Theory of mind and joint action in Parkinson’s disease

It has been suggested that the Theory of Mind (ToM) may rely on more basic processes of social cognition, such as action control (e.g., joint action), even if little is known about this relationship. The relationship between ToM and joint action can be studied in patients with Parkinson’s disease (PD), because they are characterized not only by a deficit in ToM (and in its cognitive and affective subcomponents) but also by a deficit in the inhibition of competing responses. Sixty PD patients and 60 matched healthy controls (HCs) performed a go/no-go Flanker task in both joint and individual conditions. Cognitive (Advanced Test or AT) and affective (Emotion Attribution Task or EAT) ToM also were measured. Thirty-five PD patients and matched HCs also performed the standard Flanker task, as a control measure. In patients, only individuals with high AT scores exhibited a joint Flanker effect, whereas in HCs the joint effect was found irrespectively of AT score. Patients with low EAT scores showed a greater interference effect than patients with high scores, whereas the opposite pattern was found for HCs. In regression analysis AT and EAT scores predicted the Flanker effect in the joint condition only. In the standard task, both groups showed a Flanker effect. The role of different fronto-striatal circuits, especially in PD patients, could explain the different involvement of cognitive and affective ToM in joint tasks. The Flanker effect is discussed considering the referential coding account and the attention-focus account as possible candidates to explain joint action effects.     

The nature of working memory gating in Parkinson’s disease: A multi-domain signal detection examination

Distractions are ubiquitous; our brains are inundated with task-irrelevant information. Thus, to remember successfully, one must actively maintain relevant information and prevent distraction from entering working memory. Researchers suggest the basal ganglia-prefrontal pathways are vital to this process by acting as a working memory gate. Using Parkinson’s disease as a model of frontostriatal functioning and with signal detection analyses, the present study aims to better characterize the contribution of frontostriatal pathways of this gating process and to determine how it operates across multiple domains. To achieve this, Parkinson’s disease patients and healthy controls completed verbal and spatial working memory tasks consisting of three conditions: low-load without distraction; low-load with distraction; and high-load without distraction. Patients were tested both ON and OFF dopaminergic medication, allowing for assessment of the contribution of dorsal and ventral frontostriatal pathways. The results demonstrate that when medication is withheld, Parkinson’s patients have a response bias to answer “NO” across all conditions and domains, supporting our hypothesis that the basal ganglia-prefrontal pathways allow or prevent updates of working memory. Contrastingly, medication status affects d′ in the distraction condition but not in the high- or low-load conditions. We attribute this to stimulus valuation processes that were impaired by dopaminergic medication overdosing the ventral pathway. These findings are both consistent with the hypothesis that the working memory gate filters spatial and verbal information before it enters into the working memory system, adding support for the gate being a domain-general mechanism of the central executive.     

Recognition of familiar and unfamiliar melodies in normal aging and Alzheimer’s disease

We tested normal young and elderly adults and elderly Alzheimer’s disease (AD) patients on recognition memory for tunes. In Experiment 1, AD patients and age-matched controls received a study list and an old/new recognition test of highly familiar, traditional tunes, followed by a study list and test of novel tunes. The controls performed better than did the AD patients. The controls showed the “mirror effect” of increased hits and reduced false alarms for traditional versus novel tunes, whereas the patients false-alarmed as often to traditional tunes as to novel tunes. Experiment 2 compared young adults and healthy elderly persons using a similar design. Performance was lower in the elderly group, but both younger and older subjects showed the mirror effect. Experiment 3 produced confusion between preexperimental familiarity and intraexperimental familiarity by mixing traditional and novel tunes in the study lists and tests. Here, the subjects in both age groups resembled the patients of Experiment 1 in failing to show the mirror effect. Older subjects again performed more poorly, and they differed qualitatively from younger subjects in setting stricter criteria for more nameable tunes. Distinguishing different sources of global familiarity is a factor in tune recognition, and the data suggest that this type of source monitoring is impaired in AD and involves different strategies in younger and older adults.     

Self-reference and emotional memory effects in older adults at increased genetic risk of Alzheimer’s disease

The present study investigated whether cognitively healthy older adults who are carriers of the ε4 allele of apolipoprotein E, the most prevalent genetic risk factor for late-onset Alzheimer’s disease, benefit from self-referential processing and emotional processing to the same degree as noncarriers of this gene. Participants encoded emotional and nonemotional narratives using a baseline-orienting task, semantic elaboration, or imagination-based self-referential processing and then completed a recognition memory test. Both groups of older adults showed enhanced recognition memory for narrative information following self-referential processing relative to semantic elaboration, and the magnitude of this memory effect was not affected by ε4 status. However, older adult ε4 carriers did not show an emotional enhancement effect, whereas older adult ε4 noncarriers did. These results indicate that whereas the self-reference effect is not attenuated in cognitively healthy older adults ε4 carriers, deficits in emotional memory may be an early cognitive marker of abnormal decline.     

