Perceptual motor dysfunction in Parkinson's disease: a deficit in sequential and predictive voluntary movement

Sensory manipulation as a countermeasure to robot teleoperation delays: system and evidence

In the realm of robotics and automation, robot teleoperation, which facilitates human-machine interaction in distant or hazardous settings, has surged in significance. A persistent issue in this domain is the delays between command issuance and action execution, causing negative repercussions on operator situational awareness, performance, and cognitive load. These delays, particularly in long-distance operations, are difficult to mitigate even with the most advanced computing advancements. Current solutions mainly revolve around machine-based adjustments to combat these delays. However, a notable lacuna remains in harnessing human perceptions for an enhanced subjective teleoperation experience. This paper introduces a novel approach of sensory manipulation for induced human adaptation in delayed teleoperation. Drawing from motor learning and rehabilitation principles, it is posited that strategic sensory manipulation, via altered sensory stimuli, can mitigate the subjective feeling of these delays. The focus is not on introducing new skills or adapting to novel conditions; rather, it leverages prior motor coordination experience in the context of delays. The objective is to reduce the need for extensive training or sophisticated automation designs. A human-centered experiment involving 41 participants was conducted to examine the effects of modified haptic cues in teleoperations with delays. These cues were generated from high-fidelity physics engines using parameters from robot-end sensors or physics engine simulations. The results underscored several benefits, notably the considerable reduction in task time and enhanced user perceptions about visual delays. Real-time haptic feedback, or the anchoring method, emerged as a significant contributor to these benefits, showcasing reduced cognitive load, bolstered self-confidence, and minimized frustration. Beyond the prevalent methods of automation design and training, this research underscores induced human adaptation as a pivotal avenue in robot teleoperation. It seeks to enhance teleoperation efficacy through rapid human adaptation, offering insights beyond just optimizing robotic systems for delay compensations.

Mental representation of the body in action in Parkinson's disease

Mixed findings characterize studies in Parkinson's disease (PD): some studies indicate a relationship between physical impairments and the ability to mentally represent the body, while others suggest spared abilities for this cognitive function. To clarify the matter, in the present study we explored the mental representations of the body in action in the same PD patients, taking also into account lateralization of symptoms and visual imagery skills. 10 PD patients with left- (lPD), 10 with right (rPD) lateralized symptoms (lPD), and 20 matched healthy controls have been recruited for the study. All patients were screened for neuropsychological impairments. To explore a more implicit component we used the hand laterality task (HLT), while the mental motor chronometry (MMC) was used to explore a more explicit one. Two control tasks, with objects instead of body parts, were administered to control for visual imagery skills. In the HLT, we detected the effects of biomechanical constraints effects in both controls and PD patients. In the latter group, importantly, this was true independently from lateralization of symptoms. In the MMC, we found the expected positive correlation between executed and imagined movements for both hands in controls only, while all PD patients, again independently form lateralization, only showed this effect for the left hand. In terms of visual imagery, only rPD patients differed from controls when asked to implicitly rotate letters, and in terms of accuracy only. However, this difference is explained by executive functions measured through the neuropsychological assessment rather than by a "pure" visual imagery impairment. In summary, our findings suggest that two different aspects of the mental representations of the body in action, one more implicit and the other more explicit, can be differently affected by PD. These impairments are unlikely explained by a basic visual imagery deficit. When present, impairments concern a higher dimension, related to motor functions and awareness, and not driven by sensory impairments, as shown by the independence of effects from physical laterality of symptoms.

Time Perception of an Artwork's Manipulation Is Distorted by Patients With Parkinson's Disease

Objectives: In artwork appreciation situations, individuals often show altered time perception. We tested the hypothesis that Parkinson's disease (PD) patients present movement patterns that have an impact on the time perception of artwork manipulation time. We predicted that, compared to healthy controls (non-PD), differences in the exploratory behavior of patients would evoke alteration of artwork manipulation time perception. Methods: Ten PD patients and 10 non-PD participants manipulated two reproductions of artwork with different complexity levels from the series "Bichos" by Lygia Clark. Subsequently, participants performed a verbal estimation regarding the temporal duration of their manipulations. The exploratory behavior was analyzed. Results: All participants overestimated the artwork manipulation time. However, PD patients, regardless of the artwork's level of complexity, showed shorter manipulation time and minor time overestimation compared to the non-PD participants. PD patients touched the artworks more often, especially the more complex artworks, than the non-PD participants; in contrast, PD patients moved the artworks less often, particularly the less complex artwork. Conclusion: PD patients showed an altered perception of artwork manipulation time. This suggests that exploratory behavior influenced temporal estimation. Besides, it is likely that PD patients had presented a decreased ability to manage attention during the task, which interfered in the cognitive reconstruction of its duration. Considered altogether, these appointments indicate that, as a result of cognitive and motor deficits, PD patients showed impairment in temporal information processing. The exploratory behavior facilitated the understanding of these results and processes in terms of motor-timing operations of the basal ganglia-thalamocortical system.

