Motivational and myopic mechanisms underlying dopamine medication-induced impulsive-compulsive behaviors in Parkinson's disease

IntroductionDopaminergic medications can trigger impulsive-compulsive behaviors (ICBs) in pre-disposed patients with Parkinson's disease (PD), but what this implies on a neurocognitive level is unclear. Previous findings highlighted potentially exacerbated incentive motivation (willingness to work for rewards) and choice impulsivity (preferring smaller, immediate rewards over larger, delayed rewards) in PD patients with ICBs (PD + ICBs).MethodsTo deeply understand this evidence, we studied 24 PD + ICBs and 28 PD patients without ICBs (PD-ICBs). First of all, patients underwent the assessment of impulsivity traits, mood, anxiety, and addiction condition. We further administered robust objective and subjective measures of specific aspects of motivation. Finally, we explored whether these processes might link to any heightened antisocial behavior (aggression and risky driving) in PD + ICBs.ResultsHigh levels of positive urgency trait characterized PD + ICBs. They choose to exert more effort for rewards under the conditions of low and medium reward probability and as reward magnitude increases. Findings on choice impulsivity show a great tendency to delay discounting in PD + ICBs, other than a high correlation between delay and probability discounting. In addition, we found what appears to be the first evidence of heightened reactive aggression in PD patients with ICBs. Exacerbated incentive motivation and delay discounting trended toward positively predicting reactive aggression in PD + ICBs.DiscussionOur promising results suggest that there might be immense value in future large-scale studies adopting a transdiagnostic neurocognitive endophenotype approach to understanding and predicting the addictive and aggressive behaviors that can arise from dopaminergic medication in PD

Shaping attitudes: the association between prior contact with residential aged care and resistance to enter residential aged care

Background: The ageing population is increasing, and negative attitudes towards older people are all too common and largely overlooked. However, little research has examined how ageist, prejudice, and discrimination, that often occur in healthcare settings, impact the community's perceptions of entering Residential Aged Care (RAC) in the future. In particular, studies have not investigated how contact with RAC influences individuals’ attitudes towards RAC facilities, residents and staff. This study is the first to examine individuals’ resistance towards living in RAC using the contact hypothesis, a theory of prejudice reduction. Aims: To explore how positive or negative contact with RAC residents and staff impacts individuals’ behavioural intentions towards entering RAC in the future. To examine whether perceptions of trust, independence and RAC staff mediate the relationship between contact and behavioural intentions towards entering RAC in the future. Design: A cross-sectional survey design. Method: Data were collected via online surveys using contact (positive or negative), trust, independence, perceptions of RAC staff and resistance levels (mild refusal or extreme refusal) measures. Participants (n\ua0=\ua0373) from Australia and USA were recruited using social media, word of mouth and Amazons Mechanical Turk. Findings: Individuals who experienced negative contact with RAC residents and staff were more likely to report intense resistance to RAC, “I would rather die than enter RAC”. Whereas, positive contact with RAC residents and staff was associated with reductions in the adverse appraisal of RAC staff; a diminished perception that individuals lost their independence, and an increased trust in RAC residents, facilities and staff. Participants from USA reported greater levels of resistance towards RAC in comparison with participants from Australia. This study demonstrates how interactions with RAC residents, facilities and staff are critical in shaping attitudes towards RAC. Implications for practice: It is recommended that the public are exposed to opportunities where they can experience positive contact with RAC. RAC facilities can promote interaction between the public and RAC residents through encouraging participation in community partnership programs/intergenerational programs

Depression rating scales in Parkinson's disease: A critical review updating recent literature

Depression is a prominent non-motor symptom in Parkinson's disease (PD). Assessing depression in PD remains a challenge due to the overlap of somatic symptoms between depression and PD. Other neuropsychiatric manifestations associated with PD, such as cognitive decline, also complicate assessment of depression. Therefore it is critical to investigate the validity of depression rating scales for use in PD. This will allow evaluation of observer- and self-report instruments to be administered in neurologically ill geriatric populations such as PD, and identification of appropriate scales to use in cognitively challenged PD patients. The present review includes all studies examining the validity of depression rating scales in PD. It discusses the usefulness of 13 depression rating scales in PD. The clinician-rated and widely used HAMD-17 and the self-report GDS scales are recommended for screening and measuring severity of depression in PD. The GDS-15 may be a preferred choice due to its brevity and ease of use design for older adults. Other valid and reliable instruments to use in PD include self-rated scales, such as the HADS-D, HDI, and the BDI, and the observer-report, MADRS. The CSDD displayed satisfactory validity and reliability for identification of PD patients with and without dementia. The PHQ-2, PHQ-10, SDS, CES-D, UPDRS-Depression item, IDS-SR, and IDS-C each showed some evidence of validity or reliability, however further research on the psychometric properties of these scales when used in a PD population are required. (C) 2015 Elsevier B.V. All rights reserved

A systematic review of the use of virtual reality and its effects on cognition in individuals with neurocognitive disorders

