164 results
Yoga as an Add-on Therapy in Parkinson’s Disease: A Single Group Open-label Trial
- Pooja Mailankody, Nitish Kamble, Amitabh Bhattacharya, G.S. Shubha Bhat, Thamodharan Arumugam, K. Thennarasu, Rashmi Arasappa, Shivarama Varambally, Ravi Yadav, Pramod Kumar Pal
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- Journal:
- Canadian Journal of Neurological Sciences , First View
- Published online by Cambridge University Press:
- 25 March 2024, pp. 1-8
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Objective:
We aimed to evaluate the effect of yoga on motor and non-motor symptoms and cortical excitability in patients with Parkinson’s disease (PD).
Methods:We prospectively evaluated 17 patients with PD at baseline, after one month of conventional care, and after one month of supervised yoga sessions. The motor and non-motor symptoms were evaluated using the Unified Parkinson’s disease Rating Scale (motor part III), Hoehn and Yahr stage, Montreal Cognitive Assessment, Hamilton depression rating scale, Hamilton anxiety rating scale, non-motor symptoms questionnaire and World Health Organization quality of life questionnaire. Transcranial magnetic stimulation was used to record resting motor threshold, central motor conduction time, ipsilateral silent period (iSP), contralateral silent period (cSP), short interval intracortical inhibition (SICI), and intracortical facilitation.
Results:The mean age of the patients was 55.5 ± 10.8 years, with a mean duration of illness of 4.0 ± 2.5 years. The postural stability of the patients significantly improved following yoga (0.59 ± 0.5 to 0.18 ± 0.4, p = 0.039). There was a significant reduction in the cSP from baseline (138.07 ± 27.5 ms) to 4 weeks of yoga therapy (116.94 ± 18.2 ms, p = 0.004). In addition, a significant reduction in SICI was observed after four weeks of yoga therapy (0.22 ± 0.10) to (0.46 ± 0.23), p = 0.004).
Conclusion:Yoga intervention can significantly improve postural stability in patients with PD. A significant reduction of cSP and SICI suggests a reduction in GABAergic neurotransmission following yoga therapy that may underlie the improvement observed in postural stability.
Clinicaltrialsgov identifier:CTRI/2019/02/017564
Feasibility of regional center telehealth visits utilizing a rural research network in people with Parkinson’s disease
- Tuhin Virmani, Lakshmi Pillai, Veronica Smith, Aliyah Glover, Derek Abrams, Phillip Farmer, Shorabuddin Syed, Horace J. Spencer, Aaron Kemp, Kendall Barron, Tammaria Murray, Brenda Morris, Bendi Bowers, Angela Ward, Terri Imus, Linda J. Larson-Prior, Mitesh Lotia, Fred Prior
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- Journal:
- Journal of Clinical and Translational Science / Volume 8 / Issue 1 / 2024
- Published online by Cambridge University Press:
- 25 March 2024, e63
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Background:
Impaired motor and cognitive function can make travel cumbersome for People with Parkinson’s disease (PwPD). Over 50% of PwPD cared for at the University of Arkansas for Medical Sciences (UAMS) Movement Disorders Clinic reside over 30 miles from Little Rock. Improving access to clinical care for PwPD is needed.
Objective:To explore the feasibility of remote clinic-to-clinic telehealth research visits for evaluation of multi-modal function in PwPD.
Methods:PwPD residing within 30 miles of a UAMS Regional health center were enrolled and clinic-to-clinic telehealth visits were performed. Motor and non-motor disease assessments were administered and quantified. Results were compared to participants who performed at-home telehealth visits using the same protocols during the height of the COVID pandemic.
Results:Compared to the at-home telehealth visit group (n = 50), the participants from regional centers (n = 13) had similar age and disease duration, but greater disease severity with higher total Unified Parkinson’s disease rating scale scores (Z = −2.218, p = 0.027) and lower Montreal Cognitive Assessment scores (Z = −3.350, p < 0.001). Regional center participants had lower incomes (Pearson’s chi = 21.3, p < 0.001), higher costs to attend visits (Pearson’s chi = 16.1, p = 0.003), and lived in more socioeconomically disadvantaged neighborhoods (Z = −3.120, p = 0.002). Prior research participation was lower in the regional center group (Pearson’s chi = 4.5, p = 0.034) but both groups indicated interest in future research participation.
Conclusions:Regional center research visits in PwPD in medically underserved areas are feasible and could help improve access to care and research participation in these traditionally underrepresented populations.
32 - Disappointing Results of Two Human Trials of Monoclonal Antibodies in Parkinson’s Disease
- Daniel Gibbs, Emeritus of Oregon Health and Science University
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- Dispatches from the Land of Alzheimer's
- Published online:
- 19 January 2024
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- 22 February 2024, pp 130-133
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Summary
Like Alzheimer’s disease, Parkinson’s disease is a progressive, neurodegenerative disorder that involves deposits of an abnormal protein in the brain. In Alzheimer’s disease, these abnormal proteins are extracellular beta-amyloid and intraneuronal, hyperphosphorylated tau. In Parkinson’s disease, the neuropathological findings are protein deposits of aggregated alpha-synuclein found primarily within neurons in a part of the brainstem called the substantia nigra but in other locations as well. These clumps of alpha-synuclein are called Lewy bodies.
In the August 4, 2022 issue of the New England Journal of Medicine, we have reports of two phase 2 human trials of monoclonal antibodies directed at alpha-synuclein in subjects with early-stage Parkinson’s disease, prasinezumab and cinpanemab.
Limb Temperature in Parkinson’s Disease: Is It Symmetric?
- Rebecca George, Kimberley P. Good, Heather Rigby
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- Canadian Journal of Neurological Sciences , First View
- Published online by Cambridge University Press:
- 01 February 2024, pp. 1-2
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Diversifying the research landscape: Assessing barriers to research for underrepresented populations in an online study of Parkinson’s disease
- Angie V. Sanchez, Juliana M. Ison, Helen Hemley, Jonathan D. Jackson
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- Journal of Clinical and Translational Science / Volume 8 / Issue 1 / 2024
- Published online by Cambridge University Press:
- 01 February 2024, e34
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Despite federal regulations mandating the inclusion of underrepresented groups in research, recruiting diverse participants remains challenging. Identifying and implementing solutions to recruitment barriers in real time might increase the participation of underrepresented groups. Hence, the present study created a comprehensive dashboard of barriers to research participation. Barriers to participation were recorded in real time for prospective participants. Overall, 230 prospective participants expressed interest in the study but were unable to join due to one or more barriers. Awareness of the most common obstacles to research in real time will give researchers valuable data to meaningfully modify recruitment methods.