Prefrontal Contributions to Attention and Working Memory

The processes of attention and working memory are conspicuously interlinked, suggesting that they may involve overlapping neural mechanisms. Working memory (WM) is the ability to maintain information in the absence of sensory input. Attention is the process by which a specific target is selected for further processing, and neural resources directed toward that target. The content of WM can be used to direct attention, and attention can in turn determine which information is encoded into WM. Here we discuss the similarities between attention and WM and the role prefrontal cortex (PFC) plays in each. First, at the theoretical level, we describe how attention and WM can both rely on models based on attractor states. Then we review the evidence for an overlap between the areas involved in both functions, especially the frontal eye field (FEF) portion of the prefrontal cortex. We also discuss similarities between the neural changes in visual areas observed during attention and WM. At the cellular level, we review the literature on the role of prefrontal DA in both attention and WM at the behavioral and neural levels. Finally, we summarize the anatomical evidence for an overlap between prefrontal mechanisms involved in attention and WM. Altogether, a summary of pharmacological, electrophysiological, behavioral, and anatomical evidence for a contribution of the FEF part of prefrontal cortex to attention and WM is provided.

Sensorimotor adaptation of voice fundamental frequency in Parkinson's disease

OBJECTIVE

This study examined adaptive responses to auditory perturbation of fundamental frequency (fo) in speakers with Parkinson's disease (PD) and control speakers.

METHOD

Sixteen speakers with PD and nineteen control speakers produced sustained vowels while they received perturbed auditory feedback (i.e., fo shifted upward or downward). Speakers' pitch acuity was quantified using a just-noticeable-difference (JND) paradigm. Twelve listeners provided estimates of the speech intelligibility for speakers with PD.

RESULTS

Fifteen responses from each speaker group for each shift direction were included in analyses. While control speakers generally showed consistent adaptive responses opposing the perturbation, speakers with PD showed no compensation on average, with individual PD speakers showing highly variable responses. In the PD group, the degree of compensation was not significantly correlated with age, disease progression, pitch acuity, or intelligibility.

CONCLUSIONS

These findings indicate reduced adaptation to sustained fo perturbation and higher variability in PD compared to control participants. No significant differences were seen in pitch acuity between groups, suggesting that the fo adaptation deficit in PD is not the result of purely perceptual mechanisms.

SIGNIFICANCE

These results suggest there is an impairment in vocal motor control in PD. Building on these results, contributions can be made to developing targeted voice treatments for PD.

Perceptual-motor dysfunction

PURPOSE OF REVIEW

This article highlights the importance of integrated perceptual information (motor planning, sequencing, and representation) and discusses the integration of these cognitive domains by means of feedforward and feedback loops in the successful acquisition and execution of voluntary behaviors. The article also discusses the dysfunction in the perceptual-motor process that can occur with neurologic injury, resulting in apraxias, agnosia, hemineglect, and Balint syndrome.

RECENT FINDINGS

A combination of functional imaging and lesional studies continues to refine our understanding of the role of the posterior parietal region in the integration of perception with motor action. Different disorders provide contrasting views into the nature of perceptual-motor function and its disruption. Novel rehabilitation techniques may provide improved function in the future.

SUMMARY

Studies continue to demonstrate the importance of unimodal and heteromodal association cortices, as well as the extrapyramidal system (especially the basal ganglia) in perceptual-motor functions across a wide range of activities and disease states. The nondominant hemisphere dictates where attention and intention are to be directed in space, and the dominant hemisphere provides information on how to accomplish skilled complex actions. While the role of perceptual-motor dysfunction in developmental disorders has been long considered, the role of perceptual-motor dysfunction in neurodegenerative diseases, from Parkinson disease to corticobasal syndrome to posterior cortical atrophy, is becoming more apparent. A clear need exists for more robust rehabilitation strategies in these neurodegenerative diseases.

Pain perception in acute model mice of Parkinson's disease induced by 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)

Background

Pain is the most prominent non-motor symptom observed in patients with Parkinson’s disease (PD). However, the mechanisms underlying the generation of pain in PD have not been well studied. We used a 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced mouse model of PD to analyze the relationship between pain sensory abnormalities and the degeneration of dopaminergic neurons.

Results

The latency to fall off the rotarod and the total distance traveled in round chamber were significantly reduced in MPTP-induced PD mice, consistent with motor dysfunction. MPTP-treated mice also showed remarkably shorter nociceptive response latencies compared to saline-treated mice and the subcutaneous injection of L-3,4-dihydroxyphenylalanine (L-DOPA) partially reversed pain hypersensitivity induced by MPTP treatment. We found that degeneration of cell bodies and fibers in the substantia nigra pars compacta and the striatum of MPTP-treated mice. In addition, astrocytic and microglial activation was seen in the subthalamic nucleus and neuronal activity was significantly increased in the striatum and globus pallidus. However, we did not observe any changes in neurons, astrocytes, and microglia of both the dorsal and ventral horns in the spinal cord after MPTP treatment.

Conclusions

These results suggest that the dopaminergic nigrostriatal pathway may have a role in inhibiting noxious stimuli, and that abnormal inflammatory responses and neural activity in basal ganglia is correlated to pain processing in PD induced by MPTP treatment.

