1
|
Wang W, Baker K, Umamahesan C, Gilmour S, Charlett A, Taylor D, Young AH, Dobbs RJ, Dobbs SM. Bradyphrenia and Tachyphrenia in Idiopathic Parkinsonism Appear, in Part, Iatrogenic: An Observational Study with Systematic Review Background. J Clin Med 2023; 12:6499. [PMID: 37892637 PMCID: PMC10607457 DOI: 10.3390/jcm12206499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/26/2023] [Accepted: 10/04/2023] [Indexed: 10/29/2023] Open
Abstract
We question whether bradyphrenia, slowing of cognitive processing not explained by depression or a global cognitive assessment, is a nosological entity in idiopathic parkinsonism (IP). The time taken to break contact of an index finger with a touch-sensitive plate was measured, with and without a warning in the alerting signal as to which side the imperative would indicate, in 77 people diagnosed with IP and in 124 people without an IP diagnosis. The ability to utilise a warning, measured by the difference between loge-transformed reaction times (unwarned minus warned), was termed 'cognitive efficiency'. It was approximately normally distributed. A questionnaire on self- and partner perception of proband's bradyphrenia was applied. A multivariable model showed that those prescribed levodopa were less cognitively efficient (mean -5.2 (CI -9.5, -1.0)% per 300 mg/day, p = 0.02), but those prescribed the anti-muscarinic trihexyphenidyl were more efficient (14.7 (0.2, 31.3)% per 4 mg/day, p < 0.05) and those prescribed monoamine oxidase-B inhibitor (MAOBI) tended to be more efficient (8.3 (0.0, 17.4)%, p = 0.07). The variance in efficiency was greater within IP (F-test, p = 0.01 adjusted for any demographic covariates: coefficient of variation, with and without IP, 0.68 and 0.46, respectively), but not so after adjustment for anti-parkinsonian medication (p = 0.13: coefficient of variation 0.62). The within-participant follow-up time, a median of 4.8 (interquartile range 3.1, 5.5) years (101 participants), did not influence efficiency, irrespective of IP status. Perception of bradyphrenia did not usefully predict efficiency. We conclude that both bradyphrenia and 'tachyphrenia' in IP appear to have iatrogenic components, of clinically important size, related to the dose of antiparkinsonian medication. Levodopa is the most commonly prescribed first-line medication: co-prescribing a MAOBI may circumvent its associated bradyphrenia. The previously reported greater efficiency associated with (low-dose) anti-muscarinic was confirmed.
Collapse
Affiliation(s)
- Wenjing Wang
- South London and Maudsley NHS Foundation Trust, London SE5 8AB, UK (C.U.); (D.T.); (A.H.Y.)
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK
| | - Kieran Baker
- Department of Mathematics, King’s College London, London WC2R 2LS, UK (S.G.)
| | - Chianna Umamahesan
- South London and Maudsley NHS Foundation Trust, London SE5 8AB, UK (C.U.); (D.T.); (A.H.Y.)
- Institute of Pharmaceutical Science, King’s College London, London SE1 9NH, UK;
| | - Steven Gilmour
- Department of Mathematics, King’s College London, London WC2R 2LS, UK (S.G.)
| | - André Charlett
- Institute of Pharmaceutical Science, King’s College London, London SE1 9NH, UK;
- Statistics, Modelling and Economics, UK Health Security Agency, London NW9 5EQ, UK
| | - David Taylor
- South London and Maudsley NHS Foundation Trust, London SE5 8AB, UK (C.U.); (D.T.); (A.H.Y.)
- Institute of Pharmaceutical Science, King’s College London, London SE1 9NH, UK;
| | - Allan H. Young
- South London and Maudsley NHS Foundation Trust, London SE5 8AB, UK (C.U.); (D.T.); (A.H.Y.)
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK
| | - R. John Dobbs
- South London and Maudsley NHS Foundation Trust, London SE5 8AB, UK (C.U.); (D.T.); (A.H.Y.)
- Institute of Pharmaceutical Science, King’s College London, London SE1 9NH, UK;
- Department of Gastroenterology, King’s College Hospital, London SE5 9RS, UK
| | - Sylvia M. Dobbs
- South London and Maudsley NHS Foundation Trust, London SE5 8AB, UK (C.U.); (D.T.); (A.H.Y.)
