinte Huang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.
| | - Dongbin Lyu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.
| | - Chenglin Wu
- Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, 200124, China.
| | - Tongdan Cao
- Shanghai Mental Health Center of Huangpu District, Shanghai, 200011, China.
| | - Jie Zhao
- Shanghai Mental Health Center of Huangpu District, Shanghai, 200011, China.
| | - Meiti Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.
| | - Ni Zhou
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.
| | - Weichieh Yang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.
| | - Yiming Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.
| | - Zheyi Wei
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.
| | - Bin Xie
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 20030, China.
| | - Wu Hong
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 20030, China.
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Béreau M, Van Waes V, Servant M, Magnin E, Tatu L, Anheim M. Apathy in Parkinson's Disease: Clinical Patterns and Neurobiological Basis. Cells 2023; 12:1599. [PMID: 37371068 DOI: 10.3390/cells12121599] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Apathy is commonly defined as a loss of motivation leading to a reduction in goal-directed behaviors. This multidimensional syndrome, which includes cognitive, emotional and behavioral components, is one of the most prevalent neuropsychiatric features of Parkinson's disease (PD). It has been established that the prevalence of apathy increases as PD progresses. However, the pathophysiology and anatomic substrate of this syndrome remain unclear. Apathy seems to be underpinned by impaired anatomical structures that link the prefrontal cortex with the limbic system. It can be encountered in the prodromal stage of the disease and in fluctuating PD patients receiving bilateral chronic subthalamic nucleus stimulation. In these stages, apathy may be considered as a disorder of motivation that embodies amotivational behavioral syndrome, is underpinned by combined dopaminergic and serotonergic denervation and is dopa-responsive. In contrast, in advanced PD patients, apathy may be considered as cognitive apathy that announces cognitive decline and PD dementia, is underpinned by diffuse neurotransmitter system dysfunction and Lewy pathology spreading and is no longer dopa-responsive. In this review, we discuss the clinical patterns of apathy and their treatment, the neurobiological basis of apathy, the potential role of the anatomical structures involved and the pathways in motivational and cognitive apathy.
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Affiliation(s)
- Matthieu Béreau
- Département de Neurologie, CHU de Besançon, 25000 Besançon, France
- Université de Franche-Comté, LINC Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive, 25000 Besançon, France
| | - Vincent Van Waes
- Université de Franche-Comté, LINC Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive, 25000 Besançon, France
| | - Mathieu Servant
- Université de Franche-Comté, LINC Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive, 25000 Besançon, France
| | - Eloi Magnin
- Département de Neurologie, CHU de Besançon, 25000 Besançon, France
- Université de Franche-Comté, LINC Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive, 25000 Besançon, France
| | - Laurent Tatu
- Département de Neurologie, CHU de Besançon, 25000 Besançon, France
- Université de Franche-Comté, LINC Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive, 25000 Besançon, France
- Laboratoire d'Anatomie, Université de Franche-Comté, 25000 Besançon, France
| | - Mathieu Anheim
- Département de Neurologie, CHU de Strasbourg, 67200 Strasbourg, France
- Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, 67000 Strasbourg, France
- Institut de génétique Et de Biologie Moléculaire Et Cellulaire (IGBMC), INSERM-U964, CNRS-UMR7104, Université de Strasbourg, 67400 Illkirch-Graffenstaden, France
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Thompson N, MacAskill M, Pascoe M, Anderson T, Heron CL. Dimensions of apathy in Parkinson's disease. Brain Behav 2023; 13:e2862. [PMID: 37203279 PMCID: PMC10275530 DOI: 10.1002/brb3.2862] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/16/2022] [Accepted: 12/04/2022] [Indexed: 05/20/2023] Open
Abstract
INTRODUCTION Apathy is one of the most common neuropsychiatric manifestations in Parkinson's disease (PD). Recent proposals consider apathy as a multidimensional construct, which can manifest in behavioral, cognitive, emotional, and/or social dimensions. Apathy also overlaps conceptually and clinically with other non-motor comorbidities, particularly depression. Whether all of these dimensions are applicable to the apathetic syndrome experienced by people with PD is unclear. In the present study, we investigated the multidimensional pattern of apathy associated with PD, using the recently developed Apathy Motivation Index (AMI) which probes behavioral, emotional, and social apathy dimensions. We then examined the relationship between these dimensions and other features of PD commonly associated with apathy, including depression, anxiety, cognition, and motor state. METHODS A total of 211 participants were identified from the New Zealand Brain Research Institute (NZBRI) longitudinal PD cohort. One hundred eight patients and 45 controls completed the AMI, administered as an online questionnaire, and additional assessments including neuropsychiatric, neuropsychological, and motor scores. The pattern of dimensional apathy in PD was assessed using a repeated-measured analysis of variance, while simple linear regressions were performed to evaluate relationships between these dimensions and other variables. RESULTS We found a significant interaction between group (PD versus control) and apathy subscale, driven mainly by higher levels of social and behavioral-but not emotional-apathy in those with PD. This result was strikingly similar to a previous study investigating social apathy in PD. Distinct patterns of dimensional apathy were associated with depression and anxiety, with social and behavioral apathy positively associated with depression, and emotional apathy negatively associated with anxiety. CONCLUSION This work provides further evidence for a distinct pattern of apathy in people with PD in which deficits manifest in some-but not all-dimensions of motivated behavior. It emphasizes the importance of considering apathy as a multidimensional construct in clinical and research settings.
