Visuospatial orienting of attention in Parkinson's disease

The effect of directional social cues on saccadic eye movements in Parkinson's disease

There is growing interest in how social processes and behaviour might be affected in Parkinson’s disease. A task which has been widely used to assess how people orient attention in response to social cues is the spatial cueing task. Socially relevant directional cues, such as a picture of someone gazing or pointing to the left or the right have been shown to cause orienting of visual attention in the cued direction. The basal ganglia may play a role in responding to such directional cues, but no studies to date have examined whether similar social cueing effects are seen in people with Parkinson’s disease. In this study, patients and healthy controls completed a prosaccade (Experiment 1) and an antisaccade task (Experiment 2) in which the target was preceded by arrow, eye gaze or pointing finger cues. Patients showed increased errors and response times for antisaccades but not prosaccades. Healthy participants made most anticipatory errors on pointing finger cue trials, but Parkinson's patients were equally affected by arrow, eye gaze and pointing cues. It is concluded that Parkinson's patients have a reduced ability to suppress responding to directional cues, but this effect is not specific to social cues.

Specific impairment of visual spatial covert attention mechanisms in Parkinson's disease

Visual deficits in early and high level processing nodes have been documented in Parkinson's disease (PD). Non-motor high level visual integration deficits in PD seem to have a cortical basis independently of a low level retinal contribution. It is however an open question whether sensory and visual attention deficits can be separated in PD. Here, we have explicitly separated visual and attentional disease related patterns of performance, by using bias free staircase procedures measuring psychophysical contrast sensitivity across visual space under covert attention conditions with distinct types of cues (valid, neutral and invalid). This further enabled the analysis of patterns of dorsal-ventral (up-down) and physiological inter-hemispheric asymmetries. We have found that under these carefully controlled covert attention conditions PD subjects show impaired psychophysical performance enhancement by valid attentional cues. Interestingly, PD patients also show paradoxically increased visual homogeneity of spatial performance profiles, suggesting flattening of high level modulation of spatial attention. Finally we have found impaired higher level attentional modulation of contrast sensitivity in the visual periphery, where mechanisms of covert attention are at higher demands. These findings demonstrate a specific loss of attentional mechanisms in PD and a pathological redistribution of spatial mechanisms of covert attention.

Visual working memory deficits in patients with Parkinson's disease are due to both reduced storage capacity and impaired ability to filter out irrelevant information

Given that Parkinson's disease broadly affects frontostriatal circuitry, it is not surprising that the disorder is associated with a reduction of working memory. We tested whether this reduction is due to diminished storage capacity or impaired ability to exclude task-irrelevant items. Twenty-one medication-withdrawn patients and 28 age-matched control subjects performed a visuospatial memory task while their electroencephalograms were recorded. The task required them to remember the orientations of red rectangles within the half of the screen that was cued while ignoring all green rectangles. Behavioural and electroencephalogram measures indicated that patients with Parkinson's disease were impaired at filtering out distracters, and that they were able to hold fewer items in memory than control subjects. The results support recent suggestions that the basal ganglia help control access to working memory.

Procedural learning eliminates specific slowing down of response selection in patients with idiopathic Parkinson syndrome

Patients with idiopathic Parkinson syndrome and normally aged controls participated in a psychological refractory period experiment. Two tasks were presented on each trial: auditory discrimination of high versus low tones, followed by visual classification of letters versus their mirror images. Speeded responses to both tasks were required. Stimulus onset asynchrony between the tasks was varied (short vs. long). Both groups showed equal response times overall, but patients were slower on the second task in the short stimulus onset asynchrony condition. This effect was eliminated with practice. The results were interpreted in terms of reduced capacity for cognitive processes involving decision making as a secondary symptom of the Parkinson syndrome.

[Examination of frontal lobe function of Parkinson disease patients using Stroop reaction time]

The purpose of this study is to examine frontal lobe function of non-dementia Parkinson's disease (PD) patients. We examined the neuropsychological and behavioral evaluation (Stroop reaction time: SRT). Target image (20%) and non-target image (80%) were presented to PD patients, healthy elderly controls, and healthy young subjects at random. We instructed subjects that the button should pressed on the target image. This study was designed to investigate the mental set under three conditions. The Stroop test, Word Fluency Test (WFT), and Geriatric Depression Scale (GDS) were used to assess cognitive function. The SRT of PD were congruent condition and incongruent condition increased compared with simple condition. The delay of a similar SRT was seen in the healthy elderly control and young groups. However, the SRT of PD patients was slower under incongruent condition than under congruent condition. It appears that PD spent time on judgment in under incongruent condition because the meaning of the character did not correspond to the color of the character. Because, there were no significant between PD and healthy elderly subjects in Stroop test, WFT, and GDS, frontal lobe function had a partial deficit. The SRT of PD was increased by the partial deficit in information processing ability in addition to movement dysfunction.