Impact of Non-Motor Symptoms on Quality of Life in Patients with Early-Onset Parkinson’s Disease
- Ameya Patwardhan, Nitish Kamble, Amitabh Bhattacharya, Vikram Holla, Ravi Yadav, Pramod Kumar Pal
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- Canadian Journal of Neurological Sciences , First View
- Published online by Cambridge University Press:
- 05 January 2024, pp. 1-10
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Background:
Early-onset Parkinson’s disease (EOPD) refers to patients with Parkinson’s disease (PD) whose age at disease onset is less than 50 years. Literature on the non-motor symptoms (NMS) in these patients is very limited in the Indian context. We aimed to study the NMS in patients with EOPD and its impact on the quality of life (QoL).
Methods:We included 124 patients with EOPD with a mean age at disease onset between 21 and 45 years and 60 healthy controls (HC). NMS were assessed using validated scales, and the QoL domains were evaluated using the PD QoL–39 scale (PDQ-39).
Results:The mean age at disease onset in EOPD patients was 37.33 ± 6.36 years. Majority of the patients were male (66.12%). The average disease duration was 6.62 ± 5.3 years. EOPD patients exhibited a significantly higher number of NMS per patient (7.97 ± 4.69) compared to HC (1.3 ± 1.39; p < 0.001). The most common NMS reported were urinary dysfunction, body pain, poor sleep quality, constipation, anxiety, depression, cognitive impairment, and REM sleep behavior disorder. The total NMS burden correlated with the QoL measures. Distinctive patterns of QoL subdomain involvement were identified, with sleep/fatigue, mood/cognition, and urinary dysfunction independently influencing QoL metrics.
Conclusions:Our study provides valuable insights into the NMS profile and its impact on QoL in patients with EOPD, addressing an important knowledge gap in the Indian context. By understanding the specific NMS and their influence on QoL, healthcare professionals can develop targeted interventions to address these symptoms and improve the overall QoL.
16 Relative Contributions of Motor and Non-Motor Symptoms to Caregiver Burden in Parkinson’s Disease Patients Being Evaluated for Deep Brain Stimulation
- Allyson Goldstein, Kimberly Chapman, Umer Akbar, Jennifer Davis
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 533-534
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Objective:
Parkinson’s disease (PD) is a neurodegenerative disorder affecting over 10 million people worldwide. PD is characterized by both motor (e.g., tremor, rigidity, and bradykinesia) and non-motor (including cognitive impairment and neuropsychiatric symptoms such as apathy, disinhibition, executive dysfunction) symptoms. Caregiver burden is prevalent in those providing care for patients with PD and can result in negative health complications. Past work shows associations between motor symptoms, cognitive impairment, neuropsychiatric symptoms, and caregiver burden in PD. However, their relative contributions are poorly understood. This study examined these relationships, hypothesizing that while motor symptoms, cognitive impairment, and neuropsychiatric symptoms would all affect caregiver burden, neuropsychiatric symptoms would predict burden above and beyond the contribution of the other factors
Participants and Methods:Participants were 42 people living with PD who were assessed at a hospital-based tertiary movement disorders specialty clinic for deep brain stimulation (DBS) candidacy evaluation with their caregiver. Motor exam was assessed by a PD specialist using the Unified Parkinson’s Disease Rating Scale (UPDRS). The Mini Mental State Examination (MMSE) assessed global cognition. Frontal Systems Behavior Scale (FrSBe) Family Form captured caregiver ratings of neuropsychiatric symptoms under 3 subscales: apathy, disinhibition, and executive dysfunction. The Multidimensional Caregiver Strain Index (MCSI) captured caregiver burden. Linear regression analyses examined relationships between caregiver burden (MCSI) and motor symptoms (UPDRS), cognitive impairment (MMSE), and neuropsychiatric symptoms (FrSBe).
Results:Using linear regression analyses, cognitive impairment (R2=0.08, F(1,41)=4.42, p=0.04) and neuropsychiatric symptoms (R2=0.35, F(1, 41)=21.0, p<0.01) predicted caregiver burden but motor symptoms did not (R2=0.03, F(1,41)=1.30, p=0.26). Hierarchical linear regression revealed that neuropsychiatric symptoms predicted caregiver burden above and beyond the contribution of cognitive impairment (AR2=0.28, AF(1)=12.7, p=0.001), accounting for an additional 28% of the variance in caregiver burden. Follow-up linear regression to examine the relationships between caregiver burden and the FrSBe subscales indicated that apathy (p<0.001), versus disinhibition (p=0.16) and dysexecutive behaviors (p=0.80), was the driver of the significant relationship.
Conclusions:Consistent with our hypothesis, results revealed that cognitive impairment and neuropsychiatric symptoms (specifically apathy) were independent predictors of caregiver burden, with neuropsychiatric symptoms predicting caregiver burden above and beyond the contribution of cognitive impairment. Somewhat surprisingly, motor symptoms were not a predictor of caregiver burden contrary to some previous research, though findings are mixed. Results highlight the importance of assessing for neuropsychiatric symptoms in PD, which may be overlooked by care providers relative to motor or cognitive symptoms, but which appear stressful to caregivers. Future directions include reexamining results in a larger more heterogenous sample including people living with PD at different disease stages (i.e., everyone in the present sample had severe enough symptoms to be considering DBS). Cognitive measures of executive functioning (which are more specific to PD than measures of global cognition) should also be included in future works. Development of supportive caregiver interventions specifically targeting apathy in PD may be useful. Longitudinal designs would be helpful to reexamine relationships following DBS surgery, as there are some reports of increased neuropsychiatric symptoms following the procedure.
53 REM Sleep Behavior Disorder in Parkinson’s Disease : Longitudinal Effects on Brain Lateralization
- Elisabeth Audet-Duchesne, Alexandru Hanganu
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, p. 565
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Objective:
Laterality of motor symptom onset in Parkinson’s disease (PD) is well-known and under-appreciated. It is still unclear though if this laterality might have an influence on other symptoms. Specifically, REM sleep behavior disorder has been shown to be a factor that has a high probability to be lined to PD. In this study we analyzed the longitudinal effect of REM symptomatology on brain lateralization in PD.