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Affiliation(s)
- Nasya Thompson
- New Zealand Brain Research InstituteChristchurchNew Zealand
- Department of MedicineUniversity of OtagoChristchurchNew Zealand
| | - Michael MacAskill
- New Zealand Brain Research InstituteChristchurchNew Zealand
- Department of MedicineUniversity of OtagoChristchurchNew Zealand
| | - Maddie Pascoe
- New Zealand Brain Research InstituteChristchurchNew Zealand
| | - Tim Anderson
- New Zealand Brain Research InstituteChristchurchNew Zealand
- Department of MedicineUniversity of OtagoChristchurchNew Zealand
- Department of NeurologyChristchurch Hospital, Te Whatu Ora ‐ Health New ZealandWaitaha CanterburyNew Zealand
| | - Campbell Le Heron
- New Zealand Brain Research InstituteChristchurchNew Zealand
- Department of MedicineUniversity of OtagoChristchurchNew Zealand
- Department of NeurologyChristchurch Hospital, Te Whatu Ora ‐ Health New ZealandWaitaha CanterburyNew Zealand
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Clark ML, Abimanyi-Ochom J, Le H, Long B, Orr C, Khanh-Dao Le L. A systematic review and meta-analysis of depression and apathy frequency in adult-onset Huntington's disease. Neurosci Biobehav Rev 2023; 149:105166. [PMID: 37054804 DOI: 10.1016/j.neubiorev.2023.105166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 04/07/2023] [Accepted: 04/09/2023] [Indexed: 04/15/2023]
Abstract
Depression and apathy are associated with decreased functional capacity in Huntington's disease (HD) but frequency of depression and apathy in HD is largely unknown. Systematic literature searching was conducted across 21 databases until 30 June 2021. Inclusion criteria was limited to clinician-rated assessments of depression and apathy and adult-onset HD. Inverse-variance heterogeneity meta-analyses were conducted exploring depression and apathy frequency within individuals from families affected by HD, and within individuals with confirmed HD gene-positive status. Screening identified 289 articles for full-text review; nine remained for meta-analysis. Depression frequency in the lifetime in adults affected by or at-risk for HD was 38%, I2 = 99%. Apathy frequency in the lifetime in adults affected by or at-risk for HD was 40%, I2 = 96%. The robustness of the findings improved when limiting the analysis to gene-positive individuals only where apathy was found to be slightly more common than depression, 48% and 43% respectively. Future studies may consider reporting results from juvenile-onset HD and adult-onset HD cohorts separately to further explore phenotypic profiles.
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Affiliation(s)
- Melanie L Clark
- Deakin University, Deakin Health Economics, School of Health and Social Development, Geelong, Victoria, 3220, Australia; Neurosciences Unit, North Metropolitan Health Services Mental Health Public Health Dental Services, Perth, Western Australia; Perron Institute for Neurological and Translational Science, Perth, Western Australia.
| | - Julie Abimanyi-Ochom
- Deakin University, Deakin Health Economics, School of Health and Social Development, Geelong, Victoria, 3220, Australia; Deakin University, Institute for Health Transformation, Faculty of Health, Geelong, Victoria, 3220, Australia
| | - Ha Le
- Deakin University, Deakin Health Economics, School of Health and Social Development, Geelong, Victoria, 3220, Australia; Deakin University, Institute for Health Transformation, Faculty of Health, Geelong, Victoria, 3220, Australia
| | - Brian Long
- Neurosciences Unit, North Metropolitan Health Services Mental Health Public Health Dental Services, Perth, Western Australia
| | - Carolyn Orr
- Neurosciences Unit, North Metropolitan Health Services Mental Health Public Health Dental Services, Perth, Western Australia; Perron Institute for Neurological and Translational Science, Perth, Western Australia
| | - Long Khanh-Dao Le
- Health Economics Division, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Alfalahi H, Dias SB, Khandoker AH, Chaudhuri KR, Hadjileontiadis LJ. A scoping review of neurodegenerative manifestations in explainable digital phenotyping. NPJ Parkinsons Dis 2023; 9:49. [PMID: 36997573 PMCID: PMC10063633 DOI: 10.1038/s41531-023-00494-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 03/16/2023] [Indexed: 04/03/2023] Open
Abstract
Neurologists nowadays no longer view neurodegenerative diseases, like Parkinson's and Alzheimer's disease, as single entities, but rather as a spectrum of multifaceted symptoms with heterogeneous progression courses and treatment responses. The definition of the naturalistic behavioral repertoire of early neurodegenerative manifestations is still elusive, impeding early diagnosis and intervention. Central to this view is the role of artificial intelligence (AI) in reinforcing the depth of phenotypic information, thereby supporting the paradigm shift to precision medicine and personalized healthcare. This suggestion advocates the definition of disease subtypes in a new biomarker-supported nosology framework, yet without empirical consensus on standardization, reliability and interpretability. Although the well-defined neurodegenerative processes, linked to a triad of motor and non-motor preclinical symptoms, are detected by clinical intuition, we undertake an unbiased data-driven approach to identify different patterns of neuropathology distribution based on the naturalistic behavior data inherent to populations in-the-wild. We appraise the role of remote technologies in the definition of digital phenotyping specific to brain-, body- and social-level neurodegenerative subtle symptoms, emphasizing inter- and intra-patient variability powered by deep learning. As such, the present review endeavors to exploit digital technologies and AI to create disease-specific phenotypic explanations, facilitating the understanding of neurodegenerative diseases as "bio-psycho-social" conditions. Not only does this translational effort within explainable digital phenotyping foster the understanding of disease-induced traits, but it also enhances diagnostic and, eventually, treatment personalization.
