Frontal deficits differentiate progressive supranuclear palsy from Parkinson's disease

The clinical differentiation of progressive supranuclear palsy from Parkinson's disease can be challenging, due to overlapping clinical features and a lack of diagnostic markers. Abnormalities in cognitive function form part of the clinical spectrums of these diseases and distinctive cognitive profiles may be helpful in differentiating these diseases in the diagnostic period. A comprehensive neuropsychological test battery was administered to 12 patients with clinically diagnosed progressive supranuclear palsy and 12 patients with Parkinson's disease matched for age and disease duration. Effect size (Cohen's d) was calculated for cognitive tests that were significantly different between groups. Patients with progressive supranuclear palsy performed significantly worse than those with Parkinson's disease on measures of processing speed, verbal fluency, planning, verbal abstract reasoning, verbal memory, and made more perseverative responses on a set shifting task. Measures of executive function, manual dexterity and processing speed were most diagnostically useful (Cohen's d > 2.0) in differentiating between progressive supranuclear palsy and Parkinson's disease. These findings suggest that more severe and prominent ‘frontal’ cognitive deficits in patients with progressive parkinsonism would be helpful in predicting progressive supranuclear palsy rather than Parkinson's disease and these findings may contribute to the development of diagnostic criteria.     

The Role of Recollection and Familiarity in Nondemented Parkinson's Patients

The aim of the current study was to examine if recollection and familiarity decline in nondemented Parkinson's patients. To do so we compared a sample of older people with Parkinson's disease (n = 32) to a control sample of healthy older people (n = 32) on an associative recognition task in which we manipulated the repetition of the pairs during the study phase (half of the pairs were presented once and half twice) to obtain corrected estimates of recollection, familiarity, and false recognition based on the logic of the process-dissociation procedure. The results clearly show that recollection is impaired but familiarity is preserved in nondemented Parkinson's patients. The results show that memory for pairs in Parkinson's patients relies largely on the familiarity of each item and not on a precise recollection of associative information, supporting the idea that recollection-based monitoring processes are impaired in these patients.     

Interference Effects from Observed Movement in Parkinson's Disease

Previous research has demonstrated that Parkinson's disease patients have an increased susceptibility to response conflict. In the present study, the authors investigate whether Parkinson's patients have a similar sensitivity to interference from observed movements. In all, 10 patients and 10 controls performed horizontal and vertical arm movements while watching a video of either a person performing similar movements or a moving dot. Movements were performed in the same plane (congruent) and orthogonal to the observed movement (incongruent). The off-axis variance of movements was our index of interference. Although patients tended to exhibit more off-axis variability than did controls, both groups demonstrated similar congruence effects, with greater variance in incongruent conditions. These results indicated that increased susceptibility to interference in Parkinson's disease does not extend to interference from observed movements.     

Pictorial and lexical priming: Patterns of implicit memory in Alzheimer's and Parkinson's disease patients

Lexical and pictorial priming were examined in patients with Alzheimer's disease and in demented and nondemented patients with Parkinson's disease. Control subjects were divided into young and elderly. Lexical priming used a word‐stem completion task. Pictorial priming task was based on Rey's superimposed pictures test. Elderly normal subjects demonstrated lower lexical priming scores than those of young subjects. Analysis of covariance with age and educational level as covariates showed that normal controls, demented and nondemented Parkinsonian patients, and Alzheimer patients did not differ significantly on the lexical priming task. Pictorial priming scores did not differ significantly between elderly and younger controls. In contrast there was a striking impairment of pictorial priming in Parkinsonian patients, both demented and nondemented. Performance of subjects with mild Alzheimer's disease was superior to that of nondemented Parkinsonian patients. Our results suggest that performance in lexical priming task diminishes with physiological ageing but is unaffected by mild or moderate Alzheimer's disease. Our study also observes the existence of a selective pictorial priming deficit in Parkinson's disease; however, this deficit is not specific, as it is also observed to a lesser degree in Alzheimer's disease. It may therefore be concluded that the systems serving pictorial priming are both cortical and subcortical.     