Visual search deficits in Parkinson's disease are attenuated by bottom-up target salience and top-down information

Patients with Parkinson's disease (PD), a degenerative disorder primarily affecting the nigrostriatal dopamine system, exhibit deficits in selecting task-relevant stimuli in the presence of irrelevant stimuli, such as in visual search tasks. However, results from previous studies suggest that these deficits may vary as a function of whether selection must rely primarily on the "bottom-up" salience of the target relative to background stimuli, or whether "top-down" information about the identity of the target is available to bias selection. In the present study, moderate-to-severe medicated PD patients and age-matched controls were tested on six visual search tasks that systematically varied the relationship between bottom-up target salience (feature search, noisy feature search, conjunction search) and top-down target knowledge (Target Known versus Target Unknown). Comparison of slope and intercepts of the RT x set size function provided information about the efficiency of search and non-search (e.g., decision, response) components, respectively. Patients exhibited higher intercepts than controls as bottom-up target salience decreased, however these deficits were disproportionately larger under Target Unknown compared to Target Known conditions. Slope differences between PD and controls were limited to the Target Unknown Conjunction condition, where patients exhibited a shallower slope in the target absent condition, indicating that they terminated search earlier. These results suggest that under conditions of high background noise, medicated PD patients were primarily impaired in decision and/or response processes downstream from the target search itself, and that the deficit was attenuated when top-down information was available to guide selection of the target signal.

Temporal variation in the control of goal-directed visuospatial attention in basal ganglia disorders

A predictive central-cueing paradigm was used to compare visuospatial deficits in patients with Parkinson's (PD) and Huntington's diseases (HD), employing directionally valid and invalid visual cues over a range of stimulus onset asynchronies (SOA) to elicit a saccadic response. Compared to age-matched control groups, both PD and HD patients responded erroneously to cue stimuli more frequently, increasing significantly over longer SOAs. Both valid and invalid cues resulted in elevated latencies compared to un-cued visually guided saccades, the associated 'cost' of invalid cueing significantly greater than that for valid cueing, over all SOAs. Unlike control subjects, PD and HD patients demonstrated temporal variation with cue presentation. For PD patients, latencies following directionally invalid cues were significantly longer for intermediate SOAs, suggesting difficulty overcoming a build-up of inhibitory activity over time. No validity effect was found at 1000 ms. For HD patients, latencies for validly cued saccades with 150 ms SOAs were shorter than latencies for no-cue trials, representing a 'benefit' of valid cueing. For 500 ms SOAs latencies were comparably elevated following directionally valid and invalid cues, and for 1000 ms SOAs neither cue condition resulted in increased latencies. These findings reflect the consequence of disruption to the balance of activity over the basal ganglia facilitatory and inhibitory pathways. Imbalance in PD resulted in difficulty sustaining goal-directed behaviour, and in HD, difficulty gating inappropriate behaviour.

Movement precues in planning and execution of aiming movements in Parkinson's disease

Two experiments tested how changing a planned movement affects movement initiation and execution in idiopathic Parkinson's disease (PD) patients. In Experiment 1, PD patients, elderly controls, and young adults performed discrete aiming movements to one of two targets on a digitizer. A precue (80% valid cue and 20% invalid cue of all trials) reflecting the subsequent movement direction was presented prior to the imperative stimulus. All groups produced slower reaction times (RTs) to the invalid precue condition. Only the subgroup of patients with slowest movement time showed a significant prolongation of movement for the invalid condition. This suggests that, in the most impaired patients, modifying a planned action also affects movement execution. In Experiment 2, two-segment aiming movements were used to increase the demand on movement planning. PD patients and elderly controls underwent the two precue conditions (80% valid, 20% invalid). Patients exhibited longer RTs than the controls. RT was similarly increased for the invalid condition in both groups. The patients, however, exhibited longer movement times, lower peak velocities, and higher normalized jerk scores of the first segment in the invalid condition compared to the valid condition. Conversely, the controls showed no difference between the valid and invalid cue conditions. Thus, PD patients demonstrated substantially pronounced movement slowness and variability when required to change a planned action. The results from both experiments suggest that modifying a planned action may continue beyond the initiation phase into the execution phase in PD patients.

Systematic assessment of decision models in Parkinson's disease

OBJECTIVE

To give an insight into the structural and methodological approaches used in published decision-analytic models evaluating interventions in Parkinson's disease (PD) and to derive recommendations for future comprehensive PD decision models.

METHODS

A systematic literature review was performed to identify studies that evaluated PD interventions using mathematical decision models. Using a standardized assessment form, information on the study design, methodological framework, and data sources was extracted from each publication and systematically reported. Strengths and limitations were assessed.