Parallel basal ganglia circuits for voluntary and automatic behaviour to reach rewards

The basal ganglia control body movements, value processing and decision-making. Many studies have shown that the inputs and outputs of each basal ganglia structure are topographically organized, which suggests that the basal ganglia consist of separate circuits that serve distinct functions. A notable example is the circuits that originate from the rostral (head) and caudal (tail) regions of the caudate nucleus, both of which target the superior colliculus. These two caudate regions encode the reward values of visual objects differently: flexible (short-term) values by the caudate head and stable (long-term) values by the caudate tail. These value signals in the caudate guide the orienting of gaze differently: voluntary saccades by the caudate head circuit and automatic saccades by the caudate tail circuit. Moreover, separate groups of dopamine neurons innervate the caudate head and tail and may selectively guide the flexible and stable learning/memory in the caudate regions. Studies focusing on manual handling of objects also suggest that rostrocaudally separated circuits in the basal ganglia control the action differently. These results suggest that the basal ganglia contain parallel circuits for two steps of goal-directed behaviour: finding valuable objects and manipulating the valuable objects. These parallel circuits may underlie voluntary behaviour and automatic skills, enabling animals (including humans) to adapt to both volatile and stable environments. This understanding of the functions and mechanisms of the basal ganglia parallel circuits may inform the differential diagnosis and treatment of basal ganglia disorders.

The spectrum of cognitive impairment in Lewy body diseases

Cognitive impairment represents an important and often defining component of the clinical syndromes of Lewy body disorders: Parkinson's disease and dementia with Lewy bodies. The spectrum of cognitive deficits in these Lewy body diseases encompasses a broad range of clinical features, severity of impairment, and timing of presentation. It is now recognized that cognitive dysfunction occurs not only in more advanced Parkinson's disease but also in early, untreated patients and even in those patients with pre-motor syndromes, such as rapid eye movement behavior disorder and hyposmia. In recent years, the concept of mild cognitive impairment as a transitional or pre-dementia state in Parkinson's disease has emerged. This has led to much research regarding the diagnosis, prognosis, and underlying neurobiology of mild cognitive impairment in Parkinson's disease, but has also raised questions regarding the usefulness of this concept and its application in clinical and research settings. In addition, the conundrum of whether Parkinson's disease dementia and dementia with Lewy bodies represent the same or different entities remains unresolved. Although these disorders overlap in many aspects of their presentations and pathophysiology, they differ in other elements, such as timing of cognitive, behavioral, and motor symptoms; medication responses; and neuropathological contributions. This article examines the spectrum and evolution of cognitive impairment in Lewy body disorders and debates these controversial issues in the field using point-counterpoint approaches.

Subthalamic nucleus deep brain stimulation does not improve visuo-motor impairment in Parkinson's disease

OBJECTIVE

To evaluate how bilateral subthalamic nucleus deep brain stimulation (STN-DBS) affects visuo-motor coordination (VMC) in patients with Parkinson's disease (PD).

BACKGROUND

VMC involves multi-sensory integration, motor planning, executive function and attention. VMC deficits are well-described in PD. STN-DBS conveys marked motor benefit in PD, but pyscho-cognitive complications are recognized and the effect on VMC is not known.

METHODS

Thirteen PD patients with bilateral STN-DBS underwent neurological, cognitive, and mood assessment before VMC testing with optimal DBS stimulation parameters ('on-stimulation') and then, on the same day without any medication changes, after DBS silencing and establishing motor function deterioration ('off-stimulation'). Twelve age-matched healthy controls performed 2 successive VMC testing sessions, with a break of similar duration to that of the PD group. The computer cursor was controlled with a dome-shaped 'mouse' hidden from view that minimized tremor effects. Movement duration, hand velocity, tracking continuity, directional control variables, and feedback utilization variables were measured. MANOVA was performed on (1) clinically measured motor function, (2) VMC performance and (3) mood and attention, looking for main and interaction effects of: (1) group (controls/PD), (2) test-order (controls: first/second, PD: on-stimulation/off-stimulation), (3) path (sine/square/circle) and (4) hand (dominant/non-dominant).

RESULTS

Unified PD Rating Scale (UPDRS) Part III worsened off-stimulation versus on-stimulation (mean: 42.3 versus 21.6, p = 0.02), as did finger tapping (p = 0.02), posture-gait (p = 0.01), upper limb function (p<0.001) and backwards digit span (p = 0.02). Stimulation state did not affect mood. PD patients performed worse in non-velocity related VMC variables than controls (F(5,18) = 8.5, p<0.001). In the control group there were significant main effects of hand (dominant/non-dominant), path (sine/square/circle) and test-order (Test_1/Test_2). In the PD group, hand and path effects, but no test-order (on-stimulation/off-stimulation), were found.

CONCLUSIONS

'Low-level' clinically-measured motor function responds to STN-DBS but 'high-level' motor and cognitive functions relating to VMC may be unresponsive to STN-DBS.

Motor signs in the prodromal phase of Parkinson's disease

Relatively subtle deterioration of the motor system likely occurs well before the patient meets established motor criteria for a clinical diagnosis of Parkinson's disease; ie, the occurrence of at least 2 of the cardinal motor deficits: bradykinesia, rigidity, tremor, and/or postural instability. Powerful compensatory mechanisms may mask these clinical symptoms and make them difficult to identify and evaluate in the earliest stages of the illness. This review summarizes our current knowledge of motor signs that are thought to occur in the prodromal phase of Parkinson's disease and suggests how motor assessment batteries could be designed to detect these subclinical motor deficits with a high degree of accuracy and sensitivity.