A Comparison of Effectiveness of Dohsa‐hou and the Alexander Technique on Happiness,Social Adjustment,Hope, Mental Health,and Quality of Life in Patients with Parkinson's Disease

The purpose of this study was to compare the effectiveness of Dohsa‐hou and the Alexander Technique on happiness, social adjustment, hope, mental health, and quality of life in patients with Parkinson's disease. The statistical population of this study included all of the patients with Parkinson's disease who were clients of neural therapeutic centers in Isfahan City in 2015. Among this population, 28 patients were selected through convenience sampling as the sample of the study. The Oxford Happiness Questionnaire, the Social Adjustment Scale, the Adult Hope Scale, the General Health Questionnaire, and the Word Health Quality of Life Questionnaire were used as the instruments of the study. Data were analyzed by analyses of variance with repeated measures. The results showed that both interventions of this study can improve happiness, hope, and quality of life in patients with Parkinson's disease, but Dohsa‐hou is more effective than the Alexander Technique in the improvement of happiness and hope. Probable explanations have been discussed.     

Corrigendum

Mild to moderate Parkinson's disease shows more denervation in the posterodorsal striatum and sparing of the anteroventral striatum. Dopaminergic medications can interfere with anteroventral striatum function by overdosing this relatively intact structure. The authors determined how regional striatal denervation affects medication-associated sequence learning impairment in Parkinson's disease. Eighteen Parkinson's patients performed motor sequence learning on and off levodopa. Patients underwent ¹¹C-dihydrotetrabenazine positron emission tomography scans to measure nigrostriatal denervation. Patients with more preserved putamen were more likely to exhibit levodopa-associated sequence learning impairments. Furthermore, the ratio of denervation in the anterior to posterior dorsal putamen predicted the level of learning differences on and off levodopa. These results demonstrate that the spatial pattern of nigrostriatal dopaminergic denervation predicts medication responsiveness for motor sequence learning.     

Single-Joint Movements in Parkinson's Disease: A Pulse-Width and Pulse-Height Theory Review

The process by which the brain controls single-joint movements (SJM) is still not well understood. Some studies have defined rules describing the duration and magnitude of the agonist and antagonist muscles. Therefore, the purpose of this study was to analyze scientific publications about the electromyographic characteristics of SJM performed by patients with Parkinson's disease. A bibliographical review of the years 1989–2015 was performed using keywords such as electromyography, upper limb, and Parkinson's disease. After applying the inclusion criteria, 8 articles were included for analysis. The literature indicates that despite the lack of studies, it is possible to assume that considering the SJM, those with Parkinson's disease only control the magnitude of electromyography activation, being consistent only with the pulse-height theory control.     

Effect of click trains on duration estimates by people with Parkinson's disease

Patients with a diagnosis of Parkinson's disease and age- and IQ-matched controls estimated the duration of short 500-Hz tones (325–1,225 ms), on trials where the tone was either preceded by 3 s of 5-Hz clicks, or presented without clicks. The click manipulation had been shown in earlier studies with student participants to make verbal estimates longer. Patients were tested both on and off their dopaminergic medication, and controls were also tested in two sessions. Verbal estimates were markedly and significantly longer on trials with clicks than on those without clicks for both the patients and the controls, but there were no significant performance differences between patients or controls, nor between the on and off medication sessions in the patients. The study shows that a manipulation of subjective time, which has had small but consistent effects in student participants, also affects timing in patients and adds to a growing body of evidence that timing in patients with Parkinson's disease may in many cases have the same characteristics as those of neurologically intact control groups.     

Does Response Inhibition Have Pre- and Postdiagnostic Utility in Parkinson's Disease?

ABSTRACT. Parkinson's disease (Pd) is the second most prevalent degenerative neurological condition worldwide. Improving and sustaining quality of life is an important goal for Parkinson's patients. Key areas of focus to achieve this goal include earlier diagnosis and individualized treatment. In this review the authors discuss impulse control in Pd and examine how measures of impulse control from a response inhibition task may provide clinically useful information (a) within an objective test battery to aid earlier diagnosis of Pd and (b) in postdiagnostic Pd, to better identify individuals at risk of developing impulse control disorders with dopaminergic medication.     

