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Characteristics of executive function impairment in Parkinson’s disease patients without dementia



Executive function impairments in Parkinson’s disease (PD) are well documented. However, uncertainties remain regarding the impact of these deficits on other areas of cognitive functioning. The goal of this study was to provide a comprehensive assessment of cognitive characteristics in patients with PD without dementia and to assess how any such deficits affected other areas of cognitive functioning. Forty PD patients without dementia were compared to healthy controls using measures of attention and speed of processing and a comprehensive set of executive function tests including working memory, planning, and problem solving. Measures of memory/learning and visuospatial skills were also included to examine the relationship between aspects of executive function and other areas of cognition. Patients with PD showed deficits on measures of executive function, problem solving, and visuospatial skills. However, they were unimpaired on measures of planning, attention, and memory/learning. Deficits in problem solving were only evident for tasks with a high visuospatial content and were no longer significant when visuospatial skills were controlled for. While deficits in executive function and visuospatial skills were apparent for PD patients compared to controls, many aspects of cognition remained intact. These can provide a focus for cognitive intervention strategies that can be effective in delaying decline for PD patients. (JINS, 2010, 16, 268–277.)


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*Correspondence and reprint requests to: Audrey McKinlay, University of Canterbury, Private Bag 4800, Christchurch, New Zealand. E-mail:


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Aarsland, D., Ballard, C., Larsen, J.P., & McKeith, I. (2001). A comparative study of psychiatric symptoms in dementia with Lewy bodies and Parkinson’s disease with and without dementia. International Journal of Geriatric Psychiatry, 16, 528536.
Beck, A.T., Steer, R.A., & Brown, G.K. (1996). Beck Depression Inventory (2nd ed.). New York: The Psychological Corporation.
Benton, A.L., Varney, N.R., & Hamsher, K.D. (1978). Visuospatial judgment: A clinical test. Archives of Neurology, 35, 364367.
Bohnen, N.I., & Albin, R.L. (2009). Cholinergic denervation occurs early in Parkinson disease. Neurology, 73, 256257.
Bohnen, N.I., Kaufer, D.I., Hendrickson, R., Ivanco, L.S., Lopresti, B.J., Constantine, G.M., et al. (2006). Cognitive correlates of cortical cholinergic denervation in Parkinson’s disease and parkinsonian dementia. Journal of Neurology, 253, 242247.
Bondi, M.W., Kaszniak, A.W., Bayles, K.A., & Vance, K.T. (1993). Contributions of frontal system dysfunction to memory and perceptual abilities in Parkinson’s disease. Neuropsychology, 7, 89102.
Braak, H., & Braak, E. (2000). Pathoanatomy of Parkinson’s disease. Journal of Neurology, 247(Suppl. 2), II310.
Brown, R.G., & Marsden, C.D. (1990). Cognitive function in Parkinson’s disease: From description to theory. Trends in Neuroscience, 13, 2129.
Caballol, N., Marti, M.J., & Tolosa, E. (2007). Cognitive dysfunction and dementia in Parkinson’s disease. Movement Disorders, 22, S358S366.
Cools, R. (2006). Dopaminergic modulation of cognitive function-implications for L-DOPA treatment in Parkinson’s disease. Neuroscience and Biobehavior Review, 30, 123.
Cools, R., Stefanova, E., Barker, R.A., Robbins, T.W., & Owen, A. (2002). Dopaminergic modulation of high-level cognition in Parkinson’s disease: The role of the prefrontal cortex revealed by PET. Brain: A Journal of Neurology, 125, 584594.
Cooper, J.A., Sagar, H.J., Jordan, N., Harvey, N.S., & Sullivan, E.V. (1991). Cognitive impairment in early, untreated Parkinson’s disease and its relationship to motor disability. Brain, 114, 20952122.
Cronin-Golomb, A., & Braun, A.E. (1997). Visuospatial dysfunction and problem solving in Parkinson’s disease. Neuropsychology, 11, 4452.
Daneman, M., & Carpenter, P. (1980). Individual differences in working memory and reading. Journal of Verbal Learning and Verbal Behavior, 19, 450466.
Delis, D.C., Kaplan, E., & Kramer, J.H. (2001). Delis Kaplan Executive Function System. San Antonio, TX: The Psychological Corporation.
Dimitrov, M., Grafman, J., Soares, A.H., & Clark, K. (1999). Concept formation and concept shifting in frontal lesion and Parkinson’s disease patients assessed with the California Card Sorting Test. Neuropsychology, 13, 135143.
Dubois, B., & Pillon, B. (1997). Cognitive deficits in Parkinson’s disease. Journal of Neurology, 244, 28.
Fahn, S., & Elton, R.L. (1987). Unified Parkinson’s Disease Rating Scale (Vol. 2). Florham Park NJ: Macmillan Health Care Information.
Farina, E., Gattellaro, G., Pomati, S., Magni, E., Perretti, A., Cannata, A.P., et al. (2000). Researching a differential impairment of frontal functions and explicit memory in early Parkinson’s disease. European Journal of Neurology, 7, 259267.
Folstein, M.F., Folstein, S.E., & McHugh, P.R. (1975). “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.
Graham, J.M., & Sagar, H.J. (1999). A data-driven approach to the study of heterogeneity in idiopathic Parkinson’s disease: Identification of three distinct subtypes. Movement Disorders, 14, 1020.
Higginson, C.I., King, D.S., Levine, D., Wheelock, V.L., Khamphay, N.O., & Sigvardt, K.A. (2003). The relationship between executive function and verbal memory in Parkinson’s disease. Brain Cognition, 52, 343352.
Hoehn, M.M., & Yahr, M.D. (1967). Parkinsonism: Onset, progression and mortality. Neurology, 17, 427442.
Huang, C., Mattis, P.J., Perrine, K., Brown, N., Dhawan, V., & Eidelberg, D. (2008). Metabolic abnormalities associated with mild cognitive impairment in Parkinson’s disease. Neurology, 15, 14701477.
Jacobs, D.M., Marder, K., Cote, L.F., Sano, M., Stern, Y., & Mayeuz, R. (1995). Neuropsychological characteristics of preclinical dementia in Parkinson’s disease. Neurology, 45, 16911696.
Janvin, C., Aarsland, D., & Larsen, J.P. (2005). Cognitive predictors of dementia in Parkinson’s disease: A community-based, 4-year longitudinal study. Journal of Geriatric Psychiatry and Neurology, 18, 149154.
Janvin, C., Aarsland, D., Larsen, J.P., & Hugdahl, K. (2003). Neuropsychological profile of patients with Parkinson’s disease without dementia. Dementia and Geriatric Cognitive Disorders, 15, 126131.
Jurica, P.J., Leitten, C.L., & Mattis, S. (2001). DRS-2 Dementia Rating Scale-2. Professional manual. Lutz, FL: Psychological Assessment Resources, Inc.
Levin, B.E., & Katzen, H.L. (1995). Early cognitive changes and nondementing behavioral abnormalities in Parkinson’s disease. Advances in Neurology, 65, 8595.
Lewis, S.J., Foltynie, T., Blackwell, A.D., Robbins, T.W., Owen, A.M., & Barker, R.A. (2005). Heterogeneity of Parkinson’s disease in the early clinical stages using a data driven approach. Journal of Neurology, Neurosurgery, & Psychiatry, 76, 343348.
Lezak, M.D. (1995). Neuropsychological assessment (3rd ed.). Oxford: Oxford University Press.