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Affiliation(s)
- Hessa Alfalahi
- Department of Biomedical Engineering, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates.
- Healthcare Engineering Innovation Center (HEIC), Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates.
| | - Sofia B Dias
- Department of Biomedical Engineering, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
- Healthcare Engineering Innovation Center (HEIC), Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
- CIPER, Faculdade de Motricidade Humana, University of Lisbon, Lisbon, Portugal
| | - Ahsan H Khandoker
- Department of Biomedical Engineering, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
- Healthcare Engineering Innovation Center (HEIC), Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Kallol Ray Chaudhuri
- Parkinson Foundation, International Center of Excellence, King's College London, Denmark Hills, London, UK
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Leontios J Hadjileontiadis
- Department of Biomedical Engineering, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
- Healthcare Engineering Innovation Center (HEIC), Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Ilardi CR, di Maio G, Villano I, Messina G, Monda V, Messina A, Porro C, Panaro MA, Gamboz N, Iavarone A, La Marra M. The assessment of executive functions to test the integrity of the nigrostriatal network: A pilot study. Front Psychol 2023; 14:1121251. [PMID: 37063521 PMCID: PMC10090354 DOI: 10.3389/fpsyg.2023.1121251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/13/2023] [Indexed: 03/30/2023] Open
Abstract
BackgroundParkinson’s disease (PD) is a chronic neurodegenerative disorder characterized by motor and non-motor symptoms. The latter mainly include affective, sleep, and cognitive deficits. Non-demented PD patients often demonstrate impairments in several executive domains following neuropsychological evaluation. The current pilot study aims at assessing the discriminatory power of the Frontal Assessment Battery-15 (FAB15) in differentiating (i) non-demented PD patients and healthy controls and (ii) PD patients with more and less pronounced motor symptoms.MethodsThirty-nine non-demented early-stage PD patients in the “on” dopamine state (26 females, mean age = 64.51 years, SD = 6.47, mean disease duration = 5.49 years, SD = 2.28) and 39 healthy participants (24 females, mean age = 62.60 years, SD = 5.51) were included in the study. All participants completed the FAB15. Motor symptoms of PD patients were quantified via the Unified Parkinson’s Disease Rating Scale-Part III (UPDRS-Part III) and Hoehn and Yahr staging scale (H&Y).ResultsThe FAB15 score, adjusted according to normative data for sex, age, and education, proved to be sufficiently able to discriminate PD patients from healthy controls (AUC = 0.69 [95% CI 0.60–0.75], SE = 0.06, p = 0.04, optimal cutoff = 11.29). Conversely, the battery lacked sufficient discriminative capability to differentiate PD patients based on the severity of motor symptoms.ConclusionThe FAB15 may be a valid tool for distinguishing PD patients from healthy controls. However, it might be less sensitive in identifying clinical phenotypes characterized by visuospatial impairments resulting from posteroparietal and/or temporal dysfunctions. In line with previous evidence, the battery demonstrated to be not expendable in the clinical practice for monitoring the severity of PD-related motor symptoms.
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Affiliation(s)
| | - Girolamo di Maio
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Ines Villano
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
- *Correspondence: Ines Villano,
| | - Giovanni Messina
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Vincenzo Monda
- Department of Movement Sciences and Wellbeing, University of Naples “Parthenope”, Naples, Italy
| | - Antonietta Messina
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Chiara Porro
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Maria Antonietta Panaro
- Department of Biosciences, Biotechnologies and Biopharmaceutics, University of Bari, Bari, Italy
| | - Nadia Gamboz
- Laboratory of Experimental Psychology, Suor Orsola Benincasa University, Naples, Italy
| | | | - Marco La Marra
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
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Zeng N, Aleman A, Liao C, Fang H, Xu P, Luo Y. Role of the amygdala in disrupted integration and effective connectivity of cortico-subcortical networks in apathy. Cereb Cortex 2023; 33:3171-3180. [PMID: 35834901 DOI: 10.1093/cercor/bhac267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Apathy is a quantitative reduction in motivation and goal-directed behaviors, not only observed in neuropsychiatric disorders, but also present in healthy populations. Although brain abnormalities associated with apathy in clinical disorders have been studied, the organization of brain networks in healthy individuals has yet to be identified. METHOD We examined properties of intrinsic brain networks in healthy individuals with varied levels of apathy. By using functional magnetic resonance imaging in combination with graph theory analysis and dynamic causal modeling analysis, we tested communications among nodes and modules as well as effective connectivity among brain networks. RESULTS We found that the average participation coefficient of the subcortical network, especially the amygdala, was lower in individuals with high than low apathy. Importantly, we observed weaker effective connectivity fromthe hippocampus and parahippocampal gyrus to the amygdala, and from the amygdala to the parahippocampal gyrus and medial frontal cortex in individuals with apathy. CONCLUSION These findings suggest that individuals with high apathy exhibit aberrant communication within the cortical-to-subcortical network, characterized by differences in amygdala-related effective connectivity. Our work sheds light on the neural basis of apathy in subclinical populations and may have implications for understanding the development of clinical conditions that feature apathy.