Brief Cognitive Behavioral Therapy for Insomnia in Parkinson's Disease: A Case Series Study1

Parkinson's disease (PD) patients frequently suffer from insomnia and insomnia can result in reduction of quality of life in PD. Although pharmacotherapy is most applicable for insomnia, it may cause side-effects in PD. The purpose of the study was to investigate the efficacy of brief cognitive behavioral therapy for insomnia (CBTI) in PD. A total of 11 PD patients aged 43–84 years with chronic insomnia received two sessions of CBTI. Patients reported a significant decrease in total score for the Insomnia Severity Index (ISI). The total score for the Parkinson's Disease Sleep Scale (PDSS) improved. Although objective sleep measured by actigraph did not improve, subjective sleep measured by sleep diary improved. Functional impairment measured by the Sheehan Disability Scale (SDS) significantly decreased. These results revealed that brief CBTI was effective in improving insomnia in PD, with improvements extending to functional impairments that had been affected by insomnia. Additionally, this non-pharmacotherapy treatment could be easily applied to PD patients who may have difficulty coming to the clinic frequently due to physical symptoms.     

De l’efficacité d’un « exergame » sur le stress perçu et le sentiment d’auto-efficacité chez un patient atteint de la maladie de Parkinson : résultats d’un protocole à cas unique de type ABAB

IntroductionRehabilitation is of paramount importance in Parkinson's disease because it compensates for deficiencies in the body's structures and functions and preserves relative autonomy for as long as possible. Nevertheless, people with this disease report low adherence to physical activity.ObjectiveThe purpose of this research is to examine the potential psychological benefits of using an “exergame”, a “serious game” based on physical exercise in the functional rehabilitation of Parkinson's disease, including stress and self-efficacy.MethodA single case ABAB protocol (n = 1) over 4 weeks, 1 week per phase, 3 observation points per phase, was developed. Our variables were measured by questionnaires and we used visual and statistical analysis to interpret changes in scores between Phases A and B.OutcomesThe “exergame” intervention appears to improve perceived stress and self-efficacy. The results are accompanied by an exploratory interview, reporting qualitative changes.ConclusionThe use of “exergame” in Parkinson's disease seems promising, and does not harm the person. But the methodology used is not sufficient to conclude on its real effectiveness. Further studies are needed.     

The Discriminating Properties of an Optoelectronic Movement Analysis Method in Patients With Parkinsonism

Several partly overlapping diseases have Parkinsonism as a symptom and tools that may differentiate between these disorders would be helpful. The authors evaluated the discriminating properties of the objective automated posturo-locomotor-manual (PLM) L-DOPA test in regard to health, and the movement disorders Parkinson's disease (PD), multiple system atrophy (MSA), and progressive supranuclear palsy (PSP). A PLM test–retest procedure was performed in healthy controls (n = 37) and results were compared with PLM L-DOPA tests performed by 132 patients with Parkinsonism in intermediate to advanced stages (56 PD, 53 MSA, 23 PSP). The movement time (MT) for the standardized movement and its different components was measured. The discriminating abilities of individual, or combinations of, test variables were determined by forward stepwise multiple logistic regression and evaluated with receiver-operating characteristic (ROC) analysis. Each PLM variable separated healthy persons from patients with Parkinsonism before administration of L-DOPA (area under the curve (AUC) = 0.94–0.99, p <.001 for any separate variable). A combination of (MT_off – MT_on)/MT_off and MT_on had the highest ability to separate patients with PD from patients with atypical Parkinsonism (area under the curve = 0.91, p <.001). The PLM test discriminates between healthy controls and patients with Parkinsonism, and between patients with Parkinson's disease and patients with atypical Parkinsonism.

[Supplementary material is available for this article. Go to the publisher's online edition of Journal of Motor Behavior for the following free supplemental resource: supplementary data.]     

