Executive Functioning in Daily Life in Parkinson's Disease:Initiative, Planning and Multi-Task Performance

Impairments in executive functioning are frequently observed in Parkinson's disease (PD). However, executive functioning needed in daily life is difficult to measure. Considering this difficulty the Cognitive Effort Test (CET) was recently developed. In this multi-task test the goals are specified but participants are free in their approach. This study applies the CET in PD patients and investigates whether initiative, planning and multi-tasking are associated with aspects of executive functions and psychomotor speed. Thirty-six PD patients with a mild to moderate disease severity and thirty-four healthy participants were included in this study. PD patients planned and demonstrated more sequential task execution, which was associated with a decreased psychomotor speed. Furthermore, patients with a moderate PD planned to execute fewer tasks at the same time than patients with a mild PD. No differences were found between these groups for multi-tasking. In conclusion, PD patients planned and executed the tasks of the CET sequentially rather than in parallel presumably reflecting a compensation strategy for a decreased psychomotor speed. Furthermore, patients with moderate PD appeared to take their impairments into consideration when planning how to engage the tasks of the test. This compensation could not be detected in patients with mild PD.</p

Sentence Comprehension and Its Association with Executive Functions in Patients with Parkinson's Disease

Coexistent impairments in executive functions and language comprehension in patients with Parkinson's disease (PD) have been repeatedly observed. In this study, the aim was to provide insights into the interaction between linguistic representation and processing and executive functioning. Therefore, sentence comprehension and executive functions were assessed in 28 Dutch-speaking PD patients and 28 healthy control subjects. Three aspects of the sentence materials were varied: (1) phrase structure complexity, (2) sentence length, and (3) picture congruence. PD patients with mild-to-moderate disease severity showed decreased sentence comprehension compared to healthy control subjects. The difficulties encountered by PD patients were not limited to one aspect of the sentence materials. The same pattern of results was present in healthy control subjects. Deficits in set-switching were specifically associated with the comprehension of passive sentences. Generally, our study confirms that there does not appear to be a language faculty encapsulated from the influence of executive functions

The Development of an Embedded Figures Test for the Detection of Feigned Attention Deficit Hyperactivity Disorder in Adulthood

OBJECTIVES: It has been shown that an increasing number of adults deliberately feign attention deficit hyperactivity disorder (ADHD), which demonstrates the need for new tests designed to detect feigned ADHD. METHODS: An Embedded Figures Test (EFT) was developed for the detection of feigned ADHD in adulthood. EFT performance of 51 adults with ADHD was compared to the performance of 52 matched healthy individuals, as well as to 268 undergraduate students who were randomly allocated in a simulation design to one of four experimental conditions, i.e. a control group, a naïve simulation group, a symptom-coached simulation group or a test-coached simulation group. Furthermore, an independent sample of 11 adults with ADHD as well as a sample of 17 clinicians experienced in the work with adults with ADHD were assessed for further validation of the EFT. RESULTS: The EFT was relatively easy to perform for both patients with ADHD and healthy comparisons as shown by low error rates and non-significant group differences. However, simulation groups differed from patients with ADHD by significant and large effects. An EFT index for the prediction of feigned ADHD was derived based on logistic regression coefficients. Receiver Operating Characteristics (ROC) demonstrated good classification accuracy of feigned ADHD relative to ADHD (AUC = 94.8%), i.e. high sensitivity (88%) and specificity (90%). CONCLUSIONS: This study supports the utility of the EFT for the detection of feigned adult ADHD

Financial problems of people with psychotic disorders:- a qualitative study

AimTo qualitatively explore people with psychotic disorders’ (PD) perspectives on their financial problems and the causes for these problems. BackgroundFinancial capacity is pivotal for independent living (e.g., grocery shopping, paying bills), and financial incapacity can have far-reaching consequences (e.g., poverty, diminished societal participation, losing financial independence). Finances are a key challenge for people with PD. They often rely on government benefits as their source of income, with approximately one-third of people being unemployed. Sometimes, caregivers or financial guardians have to intervene. Most studies addressing financial problems of people with PD use a quantitative approach. One qualitative study suggests that psychotic experiences interrupted people’s working situation and, therefore, their financial stability. However, scientific literature on this topic is scarce. A broader and richer approach to studying financial problems of people with PD is thus urgently needed. MethodFourteen people with PD were recruited using purposive sampling. Semi-structured, in-depth interviews were conducted. The Qualitative Analysis Guide of Leuven served as an iterative guide for data-analysis.Results People with PD face many financial problems, sometimes even triggering psychosis. These are subdivided into four categories: covering expenses, financial management, housing, and conflicts and legal problems. Causes for financial problems consist of seven categories: psychotic vulnerability directly (e.g., due to positive symptoms), indirectly (e.g., due to high healthcare costs), substance use, high costs, overspending, fraud, and a lack of developed financial skills. Categories are illustrated with relevant quotations. Conclusions People with PD experience various and often multiple financial problems, from having a limited budget to homelessness. This study uniquely describes the wide-ranging causes for these problems, both related and unrelated to psychotic vulnerability. Thus, financial problems of people with PD is an important, complex topic that deserves more clinical and scientific attention. Future studies could focus on perspectives of other stakeholders (e.g. caregivers)

Financial problems of people with psychotic disorders:- a qualitative study

AimTo qualitatively explore people with psychotic disorders’ (PD) perspectives on their financial problems and the causes for these problems. BackgroundFinancial capacity is pivotal for independent living (e.g., grocery shopping, paying bills), and financial incapacity can have far-reaching consequences (e.g., poverty, diminished societal participation, losing financial independence). Finances are a key challenge for people with PD. They often rely on government benefits as their source of income, with approximately one-third of people being unemployed. Sometimes, caregivers or financial guardians have to intervene. Most studies addressing financial problems of people with PD use a quantitative approach. One qualitative study suggests that psychotic experiences interrupted people’s working situation and, therefore, their financial stability. However, scientific literature on this topic is scarce. A broader and richer approach to studying financial problems of people with PD is thus urgently needed. MethodFourteen people with PD were recruited using purposive sampling. Semi-structured, in-depth interviews were conducted. The Qualitative Analysis Guide of Leuven served as an iterative guide for data-analysis.Results People with PD face many financial problems, sometimes even triggering psychosis. These are subdivided into four categories: covering expenses, financial management, housing, and conflicts and legal problems. Causes for financial problems consist of seven categories: psychotic vulnerability directly (e.g., due to positive symptoms), indirectly (e.g., due to high healthcare costs), substance use, high costs, overspending, fraud, and a lack of developed financial skills. Categories are illustrated with relevant quotations. Conclusions People with PD experience various and often multiple financial problems, from having a limited budget to homelessness. This study uniquely describes the wide-ranging causes for these problems, both related and unrelated to psychotic vulnerability. Thus, financial problems of people with PD is an important, complex topic that deserves more clinical and scientific attention. Future studies could focus on perspectives of other stakeholders (e.g. caregivers)