RESULTS

We identified eight studies that used mathematical models to evaluate different pharmaceutical (n=7) and surgical (n=1) treatment options in PD. All models included economic evaluations. Modeling approaches comprised mathematical equations, decision trees, and Markov models with a time horizon ranging from 5 years to lifetime. All based progression on the evolution of clinical surrogate endpoints. Treatment effects were either modeled via reduction of symptomatic progression and/or initial symptomatic improvement or via reduction of adverse effect rates. No model is currently available that encompasses both the underlying biologic disease progression and the spectrum of all relevant complications and also links them to patient preferences and economic outcomes.

CONCLUSIONS

Models have been successfully applied to evaluate PD treatments. However, currently available models have substantial limitations. We recommend that a comprehensive, generic, and flexible decision model for PD that can be applied to different treatment strategies should consider a large spectrum of clinically relevant outcomes and complications of the disease during a sufficiently long time horizon, include PD-specific mortality, systematically evaluate uncertainty including heterogeneity effects, and should be validated by independent data or other models. Approaches to model treatment effects included reduction of symptomatic progression, initial symptomatic improvement, or reduction of adverse effects. We believe that structural bias could be avoided if underlying disease progression and treatment effects on symptoms are modeled separately.

L-dopa effects on preprogramming and control activity in a skilled motor act in Parkinson's disease

OBJECTIVES

The authors investigated whether preprogramming (Bereitschaftspotential, BP) and control activity (skilled performance positivity, SPP) in a bimanual, sequential skilled performance task (SPT) is sensitive to L-dopa administration in non-demented Parkinson's disease (PD) patients.

METHODS

Movement related potentials (MRPs) were recorded in 12 non-demented parkinsonian patients before and after acute L-dopa administration, and in 17 control subjects, all of whom were performing SPT for the first time. BP, SPP and correct performances were evaluated both as a grand average and in sequential blocks in order to verify the learning effect.

RESULTS

After L-dopa administration the PD patients scored a significantly higher percentage of correct performances (P<0.05), linked to a decreased BP amplitude (P<0.001) and an increased SPP amplitude (P<0.005), than before therapy. Dynamic evaluation through the block analysis did not show any learning effect in off-therapy patients but showed that L-dopa intake improved learning, linked to a BP amplitude decrease (P<0.005) and a SPP amplitude increase (P<0.05). Furthermore, L-dopa minimized differences in the learning trend between off-therapy PD patients and controls.

CONCLUSIONS

Our findings suggest that skilled motor learning is impaired in non-demented untreated PD patients. Dopaminergic drug administration seems to restore the ability of PD patients to use more automatic motor strategies, as demonstrated by the electrophysiological and behavioural pattern, which became more similar to that of normal subjects.

The psychological refractory period in Parkinson's disease

The Psychological Refractory Period paradigm was used to investigate whether patients with Parkinson's disease showed disproportional deficits in regulating responses to two sequential presented stimuli. The first task required a speeded key-press response to an auditory stimulus, and the second task required a speeded key-press response to a visual stimulus. The stimulus onset asynchrony (SOA) between Task 1 and Task 2 was 50 msec., 150 msec., and 650 msec. According to the bottleneck model, the SOA manipulation should not affect performance on Task 1, but reaction time for Task 2 should increase as the SOA between the two tasks decreased. The increase in reaction time for Task 2 was referred to as the Psychological Refractory Period. In this study, both patients with Parkinson's disease and normal controls showed classical effects. More importantly, although the 22 patients with Parkinison's disease took longer to respond to both Tasks 1 and 2 than the 20 normal controls, the effects of the Psychological Refractory Period for the two groups were of the same magnitude. The results suggest that Parkinson's disease affects only the response-execution stages rather than the response-selection stages, based on the central bottleneck model.

Object-based and location-based shifting of attention in Parkinson's disease

Research into Parkinson's disease has made much use of the precuing paradigm developed by Posner to examine patients' ability to shift visuospatial attention. The majority of studies indicate that patients with Parkinson's disease have significantly reduced shift costs when compared with normal controls. This reduction in costs is ascribed to abnormal maintenance of attention resulting from Parkinson's disease. We know that visual attention is not directed to spatial locations alone but that it may also be directed to object representations. To date, however, it has not been clear whether the reduced shift costs apparent in Parkinson's disease patients are evident only on spatial locations or on both spatial locations and object representations. Therefore, in the current study we have adopted a new technique with a view to studying both location-based and object-based attentional components within the same paradigm. Our results with 17 patients with Parkinson's disease suggest, at least in the early stages, patients do not show deficits in maintenance of attention to the miscued source of stimulation as reflected in their normal magnitude of cuing effect related to shifting between locations and between objects. 14 normal persons were control subjects.