Horizontal and vertical attentional orienting in Parkinson’s disease

Patients with Parkinson’s disease (PD) typically suffer from an asymmetric degeneration of dopaminergic cells in the substantia nigra, resulting in right-sided (RPD) or left-sided (LPD) predominance of motor symptomatology. As the dopaminergic system is also involved in attention, we examined horizontal and vertical orienting of attention in LPD (N = 10), RPD (N = 9) and controls (N = 10). Four LPD patients demonstrated left neglect and three LPD patients demonstrated neglect for the upper visual field. LPD patients demonstrated a slower performance in detecting targets in the left hemifield and did not demonstrate a validity effect, unlike RPD patients and controls. RPD patients performed similar to controls, with the exception of one patient showing left and another showing right neglect, and two RPD patients demonstrated lower neglect. In sum, horizontal and vertical orienting of attention can be affected in Parkinson’s disease – particularly in LPD – from very subtle slowing to clinically detectable horizontal and/or vertical neglect.     

Working memory span tasks: A methodological review and user’s guide

Working memory (WM) span tasks—and in particular, counting span, operation span, and reading span tasks—are widely used measures of WM capacity. Despite their popularity, however, there has never been a comprehensive analysis of the merits of WM span tasks as measurement tools. Here, we review the genesis of these tasks and discuss how and why they came to be so influential. In so doing, we address the reliability and validity of the tasks, and we consider more technical aspects of the tasks, such as optimal administration and scoring procedures. Finally, we discuss statistical and methodological techniques that have commonly been used in conjunction with WM span tasks, such as latent variable analysis and extreme-groups designs.     

Dysexecutive syndrome in Parkinson’s disease: the GREFEX study

The objectives of this study were to characterize the frequencies and profiles of behavioral and cognitive dysexecutive syndromes in PD (based on validated battery and diagnostic criteria) and to develop a shortened diagnostic battery. Eighty-eight non-demented patients with a diagnosis of PD were examined with an executive validated battery. Using a validated framework, the patients’ test results were interpreted with respect to normative data from 780 controls. A dysexecutive syndrome was observed in 80.6% of the patients [95% confidence interval: 71.1–90.1]. The dysexecutive profile was characterized by prominent impairments in deduction, flexibility, inhibition and initiation in the cognitive domain, and by global hypoactivity with apathy and hyperactivity in the behavioral domain. This finding implies that patients with PD should be assessed with cognitive tests and a validated inventory for behavioral dysexecutive syndromes. A shortened battery (based on three cognitive tests and three behavioral domains) provided high diagnostic accuracy.     

Impulse control disorders in Parkinson’s disease: Predominant role of psychological determinants

Objectives: Impulse Control Disorders (ICDs) in Parkinson’s disease (PD) have previously almost exclusively been considered to result from anti-parkinsonian medication. However, this biomedical perspective has failed to achieve a full understanding of the phenomenon and it is argued that a failure to consider psychological factors is a critical omission.

Design: The present study examined the predictive relationship between ICDs in PD and a range of psychological measures, whilst controlling for a number of biomedical determinants.

Main outcome measures: One hundred participants with idiopathic PD completed questionnaires that assessed demographic and clinical characteristics, psychological measures and the presence of ICDs (QUIP-RS).

Results: Increased use of a ‘negative’ coping strategy, stronger illness identity, more emotional illness representations and stress were found to be significant predictors of ICDs, and different psychological predictors were associated with different ICDs. Medication was not found to predict ICDs in the presence of psychological factors, either when total treatment levels were considered or when agonist dose was considered alone.

Conclusions: This study provides the first quantitative evidence of a predominant predictive relationship between psychological factors and ICDs in PD. The results suggest that psychological interventions may have useful therapeutic role to play for ICDs in PD.     

Subjective organization in the episodic memory of individuals with Parkinson’s disease associated with mild cognitive impairment

Word clustering (i.e., the ability to reproduce the same word pairs in consecutive recall trials of an unrelated word list) has been extensively investigated as a proxy of subjective organization (SO) of memorandum. In healthy subjects and in groups of brain-damaged patients, the rate of SO generally predicts accuracy of word list recall. This study aimed at evaluating SO in the performance of patients with Parkinson’s disease (PD) on a word list recall task in order to investigate the basic mechanisms of episodic memory impairment that are frequently observed in these patients. For this purpose, 56 PD patients, who were stratified according to the presence and quality of mild cognitive impairment (MCI), and a group of healthy controls (HCs) were administered a word list task and an extensive battery of neuropsychological tests. Results showed that recall accuracy on the word list task progressively decreased passing from HC to PD patients without cognitive impairment, to patients with single-domain dysexecutive MCI and to patients with multiple-domain dysexecutive and amnesic MCI. Conversely, only the latter PD group showed a lower SO score than that achieved by the other groups. In the overall PD group, correlational and regression analyses demonstrated that SO scores and a composite score of executive functions were not reciprocally related, but both provided an independent and significant contribution to the prediction of word list recall accuracy. These data are discussed in terms of the contribution of executive functions and hippocampal storage processes to the onset of memory impairment in PD.     