Participants and Methods:We used the baseline and 3-year visit data of 116 participants (67 without REM (PD-non-REM), 49 with REM (PD-REM)) aged 37-81 years from the Parkinson’s Progression Markers Initiative (PPMI) dataset. Statistical 3T MRI data (cortical thicknesses, areas, foldings of cortical Desikan atlas and volumes of subcortical regions) were obtained via FreeSurfer 7.1.1. Lateralization was computed using the formula: (left-right)/(lef +right). Mixed ANOVAs were performed on each region of interest.
Results:Our findings showed an increased right asymmetry of the paracentral lobule area and of the pars orbitalis area and volume in PD-REM. There was a reduced right asymmetry of the parietal inferior volume at baseline in PD-REM, whereas REM symptomatology had a stable effect at the 3 years visit. At baseline, there was an increased left asymmetry of the thickness of the caudal anterior cingulate, pars orbitalis and pars triangularis regions in PD-REM. After 3 years, there was an increased right asymmetry in those regions. The precentral, frontal superior and transversal temporal gyri showed inverse results: an increased right asymmetry of the thickness at baseline and an increased left asymmetry after 3 years. Finally, REM symptomatology is associated with more significant increases of the left asymmetry of the frontal superior gyrus volume and of the right asymmetry of the supramarginal gyrus volume after 3 years than at baseline.
Conclusions:These results provide evidence of the modulating effect of the disease progression on the relationship between REM symptoms and brain lateralization in PD.
4 An Update: Greater Apathy Associated with Selective Serotonin Reuptake Inhibitor Use in Parkinson’s Disease
- Rachel Schade, Lauren Kenney, Alyssa Ray, Lauren Santos, Francesca Lopez, Adrianna Ratajska, Katie Rodriguez
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 110-111
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Objective:
Apathy is a primary lack of motivation that is frequently reported in Parkinson’s disease (PD) and often misdiagnosed as depression. In PD, apathy worsens over time with motor symptom progression. Evidence over the past 15 years has documented that use of selective serotonin reuptake inhibitors (SSRIs) is associated with increased apathy in patients with depression, including individuals with PD. In PD, this appears to be related to downregulation of dopaminergic systems by serotonin. Despite increasing evidence, SSRIs continue to be heavily prescribed in individuals with PD— potentially worsening apathy and decreasing quality of life for these individuals. This study is an update, re-examining the relationship between apathy and the use of SSRIs and other antidepressants in a large cohort of individuals with PD.
Participants and Methods:Participants included a convenience sample of 387 nondemented individuals with idiopathic PD who were in their mid-60's (mean age=64.9+8.72 years), well-educated (mean=14.95+2.78 years), predominantly male (72.4%), non-Hispanic white (94.5%), and in mid-stage of disease severity (on medication Unified Parkinson Disease Rating Scale motor score=25.3+10.1). All scored above clinical cutoff for dementia on a cognitive screener (Dementia Rating Scale-2 (DRS) > 125). Medications, cognitive, mood, and clinical data were extracted from chart review. Depression and apathy were measured using the Beck Depression Inventory-II (BDI-Il) and the Apathy Scale (AS). Antidepressant medications were grouped into SSRIs, serotonin and norepinephrine reuptake inhibitors (SNRIs) and other. Analyses included bootstrapped Pearson’s correlations, Pearson’s chi-square, and linear regressions
Results:Among 387 individuals with PD, 41.3% (N=160) were taking antidepressant medications. Of these 160, 61.3% were on SSRIs, 24.4% on SNRIs, and the remainder on other antidepressants. Approximately 36.9% of the 387 PD patients exceeded recommended clinical cutoffs for apathy (AS >14) and 23.5% for depression (BDI-II >14) (Starkstein et al., 1992; Beck et al., 1996). Individuals taking SSRIs (N=98, x2=5.14, p=0.023) or SNRIs (N=39; x2=5.43, p=0.020) were more likely to be clinically apathetic than those taking other depression medications (N=23; x2=1.28, p=0.26). Results of a multiple regression with age, education, disease duration, motor severity, DRS-2, BDI-II, and all psychotropic medications (anti-depressants, anti-anxiety, anti-psychotics) as independent variables explained 42.8% of the variance in total apathy scores (F[17,285]=12.550, p<0.001). SSRIs were the only medication to significantly predict greater AS scores (ß=0.110, p=0.020) in this model. Less education (ß=-0.119, p=0.017) worse cognition (ß=-0.128, p=0.009), and greater depressive symptoms (ß=0.561, p<0.001) were also significant predictors of apathy.
Conclusions:These findings suggest that use of SSRIs, but not other antidepressants, is associated with greater apathy in PD. Given the interactive relationship between serotonin and dopamine, the current findings highlight the importance of considering apathy as a potential adverse effect when determining which anti-depressants to prescribe to individuals with PD. Similarly, switching a SSRI for an alternative anti-depressant in individuals with PD who are apathetic may be a potential treatment for apathy that needs further study. Longitudinal studies are also needed to elucidate the relationship of apathy and anti-depressant use over time, specifically to determine potential causality of this observed association. Funding: T32-NS082168
3 The Relationship Between Depression, Anxiety, and Autonomic Dysfunction in de novo Parkinson’s Disease Patients Over Time
- Adrianna M. Ratajska, Francesca V. Lopez, Lauren E. Kenney, Katie Rodriguez, Rachel Schade, Joshua Gertler, Dawn Bowers
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 109-110
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Objective:
Autonomic dysfunction is an important non-motor symptom of Parkinson’s disease (PD), with point prevalence estimates of approximately 50-70%. Common presentations include cardiovascular dysregulation, gastrointestinal dysfunction, impaired thermoregulation, and sexual dysfunction. In the present study, we sought to examine whether autonomic symptoms would predict trajectories of change in depression and anxiety over a 5-year period in newly diagnosed individuals with PD. Given that alterations in autonomic nervous system functioning (e.g., reduced heart rate variability, lower autonomic arousal) are frequently observed in individuals who have anxiety and depression, as well as the negative influence these symptoms can have on quality of life/functioning, we predicted that greater autonomic symptoms would be related to increased mood symptoms over time.