Altered perceptual sensitivity to kinematic invariants in Parkinson's disease

Ample evidence exists for coupling between action and perception in neurologically healthy individuals, yet the precise nature of the internal representations shared between these domains remains unclear. One experimentally derived view is that the invariant properties and constraints characterizing movement generation are also manifested during motion perception. One prominent motor invariant is the "two-third power law," describing the strong relation between the kinematics of motion and the geometrical features of the path followed by the hand during planar drawing movements. The two-thirds power law not only characterizes various movement generation tasks but also seems to constrain visual perception of motion. The present study aimed to assess whether motor invariants, such as the two thirds power law also constrain motion perception in patients with Parkinson's disease (PD). Patients with PD and age-matched controls were asked to observe the movement of a light spot rotating on an elliptical path and to modify its velocity until it appeared to move most uniformly. As in previous reports controls tended to choose those movements close to obeying the two-thirds power law as most uniform. Patients with PD displayed a more variable behavior, choosing on average, movements closer but not equal to a constant velocity. Our results thus demonstrate impairments in how the two-thirds power law constrains motion perception in patients with PD, where this relationship between velocity and curvature appears to be preserved but scaled down. Recent hypotheses on the role of the basal ganglia in motor timing may explain these irregularities. Alternatively, these impairments in perception of movement may reflect similar deficits in motor production.

Complex Motor Performance and Parkinson's Disease

Une étude a été menée sur la performance de sept patients atteints de la maladie de Parkinson qui avaient à effectuer une tache de repérage de mouvements discontinue et qui, dans un premier temps, étaient sous medication (symptômes atténués) et, dans un deuxième temps, sans médication (symptômes non atténués). Les résultats obtenus ont été comparés avec ceux provenant de sept personnes d'âge et de sexe similaires et non atteintes de la maladie de Parkinson. Toutes les personnes ont donné 2 000 réponses au cours de la tâche, ce qui a permis d'obtenir des variations sur la probabilité directionnelle et la distance de déplacement. Dans l'ensemble, les résultats indiquent que lorsque les malades parkinsonniens sous médication obtenaient suffisamment de temps pour pratiquer et apprendre une nouvelle tâche, ils se comportaient de la même façon que les personnes témoins d'âge semblable. Cependant, on a noté deux situations ou les réponses des personnes atteintes de la maladie de Parkinson étaient visiblement plus lentes: (a) dans leur habileté à prendre des décisions lorsque la direction du mouvement était moins prévisible, et, (b) lorsqu'ils devaient rajuster leurs réponses motrices après un faux mouvement subit.

Cerebral cortical and subcortical cholinergic deficits in parkinsonian syndromes

OBJECTIVES

Cholinergic projections to cerebral cortical and subcortical regions are decreased in Parkinson disease (PD), but not evaluated in the parkinsonian syndromes of multiple system atrophy (MSA-P) and progressive supranuclear palsy (PSP). We studied cholinergic innervation in these disorders as compared to age-appropriate normal control subjects.

METHODS

We used PET with [(11)C]PMP to measure acetylcholinesterase (AChE) activity in multiple cerebral cortical and subcortical regions. We studied 22 normal controls, 12 patients with PD, 13 patients with MSA-P, and 4 patients with PSP.

RESULTS

We found significantly decreased AChE activity in most cerebral cortical regions in PD and MSA-P, and a similar but nonsignificant decrease in PSP. No differences were found between PD and MSA-P. Significantly decreased AChE activity was found in PD in striatum, cerebellum, and thalamus, with a marginally significant decrease in mesencephalon and no change in pons. Significantly greater declines in AChE activity in all subcortical regions were seen in MSA-P and PSP vs in PD. Decreased AChE activity in brainstem and cerebellum of all 3 disorders correlated with disturbances of balance and gait.

CONCLUSIONS

Cerebral cortical cholinergic activity is decreased to a similar level in Parkinson disease (PD), parkinsonian syndromes of multiple system atrophy (MSA-P), and progressive supranuclear palsy (PSP) as compared to normal controls. Subcortical cholinergic activity is significantly more decreased in MSA-P and PSP than in PD. The more substantial decrease reflects greater impairment in the pontine cholinergic group, which is important in motor activity, particularly gait. These differences may account for the greater gait disturbances in the early stages of MSA-P and PSP than in PD.

Supplementary motor area structure and function: Review and hypotheses

Though its existence has been known for well over 30 years, only recently has the supplementary motor area (SMA) and its role in the cortical organization of movement come to be examined in detail by neuroscientists. Evidence from a wide variety of investigational perspectives is reviewed in an attempt to synthesize a conceptual framework for understanding SMA function. It is suggested that the SMA has an important role to play in the intentional process whereby internal context influences the elaboration of action. It may be viewed as phylogenetically older motor cortex, derived from anterior cingulate periarchicortical limbic cortex, which, as a key part of a medial premotor system, is crucial in the “programming” and fluent execution of extended action sequences which are “projectional” in that they rely on model-based prediction. This medial system can be distinguished from a lateral premotor system postulated to have evolved over phylogeny from a different neural source. An anatomico-physiologic model of the medial premotor system is proposed which embodies the principles of cyclicity and reentrance in the process of selecting those neural components to become active in conjunction with the performance of a particular action. The postulated dynamic action of this model in the microgenesis of a discrete action is outlined. It is concluded that although there is a great deal to be learned about the SMA, a convergence of current evidence can be identified. Such evidence suggests that the SMA plays an important role in the development of the intention-to-act and the specification and elaboration of action through its mediation between medial limbic cortex and primary motor cortex.