Impaired sequential and partially compensated probabilistic skill learning in Parkinson's disease

The striatal dopaminergic dysfunction in Parkinson's disease (PD) has been associated with deficits in skill learning in numerous studies, but some of the findings remain controversial. Our aim was to explore the generality of the learning deficit using two widely reported skill learning tasks in the same group of Parkinson's patients. Thirty-four patients with PD (mean age: 62.83 years, SD: 7.67) were compared to age-matched healthy adults. Two tasks were employed: the Serial Reaction Time Task (SRT), testing the learning of motor sequences, and the Weather Prediction (WP) task, testing non-sequential probabilistic category learning. On the SRT task, patients with PD showed no significant evidence for sequence learning. These results support and also extend previous findings, suggesting that motor skill learning is vulnerable in PD. On the WP task, the PD group showed the same amount of learning as controls, but they exploited qualitatively different strategies in predicting the target categories. While controls typically combined probabilities from multiple predicting cues, patients with PD instead focused on individual cues. We also found moderate to high correlations between the different measures of skill learning. These findings support our hypothesis that skill learning is generally impaired in PD, and can in some cases be compensated by relying on alternative learning strategies.     

The Question of a Jungian Community

The author describes her relationship with the reality of Parkinson's disease—how she twists and turns and pivots and falls with this rapacious intrusion, and how a new, hitherto unknown space opens between Parkinson's and herself. This new space claims its own dynamic, objective reality. In attempts to consciously access the reality of this third space, the author faces paradox, “plays” with metaphor, and tries to recognize the right “reality.” She considers Freud's reality and pleasure principles, Winnicott's iconoclastic declaration of “health being the ability to play with psychosis,” and Jung's transcendent function. She also calls on Hermes with his wings to fly through otherwise impenetrable borders. As an incantation, an evocation or a pathway, she implores Hermes to breathe in flight. In the midst of this inner work, the dragonfly literally appears, emanating transformation.     

The Caregivers' Attachment and Relationship Education Class: A New and Promising Group Therapy for Caregivers of Individuals with Parkinson's Disease

The authors examined whether a newly developed group therapy, based on principles of attachment theory and emotionally focused couples therapy, can potentially address the unique mental health and relationship difficulties in caregivers of individuals with Parkinson's disease. A comprehensive outreach effort, involving a review of 251 military veterans' medical records, yielded enrollment of seven spousal caregivers in the group therapy. At 1-month follow-up, caregivers who initially reported mild or greater levels of caregiver burden demonstrated statistically reliable declines in psychological distress, relationship distress, or both. Posttreatment surveys indicated positive perceptions in overall helpfulness of treatment goals, as well as positive changes in insight (e.g., greater understanding of the patient's attachment needs) and behaviors (e.g., greater social contact and self-care of the caregiver). Results are considered in the context of inadequate access to treatment for caregivers of spouses with Parkinson's disease or other major medical issues.     

Natural kind and entitative beliefs in relation to prejudice toward mental disorders

Mental health campaigns often promote biogenetic beliefs to reduce stigma, but their effectiveness may vary across disorders. Our study (N = 127) examined two components of essentialist beliefs—entitative (i.e., characterizing groupness) and natural kinds (i.e., biogenetic)—about two stigmatized mental disorders (schizophrenia, alcoholism) as well as a somatic disorder (Parkinson's disease), and their relation to prejudice. The three disorders significantly differed in natural kind beliefs (Parkinson's highest, then schizophrenia, and alcoholism lowest) and prejudice (alcoholism highest, then schizophrenia, and Parkinson's lowest), but not entitative beliefs. Entitative beliefs, however, was a stronger predictor of prejudice against schizophrenia than natural kind beliefs even after controlling for social dominance orientation and prior contact. Implications for anti‐stigma efforts and strategies are discussed.     