Participants and Methods:Participants included 414 individuals from the Parkinson’s Progression Markers Initiative, a prospective study of newly diagnosed and untreated individuals with PD. The PD participants (mean age=61.6+9.7, mean education=15.6+3.0, 92.5% non-Hispanic White) were followed annually for up to five years. Self-reported autonomic symptoms were measured using the Scales for Outcomes in Parkinson’s Disease-Autonomic Dysfunction (SCOPA-AUT), which consists of a total score and 6 subdomain scores (gastrointestinal, urinary, cardiovascular, thermoregulatory, pupillomotor, sexual). Mood measures included the Geriatric Depression Scale (GDS) and State-Trait Anxiety Inventory (STAI). Motor severity was assessed using the Unified Parkinson’s Disease Rating Scale (UPDRS) Part III. Bootstrapped linear regressions were performed to evaluate the relationship between autonomic symptoms (subdomains) and mood using data from the last visit (year 5). For longitudinal analyses, bootstrapped multilevel modeling was used to examine a) changes in SCOPA-AUT total over time (unconditional growth model only) and b) the relationship between mood and SCOPA-AUT total score over time, controlling for age/sex and motor severity.
Results:Autonomic symptoms explained 28.2% of the total variance in trait anxiety, with unique predictors of gastrointestinal (/3=.266, p<.001) and thermoregulatory (ß=.202, p=.004) symptoms. For depression, autonomic symptoms explained 27.9% of the total variance, with unique predictors of gastrointestinal (ß=.225, p=.012), thermoregulatory (ß=.178, p=.013), and cardiovascular (ß=.154, p=.012) symptoms. There was a gradual linear increase in total autonomic symptoms over time (b=0.86, p<.001). Greater total autonomic symptoms were associated with higher average trait anxiety (b=0.54, p<.001), slightly greater increase in trait anxiety over time (b=0.04, p<.05), and occasion-to-occasion fluctuations in trait anxiety (b=0.24, p<.001). Similarly, increased total autonomic symptoms were associated with higher average depressive symptoms (b=0.14, p<.001), minimally greater increase in depressive symptoms over time (b=0.01, p<.05), and occasion-to-occasion fluctuations in depressive symptoms (b=0.08, p<.001). Motor severity did not explain individual differences or trajectories of change in depression or trait anxiety.
Conclusions:Autonomic symptoms, particularly gastrointestinal, cardiovascular, and thermoregulatory dysfunction, were related to increased mood symptoms in PD patients and predicted increases in depression/anxiety over time. Our findings do not distinguish between two theoretical possibilities - whether autonomic symptoms lead to depression/anxiety versus involvement of co-occurring neural systems underlying both. Regardless, our study highlights the importance of treating autonomic dysfunction in early PD, and future work should incorporate additional measures of autonomic dysfunction (e.g., physiological probes).
65 Is Basal Forebrain Volume Loss Associated with Visual Hallucinations, Mild Cognitive Impairment, or Concomitant Symptomology in Advanced Parkinson’s Disease?
- Sabrina M Adamo, Vaishali Mutreja, Marta Statucka, Batu Kaya, Taylor W Schmitz, Anthony C Ruocco, Melanie Cohn
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 575-576
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Objective:
Among individuals with Parkinson’s Disease (PD), visual hallucinations (VH) and mild cognitive impairment (MCI) are highly prevalent and often co-occur. Atrophy in similar brain regions [e.g. cholinergic basal forebrain (BF) nuclei] as well as specific cognitive difficulties (e.g. posterior-cortical abilities such as semantic fluency and visuoperception) have been associated with the presentation of each symptom type. While there are separate lines of evidence implicating BF volume in MCI and VH, no study to date has examined BF integrity in patients with concurrent MCI and VH symptomology. Furthermore, no prior studies examining BF integrity in MCI and VH have accounted for the potential confounding effects of dopaminergic medications which are known to exacerbate both symptom types. The aims of this study were to harmonize or bridge the two bodies of literature to determine the common neural substrate of PD-VH and PD-MCI (with an emphasis on the BF), to examine the confounding effects of dopaminergic pharmacotherapy, and to examine whether nondopaminergic “posterior” cognitive abilities differ between PD-MCI with versus without VH.
Participants and Methods:This study used a clinical chart review and MRI data to examine the associations between BF volume in a large group (n=296) of advanced PD patients (∼10 years disease duration) with and without each VH and MCI, covarying the effect of dopaminergic therapy. A two-way ANCOVA was run on total and regional BF volumes (i.e., total BF volume, and four nuclei including Ch4, Ch4p, Ch1-2, Ch3) using VH and MCI as independent variables, while covarying for dopaminergic medication. Using Mann-Whitney U tests, we compared the performance of individuals with MCI-VH versus that of individuals with MCI-noVH on tasks of semantic verbal fluency and of visuoperceptual skills (e.g., judgement of line orientation, object decision, and silhouettes).
Results:There were two major findings: (1) atrophy of the Ch4 region in the BF was associated with MCI with VH while Ch1-2 was associated with MCI regardless of VH status, and (2) patients with both MCI and VH had poorer performance than individuals with MCI without VH on tasks measuring object recognition but not on tasks of visuospatial perception or semantic verbal fluency. These results remained stable regardless of whether or not dopaminergic medication was included in the model.
Conclusions:PD is a heterogeneous disease with different subtypes reflecting both dopaminergic and cholinergic dysfunction. Our findings suggest further dissociations within the cholinergic system. First, atrophy in Ch4, which projects to the cortical mantle, was preferentially associated with VH symptoms and object-based visuoperception deficits. This is consistent with proposals that VH are real-world manifestations of visuoperceptual deficits. Second, Ch1-2 atrophy, which projects primarily to the hippocampus, was associated with MCI regardless of VH. Future research will extend this work to other cognitive abilities such as memory, to analyses of brain networks that implicate the BF, and to the investigation of the relationship between anti-cholinergic medications and symptom presentation in PD.
1 Basal Forebrain Free Water Fraction is Associated with Cortical Cholinergic Levels in Idiopathic Parkinson’s Disease
- Samuel J Crowley, Prabesh Kanel, Stiven Roytman, Nicolaas I Bohnen, Benjamin M Hampstead
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 108-109
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Objective:
Cognitive dysfunction is a common non-motor symptom of Parkinson’s disease (PD). Cognitive decline in PD is likely associated with dysfunction in the cholinergic system, which is affected by synuclein pathology early in the disease course. Recent studies have shown an association between reduced integrity of the basal forebrain (BF), which provides cholinergic innervation to most of cortex, and diminished cognitive functioning in PD. Specifically, those with PD and reduced cholinergic innervation also have higher rates of cognitive impairment. However, no study has directly investigated the relationship between basal forebrain integrity and cortical cholinergic levels. In the present study, we examined this relationship through measures of basal forebrain microstructural integrity and cholinergic nerve terminal density in cortical and subcortical gray matter.