Changes in regional activity are accompanied with changes in inter-regional connectivity during 4 weeks motor learning

Structural equation modeling (SEM) and fMRI were used to test whether changes in the regional activity are accompanied by changes in the inter-regional connectivity as motor practice progresses. Ten healthy subjects were trained to perform finger movement task daily for 4 weeks. Three sessions of fMRI images were acquired within 4 weeks. The changes in inter-regional connectivity were evaluated by measuring the effective connectivity between the primary motor area (M1), supplementary motor area (SMA), dorsal premotor cortex (PMd), basal ganglia (BG), cerebellum (CB), and posterior ventrolateral prefrontal cortex (pVLPFC). The regional activities in M1 and SMA increased from pre-training to week 2 and decreased from week 2 to week 4. The inter-regional connectivity generally increased in strength (with SEM path coefficients becoming more positive or negative) as practice progressed. The increases in the strength of the inter-regional connectivity may reflect long-term reorganization of the skilled motor network. We suggest that the performance gain was achieved by dynamically tuning the inter-regional connectivity in the motor network.

Dementia and mild cognitive impairment in patients with Parkinson's disease

The objective of this research was to assess the occurrence of cognitive impairment in 32 individuals (average age: 67.2 years old) with Parkinson' disease (PD). Procedures: clinical-neurological assessment; modified Hoehn and Yahr staging scale (HYS); standard neuropsychological battery of CERAD (Consortium to Establish a Registry for Alzheimer' Disease); Pfeffer questionnaire; and Clinical Dementia Rating. A comparison was made with a control group (CG), consisting of 26 individuals with similar age and educational level but without cognitive impairment. The PD patients showed an inferior performance in the CERAD battery when compared to the CG. Three PD sub-groups were characterised according to cognition: no cognitive impairment - 15 cases; mild cognitive impairment - 10; dementia - 7 cases. There was a significant association between motor disability (HYS) and the occurrence of dementia. Dementia and mild cognitive impairment frequently occur in PD patients and should be investigated in a routine way.

Visuo-motor coordination deficits and motor impairments in Parkinson's disease

Background

Visuo-motor coordination (VMC) requires normal cognitive executive functionality, an ability to transform visual inputs into movement plans and motor-execution skills, all of which are known to be impaired in Parkinson's disease (PD). Not surprisingly, a VMC deficit in PD is well documented. Still, it is not known how this deficit relates to motor symptoms that are assessed routinely in the neurological clinic. Such relationship should reveal how particular motor dysfunctions combine with cognitive and sensory–motor impairments to produce a complex behavioral disability.

Methods and Findings

Thirty nine early/moderate PD patients were routinely evaluated, including motor Unified Parkinson's Disease Rating Scale (UPDRS) based assessment, A VMC testing battery in which the subjects had to track a target moving on screen along 3 different paths, and to freely trace these paths followed. Detailed kinematic analysis of tracking/tracing performance was done. Statistical analysis of the correlations between measures depicting various aspects of VMC control and UPDRS items was performed. The VMC measures which correlated most strongly with clinical symptoms represent the ability to organize tracking movements and program their direction, rather than measures representing motor-execution skills of the hand. The strong correlations of these VMC measures with total UPDRS score were weakened when the UPDRS hand-motor part was considered specifically, and were insignificant in relation to tremor of the hand. In contrast, all correlations of VMC measures with the gait/posture part of the UPDRS were found to be strongest.

Conclusions

Our apparently counterintuitive findings suggest that the VMC deficit pertains more strongly to a PD related change in cognitive-executive control, than to a reduction in motor capabilities. The recently demonstrated relationship between gait/posture impairment and a cognitive decline, as found in PD, concords with this suggestion and may explain the strong correlation between VMC dysfunction and gait/posture impairment. Accordingly, we propose that what appears to reflect a motor deficit in fact represents a multisystem failure, dominated by a cognitive decline.

Which Motor Disorder in Parkinson's Disease Indicates the True Motor Function of the Basal Ganglia?

Parkinson's disease in its earlier stages is argued to be the best available model for human basal ganglia dysfunction. The negative motor symptoms of Parkinson's disease are considered to give the greatest clue to normal function of this region of the brain. Particular attention is given to disorders of movement. These include delayed initiation and slowed execution of simple fast movements, due to abnormal specification of initial agonist activity. This might compromise predictive motor action, but this is shown to be preserved in Parkinson's disease. Disorders of more complex movements, such as repetitive, concurrent and sequential motor actions, are also abnormal in Parkinson's disease. These various defects are discussed in terms of a motor strategy involving the selection and sequencing of motor programmes to form a motor plan, and the initiation and execution of that motor plan. On the evidence available, it is suggested that patients with Parkinson's disease are unable to automatically execute learnt motor plans.

Predictive information and error processing: The role of medial-frontal cortex during motor control

We have recently provided evidence that an error-related negativity (ERN), an ERP component generated within medial-frontal cortex, is elicited by errors made during the performance of a continuous tracking task (O.E. Krigolson & C.B. Holroyd, 2006). In the present study we conducted two experiments to investigate the ability of the medial-frontal error system to evaluate predictive error information. In two experiments participants used a joystick to perform a computer-based continuous tracking task in which some tracking errors were inevitable. In both experiments, half of these errors were preceded by a predictive cue. The results of both experiments indicated that an ERN-like waveform was elicited by tracking errors. Furthermore, in both experiments the predicted error waveforms had an earlier peak latency than the unpredicted error waveforms. These results demonstrate that the medial-frontal error system can evaluate predictive error information.

