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.     

Comparative assessment of the behaviour of drivers with Mild Cognitive Impairment or Alzheimer’s disease in different road and traffic conditions

The objective of this research was the analysis of the driving performance of drivers with Mild Cognitive Impairment (MCI) or Alzheimer’s disease (AD), in different road and traffic conditions, on the basis of a driving simulator experiment. In this experiment, healthy “control” drivers, patients with MCI, and patients with AD, drove at several scenarios at the simulator, after a thorough neurological and neuropsychological assessment. The scenarios include driving in rural and urban areas in low and high traffic volumes. The driving performance of healthy and impaired drivers was analysed and compared by means of Repeated Measures General Linear Modelling techniques. A sample of 75 participants was analysed, out of which 23 were MCI patients and 14 were AD patients. Various driving performance measures were examined, including longitudinal and lateral control measures. The results suggest that the two examined cerebral diseases do affect driving performance, and there were common driving patterns for both cerebral diseases, as well as particular characteristics of specific pathologies. More specifically, cognitively impaired drivers drive at lower speeds and with larger headway compared to healthy drivers. Moreover, they appear to have difficulties in positioning the vehicle on the lane. The group of patients had difficulties in all road and traffic environments, and especially when traffic volume was high. Most importantly, both cerebral diseases appear to significantly impair reaction times at incidents. The results of this research suggest that compensatory behaviours developed by impaired drivers are not adequate to counterbalance the direct effects of these cerebral diseases on driving skills. They also demonstrate that driving impairments increase as cognitive impairments become more severe (from MCI to AD).     

Possible selves in patients with right- versus left-onset Parkinson’s disease

Possible selves can be used to self-regulate and guide behavior towards what is desired to be achieved or avoided in life. Previous work suggests laterality effects exist within the brain regarding approach and avoidance systems to achieve self-regulation. A modified version of the possible selves task was administered to 45 patients with PD (22 right-onset and 23 left-onset) and 25 community dwelling control subjects (CS). Only 11.1% of patients exhibited balance among their hoped-for and feared possible selves versus 28% of CS. More right-onset patients used a promotion strategy whereas more left-onset patients used a prevention strategy. Patients with left-onset PD thought more about their feared selves, exhibiting reduced goal-directed behavior. Findings among the left-onset group indicate relative dependence of self-regulation on right-sided avoidance brain systems. This may point to an inability to move away from negative outcomes and to work towards rewarding outcomes, which could affect psychological health.     

Aging,memory loss,and Alzheimer’s disease: What do refugees from the former Soviet Union think?

ABSTRACT

Since the mid-1970s, approximately 700,000 émigrés from the former Soviet Union (FSU), most of Jewish descent, settled in the United States. Now, 25 or more years post-emigration, they have “aged in place” in the United States, but their values, beliefs, and attitudes about growing old, memory changes, and Alzheimer’s disease remain grounded in their earlier life experiences. Based on findings from a study of the social and cultural factors affecting beliefs about Alzheimer’s disease, aging, and memory loss, this article examines how past life experiences, the immigration experience, and cultural values affect Russian-speaking refugees’ beliefs and views about aging, memory loss, and Alzheimer’s disease.     

Variability in subcortical aphasia is due to variable sites of cortical hypoperfusion

A variety of fluent and nonfluent aphasias have been reported after left basal ganglia stroke. It has been speculated that this heterogeneity may reflect variations in cortical hypoperfusion resulting from large vessel stenosis. To test this hypothesis, a consecutive series of 24 patients with left caudate infarct identified with diffusion-weighted imaging underwent language testing and perfusion-weighted imaging < 24h from onset of symptoms. Specific regions in perisylvian cortex were rated for the percentage of the region that was hypoperfused. Aphasia type was determined on the basis of speech fluency, comprehension, and repetition performance on the language tests. Association between aphasia type/language impairment and regions of hypoperfusion were identified with Fisher's exact tests. Results demonstrated that in patients with acute left caudate infarct, the presence and type of aphasia reflected regions of hypoperfusion, and generally followed predictions based on chronic lesion studies, regarding anatomical lesions associated with classic aphasia types.     

An experimentally confirmed statistical model on arm movement

The purpose of this research work was to develop a methodology to model arm movement in normal subjects and neurologically impaired individuals through the application of a statistical modelling method. Thirteen subjects with Parkinson's disease and 29 normal controls were recruited to participate in an arm motor task. An infrared optoelectronic kinematic movement analysis system was employed to record arm movement at 50 times per second. This study identified the modified extended Freundlich model as one that could be used to describe this task. Results showed that this model fit the data well and that it has a good correspondence between the observed and the predicted data. However, verification of the model showed that the residuals contained a sizeable autocorrelation factor. The Cochrane and Orcutt method was applied to remove this factor, which improved the fit of the model. Results showed that Parkinson's disease subjects had a higher autocorrelation coefficient than the normal subjects for this task. A positive correlation (r(s) = 0.72, p < 0.001) was found between the Langton-Hewer stage and the autocorrelation coefficient of PD subjects. This finding suggests that if autocorrelation is positively correlated with disease progression, clinicians in their clinical practice might use the autocorrelation value as a useful indicator to quantify the progression of a subjects' disease. Significant differences in model parameters were seen between normal and Parkinson's disease subjects. The use of such a model to represent and quantify movement patterns provides an important base for future study.     

The relationship between executive function and verbal memory in Parkinson's disease

A growing body of evidence suggests that the various cognitive symptoms found in Parkinson's disease (PD) are secondary to executive dysfunction. Studies addressing this possibility for memory impairment specifically have not included measures of working memory nor have they ruled-out potential mediating variables such as overall level of cognitive impairment or depression. The purpose of this study was to include measures of these variables in determining the relationship between multiple aspects of executive function and delayed verbal recall in 32 idiopathic PD patients. Results were consistent with the original hypothesis and further suggest that working memory is a key factor in recall memory and may mediate the relationship between other executive measures and recall in PD.     

A Meta-Analysis of Structural and Functional Brain Imaging in Dementia of the Alzheimer's Type: A Neuroimaging Profile

We conducted a quantitative review of the imaging literature using meta-analytic methodology to characterize further the magnitude of hippocampal deficit in probable Alzheimer's disease (AD) and to determine whether other neuroanatomic structures in AD can better discriminate the disease from normal aging. Additionally, we parceled the discriminability of neuroanatomic structures by duration of disease to determine those structures most sensitive to AD in its early and late stages. One hundred twenty-one studies published between 1984 and 2000 met criteria for inclusion in the present analysis. In total, structural (i.e., CT and MRI) and functional (i.e., SPECT and PET) neuroimaging results from 3511 patients with AD, and 1632 normal healthy controls were recorded across meta-analyses. Our results include neuroimaging profiles for both early onset and longer duration patients with AD. In sum, these profiles yield a signature of diagnostic markers in both cortical and subcortical neuroanatomic areas. This signature is consistent with the clinical phenomenology of Alzheimer's dementia and should aid in the positive identification of AD.