Participants and Methods:Participants included 92 non-demented individuals with idiopathic PD (M:F=64:28; Age=67.0±7.1 yrs) who underwent structural MRI, diffusion MRI, and [18F] fluoroethoxybenzovesamicol (FEOBV) cholinergic PET imaging. We used a basal forebrain and region of interest defined by AssemblyNet, which uses ensembles of pretrained convolutional neural networks to create a full brain segmentation. Bilateral putamen from this atlas was also included as a control region. We measured microstructural integrity using free water fraction (FWF), a diffusion MRI-derived metric of extracellular water that associates with cellular density and neuroinflammation. For PET data, we computed the distribution volume ratio (DVR) by regions as defined by FreeSurfer. A factor analysis of DVR in all 88 FreeSurfer ROIs resulted in seven clusters of ROIs covering 1) widespread bilateral cortical regions (PC1); 2) subcortical and limbic regions (PC2); 3) bilateral cingulate regions (PC3); 4) left frontal regions (PC4); 5) right frontal and temporal regions (PC5); 6) cerebellum (PC6); and 7) bilateral entorhinal cortex and left temporal cortex (PC7). We performed seven separate regression analyses per ROI (controlling for age and disease duration) to evaluate the association between BF FWF and cholinergic levels in these regions. To determine if these ROIs showed unique associations with BF FWF, we then entered ROIs with a significant association with BF FWF as independent variables in a stepwise regression with forward selection with BF FWF as the dependent variable.
Results:BF FWF was significantly and negatively associated with cholinergic levels in PC1 (AR2=.042, ß=-0.208, p=.04), PC3 (AR2=.044, ß=-0.206, p=.03), PC4 (AR2=.056, ß=-0.239, p=.02), and PC7 (ß=-0.215, p=.04). BF FWF trended towards a negative association with cholinergic levels in PC5 (AR2=.045, ß=-0.168, p=.09) and PC6 (ß=-0.188, p=.09). Putamen FWF did not significantly associate with any of the ROIs. In the follow-up stepwise regression, only PC4 contributed significantly to the overall model (AR2=.061, ß=-0.261, p=.02).
Conclusions:Basal forebrain FWF was inversely related to cholinergic levels in regions that are directly innervated by the basal forebrain (e.g., cingulate cortex, left frontal cortex, and bilateral entorhinal cortex). Future research should directly investigate the relationship between basal forebrain integrity, cortical cholinergic levels, and cognition. Separating the basal forebrain into specific nuclei would also be beneficial, as different nuclei may have differing associations with specific hemispheric cholinergic pathways and cognition.
20 Laterality of Motor Symptom Onset is Not Associated with Cognitive Performance or Mood Symptoms in a Sample of 600 Individuals with Idiopathic Parkinson’s Disease”
- Joshua Gertler, Lauren Kenney, Adrianna M Ratajska, Francesca V Lopez, Katie Rodriguez, Rachel Schade, Dawn Bowers
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- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 537-538
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Objective:
Parkinson’s disease (PD) is typically characterized by unilateral onset of motor symptoms (i.e., tremors, rigidity) which is caused by dopaminergic degeneration of the substantia nigra that influences basal ganglia-prefrontal circuitry. Over time, motor symptoms become more bilateral, though continue to remain asymmetric. Many neuropsychological studies suggest that laterality of motor onset may be linked to hemispheric specific cognitive or mood changes. Namely, worse verbal/language performance may be present in individuals with right body (left hemisphere) onset and conversely for visuospatial performance, with depression symptoms relating more so to individuals with right body (left hemisphere) onset. To date, findings are often inconsistent, with some studies showing evidence for laterality effects and others not. The basis for this inconsistency is unclear, though one possibility relates to small sample sizes and varying methodologies. Thus, the goal of this study was to examine potential cognitive and mood laterality effects in a large clinical sample of individuals with PD.
Participants and Methods:Participants included a convenience sample of 600 nondemented individuals with idiopathic PD from the University of Florida Fixel Institute Movement Disorders Center. As a group, participants were around 60 years of age (Mean Age=63.9+9.4), well educated (Mean years=14.9+2.7), predominantly male (70%), and white non-Hispanic (93%). Side of initial motor symptom onset was based on self-report: Right (N=337) and Left (N=263). Approximately 79% were tremor predominant. All received mood and neurocognitive measures as part of standard clinical care, including indices of executive function (Stroop Color-Word, Trails B, Letter Fluency), recent verbal memory (delayed recall: Hopkin’s Verbal Learning Test, WMS-III Logical Memory), language (Boston Naming Test, Animal fluency), visuospatial skills (Judgment of Line Orientation, Facial Recognition Test). Evaluation of emotion symptoms included: depression (Beck Depression Inventory-II), apathy (Apathy Scale), and anxiety (State-Trait Anxiety Inventory). Analyses used raw scores from these measures. Due to non-normality of most measures’ distributions, laterality effects were examined using bootstrapped multivariate methods (multivariate analysis of variance [MANOVA]). Separate MANOVA’s were run for each cognitive domain (i.e., EF, language, etc.) and mood measures.
Results:The right and left sided onset groups did not significantly differ in demographic (age, education, sex) or disease characteristics (duration, PD subtype). Results of the MANOVA’s with cognitive variables were all nonsignificant broadly (all with F’s ranging from .33 to .94) and at the single test level. Similarly, the left and right onset groups did not significantly differ (a=0.05) across standard scales of depression (F=0.031), anxiety (Trait F=0.463; State F=3.29), and apathy (F=0.74).
Conclusions:We found no evidence that laterality of initial motor symptoms influenced cognitive or mood symptoms in a large cohort of 600 individuals with PD. These findings raise questions about importance of motor onset laterality for cognitive and emotion related changes in PD. Future studies should move beyond self-report and behavioral motor scales for determining hemispheric contributions. In PD, use of refined metrics for determining the extent of asymmetric dopaminergic degeneration (e.g., DAT scan) at the hemispheric level coupled with sensitive neuropsychological measures may provide clearer understanding of potential neural circuitry relationships.
6 Improved verbal fluency following unilateral right hemisphere subthalamic nucleus deep brain stimulation for Parkinson’s disease: Is implant hemisphere a modifiable risk factor for cognitive decline?