Multiple Dopamine Functions at Different Time Courses

Many lesion studies report an amazing variety of deficits in behavioral functions that cannot possibly be encoded in great detail by the relatively small number of midbrain dopamine neurons. Although hoping to unravel a single dopamine function underlying these phenomena, electrophysiological and neurochemical studies still give a confusing, mutually exclusive, and partly contradictory account of dopamine's role in behavior. However, the speed of observed phasic dopamine changes varies several thousand fold, which offers a means to differentiate the behavioral relationships according to their time courses. Thus dopamine is involved in mediating the reactivity of the organism to the environment at different time scales, from fast impulse responses related to reward via slower changes with uncertainty, punishment, and possibly movement to the tonic enabling of postsynaptic motor, cognitive, and motivational systems deficient in Parkinson's disease.

GABAergic output of the basal ganglia

Using GABAergic outputs from the SNr or GP(i), the basal ganglia exert inhibitory control over several motor areas in the brainstem which in turn control the central pattern generators for the basic motor repertoire including eye-head orientation, locomotion, mouth movements, and vocalization. These movements are by default kept suppressed by tonic rapid firing of SNr/GP(i) neurons, but can be released by a selective removal of the tonic inhibition. Derangement of the SNr/GP(i) outputs leads to either an inability to initiate movements (akinesia) or an inability to suppress movements (involuntary movements). Although the spatio-temporal patterns of individual movements are largely innate and fixed, it is essential for survival to select appropriate movements and arrange them in an appropriate order depending on the context, and this is what the basal ganglia presumably do. To achieve such a goal, however, the basal ganglia need to be trained to optimize their outputs with the aid of cortical inputs carrying sensorimotor and cognitive information and dopaminergic inputs carrying reward-related information. The basal ganglia output to the thalamus, which is particularly developed in primates, provides the basal ganglia with an advanced ability to organize behavior by including the motor skill mechanisms in which new movement patterns can be created by practice. To summarize, an essential function of the basal ganglia is to select, sort, and integrate innate movements and learned movements, together with cognitive and emotional mental operations, to achieve purposeful behaviors. Intricate hand-finger movements do not occur in isolation; they are always associated with appropriate motor sets, such as eye-head orientation and posture.

Postural control, gait, and dopamine functions in parkinsonian movement disorders

Balance impairments and falls, which are common in patients who have parkinsonian movement disorders, are a serious threat to the health of these individuals. However, the underlying mechanisms cannot be fully explained by presynaptic dopaminergic denervation, because balance impairment is at least responsive to L-dopa therapy. This article reviews the latest clinically relevant literature relating postural control, gait, and dopamine in patients who have parkinsonian movement disorders.

Cognitive deficits and psychosis in Parkinson's disease: a review of pathophysiology and therapeutic options

Parkinson's disease is a neurodegenerative disorder causing not only motor dysfunction but also cognitive, psychiatric, autonomic and sensory disturbances. Symptoms of dementia and psychosis are common: longitudinal studies suggest that up to 75% of patients with Parkinson's disease may eventually develop dementia, and the prevalence of hallucinations ranges from 16-17% in population-based surveys to 30-40% in hospital-based series. These cognitive and behavioural features are important in terms of prognosis, nursing home placement and mortality. The pattern of cognitive deficits in Parkinson's disease is variable, but often includes executive impairment similar to that seen in patients with frontal lesions, as well as episodic memory impairment, visuospatial dysfunction and impaired verbal fluency. The most common manifestation of psychosis in Parkinson's disease is visual hallucinations, but delusions, paranoid beliefs, agitation and florid psychosis can also occur. An understanding of the pathophysiology underlying these symptoms is essential to the development of targeted therapeutic strategies. Post-mortem studies suggest an association between Lewy body deposition and dementia in Parkinson's disease, and indeed Parkinson's disease and dementia with Lewy bodies may form part of the same disease spectrum. Whether Lewy bodies actually play a causative role in cognitive dysfunction, however, is unknown. Deficits in neurotransmitter systems provide more obvious therapeutic targets and dysfunction of dopaminergic, cholinergic, noradrenergic and serotonergic systems have all been implicated; these may each underlie different features of Parkinson's disease dementia, perhaps explaining some of the heterogeneity of the syndrome. Psychosis has traditionally been considered as a dopaminergic drug-induced phenomenon, but factors intrinsic to the disease process itself also cause hallucinations and delusions. These factors may include Lewy body deposition in the limbic system, cholinergic deficits and impairments of primary visual processing. Therapeutic intervention for cognitive and behavioural symptoms in Parkinson's disease currently focuses on two main groups of drugs: cholinesterase inhibitors and atypical antipsychotics. A recent large, randomised, controlled trial suggests that cholinesterase inhibitors can produce a modest improvement in cognitive function, as well as psychotic symptoms, generally without an adverse effect on motor function. Certain atypical antipsychotics allow hallucinations, delusions and behavioural problems to be brought under control with minimal deleterious effects on motor function and cognition, but their safety in elderly patients has recently been called into question. Deep brain stimulation does not appear to be a useful treatment for cognitive and psychiatric dysfunction in patients with Parkinson's disease. Modafinil improves alertness in Parkinson's disease and warrants further investigation to establish its effects on cognitive performance.