Semantic Fluency Performance of Patients with Cortical and Subcortical Neurodegenerative Diseases

Previous studies using the Animals Fluency Test have shown that dementia patients with Alzheimer's disease (AD), Huntington's disease (HD), or Parkinson's disease (PD) produce fewer correct words and have smaller semantic cluster sizes than controls or PD patients without dementia (PDND). Although the number of correct words generated by the patients with AD was positively correlated with mental status, cluster size, surprisingly, was not. To increase word output and increase the reliability of estimates of cluster size, semantic fluency was reexamined using the Supermarket Fluency Task. Overall, patients with HD or PD with dementia (PDD) exhibited reduced cluster sizes compared to older controls or PDND patients, but cluster sizes were only marginally reduced for patients with AD. These effects were evident only for female participants, because the cluster sizes for elderly control men were substantially smaller than those of elderly women. For the female patients with AD, cluster size was correlated with mental status, but the relationship was nonlinear. Cluster size was normal for mildly demented patients with AD, but much reduced for moderately or severely demented participants. In contrast to a previous report, in the present study the proportion of category labels generated was increased for patients with HD with dementia but not for patients with AD. This finding questions one line of evidence that semantic memory stores undergo “bottom-up” degradation in AD. Together with previous results, these findings indicate that semantic cluster size reflects efficiency of access to semantic knowledge which is similarly compromised in subcortical and cortical diseases.     

Understanding speaker attitudes from prosody by adults with Parkinson's disease

The ability to interpret vocal (prosodic) cues during social interactions can be disrupted by Parkinson's disease, with notable effects on how emotions are understood from speech. This study investigated whether PD patients who have emotional prosody deficits exhibit further difficulties decoding the attitude of a speaker from prosody. Vocally inflected but semantically nonsensical ‘pseudo‐utterances’ were presented to listener groups with and without PD in two separate rating tasks. Task 1 required participants to rate how confident a speaker sounded from their voice and Task 2 required listeners to rate how polite the speaker sounded for a comparable set of pseudo‐utterances. The results showed that PD patients were significantly less able than HC participants to use prosodic cues to differentiate intended levels of speaker confidence in speech, although the patients could accurately detect the polite/impolite attitude of the speaker from prosody in most cases. Our data suggest that many PD patients fail to use vocal cues to effectively infer a speaker's emotions as well as certain attitudes in speech such as confidence, consistent with the idea that the basal ganglia play a role in the meaningful processing of prosodic sequences in spoken language ( Pell & Leonard, 2003 ).     

Disturbance of spontaneous and posed facial expressions in Parkinson's disease

The effects of Parkinson's disease (PD) on spontaneous and posed facial activity and on the control of facial muscles were assessed by comparing 22 PD patients with 22 controls. Facial activity was analysed using the Facial Action Coding System (FACS; Ekman & Friesen, 1978). As predicted, PD patients showed reduced levels of spontaneous and posed facial expression in reaction to unpleasant odours compared to controls. PD patients were less successful than controls in masking or intensifying negative facial expressions. PD patients were also less able than controls to imitate specific facial muscle movements, but did not differ in the ability to pose emotional facial expressions. These results suggest that not only is spontaneous facial activity disturbed in PD, but also to some degree the ability to pose facial expressions, to mask facial expressions with other expressions, and to deliberately move specific muscles in the face.     

To the influence of general slowing and medication on identity‐ and location‐based priming effects in patients with Parkinson's disease

Previous studies on inhibitory mechanisms assessed by negative priming (NP) paradigms in patients suffering from Parkinson's disease (PD) have yielded highly ambiguous results. The present study examined two possible reasons for this heterogeneity: general slowing and anti‐Parkinsonian medication. Their effects on identity and location NP and positive priming (PP) were investigated. Twenty medicated PD patients and 20 PD patients after drug withdrawal were compared to 20 sex‐ and age‐matched healthy controls. The influence of PD patients' general slowing on priming effects was statistically controlled. Location NP was found not to be affected by PD, whereas identity NP was reduced in medicated PD patients compared to non‐medicated PD patients and healthy controls. At first, identity and location PP appeared to be enhanced in both PD groups. After controlling for general slowing, however, differences between PD patients and healthy controls disappeared. These findings endorse the notion that uncontrolled effects of both, PD‐related general slowing and anti‐Parkinsonian medication may have contributed to previously conflicting results on priming effects in PD patients.