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Affiliation(s)
- Ningning Zeng
- Shenzhen Key Laboratory of Affective and Social Neuroscience, Magnetic Resonance Imaging Center, Center for Brain Disorders and Cognitive Sciences, Shenzhen University, Shenzhen 518060, China
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neuroscience, University Medical Center Groningen, University of Groningen, Groningen 9713 AW, The Netherlands
| | - André Aleman
- Shenzhen Key Laboratory of Affective and Social Neuroscience, Magnetic Resonance Imaging Center, Center for Brain Disorders and Cognitive Sciences, Shenzhen University, Shenzhen 518060, China
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neuroscience, University Medical Center Groningen, University of Groningen, Groningen 9713 AW, The Netherlands
| | - Chong Liao
- Shenzhen Key Laboratory of Affective and Social Neuroscience, Magnetic Resonance Imaging Center, Center for Brain Disorders and Cognitive Sciences, Shenzhen University, Shenzhen 518060, China
| | - Huihua Fang
- Shenzhen Key Laboratory of Affective and Social Neuroscience, Magnetic Resonance Imaging Center, Center for Brain Disorders and Cognitive Sciences, Shenzhen University, Shenzhen 518060, China
- Department of Psychology, University of Mannheim, Mannheim, Germany
| | - Pengfei Xu
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (BNU), Faculty of Psychology, Beijing Normal University, Beijing 100875, China
| | - Yuejia Luo
- The State Key Lab of Cognitive and Learning, Faculty of Psychology, Beijing Normal University, Beijing 100875, China
- The Research Center of Brain Science and Visual Cognition, Kunming University of Science and Technology, Kunming 650504, China
- College of Teacher Education, Qilu Normal University, Jinan 250200, China
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Mobile health technology, exercise adherence and optimal nutrition post rehabilitation among people with Parkinson's Disease (mHEXANUT) - a randomized controlled trial protocol. BMC Neurol 2023; 23:93. [PMID: 36864377 PMCID: PMC9979434 DOI: 10.1186/s12883-023-03134-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/21/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Although it is well known that regular physical activity and exercise, as well as maintaining adequate nutritional status is important to delaying symptom development and maintaining physical capacity and function in people with Parkinson's Disease (PD), many are unable to follow self-management recommendations. Active interventions have shown short-term effects, but there is a need for interventions that facilitate self-management over the course of the disease. Until now, no studies have combined exercise and nutritional interventions with an individual self-management approach in PD. Thus, we aim to examine the effect of a six-month mobile health technology(m-health)-based follow-up programme, focusing on self-management in exercise and nutrition, after an in-service interdisciplinary rehabilitation programme. METHODS A single-blinded, two-group randomised controlled trial. Participants are Adults aged 40 or older, with idiopathic PD, Hoehn and Yahr 1-3, living at home. The intervention group receives a monthly, individualized, digital conversation with a PT, combined with use of an activity tracker. People at nutritional risk get additional digital-follow-up from a nutritional specialist. The control group receives usual care. The primary outcome is physical capacity, measured by 6-min walk test (6MWT). Secondary outcomes are nutritional status, Health related quality of life (HRQOL), physical function and exercise adherence. All measurements are performed at baseline, after 3 months and after 6 months. Sample size, based on primary outcome, is set at 100 participants randomized into the two arms, including an estimated 20% drop out. DISCUSSION The increasing prevalence of PD globally makes it even more important to develop evidence-based interventions that can increase motivation to stay active, promote adequate nutritional status and improve self-management in people with PD. The individually tailored digital follow-up programme, based on evidence-based practice, has the potential to promote evidence-based decision-making and to empower people with PD to implement exercise and optimal nutrition in their daily lives and, hopefully, increase adherence to exercise and nutritional recommendations. TRIAL REGISTRATION ClinicalTrials.gov (NCT04945876). First registration 01.03.2021.
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Coundouris SP, von Hippel C, Lehn AC, Henry JD. The antecedents and consequences of stereotype threat in Parkinson's disease. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2023; 62:1-9. [PMID: 36124953 PMCID: PMC10087132 DOI: 10.1111/bjc.12390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 09/05/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to examine what factors make people with Parkinson's disease more susceptible to stereotype threat (i.e., the concern of being evaluated in line with negative group-based stereotypes) and the clinical consequences of this. METHOD Forty-nine people with Parkinson's disease completed a measure of stereotype threat, as well as measures that indexed potential antecedents and clinical consequences of stereotype threat. RESULTS Younger age and greater communication difficulties emerged as significant predictors of stereotype threat. Higher stereotype threat was also associated with increased emotional distress. CONCLUSIONS These findings are an important first step in understanding stereotype threat in Parkinson's disease and may help to guide the development of intervention and educational efforts aimed at countering its effects.