- Victor A Del Bene, Roy C Martin, Sarah A Brinkerhoff, Joseph W Olson, Dario Marotta, Christopher L Gonzalez, Kelly A Mills, J Nicole Bentley, Barton L Guthrie, Harrison C Walker
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 112-113
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Objective:
Non-motor symptoms, such as mild cognitive impairment and dementia, are an overwhelming cause of disability in Parkinson’s disease (PD). While subthalamic nucleus deep brain stimulation (STN DBS) is safe and effective for motor symptoms, declines in verbal fluency after bilateral DBS surgery have been widely replicated. However, little is known about cognitive outcomes following unilateral surgeries.
Participants and Methods:We enrolled 31 PD patients who underwent unilateral STN-DBS in a randomized, cross-over, double-blind study (SUNDIAL Trial). Targets were chosen based on treatment of the most symptomatic side (n = 17 left hemisphere and 14 right hemisphere). All participants completed a neuropsychological battery (FAS/CFL, AVLT, DKEFS Color-Word Test) at baseline, then 2, 4, and 6 months post-surgery. Outcomes include raw scores for verbal fluency, immediate and delayed recall, and DKEFS Color-Word Inhibition trial (Trial 3) completion time. At 2, 4, and 6 months, the neurostimulation type (directional versus ring mode) was randomized for each participant. We compared baseline scores for all cognitive outcome measures using Welch’s two-sample t-tests and used linear mixed effects models to examine longitudinal effects of hemisphere and stimulation on cognition. This test battery was converted to a teleneuropsychology administration because of COVID-19 mid-study, and this was included as a covariate in all statistical models, along with years of education, baseline cognitive scores, and levodopa equivalent medication dose at each time point.
Results:At baseline, patients who underwent left hemisphere implants scored lower on verbal fluency than right implants (t(20.66) = -2.49, p = 0.02). There were not significant differences between hemispheres in immediate recall (p = 0.57), delayed recall (p = 0.22), or response inhibition (p = 0.51). Post-operatively, left STN DBS patients experienced significant declines in verbal fluency over the study period (p = 0.02), while patients with right-sided stimulation demonstrated improvements (p < .001). There was no main effect of stimulation parameters (directional versus ring) on verbal fluency, memory, or inhibition, but there was a three-way interaction between time, stimulation parameters, and hemisphere on inhibition, such that left STN DBS patients receiving ring stimulation completed the inhibition trial faster (p = 0.035). After surgery, right STN DBS patients displayed faster inhibition times than patients with left implants (p = 0.015).
Conclusions:Declines in verbal fluency after bilateral stimulation are the most commonly reported cognitive sequalae of DBS for movement disorders. Here we found group level declines in verbal fluency after unilateral left STN implants, but not right STN DBS up to 6 months after surgery. Patients with right hemisphere implants displayed improvements in verbal fluency. Compared to bilateral DBS, unilateral DBS surgery, particularly in the right hemisphere, is likely a modifiable risk factor for verbal fluency declines in patients with Parkinson’s disease.
62 Prediction of Mild Cognitive Impairment Conversion Using Cox Model in Parkinson’s Disease
- Lyna Mariam El Haffaf, Lucas Ronat, Alexandru Hanganu
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 572-573
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Objective:
Mild cognitive impairment (MCI) in Parkinson’s disease (PD) is a critical state to consider. In fact, PD patients with MCI are more likely to develop dementia than the general population. Thus, identifying the risk factors for developing MCI in patients with PD could help with disease prevention. We aim to use the Cox regression model to identify the variables involved in the development of MCI in healthy controls (HC) and in a PD cohort.
Participants and Methods:The Parkinson’s Progressive Markers Initiative (PPMI) database was used to analyze data from 166 HC and 365 patients with PD. They were analyzed longitudinally, at baseline and at 3-year follow up. Both HC and PD were further divided in 2 groups based on the presence or absence of MCI. Conversion to MCI was defined as the first detection of MCI. For all participants, we extracted the (1) Neuropsychiatric symptoms (anxiety, impulsive-compulsive disorders and sleep impairment), (2) 3T MRI-based data (cortical and subcortical brain volumes based on the Desikan atlas, using FreeSurfer 7.1.1) and (3) genetic markers (MAPT and APOE £4 genes). We used Python 3.9 to perform three Cox proportional hazard models (PD-HC, HC only and PD only) and to model the risk of conversion to MCI, attributable to neuropsychiatric symptoms and cortical brain parameters. We included as covariates: age, sex, education, and disease duration (for the PD group). Hazard ratios (HRs) along with their 95% confidence intervals (CIs) are reported.
Results:When including both HC and PD in the model, Cox regression analyses showed that age of onset, diagnosis, the State-Trait Anxiety Inventory (STAI) and sleep impairment are variables that are associated with a greater risk of conversion to MCI (p<.005). For HC, only the STAI and the genetic marker MAPT were significantly associated with a risk of cognitive decline (p<.05). These results further indicated that a greater anxiety score at the STAI leads to a greater chance of developing a MCI whereas being a carrier of the MAPT gene reduces the risk of MCI. Regarding analysis on PD, results revealed that the STAI and the cortical volumes of the frontal dorsolateral and temporal regions are involved with a greater risk of developing a MCI (p<.05).
Conclusions:These analyses show that the neuropsychiatric symptom of anxiety seem to play an important role in the development of a MCI (significant in all three analyses). For patients with PD, cortical volumes of the frontal dorsolateral and temporal regions are significantly related to risk of MCI. This study highlights the importance of considering neuropsychiatric symptoms as well as cerebral volumes as key factors in the development of MCI in PD.
5 Midbrain Degeneration and Cognition in Parkinson’s Disease
- Kayla R Julio, Stephanie R Nitschke, Nicholas Shaff, Christopher Wertz, Andrew Mayer, Andrei Vakhtin, Gerson Suarez Cedeno, Amanda Deligtisch, Sarah Pirio Richardson, Sephira G Ryman
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 414-415
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Objective:
Neuromelanin imaging is an emerging biomarker for PD as it captures degeneration of the midbrain, a process which is associated with the motor symptoms of the disease. Currently, it is unknown whether this degeneration also contributes to cognitive dysfunction in PD beyond dysfunction associated with fronto-subcortical systems, as quantitative examination of substantia nigra (SN) degeneration could not be studied until recently.
In the current study, we examine whether neuromelanin signal is associated with broader cognitive dysfunction in PD patients with varying degrees of cognitive impairment: PD with normal cognition (PD-NC), PD with mild cognitive impairment (PD-MCI), and healthy controls (HC).