Introduction: Virtual reality (VR) interventions are increasingly used in individuals with brain injuries. The objective of this study was to determine the effects of VR on overall cognitive functioning in individuals with neurocognitive disorders (NCDs). Methods: Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review of the published literature on immersive and nonimmersive VR technologies targeting cognition in minor and major NCDs was conducted: (PROSPERO registration number: CRD42019121953). Results: A total of 22 studies were included in the review, for an aggregated sample of 564 individuals with NCDs. Most of the studies were conducted on patients who had stroke (27.3%), followed by mild cognitive impairment (22.7%) and Alzheimer's disease (13.6%). VR interventions used for cognitive rehabilitation suggested to improve cognition (e.g. memory, dual tasking, and visual attention), and secondarily to psychological functioning (e.g. reduction of anxiety, higher levels of well-being, and increased use of coping strategies). Conclusion: VR interventions are useful to improve cognition and psychological symptoms in NCDs

Motivational and myopic mechanisms underlying dopamine medication-induced impulsive-compulsive behaviors in Parkinson's disease

Introduction: Dopaminergic medications can trigger impulsive-compulsive behaviors (ICBs) in pre-disposed patients with Parkinson's disease (PD), but what this implies on a neurocognitive level is unclear. Previous findings highlighted potentially exacerbated incentive motivation (willingness to work for rewards) and choice impulsivity (preferring smaller, immediate rewards over larger, delayed rewards) in PD patients with ICBs (PD + ICBs). Methods: To deeply understand this evidence, we studied 24 PD + ICBs and 28 PD patients without ICBs (PD-ICBs). First of all, patients underwent the assessment of impulsivity traits, mood, anxiety, and addiction condition. We further administered robust objective and subjective measures of specific aspects of motivation. Finally, we explored whether these processes might link to any heightened antisocial behavior (aggression and risky driving) in PD + ICBs. Results: High levels of positive urgency trait characterized PD + ICBs. They choose to exert more effort for rewards under the conditions of low and medium reward probability and as reward magnitude increases. Findings on choice impulsivity show a great tendency to delay discounting in PD + ICBs, other than a high correlation between delay and probability discounting. In addition, we found what appears to be the first evidence of heightened reactive aggression in PD patients with ICBs. Exacerbated incentive motivation and delay discounting trended toward positively predicting reactive aggression in PD + ICBs. Discussion: Our promising results suggest that there might be immense value in future large-scale studies adopting a transdiagnostic neurocognitive endophenotype approach to understanding and predicting the addictive and aggressive behaviors that can arise from dopaminergic medication in PD

A neurophysiological study of semantic processing in Parkinson’s disease

Objectives: Cognitive-linguistic impairments in Parkinson's disease (PD) have been well documented; however, few studies have explored the neurophysiological underpinnings of semantic deficits in PD. This study investigated semantic function in PD using event-related potentials. Methods: Eighteen people with PD and 18 healthy controls performed a semantic judgement task on written word pairs that were either congruent or incongruent. Results: The mean amplitude of the N400 for new incongruent word pairs was similar for both groups, however the onset latency was delayed in the PD group. Further analysis of the data revealed that both groups demonstrated attenuation of the N400 for repeated incongruent trials, as well as attenuation of the P600 component for repeated congruent trials. Conclusions: The presence of N400 congruity and N400 repetition effects in the PD group suggests that semantic processing is generally intact, but with a slower time course as evidenced by the delayed N400. Additional research will be required to determine whether N400 and P600 repetition effects are sensitive to further cognitive decline in PD

Remote delivery of psychological interventions for Parkinson's disease

Objective:: Over two-thirds of Parkinson's disease (PD) patients experience comorbid neuropsychiatric symptoms, which adversely impact their quality of life and often require intervention. There is a preference for non-pharmacological, psychological approaches in addressing these symptoms. Given mobility limitations, travel burden, and cost, accessibility to psychological treatment can be problematic in this population. There has been a recent shift toward delivering care via telehealth in PD. Accordingly, this review aimed to examine remotely delivered psychological interventions for PD patients. Results:: Most of the telehealth studies for PD involved Cognitive Behavioral Therapy (CBT) based anxiety and depression telephone interventions with relatively short (one month) follow-up periods. Conclusion:: Although a preliminary work indicates efficacy, future studies should demonstrate the non-inferiority of these telehealth programs compared to face-to-face delivery, and examine the long-term outcomes of remotely delivered therapy. Video-conferencing (VC) appears to be a promising modality to overcome noted limitations of telephone delivery, and has demonstrated efficacy for PD speech programs. Further research should be conducted evaluating telehealth VC modalities for delivery of psychotherapy including CBT, as well as mindfulness-based therapy and acceptance and commitment therapy for remote treatment of depression and anxiety in PD

Anxiety rating scales in Parkinson's disease: a critical review updating recent literature

Background: Assessing anxiety in Parkinson's disease (PD) has been a recent focus, and a number of studies have extensively investigated the validity of anxiety rating scales in PD. The present review aims to provide an overview of anxiety scales widely used and/or validated in PD, and to highlight recommendations for future research required in this area