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Affiliation(s)
| | | | - Alexander C. Lehn
- Department of NeurologyPrincess Alexandra HospitalWoolloongabbaQueenslandAustralia
- The University of Queensland Princess Alexandra Hospital Clinical SchoolWoolloongabbaQueenslandAustralia
| | - Julie D. Henry
- School of PsychologyThe University of QueenslandBrisbaneQueenslandAustralia
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Wouts L, Marijnissen RM, Oude Voshaar RC, Beekman ATF. Strengths and Weaknesses of the Vascular Apathy Hypothesis: A Narrative Review. Am J Geriatr Psychiatry 2023; 31:183-194. [PMID: 36283953 DOI: 10.1016/j.jagp.2022.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/12/2022] [Accepted: 09/27/2022] [Indexed: 10/07/2022]
Abstract
The vascular apathy hypothesis states that cerebral small vessel disease (CSVD) can cause apathy, even when no other symptoms of CSVD are present. In order to examine this hypothesis, the objectives of this narrative review are to evaluate the evidence for a pathophysiological mechanism linking CSVD to apathy and to examine whether CSVD can be a sole cause of apathy. The nature of the CSVD-apathy relationship was evaluated using the Bradford Hill criteria as a method for research on the distinction between association and causation. Pathological, neuroimaging, and behavioral studies show that CSVD can cause lesions in the reward network, which causes an apathy syndrome. Studies in healthy older individuals, stroke patients and cognitively impaired persons consistently show an association between CSVD markers and apathy, although studies in older persons suffering from depression are inconclusive. A biological gradient is confirmed, as well as a temporal relationship, although the evidence for the latter is still weak. The specificity of this causal relationship is low given there often are other contributing factors in CSVD patients with apathy, particularly depression and cognitive deterioration. Differentiating between vascular apathy and other apathy syndromes on the basis of clinical features is not yet possible, while in-depth knowledge about differences in the prognosis and efficacy of treatment options for apathy caused by CSVD and other apathy syndromes is lacking. Since we cannot differentiate between etiologically different apathy syndromes as yet, it is premature to use the term vascular apathy which would suggest a distinct clinical apathy syndrome.
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Affiliation(s)
- Lonneke Wouts
- Department of Old Age Psychiatry (L.W.), Pro Persona Mental Health Institute, Nijmegen, the Netherlands; Department of Psychiatry (L.W., R.M.M., R.C.O.), University Medical Center Groningen (UMCG), Groningen, the Netherlands.
| | - Radboud M Marijnissen
- Department of Psychiatry (L.W., R.M.M., R.C.O.), University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - Richard C Oude Voshaar
- Department of Psychiatry (L.W., R.M.M., R.C.O.), University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry (A.T.F.B.), Amsterdam UMC, Vrije Universiteit, and GGZinGeest, Amsterdam, the Netherlands
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Mata I, Salles P, Cornejo-Olivas M, Saffie P, Ross OA, Reed X, Bandres-Ciga S. LRRK2: Genetic mechanisms vs genetic subtypes. HANDBOOK OF CLINICAL NEUROLOGY 2023; 193:133-154. [PMID: 36803807 DOI: 10.1016/b978-0-323-85555-6.00018-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
In 2004, the identification of pathogenic variants in the LRRK2 gene across several families with autosomal dominant late-onset Parkinson's disease (PD) revolutionized our understanding of the role of genetics in PD. Previous beliefs that genetics in PD was limited to rare early-onset or familial forms of the disease were quickly dispelled. Currently, we recognize LRRK2 p.G2019S as the most common genetic cause of both sporadic and familial PD, with more than 100,000 affected carriers across the globe. The frequency of LRRK2 p.G2019S is also highly variable across populations, with some regions of Asian or Latin America reporting close to 0%, contrasting to Ashkenazi Jews or North African Berbers reporting up to 13% and 40%, respectively. Patients with LRRK2 pathogenic variants are clinically and pathologically heterogeneous, highlighting the age-related variable penetrance that also characterizes LRRK2-related disease. Indeed, the majority of patients with LRRK2-related disease are characterized by a relatively mild Parkinsonism with less motor symptoms with variable presence of α-synuclein and/or tau aggregates, with pathologic pleomorphism widely described. At a functional cellular level, it is likely that pathogenic variants mediate a toxic gain-of-function of the LRRK2 protein resulting in increased kinase activity perhaps in a cell-specific manner; by contrast, some LRRK2 variants appear to be protective reducing PD risk by decreasing the kinase activity. Therefore, employing this information to define appropriate patient populations for clinical trials of targeted kinase LRRK2 inhibition strategies is very promising and demonstrates a potential future application for PD using precision medicine.
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Affiliation(s)
- Ignacio Mata
- Genomic Medicine Institute (GMI), Cleveland Clinic, Cleveland, OH, United States.
| | - Philippe Salles
- Corporación Centro de Trastornos del Movimiento (CETRAM), Lo Espejo, Santiago, Chile
| | - Mario Cornejo-Olivas
- Neurogenetics Research Center, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Paula Saffie
- Corporación Centro de Trastornos del Movimiento (CETRAM), Lo Espejo, Santiago, Chile
| | - Owen A Ross
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, United States
| | - Xylena Reed
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, United States
| | - Sara Bandres-Ciga
- Laboratory of Neurogenetics and Center for Alzheimer's and Related Dementias, National Institute on Aging, National Institutes of Health, Bethesda, MD, United States
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Costello H, Roiser JP, Howard R. Antidepressant medications in dementia: evidence and potential mechanisms of treatment-resistance. Psychol Med 2023; 53:654-667. [PMID: 36621964 PMCID: PMC9976038 DOI: 10.1017/s003329172200397x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 10/13/2022] [Accepted: 12/20/2022] [Indexed: 01/10/2023]
Abstract
Depression in dementia is common, disabling and causes significant distress to patients and carers. Despite widespread use of antidepressants for depression in dementia, there is no evidence of therapeutic efficacy, and their use is potentially harmful in this patient group. Depression in dementia has poor outcomes and effective treatments are urgently needed. Understanding why antidepressants are ineffective in depression in dementia could provide insight into their mechanism of action and aid identification of new therapeutic targets. In this review we discuss why depression in dementia may be a distinct entity, current theories of how antidepressants work and how these mechanisms of action may be affected by disease processes in dementia. We also consider why clinicians continue to prescribe antidepressants in dementia, and novel approaches to understand and identify effective treatments for patients living with depression and dementia.