Participants and Methods:11 PD-NC, 16 PD-MCI and 14 age and sex-matched healthy controls (HC) participated in the study. PD participants were diagnosed with MCI based on the Movement Disorders Society Task force, Level II assessment (comprehensive assessment). In addition, all participants underwent an MRI scan that included a T1-weighted sequence and a neuromelanin-sensitive (NM-MRI) sequence. Contrast-to-noise-ratio of the substantia nigra pars compacta (SNc) was calculated and a distribution-corrected z-score was used to identify the number of extrema voxels for each individual, suggestive of the number of voxels that have exhibited significant degeneration (extrema_count). An analysis of covariance (ANCOVA) was used to evaluate group differences between HC, PD-NC, and PD-MCI in the extrema_count accounting for age, sex, and education. A multiple regression for each cognitive variable with extrema_count as the dependent variable adjusting for age, sex, and education were conducted.
Results:A significant main effect of group (F(2, 33) = 33.548 ; p < 0.001) indicated that PD-NC (21.55 ± 12.57) and PD-MCI (43.64 ± 32.84) patients exhibited significantly greater extrema_counts relative to HC (3.36 ± 3.61; both p < 0.001). Regression results indicated that higher extrema_counts were associated with worse cognitive performance across cognitive domains, including working memory (Digit Span Backward; R2 = .357, F(1,20) = 5.295, p = .032), (Hopkins Verbal Learning Test - Revised, Trials 1 to 3; R2 = .432, F(1,20) = 5.819, p = .026).
Conclusions:PD patients (PD-NC and PD-MCI) exhibited decreased neuromelanin in the SNc relative to healthy controls, confirming the ability of the NM-MRI sequence to differentiate PD from HC. There was no significant difference in SNc neuromelanin levels between PD-NC patients and PD-MCI patients, however, this is likely due to the small sample size. In addition, significant SNc degeneration was associated with worse cognitive performances in tasks associated with working memory and executive functioning. These results warrant further examination of the role of SN in PD patients with differing levels of cognitive impairment.
19 Oral Versus Written Trail Making Test Scores in Patients with Movement Disorders
- Joshua T Fox-Fuller, Kayci L Vickers, Jessica L Saurman, Rachel Wechsler, Amanda Eakin, Felicia C Goldstein
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 536-537
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Objective:
During the COVID-19 pandemic the Oral Trail Making Test (O-TMT) was frequently used as a telehealth-compatible substitute for the written version of the Trail Making Test (W-TMT). There is significant debate among neuropsychologists about the degree to which the O-TMT measures the same cognitive abilities as the W-TMT (i.e., processing speed for part A and set-shifting for part B). Given the continued use of the O-TMT - especially for patients with fine-motor or visual impairments -we examined how O-TMT and W-TMT scores were correlated in patients with movement disorders.
Participants and Methods:Between April 2021 and July 2022 thirty individuals with movement disorders (n=27 idiopathic Parkinson’s disease [PD]; n=1 drug-induced PD; n=1 progressive supranuclear palsy [PSP]; n=1 possible PSP) completed in-person neuropsychological evaluations at the Emory Brain Health Center in Atlanta, GA. The patients were on average 71.3 years old (SD=7.5 years), had 16 years of education (SD=2.8 years), and the majority were non-Hispanic White (n=27 White; n=3 African American) and male (n=17). In addition to other neuropsychological measures, these patients completed both the O-TMT and the W-TMT. O-TMT and W-TMT administration was counterbalanced across patients and took place thirty-minutes apart. Raw scores (i.e., time in seconds) to complete O-TMT and W-TMT part A and part B, as well as discrepancy scores (part B - part A), were used for statistical analysis; a raw score of 300 seconds was assigned when a participant could not complete that section of the O-TMT or W-TMT. Given the non-normal distribution of the data, Spearman correlations were performed between O-TMT and W-TMT scores.
Results:Ten patients were unable to perform W-TMT part B. Of these, seven patients could also not perform O-TMT part B. Part A scores on O-TMT and W-TMT were not significantly correlated (rs = 0.27, p = .15). In contrast, part B scores were strongly correlated, such that slower performances on O-TMT part B corresponded with slower performances on W-TMT part B (rs = 0.82, p < .001). Discrepancy scores for the O-TMT and W-TMT were also significantly correlated, such that larger part A and part B discrepancy scores on O-TMT corresponded with larger discrepancy scores on W-TMT (rs = 0.78, p <.001). The pattern of results was replicated when examining these correlations only in patients who could complete all parts of O-TMT and W-TMT (n=19); part A scores of the O-TMT and W-TMT were again not correlated (rs = -0.20, p = .41), whereas the part B scores (rs = 0.54, p = .02) and discrepancy scores (rs = 0.59, p = .008) were significantly correlated.
Conclusions:Results suggest that an oral version of the Trail Making Test shows promise as an alternative to the written version for assessing set shifting abilities. These findings are limited to patients with movement disorders, and future research with diverse patient populations could help determine whether O-TMT can be generalized to other patient groups. Additionally, future research should examine whether O-TMT scores obtained via virtual testing correspond with W-TMT scores obtained in-person.
5 Anticholinergic Medications, Cognition, and Parkinson’s Disease. Do Medications matter?
- Lauren G Santos, Lauren E Kenney, Alyssa Ray, Alfredo A Paredes, Adrianna M Ratajska, Dawn Bowers
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 111-112
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Objective:
While Parkinson’s disease (PD) is traditionally known as a movement disorder, cognitive decline is one of the most debilitating and common non-motor symptoms. Cognitive profiles of individuals with PD are notably heterogeneous (Goldman et al., 2018). While this variability may arise from the disease itself, other factors might play a role. Greater anticholinergic medication use has been linked to worse cognition in those with PD (Fox et al., 2011, Shah et al., 2013). However, past studies on this topic had small sample sizes, limited ranges of disease duration, and only used cognitive screeners. Thus, this study aimed to examine this question within a large, clinical sample, using a more comprehensive neuropsychological battery. We hypothesized that higher anticholinergic medication usage would relate to worse cognitive performance, particularly memory.