- Institute of Pharmaceutical Science, King’s College London, London SE1 9NH, UK;
- Department of Gastroenterology, King’s College Hospital, London SE5 9RS, UK
| |
Collapse
|
2
|
Muacevic A, Adler JR, Adidam S, Jagroo J. Blepharospasm and Bradyphrenia With Infarction of the Artery of Percheron: A Case Report. Cureus 2022; 14:e31814. [PMID: 36579281 PMCID: PMC9782457 DOI: 10.7759/cureus.31814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2022] [Indexed: 11/24/2022] Open
Abstract
The artery of Percheron (AOP) is a variant of the posterior cerebral circulation where a single branch of either posterior cerebral artery supplies both paramedian territories of the thalami. A stroke of the AOP has become a neurodiagnostic conundrum due to its relative rarity and vague symptoms, and, hence, a missed opportunity for recanalization treatment. The classical presentation of AOP stroke is the triad of altered mental status, vertical gaze palsy, and memory impairment. Here, we describe a retrospective case review of a 59-year-old male presenting with confusion and slurred speech with subsequent symptoms such as blepharospasm and bradyphrenia. The initial computed tomography of the head failed to recognize the bilateral thalamic infarct which was established on day three on brain magnetic resonance imaging. Because the patient was out of the therapeutic window for thrombolysis, dual antiplatelet therapy was started. The patient made a rapid recovery to near-baseline function and was discharged to rehab services. This case is unique with the clinical presentation of both blepharospasm and bradyphrenia being rarely found in the literature. The shared insult to the basal ganglia-thalamocortical circuits may have caused both symptoms. Physician awareness of these subtle findings can increase awareness, earlier diagnosis, and treatment of bilateral thalamic lesions and AOP strokes.
Collapse
|
4
|
Steinke A, Lange F, Seer C, Hendel MK, Kopp B. Computational Modeling for Neuropsychological Assessment of Bradyphrenia in Parkinson's Disease. J Clin Med 2020; 9:E1158. [PMID: 32325662 PMCID: PMC7230210 DOI: 10.3390/jcm9041158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/09/2020] [Accepted: 04/16/2020] [Indexed: 12/13/2022] Open
Abstract
The neural mechanisms of cognitive dysfunctions in neurological diseases remain poorly understood. Here, we conjecture that this unsatisfying state-of-the-art is in part due to the non-specificity of the typical behavioral indicators for cognitive dysfunctions. Our study addresses the topic by advancing the assessment of cognitive dysfunctions through computational modeling. We investigate bradyphrenia in Parkinson's disease (PD) as an exemplary case of cognitive dysfunctions in neurological diseases. Our computational model conceptualizes trial-by-trial behavioral data as resulting from parallel cognitive and sensorimotor reinforcement learning. We assessed PD patients 'on' and 'off' their dopaminergic medication and matched healthy control (HC) participants on a computerized version of the Wisconsin Card Sorting Test. PD patients showed increased retention of learned cognitive information and decreased retention of learned sensorimotor information from previous trials in comparison to HC participants. Systemic dopamine replacement therapy did not remedy these cognitive dysfunctions in PD patients but incurred non-desirable side effects such as decreasing cognitive learning from positive feedback. Our results reveal novel insights into facets of bradyphrenia that are indiscernible by observable behavioral indicators of cognitive dysfunctions. We discuss how computational modeling may contribute to the advancement of future research on brain-behavior relationships and neuropsychological assessment.
Collapse
Affiliation(s)
- Alexander Steinke
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Florian Lange
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
- Behavioral Engineering Research Group, KU Leuven, Naamsestraat 69, 3000 Leuven, Belgium
| | - Caroline Seer
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
- Movement Control & Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven, Tervuursevest 101, 3001 Leuven, Belgium
- LBI - KU Leuven Brain Institute, KU Leuven, 3000 Leuven, Belgium
| | - Merle K. Hendel
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Bruno Kopp
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| |
Collapse
|
5
|
Firbank MJ, O'Brien JT, Taylor JP. Long reaction times are associated with delayed brain activity in lewy body dementia. Hum Brain Mapp 2017; 39:633-643. [PMID: 29094778 PMCID: PMC5813138 DOI: 10.1002/hbm.23866] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 10/13/2017] [Accepted: 10/18/2017] [Indexed: 12/22/2022] Open
Abstract
A significant symptom of Lewy body dementia (LBD) is slow cognitive processing or bradyphrenia. In a previous fMRI task‐based study, we found slower responses in LBD, accompanied by greater deactivation in the default mode network. In this study, we investigated the timing and magnitude of the activations and deactivations with respect to reaction time to determine whether the slower responses in LBD were associated with delayed neuronal activity. Using fMRI, we examined the magnitude and latency of activations and deactivations during an event‐related attention task in 32 patients with LBD and 23 healthy controls using predefined regions of interest. Default mode network deactivations did not significantly differ in their timing between groups or task conditions, while the task‐related activations in the parietal, occipital, frontal, and motor cortex were all significantly later in the LBD group. Repeating the analysis with reaction time as a parametric modulator of activation magnitude produced similar findings, with the reaction time modulator being significant in a number of regions including the default mode network, suggesting that the increased deactivation in LBD is partly explained by slower task completion. Our data suggest that the default mode network deactivation is initiated at the start of the task, and remains deactivated until its end, with the increased magnitude of deactivation in LBD reflecting the more prolonged cognitive processing in these patients. These data add substantially to our understanding of the neural origins of bradyphrenia, which will be essential for determining optimum therapeutic strategies for cognitive impairment in LBD. Hum Brain Mapp 39:633–643, 2018. © 2017 The Authors Human Brain Mapping Published by Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Michael J Firbank
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, United Kingdom
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - John Paul Taylor
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, United Kingdom
| |
Collapse
|