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Affiliation(s)
- Harry Costello
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Jonathan P. Roiser
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Robert Howard
- Division of Psychiatry, University College London, London, UK
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Kinger SB, Juneau T, Kaplan RI, Pluim CF, Fox-Fuller JT, Wang T, Mukadam N, Neargarder S, Salazar RD, Cronin-Golomb A. Changes in Apathy, Depression, and Anxiety in Parkinson's Disease from before to during the COVID-19 Era. Brain Sci 2023; 13:199. [PMID: 36831742 PMCID: PMC9954738 DOI: 10.3390/brainsci13020199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/26/2023] Open
Abstract
Apathy, depression, and anxiety are common non-motor symptoms of Parkinson's disease (PD). Tracking the changes in such symptoms over time would be valuable not only to determine their natural course during the disease, but also to establish the effects of unusual historical events interacting with the natural course. Having collected data on apathy (Apathy Scale), depression (Beck Depression Inventory-II), and anxiety (Parkinson's Anxiety Scale) in a large sample of persons with PD (PwPD) before the beginning of the COVID-19 era, we followed up with these individuals to investigate the changes in their prevalence of apathy, depression, and anxiety across two timepoints (T1 and T2). Of the original 347 participants, 111 responded and provided complete data at T2. The data collection at T1, before COVID-19, occurred between 2017-2018. The data collection at T2 occurred in 2021 and included the same measures, with the addition of the Coronavirus Impact Scale to assess the effects of the pandemic on the individual participants. Over this period, there was a significant increase in apathy, but not in depression or anxiety. Anxiety and depression, but not apathy, were correlated with the impact of COVID-19.
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Affiliation(s)
- Shraddha B. Kinger
- Department of Psychological and Brain Sciences, Boston University, Boston, MA 02215, USA
| | - Truley Juneau
- Department of Psychological and Brain Sciences, Boston University, Boston, MA 02215, USA
| | - Rini I. Kaplan
- Department of Psychological and Brain Sciences, Boston University, Boston, MA 02215, USA
| | - Celina F. Pluim
- Department of Psychological and Brain Sciences, Boston University, Boston, MA 02215, USA
| | - Joshua T. Fox-Fuller
- Department of Psychological and Brain Sciences, Boston University, Boston, MA 02215, USA
| | - Timothy Wang
- Department of Psychological and Brain Sciences, Boston University, Boston, MA 02215, USA
| | - Nishaat Mukadam
- Department of Psychological and Brain Sciences, Boston University, Boston, MA 02215, USA
| | - Sandy Neargarder
- Department of Psychological and Brain Sciences, Boston University, Boston, MA 02215, USA
- Department of Psychology, Bridgewater State University, Bridgewater, MA 02325, USA
| | - Robert D. Salazar
- Department of Psychological and Brain Sciences, Boston University, Boston, MA 02215, USA
| | - Alice Cronin-Golomb
- Department of Psychological and Brain Sciences, Boston University, Boston, MA 02215, USA
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Li JT, Qu Y, Gao HL, Li JY, Qin QX, Wang DL, Zhao JW, Mao ZJ, Min Z, Xiong YJ, Xue Z. A nomogram based on iron metabolism can help identify apathy in patients with Parkinson's disease. Front Aging Neurosci 2023; 14:1062964. [PMID: 36742206 PMCID: PMC9892642 DOI: 10.3389/fnagi.2022.1062964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/23/2022] [Indexed: 01/20/2023] Open
Abstract
Backgrounds Apathy is common in Parkinson's disease (PD) but difficult to identify. Growing evidence suggests that abnormal iron metabolism is associated with apathy in PD. We aimed to investigate the clinical features and iron metabolism of apathetic patients with PD, and construct a nomogram for predicting apathy in PD. Methods Data of 201 patients with PD were analyzed. Demographic data, Apathy Scale (AS) assessments, and serum iron metabolism parameters were obtained. Spearman correlations were used to assess relationships between AS scores and iron metabolism parameters, separately for male and female patients. Additionally, a nomograph for detecting apathetic patients with PD was built based on the results of logistic regression analysis. Results The serum transferrin (TRF, p < 0.0024) concentration and total iron binding capacity (TIBC, p < 0.0024) were lower in the apathetic group after Bonferroni correction, and they were negatively associated with AS scores in male participants with PD (TRF, r = -0.27, p = 0.010; TIBC, r = -0.259, p = 0.014). The nomogram was developed by incorporating the following five parameters: age, sex, serum iron concentration, TIBC and Hamilton Depression Rating Scale (HAMD) scores, which showed good discrimination and calibration, with a consistency index of 0.799 (95% confidence interval = 0.732-0.865). Conclusion Abnormal iron metabolism may contribute to apathy in PD, especially among men. TIBC levels in combination with HAMD scores can be effectively used for the prediction of apathetic patients with PD.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Zheng Xue