Marie, R.M., Barre, L., Dupuy, B., Viader, F., Defer, G., & Baron, J.C. (1999). Relationships between striatal dopamine denervation and frontal executive tests in Parkinson’s disease. Neuroscience Letters, 260, 7780.
Marinus, J., Visser, M., Verwey, N.A., Verhey, F.R., Middelkoop, H.A., Stiggelbout, A.M., et al. (2003). Assessment of cognition in Parkinson’s disease. Neurology, 61, 12221228.
McKinlay, A., Grace, R.C., Dalrymple-Alford, J.C., Anderson, T.J., Fink, J., & Roger, D. (2008a). Neuropsychiatric problems in Parkinson’s disease: Comparisons between self and significant other report. Aging and Mental Health, 5, 649655.
McKinlay, A., Grace, R.C., Kaller, C.P., Dalrymple-Alford, J.C., Anderson, T.J., Fink, J., et al. (2009). Planning deficits in Parkinson’s disease: A comparison of two tower tasks. Applied Neuropsychology, 16, 77185.
McKinlay, A., Kaller, C.P., Grace, R.C., Dalrymple-Alford, J.C., Anderson, T.J., Fink, J., et al. (2008b). Planning in Parkinson’s disease: A matter of problem structure? Neuropschologia, 46, 384389.
Muslimovic, D., Post, B., Speelman, J.D., & Schmand, B. (2005). Cognitive profile of patients with newly diagnosed Parkinson disease. Neurology, 65, 12391245.
Owen, A.M. (2004). Cognitive dysfunction in Parkinson’s disease: The role of frontostriatal circuitry. Neuroscientist, 10, 525537.
Pillon, B., Boller, F., Levy, R., & Dubois, B. (2001). Cognitive deficits and dementia in Parkinson’s disease. In Boller, F. & Cappa, S.F. (Eds.), Handbook of neuropsychology (2nd ed.), Vol. 6. (pp. 311371). New York: Elsevier Science.
Riedel, O., Klotsche, J., Spottke, A., Deuschl, G., Forstl, H., Henn, F., et al. (2008). Cognitive impairment in 873 patients with idiopathic Parkinson’s disease. Results from the German Study on Epidemiology of Parkinson’s Disease with Dementia (GEPAD). Journal of Neurology, 255, 255264.
Royall, D.R., Cordes, J.A., & Polk, M. (1998). CLOX: An executive clock drawing task. Journal of Neurology, Neurosurgery & Psychiatry, 64, 588594.
Salthouse, T.A. (2005). Relations between cognitive abilities and measures of executive functioning. Neuropsychology, 19, 532545.
Sammer, G., Reuter, I., Hullmann, K., Kaps, M., & Vaitl, D. (2006). Training of executive functions in Parkinson’s disease. Journal of the Neurological Sciences, 248, 115119.
Schrag, A., Jahanshahi, M., & Quinn, N. (2000). What contributes to quality of life in patients with Parkinson’s disease? Journal of Neurology, Neurosurgery & Psychiatry, 69, 308312.
Sinforiani, E., Banchier, L., Zucchella, C., Pacchetti, C., & Sandrini, G. (2004). Cognitive rehabilitation in Parkinson’s disease. Archives of Gerontology and Geriatrics 9, 387391.
Spreen, O., & Strauss, E. (1998). A compendium of neuropsychological tests (3rd ed.). Victoria: Oxford University Press.
Tamaru, F. (1997). Disturbances in higher function in Parkinson’s disease. European Neurology, 38(Suppl 2), 3336.
Taylor, A.E., & Saint-Cyr, J.A. (1995). The neuropsychology of Parkinson’s disease. Brain Cognition, 28, 281296.
Troster, A.I., & Fields, J.A. (1995). Frontal cognitive function and memory in Parkinson’s disease: Toward a distinction between prospective and declarative memory impairments? Behavioural Neurology, 8, 5974.
Uekermann, J., Daum, I., Bielawski, M., Muhlack, S., Peters, S., Przuntek, H., et al. (2004). Differential executive control impairments in early Parkinson’s disease. Journal of Neural Transmission, Suppl(68), 3951.
Waterfall, M.L., & Crowe, S.F. (1995). Meta-analytic comparison of the components of visual cognition in Parkinson’s disease. Journal of Clinical and Experimental Neuropsychology, 17, 759772.
Wechsler, D.A. (1997). WAIS-III, WMS-III technical manual. San Antonio, TX: The Psychological Corporation.
Wechsler, D.A. (1999). Abbreviated Scale of Intelligence. San Antonio, TX: The Psychological Corporation.
Weintraub, D., & Stern, M.B. (2005). Psychiatric complications in Parkinson disease. American Journal of Geriatric Psychiatry, 13, 844851.
Welsh, M.C., Revilla, V., Strongin, D., & Kepler, M. (2000). Towers of Hanoi and London: Is the nonshared variance due to differences in task administration? Perceptual and Motor Skills, 90, 562572.
Wilson, B.A., Alderman, N., Burgess, P.W., Emslie, H., & Evan, J.J. (1996). Behavioural Assessment of the Dysexecutive Syndrome. Bury St Edmonds, UK: Thames Valley Test Company.
Witt, K., Daniels, C., Daniel, V., Schmitt-Eliassen, J., Volkmann, J., & Deuschl, G. (2006). Patients with Parkinson’s disease learn to control complex systems: An indication for intact implicit cognitive skill learning. Neuropsychologia, 44, 24452451.
Woods, S.P., & Troster, A.I. (2003). Prodromal frontal/executive dysfunction predicts incident dementia in Parkinson’s disease. Journal of the International Neuropsychological Society, 9, 1724.
Zamarian, L., Visani, P., Delazer, M., Seppi, K., Mair, K.J., & Diem, A. (2006). Parkinson’s disease and arithmetics: The role of executive functions. Journal of the Neurological Sciences, 248, 124130.
Zgaljardic, D.J., Borod, J.C., Foldi, N.S., & Mattis, P. (2003). A review of the cognitive and behavioral sequelae of Parkinson’s disease: Relationship to frontostriatal circuitry. Cognitive and Behavioral Neurology, 16, 193210.


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Characteristics of executive function impairment in Parkinson’s disease patients without dementia



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