Participants and Methods:Participants included 491 nondemented individuals with PD (m=64.7, SD=9.04 years old; education m=15.01, SD=2.79; 71.9% male; 94.3% non-Hispanics white) who underwent a comprehensive neuropsychological assessment at the UF Fixel Institute’s movement disorders program. Medications at the time of the neuropsychological evaluation were identified from chart review and scored based on anticholinergic properties using the Magellan Anticholinergic Risk Scale (Rudolph J.L., et al, 2008); each medication was scored from 0 (no load) to 3 (high load). The neuropsychological battery included measures across 5 cognitive domains: (1) executive function (Trails B, Stroop Interference, Letter Fluency), (2) verbal delayed memory (WMS-III Logical Memory and Hopkin’s Verbal Learning Test-Revised delayed recalls), (3) language (Boston Naming Test-II, Animal Fluency), (4) visuospatial skills (Judgment of Line Orientation, Face Recognition Test), and (5) attention/working memory (WAIS-III Digit Span Forward and Backward). The published normative scores for each task were converted into z-scores and averaged into a domain composite. Due to non-normality of Magellan scores, Spearman correlations examined the relationship between each cognitive domain composite score and Magellan scores.
Results:As predicted, higher Magellan scores were significantly associated with worse memory (r=-0.11, p=0.016), with a small effect size. There were no significant relationships between Magellan scores and the remaining cognitive domains (EF, language, visuospatial, attention).
Conclusions:We found that greater anticholinergic burden was associated with worse performance on memory, but not other neuropsychological domains, in a large cohort of nondemented individuals with PD who underwent comprehensive assessment. This finding corresponds to previous literature in smaller PD cohorts. Though the effect size was low, this finding highlights the importance of monitoring anticholinergic burden in PD patients in order to minimize detrimental effects of medications on memory function. Future work should examine whether greater anticholinergic burden predicts future progression of memory decline.
Acknowledgement: Supported in part by the NIH, T32-NS082168
61 Factors Affecting Executive Functioning in Patients with Parkinson’s Disease
- Kristen N Focht, Abigail C Lyon
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 571-572
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Objective:
Parkinson’s disease (PD) is one of the most prevalent neurodegenerative conditions that leads to progressive degeneration in areas of the brain that control movement. As the disease progresses, cognition is also frequently affected, primarily executive functioning. Multiple factors may be involved in the relationship between PD and cognitive dysfunction. This study seeks to determine the association between disease duration (i.e., years since PD diagnosis), vascular comorbidities, and cognitive reserve (CR) and their relationship with executive functioning, in a clinic-referred PD population.
Participants and Methods:Participants included English-speaking subjects with a diagnosis of PD made by the patient’s treating neurologist (i.e., movement disorders specialist) who received their neurological care and had undergone a comprehensive neuropsychological evaluation at Thomas Jefferson University Hospital in Philadelphia, PA over the past five years. The sample consists of 67 patients. Comprehensive medical and psychiatric histories were obtained, and individuals with severe psychopathology (e.g., bipolar disorder or schizophrenia), medical or other neurological disorders (e.g., seizure disorder, stroke, documented head injury that was more severe than a mild TBI or intracranial bleeding) that could account entirely for cognitive impairment were excluded. An overall domain score of executive functioning was calculated by averaging each participant’s T-scores for the individual neuropsychological tests. Regression analysis was utilized to explore the relationship between number of vascular comorbidities, disease duration, and CR, as measured by a composite of formal education and literacy level, with executive functioning performance on neuropsychological testing for this sample.
Results:The model explains 12.1% of the variance of executive functioning performance (F (3, 66) = 2.883, p = 0.043). A significant positive relationship was found between CR and executive functioning (b = .335, p = 0.008). No significant relationships were found between vascular comorbidities or disease duration with executive functioning. The relationship between CR and each neuropsychological measure was explored independently using Pearson correlation (2-tailed). Significant positive correlations were found between CR and WAIS-IV or WASI-II Similarities (r = .49, p < .001), CR and WAIS-IV or WASI-II Matrix Reasoning (r = .46, p = .001), and CR and FAS (r = .26, p = .037). No significant relationships were found between CR and TMT-B (r = .07, p = .565) or CR and Stroop Color and Word Interference (r = .17, p = .240).
Conclusions:Results suggest that CR may be a better predictor of executive functioning in patients with PD than number of vascular comorbidities or disease duration. Stronger premorbid cognitive functioning and better cognitive efficiency may be neuroprotective and stave off cognitive decline in Parkinson’s disease.
4 Assessing Visuospatial Skills in Parkinson’s Disease Using the Identi-Fi
- AnneMarie Teti, Ryan C. Thompson, Grant G. Moncrief, Robert M. Roth
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 690-691
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Objective:
Patients with Parkinson’s disease (PD) commonly show deficits on tests of visuospatial functioning. The Identi-Fi is a new measure of visual organization and recognition composed of two components. The Visual Recognition (VR) subtest asks persons to identify an object that has been broken its pieces and rearranged, akin to the Hooper Visual Organization Test, but using updated and colorful pictures. The Visual Matching (VM) subtest involves showing the same stimuli, but the examinee must select the correct response from among five choices (1 correct and 4 foils), placing greater demand on visuospatial discrimination. Together, the two subtests comprise the Visual Organization Index (VOI), reflecting overall visual processing and organization ability. The present study examined performance on the Identi-Fi in patients with PD and its association with other aspects of cognition.
Participants and Methods:Participants were 23 patients with PD (95% male; mean age = 69.7 years [SD = 7.8], range = 47-79) and 12 patients with cognitive concerns (CC) who were intact on neuropsychological testing (excluding consideration of Identi-Fi scores; 50% male, mean age = 71.08 [SD = 6.27], range = 60-78) seen for a neuropsychological evaluation at a large Northeastern medical center. As part of a larger battery, patients completed the Identi-Fi, Trail Making Test (TMT), Category Fluency, Test of Premorbid Functioning (TOPF), and Brief Visuospatial Memory Test, Revised (BVMT-R).
Results:The PD group performed significantly worse than the CC group on VR and VM, as well as VOI, of the Identi-Fi (p < .001). Within the PD group, poorer VR, VM, and VOI performance was associated with lower scores on the TOPF (p < .05), BVMT-R learning (p < .05) and delayed recall (p < .05), as well as TMT Parts A and B (p < .05). VR was significantly correlated with Category Fluency (p < .05), while a trend was seen for the association between VOI and Category Fluency (p = .094).
Conclusions:Identi-Fi performance was worse in the PD group than the CC group, which is consistent with prior research indicating that visuospatial processing is often abnormal in patients with PD. Furthermore, findings indicate that poorer performance on the Identi-Fi in the PD group is associated with poorer cognitive functioning in other domains (i.e., visuospatial learning and memory, processing speed, cognitive flexibility, and semantic fluency), as well as lower premorbid intellectual functioning. While these findings suggest that the Identi-Fi is useful in identifying visuospatial dysfunction in PD, findings should be interpreted with caution given the small sample sizes and uneven gender distribution