Self-unawareness of levodopa induced dyskinesias in patients with Parkinson’s disease

The study analyzes the presence of dyskinesias-reduced-self-awareness in forty-eight patients suffering from Parkinson’s disease (PD). As the association with executive dysfunction is a matter of debate and we hypothesize it plays an important role in dyskinesias self-unawareness, we analyzed the role of dopaminergic treatment on the medial-prefrontal-ventral-striatal circuitry using a neurocognitive approach. Special attention was given to metacognitive abilities related to action-monitoring that represent a novel explanation of the phenomenon.PD patients were assessed using different rating scales that we devised to measure movement awareness disorders. In order to ascertain whether each variable measured at a cognitive-clinical level contributes to predicting the scores of the movement-disorder-awareness-scales, we conducted multiple logistic regression models using the latter as binary dependent variables. We used the Wisconsin Card Sorting Test-metacognitive-version to assess the executive functions of the prefrontal-ventral-striatal circuitry.Data showed that a reduction of self-awareness using the Dyskinesia rating scale was associated with global monitoring (p = .04), monitoring resolution (p = .04) and control sensitivity (p = .04). Patients failed to perceive their performance, distinguish between correct and incorrect sorts, be confident in their choice and consequently decide to gamble during the task.We did not find any association with executive functions using the hypo-bradykinesia rating scale.Our findings indicate that when the comparator mechanism for monitoring attentive performance is compromised at a prefrontal striatal level, patients lose the ability to recognize their motor disturbances that do not achieve conscious awareness.     

Executive function in Parkinson’s disease: contributions of the dorsal frontostriatal pathways to action and motivation

Disruption of the dorsal frontostriatal pathways in Parkinson’s disease (PD) is associated with impairments in motivation, as well as in executive function. The goal of this study was to investigate whether these impairments are related and, if so, whether the disruption of frontostriatal pathways compromises the ability to process the motivational aspects of feedback in such tasks. In Experiment 1, informative feedback improved the performance of young, healthy participants in a task-switching paradigm. This task-switching paradigm was then used in Experiment 2 to test whether feedback would improve the performance of 17 PD patients and age-matched controls. The PD group benefitted from feedback to the same degree as control participants; however, depression scores on the Beck Depression Inventory were significantly related to feedback usage, especially when response selection demands were high. Regardless of feedback, PD patients were more impaired when response demands were high than in an equally difficult condition with low action demands. These results suggest that response selection is a core impairment of insufficient dopamine to the dorsal frontal striatal pathways.     

Laterality of repetitive finger movement performance and clinical features of Parkinson’s disease

Impairments in acoustically cued repetitive finger movement often emerge at rates near to and above 2 Hz in persons with Parkinson’s Disease (PD) in which some patients move faster (hastening) and others move slower (bradykinetic). The clinical features impacting this differential performance of repetitive finger movement remain unknown. The purpose of this study was to compare repetitive finger movement performance between the more and less affected side, and the difference in clinical ratings among performance groups. Forty-one participants diagnosed with idiopathic PD completed an acoustically cued repetitive finger movement task while “on” medication. Eighteen participants moved faster, 10 moved slower, and 13 were able to maintain the appropriate rate at rates above 2 Hz. Clinical measures of laterality, disease severity, and the UPDRS were obtained. There were no significant differences between the more and less affected sides regardless of performance group. Comparison of disease severity, tremor, and rigidity among performance groups revealed no significant differences. Comparison of posture and postural instability scores revealed that the participants that demonstrated hastening had worse posture and postural instability scores. Consideration of movement rate during the clinical evaluation of repetitive finger movement may provide additional insight into varying disease features in persons with PD.     