Neural modeling and imaging of the cortical interactions underlying syllable production

This paper describes a neural model of speech acquisition and production that accounts for a wide range of acoustic, kinematic, and neuroimaging data concerning the control of speech movements. The model is a neural network whose components correspond to regions of the cerebral cortex and cerebellum, including premotor, motor, auditory, and somatosensory cortical areas. Computer simulations of the model verify its ability to account for compensation to lip and jaw perturbations during speech. Specific anatomical locations of the model's components are estimated, and these estimates are used to simulate fMRI experiments of simple syllable production.

Cognitive correlates of cortical cholinergic denervation in Parkinson’s disease and parkinsonian dementia

We recently reported findings that loss of cortical acetylcholinesterase (AChE) activity is greater in parkinsonian dementia than in Alzheimer's disease (AD). In this study we determined cognitive correlates of in vivo cortical AChE activity in patients with parkinsonian dementia (PDem, n = 11), Parkinson's disease without dementia (PD, n = 13), and in normal controls (NC, n = 14) using N-[(11)C]methyl-piperidin-4-yl propionate ([(11)C]PMP) AChE positron emission tomography (PET). Cortical AChE activity was significantly reduced in the PDem (-20.9%) and PD (-12.7 %) subjects (P < 0.001) when compared with the control subjects. Analysis of the cognitive data within the patient groups demonstrated that scores on the WAIS-III Digit Span, a test of working memory and attention, had most robust correlation with cortical AChE activity (R = 0.61, p < 0.005). There were also significant correlations between cortical AChE activity and other tests of attentional and executive functions, such as the Trail Making and Stroop Color Word tests. There was no significant correlation between cortical AChE activity and duration of motor disease (R = -0.01, ns) or severity of parkinsonian motor symptoms (R = 0.14, ns). We conclude that cortical cholinergic denervation in PD and parkinsonian dementia is associated with decreased performance on tests of attentional and executive functioning.

Basal Ganglia and Cerebellar Inputs to ‘AIP’

The anterior intraparietal area (AIP) is a subregion of area 7b in posterior parietal cortex. AIP neurons respond to the sight of objects, as well as to the act of grasping them. We used retrograde transneuronal transport of rabies virus to examine subcortical inputs to AIP in the monkey. Virus transport labeled substantial numbers of neurons in the substantia nigra pars reticulata (SNpr), as well as in the dentate nucleus of the cerebellum. The hotspots of labeled neurons in SNpr and in dentate after AIP injections were separate from those created by virus injections into several other parietal or frontal regions. These observations provide the first evidence that a major output nucleus of the basal ganglia, the SNpr, projects to a region of posterior parietal cortex. In addition, our findings provide further support for the concept that posterior parietal cortex is a target of cerebellar output.

What causes mental dysfunction in Parkinson's disease?

Parkinson's disease (PD) is frequently associated with mental dysfunction. Domain-specific cognitive deficits are ubiquitous, and although they may not be clinically apparent in all patients, they are demonstrable by neuropsychological testing. Dementia is less frequent but is present significantly more in PD patients than in controls, with a cumulative prevalence rate up to 40% and up to six-fold increased incidence. Cognitive impairment mainly involves executive and visuospatial functions; memory is secondarily impaired with relatively preserved recognition. Qualitatively, the neuropsychological profile of dementia encompasses the same type of deficits found in nondemented PD patients. The dementia seen in PD, therefore, can be described as a dysexecutive syndrome combined with visuospatial dysfunction and behavioural symptoms. Dopaminergic, noradrenergic, serotoninergic, and cholinergic deficits have all been described as the underlying neurochemical impairment, but the strongest evidence exists for a cholinergic dysfunction. Involvement of brainstem nuclei, limbic structures, and cerebral cortex have been suggested as the site, and Lewy body (LB) degeneration and Alzheimer-type changes as the type of pathology underlying the mental dysfunction in PD. Although there is still some controversy as to the site and type of pathology, recent evidence suggests that LB-type degeneration in limbic structures and cerebral cortex, with consequent synaptic and cell loss, is the main pathological state associated with dementia in PD.

Dementia associated with Parkinson's disease

Dementia affects about 40% of patients with Parkinson's disease; the incidence of dementia in these patients is up to six times that in healthy people. Clinically, the prototype of dementia in PD is a dysexecutive syndrome. Loss of cholinergic, dopaminergic, and noradrenergic innervation has been suggested to be the underlying neurochemical deficits. Nigral pathology alone is probably not sufficient for the development of dementia. Although there is some controversy with regard to the site and type of pathology involved, dementia is likely to be associated with the spread of pathology to other subcortical nuclei, the limbic system, and the cerebral cortex. On the basis of more recent studies, the main pathology seems to be Lewy-body-type degeneration with associated cellular and synaptic loss in cortical and limbic structures. Alzheimer's disease-type pathology is commonly associated with dementia but less predictive. Recent evidence from small studies suggests that cholinesterase inhibitors may be effective in the treatment of dementia associated with PD.