- *Correspondence: Yong-jie Xiong, ; Zheng Xue,
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Choi SM, Cho SH, Choe Y, Kim BC. Clinical determinants of apathy and its impact on health-related quality of life in early Parkinson disease. Medicine (Baltimore) 2023; 102:e32674. [PMID: 36637959 PMCID: PMC9839259 DOI: 10.1097/md.0000000000032674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Apathy is a common non-motor symptom of Parkinson disease (PD) that can affect the health-related quality of life (HRQoL) of patients and caregivers. This study aimed to investigate the clinical determinants of apathy and its impact on HRQoL in patients with early PD. We enrolled 324 patients with early PD with modified Hoehn-Yahr stages 1 to 3 and a disease duration ≤5 years. Demographic information was obtained, and motor and non-motor symptoms were evaluated with relevant scales. Apathy was present in 110 of 324 (33.9%) patients. Compared with patients with non-apathetic PD, those with apathetic PD had significantly higher modified Hoehn-Yahr stage, Unified Parkinson's Disease Rating Scale-II (UPDRS-II) score, Non-Motor Symptoms Scale (NMSS) total score, Beck Depression Inventory (BDI) score, and Parkinson's Disease Questionnaire-8 (PDQ-8) score. Clinical variables independently associated with the Apathy Evaluation Scale (AES) score were NMSS domain 3 score and BDI score. The univariate regression analysis revealed that the PDQ-8 score was significantly associated with age; disease duration; formal education duration; and UPDRS-III, UPDRS-II, NMSS total, Mini-Mental Status Examination, BDI, Beck Anxiety Inventory, and AES scores. Independent predictors of the PDQ-8 score in the multivariate regression analysis were UPDRS-III, UPDRS-II, NMSS total, NMSS domain 3, Beck Anxiety Inventory, and AES scores. In the present study, apathy was an independent predictor of HRQoL in patients with early PD. Therefore, identifying and managing apathy could help improve HRQoL in patients with early PD.
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Affiliation(s)
- Seong-Min Choi
- Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea
- Department of Neurology, Chonnam National University Medical School, Gwangju, South Korea
- National Research Center for Dementia, Gwangju, South Korea
| | - Soo Hyun Cho
- Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea
- Department of Neurology, Chonnam National University Medical School, Gwangju, South Korea
| | | | - Byeong C. Kim
- Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea
- Department of Neurology, Chonnam National University Medical School, Gwangju, South Korea
- National Research Center for Dementia, Gwangju, South Korea
- * Correspondence: Byeong C. Kim, Department of Neurology, Chonnam National University Medical School, 42 Jebong-ro, Dong-gu, Gwangju 58128, South Korea (e-mail: )
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Piers RJ, Farchione TJ, Wong B, Rosellini AJ, Cronin‐Golomb A. Telehealth Transdiagnostic Cognitive Behavioral Therapy for Depression in Parkinson's Disease: A Pilot Randomized Controlled Trial. Mov Disord Clin Pract 2023; 10:79-85. [PMID: 36704072 PMCID: PMC9847300 DOI: 10.1002/mdc3.13587] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/25/2022] [Accepted: 08/30/2022] [Indexed: 01/29/2023] Open
Abstract
Background Cognitive behavioral therapy (CBT) is an effective treatment for depression in persons with Parkinson's disease (PwPD), but there are significant barriers preventing PwPD from receiving care in person. Telehealth CBT circumvents many of these barriers. Objectives We conducted a pilot randomized controlled trial evaluating the efficacy, feasibility, and acceptability of telehealth transdiagnostic CBT intervention for depression in PwPD. Methods Twelve PwPD with Major Depressive Disorder were enrolled, half randomly assigned to the treatment-immediate condition (TI) and half to the waitlist control condition (WLC). TI and WLC participants received 12 CBT sessions and assessments before treatment, immediately after treatment, and at the 6-week follow-up. Results The intervention was efficacious for treating depression in PwPD, with secondary benefits to anxiety, apathy, learning, memory, and quality of life. Improvements were largely maintained at follow-up. The intervention was highly feasible and acceptable. Conclusions Telehealth transdiagnostic CBT was an effective intervention for PwPD with depression.