Psychophysiological and behavioral differences as a function of age and Parkinson’s disease

Differences related to age and to specific neurological (Parkinsonian) damage were studied by contrasting, respectively, old (mean age 64 years) and young (27 years) subjects (N=15), and old-normal (N=15) and old-Parkinsonian (N=15) subjects. Both behavioral as well as psychophysiological dependent variables were employed. The behavioral measure was performance on a discrimination learning task, while the psychophysiological measures were based on habituation to a repeated tone stimulus and on a Pavlovian differential conditioning preparation. The behavioral task showed predominantly age-related differences, with the young learning faster. Another age-related difference was interpreted as showing a more insight-like learning process in the young. Response-bias (beta) values did not differ between groups. Age-related differences also emerged more clearly than specific-neurological-damage differences in the psychophysiological data. The older subjects manifested markedly less autonomic conditioning, which was probably due to a lowering of reactivity, as well as the emergence of habituation to the (loud-noise) unconditional stimulus. A correlational analysis of discrimination conditioning also yielded age-related differences. Most notably, reactivity played a greater role in conditioning in the old than in the young subjects. The results illustrated how psychophysiological measures can provide information that complements those provided by behavioral measures.     

Does expanded retrieval produce benefits over equal-interval spacing? Explorations of spacing effects in healthy aging and early stage Alzheimer's disease

Three experiments explored different schedules of retrieval practice in young adults, older adults, and individuals with dementia of the Alzheimer type. In each experiment, an initial acquisition phase was presented in which participants studied or attempted to retrieve response words to cues, followed by a later cued-recall test. Experiment 1 produced a benefit of expanded retrieval over equal-interval retrieval during acquisition, but this benefit was lost in final cued recall. In Experiments 2 and 3, participants received corrective feedback during acquisition and modified spacing schedules. There was again no evidence of a difference between expanded and equal-interval conditions in final cued recall. Discussion focuses on the potential benefits and costs of expanded retrieval on a theoretical and applied level.     

Children’s decision making: the effects of training,reinforcement, and memory aids

Previous research on children’s decision making [Cogn. Dev. 6 (1991a) 77] has found that, unlike older children and adults, young children are frequently unable to eliminate an alternative as soon as it is clear that it is unsuitable. More precisely, young children have difficulty ignoring irrelevant information and attending to relevant information when examining alternatives. The present study explored whether children’s tendency to ignore relevant information is due to the saliency of that information, the child’s lack of motivation, or memory limitations of the child. To test these hypotheses, 197 second and fifth graders were divided into four groups: a training group designed to overcome saliency concerns, a reinforcement group designed to overcome motivation problems, a marking group designed to overcome memory limitations, and a control group. Children in the training and reinforcement groups examined less irrelevant information than did children in the control group; however, marking unsuitable alternatives did not improve children’s performance. This left the role of memory unclear. Additionally, verbal skill level was related to the number of irrelevant items examined for all children, but accounted for a minimal amount of variance.     

A paradigm for emulating the early learning stage of handwriting: Performance comparison between healthy controls and Parkinson’s disease patients in drawing loop shapes

We present a novel paradigm, aimed at emulating the early stage of handwriting learning in proficient writers, by asking them to produce a familiar shape through a novel (unfamiliar) motor plan. Handwriting of beginner writers is characterized by slower movements, reduced spatial precision, lower fluency and reduced force regulation compared to those observed in the handwriting production of proficient writers. Features observed in the ink trace obtained with the novel motor plan and performance comparison of the handwriting obtained by familiar and unfamiliar motor plan suggest that the proposed paradigm is able to elicit non-automated movements in proficient writers.As that produced by beginner writers, handwriting of Parkinson’s disease (PD) patients is characterized by lack of fluency, slowness and abrupt changes of direction. Furthermore, PD patients show impaired performance in learning novel motor behaviors, as well as in executing motor behaviors acquired before the onset of the disease. We used the proposed paradigm for comparing the performance achieved by healthy controls in writing a familiar shape through a novel motor plan with those obtained by PD patients performing a well-known motor plan for drawing the same shape. Our analysis points out some similarities between performance obtained by healthy controls and those obtained by PD patients, sustaining the hypothesis that the fine tuning of the motor plan parameters involved in the handwriting production is impaired by PD.     

Optimized cuttlefish algorithm for diagnosis of Parkinson’s disease

This paper presents an optimized cuttlefish algorithm for feature selection based on the traditional cuttlefish algorithm, which can be used for diagnosis of Parkinson’s disease at its early stage. Parkinson is a central nervous system disorder, caused due to the loss of brain cells. Parkinson's disease is incurable and could eventually lead to death but medications can help to control symptoms and elongate the patient's life to some extent. The proposed model uses the traditional cuttlefish algorithm as a search strategy to ascertain the optimal subset of features. The decision tree and k-nearest neighbor classifier as a judgment on the selected features. The Parkinson speech with multiple types of sound recordings and Parkinson Handwriting sample’s datasets are used to evaluate the proposed model. The proposed algorithm can be used in predicting the Parkinson’s disease with an accuracy of approximately 94% and help individual to have proper treatment at early stage. The experimental result reveals that the proposed bio-inspired algorithm finds an optimal subset of features, maximizing the accuracy, minimizing number of features selected and is more stable.