Motor sequencing in Parkinson's disease: relationship to executive function and motor rigidity

Parkinson's disease (PD) is a movement disorder that also affects central cognitive processing; however, the extent to which high-order cognitive processes disrupted by PD affect complex motor function is incompletely explicated. The present analysis provides an examination of the relative contributions of simple motor versus complex cognitive functions involving sequencing, problem solving, and overall cognitive status to complex motor movements involving sequencing and temporal ordering in PD. Motor sequencing performance was videotaped for quantitative scoring. Compared with an age-matched control group, the PD group was impaired on motor agility and motor sequencing tasks in addition to cognitive sequencing and set shifting tasks. Neither current cognitive functioning, age, disease duration, nor overall intellectual abilities accounted for the relationships between motor sequencing and cognitive sequencing abilities in PD. By contrast, both sequencing and nonsequencing executive functions predicted motor sequencing performance as well as or better than motor rigidity or overall cognitive status. These relationships were strongest for the most challenging motor sequencing task, fist-edge-palm, and did not apply to the least challenging task, which required simple alternations of hand movements. Unlike PD, controls showed correlations between motor sequencing tests and executive functioning only tapping nonsequencing abilities. Thus, despite the predominant motor feature of PD, executive functions, as assessed by sequencing and set formation, predicted motor sequencing performance as well as or better than simple motor performance. The results further suggest that the more complex the motor sequencing task, the more susceptible it is to influence from generalized cognitive sequencing ability.

Spared error-related potentials in mild to moderate Parkinson's disease

Several lines of evidence indicate that people with Parkinson's disease are impaired at detecting their own motor errors. In the present study, we use a component of the event-related brain potential called the error-related negativity (ERN) to ask whether a high-level, generic error-processing system is compromised in Parkinson's disease. We recorded the electroencephalogram (EEG) from nine patients with mild to moderate Parkinson's disease and from nine normal control subjects while they performed a choice reaction time task. We found that the amplitude of the ERN was the same for both populations, indicating that the error-processing system associated with the ERN is not severely compromised in this Parkinson's disease population. These results are discussed in terms of disease progression.

Distinct contribution of the striatum and cerebellum to motor learning

The striatum and cerebellum have been shown to be key structures of a distributed system for the control of skilled movements. However, the mechanisms under which they operate remain unclear. This study compared the performance of patients with Parkinson's disease (PD) or with cerebellar damage (CE) to that of age-matched controls. Each group performed two visuomotor paradigms: a random variant of the serial reaction time (SRT) task that tested the subject's ability to make efficient stimulus-response associations and an adapted version of the mirror-tracing task that measured their capacity to combine simple movements into complex ones. PD patients with bilateral striatal damage showed an impaired learning profile on the SRT task and a normal facilitation effect in the tracing task, while CE patients showed the reverse pattern. Although further research is needed, the present findings suggest that the striatum and cerebellum are involved in distinct learning mechanisms.

Visuomotor skill learning on serial reaction time task in patients with early Parkinson's disease

This study tested the role of basal ganglia in visuomotor skill learning. Thirty-nine patients early in the course of Parkinson's disease (PD) and 30 patients after operation for an aneurysm of the anterior communicating artery (ACoA) were compared with 31 matched control subjects on a Serial Reaction Time test (SRTt). The patients with PD showed impaired visuomotor skill learning across the repeating blocks, in the presence of preserved declarative knowledge of embedded sequences, in contrast to the ACoA group in whom the reverse pattern was observed. The significant correlation in patients with PD between the standard neuropsychological and motor measures and the performance observed in the skill acquisition test, in the ACoA group and control subjects was not observed. The suggestion that this learning impairment could not be attributed to a motor deficit per se was also confirmed more directly for patients with PD. Accuracy of performance after the initial learning phase on the SRTt in patients with PD was associated predominantly with visual span capacity measures. Declarative knowledge of the embedded sequence of the SRTt was correlated to general cognitive and verbal span abilities in the PD group. The impairment observed in the PD group was not the result of a general decline in cognitive functioning, mood disturbances, or the severity of the motor symptoms.

Role of the basal ganglia in the control of purposive saccadic eye movements

In addition to their well-known role in skeletal movements, the basal ganglia control saccadic eye movements (saccades) by means of their connection to the superior colliculus (SC). The SC receives convergent inputs from cerebral cortical areas and the basal ganglia. To make a saccade to an object purposefully, appropriate signals must be selected out of the cortical inputs, in which the basal ganglia play a crucial role. This is done by the sustained inhibitory input from the substantia nigra pars reticulata (SNr) to the SC. This inhibition can be removed by another inhibition from the caudate nucleus (CD) to the SNr, which results in a disinhibition of the SC. The basal ganglia have another mechanism, involving the external segment of the globus pallidus and the subthalamic nucleus, with which the SNr-SC inhibition can further be enhanced. The sensorimotor signals carried by the basal ganglia neurons are strongly modulated depending on the behavioral context, which reflects working memory, expectation, and attention. Expectation of reward is a critical determinant in that the saccade that has been rewarded is facilitated subsequently. The interaction between cortical and dopaminergic inputs to CD neurons may underlie the behavioral adaptation toward purposeful saccades.

The neurobiological basis of time estimation and temporal order

Time estimation may be evaluated with the use of four major paradigms: temporal discrimination, verbal estimation, temporal production, and temporal reproduction. On the basis of testing of normal subjects and patients with brain lesions, it has been shown that the cerebellum, the basal ganglia, and the prefrontal cortex are involved in time estimation. In particular, studies in humans and animals have indicated that facilitation of dopamine transmission speeds up the internal clock, while inhibition of dopamine transmission slows it down. It has been hypothesized that the central timer is located in the cerebellum, while the planning abilities subserving the estimation of longer intervals are mediated by the prefrontal cortex. It remains to be determined whether time estimation is related to memory of temporal order or context and whether time-related tasks are correlated with working memory.