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Affiliation(s)
- Ryan J. Piers
- Department of Psychological and Brain SciencesBoston UniversityBostonMassachusettsUSA
| | - Todd J. Farchione
- Department of Psychological and Brain SciencesBoston UniversityBostonMassachusettsUSA
| | - Bonnie Wong
- Department of Psychological and Brain SciencesBoston UniversityBostonMassachusettsUSA
- Department of PsychiatryMassachusetts General HospitalCharlestownMassachusettsUSA
| | - Anthony J. Rosellini
- Department of Psychological and Brain SciencesBoston UniversityBostonMassachusettsUSA
| | - Alice Cronin‐Golomb
- Department of Psychological and Brain SciencesBoston UniversityBostonMassachusettsUSA
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Hong JY, Lee PH. Subjective Cognitive Complaints in Cognitively Normal Patients With Parkinson's Disease: A Systematic Review. J Mov Disord 2023; 16:1-12. [PMID: 36353806 PMCID: PMC9978265 DOI: 10.14802/jmd.22059] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 08/15/2022] [Indexed: 11/11/2022] Open
Abstract
Subjective cognitive complaints (SCCs) refer to self-perceived cognitive decline and are related to objective cognitive decline. SCCs in cognitively normal individuals are considered a preclinical sign of subsequent cognitive impairment due to Alzheimer's disease, and SCCs in cognitively normal patients with Parkinson's disease (PD) are also gaining attention. The aim of this review was to provide an overview of the current research on SCCs in cognitively normal patients with PD. A systematic search found a lack of consistency in the methodologies used to define and measure SCCs. Although the association between SCCs and objective cognitive performance in cognitively normal patients with PD is controversial, SCCs appear to be predictive of subsequent cognitive decline. These findings support the clinical value of SCCs in cognitively normal status in PD; however, further convincing evidence from biomarker studies is needed to provide a pathophysiological basis for these findings. Additionally, a consensus on the definition and assessment of SCCs is needed for further investigations.
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Affiliation(s)
- Jin Yong Hong
- Department of Neurology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea,Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea,Corresponding author: Phil Hyu Lee, MD, PhD Department of Neurology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea / Tel: +82-2-2228-1608 / Fax: +82-2-393-0705 / E-mail:
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Lopez FV, Kenney LE, Ratajska A, Jacobson CE, Bowers D. What does the Dementia Rating Scale-2 measure? The relationship of neuropsychological measures to DRS-2 total and subscale scores in non-demented individuals with Parkinson's disease. Clin Neuropsychol 2023; 37:174-193. [PMID: 34779350 PMCID: PMC9107526 DOI: 10.1080/13854046.2021.1999505] [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] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The Dementia Rating Scale-2 (DRS-2) is recommended for assessing global cognition in Parkinson's disease (PD) by the Movement Disorder Society. However, empirical evidence is limited regarding the degree to which the DRS-2 corresponds to traditional neurocognitive domains (i.e., construct validity) in PD. Thus, this study aims to determine the construct validity of the DRS-2 in a non-demented sample of PD patients. METHOD Patients with PD (n = 359; mean age = 64.50 ± 8.53, education = 14.97 ± 2.73, disease duration = 8.48 ± 4.87, UPDRS Part III motor scale scores = 25.23 ± 10.17) completed the DRS-2 as part of a comprehensive neuropsychological assessment consisting of attention/working memory, executive function, language, delayed recall, and visuoperceptual-spatial skills.Bootstrapped bias-corrected Spearman rho's correlations andhierarchical linear regressions were performed to examine construct validity of DRS-2 total and subscale scores. RESULTS Speeded measures of set-shifting, rapid word generation to letter and semantic cues, and simple visuoperceptual skills largely accounted for variance in DRS-2 total scores. Most DRS-2 subscale scores showed weak relationships with theoretically related neuropsychological measures. CONCLUSIONS DRS-2 total scores reflect impairment across a range of cognitive domains (i.e., executive, language, and visuoperception), while DRS-2 subscale scores have limited construct validity. Together, the DRS-2 does not appear to have utility beyond screening for global cognition in PD.
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Affiliation(s)
- Francesca V. Lopez
- Department of Clinical and Health Psychology, University of
Florida, Gainesville, FL, USA
| | - Lauren E. Kenney
- Department of Clinical and Health Psychology, University of
Florida, Gainesville, FL, USA
| | - Adrianna Ratajska
- Department of Clinical and Health Psychology, University of
Florida, Gainesville, FL, USA
| | - Charles E. Jacobson
- Department of Neurology, Norman Fixel Institute for
Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Dawn Bowers
- Department of Clinical and Health Psychology, University of
Florida, Gainesville, FL, USA;,Department of Neurology, Norman Fixel Institute for
Neurological Diseases, University of Florida, Gainesville, FL, USA
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The importance of a multidimensional approach to the preclinical study of major depressive disorder and apathy. Emerg Top Life Sci 2022; 6:479-489. [PMID: 36413089 PMCID: PMC9788393 DOI: 10.1042/etls20220004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 11/24/2022]
Abstract
Both the neuropsychiatric syndrome of apathy and major depressive disorder comprise a heterogenous cluster of symptoms which span multiple behavioural domains. Despite this heterogeneity, there is a tendency in the preclinical literature to conclude a MDD or apathy-like phenotype from a single dimensional behavioural task used in isolation, which may lead to inaccurate phenotypic interpretation. This is significant, as apathy and major depressive disorder are clinically distinct with different underlying mechanisms and treatment approaches. At the clinical level, apathy and major depressive disorder can be dissociated in the negative valence (loss) domain of the Research Domain Criteria. Symptoms of MDD in the negative valence (loss) domain can include an exaggerated response to emotionally salient stimuli and low mood, while in contrast apathy is characterised by an emotionally blunted state. In this article, we highlight how using a single dimensional approach can limit psychiatric model interpretation. We discuss how integrating behavioural findings from both the positive and negative (loss) valence domains of the Research Domain Criteria can benefit interpretation of findings. We focus particularly on behaviours relating to the negative valence (loss) domain, which may be used to distinguish between apathy and major depressive disorder at the preclinical level. Finally, we consider how future approaches using home cage monitoring may offer a new opportunity to detect distinct behavioural profiles and benefit the overall translatability of findings.
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