The relation of anxiety and cognition in Parkinson's disease

OBJECTIVE: Parkinson’s disease (PD) has long been conceptualized as a motor disorder, but nonmotor symptoms also manifest in the disease and significantly reduce quality of life. Anxiety and cognitive dysfunction are prevalent nonmotor symptoms, even in early disease stages, but the relation between these symptoms remains poorly understood. We examined self-reported anxiety and neurocognitive function, indexed by measures of executive function (set-shifting and phonemic fluency), categorical fluency, and attention/working memory. We hypothesized that anxiety would correlate with cognitive performance. METHOD: The Beck Anxiety Inventory and cognitive tests (Trail Making, Verbal Fluency, Digit Span) were administered to 77 nondemented adults with mild to moderate idiopathic PD (39 men, 38 women; Mage = 62.9 years). RESULTS: Higher anxiety was associated with more advanced disease stage and severity and with poorer set-shifting when using a derived metric to account for motoric slowing. Depression correlated with greater anxiety and disease severity, but not with cognitive performance. CONCLUSIONS: Our findings support the association of anxiety with a specific domain of executive function, set-shifting, in nondemented individuals with mild to moderate PD, raising the possibility that treatment of anxiety may alleviate aspects of executive dysfunction in this population.Accepted manuscrip

Spatial judgment in Parkinson's disease: Contributions of attentional and executive dysfunction

Spatial judgment is impaired in Parkinson's disease (PD), with previous research suggesting that disruptions in attention and executive function are likely contributors. If judgment of center places demands on frontal systems, performance on tests of attention/executive function may correlate with extent of bias in PD, and attentional disturbance may predict inconsistency in spatial judgment. The relation of spatial judgment to attention/executive function may differ for those with left-side versus right-side motor onset (LPD, RPD), reflecting effects of attentional lateralization. We assessed 42 RPD, 37 LPD, and 67 healthy control participants with a Landmark task (LM) in which a cursor moved horizontally from the right (right-LM) or left (left-LM). The task was to judge the center of the line. Participants also performed neuropsychological tests of attention and executive function. LM group differences were found on left-LM only, with both PD subgroups biased leftward of the control group (RPD p < .05; LPD p < .01; no RPD-LPD difference). For left-LM trials, extent of bias significantly correlated with performance on the cognitive tasks for PD but not for the control group. PD showed greater variability in perceived center than the control group; this variability correlated with performance on the cognitive tasks. The correlations between performance on the test of spatial judgment and the tests of attention/executive function suggest that frontal-based attentional dysfunction affects dynamic spatial judgment, both in extent of spatial bias and in consistency of response as indexed by intertrial variability. (PsycINFO Database Record (c) 2019 APA, all rights reserved).R01 NS067128 - NINDS NIH HHS; R21 NS043730 - NINDS NIH HHS; National Institute of Neurological Disorders and Stroke; American Parkinson's Disease Association; Massachusetts ChapterAccepted manuscrip

The effect of Parkinson’s disease subgroups on verbal and nonverbal fluency

BACKGROUND: Parkinson’s disease (PD) leads to deficits in executive function, including verbal and nonverbal fluency, as a result of compromised frontostriatal circuits. It is unknown whether deficits in verbal and nonverbal fluency in PD are driven by certain subgroups of patients, or how strategy use may facilitate performance. PARTICIPANTS: Sixty-five nondemented individuals with PD, including 36 with right-body onset (RPD; 20 with tremor as their initial symptom, 16 nontremor) and 29 with left-body onset (LPD; 14 with tremor as their initial symptom, 15 nontremor), and 52 normal control participants (NC) took part in the study. MEASUREMENTS: Verbal fluency was assessed using the FAS and Animals tests. Nonverbal fluency was assessed using the Ruff Figural Fluency Test. RESULTS: Both RPD and LPD were impaired in generating words and in using clustering and switching strategies on phonemic verbal fluency, whereas different patterns of impairment were found on nonverbal fluency depending on the interaction of side of onset and initial motor symptom (tremor vs. nontremor). Strategy use correlated with number of correct responses on verbal fluency in LPD, RPD, and NC. By contrast, on nonverbal fluency, strategy use correlated with correct responses for RPD and LPD, but not for NC. CONCLUSION: Our findings demonstrate the importance of considering subgroups in PD and analyzing subcomponents of verbal and nonverbal fluency (correct responses, errors, and strategies), which may depend differently on the integrity of dorsolateral prefrontal cortex, inferior frontal cortex, and anterior cingulate cortex.Published versio

Effect of visual cues on the resolution of perceptual ambiguity in Parkinson’s disease and normal aging

Parkinson's disease (PD) and normal aging have been associated with changes in visual perception, including reliance on external cues to guide behavior. This raises the question of the extent to which these groups use visual cues when disambiguating information. Twenty-seven individuals with PD, 23 normal control adults (NC), and 20 younger adults (YA) were presented a Necker cube in which one face was highlighted by thickening the lines defining the face. The hypothesis was that the visual cues would help PD and NC to exert better control over bistable perception. There were three conditions, including passive viewing and two volitional-control conditions (hold one percept in front; and switch: speed up the alternation between the two). In the Hold condition, the cue was either consistent or inconsistent with task instructions. Mean dominance durations (time spent on each percept) under passive viewing were comparable in PD and NC, and shorter in YA. PD and YA increased dominance durations in the Hold cue-consistent condition relative to NC, meaning that appropriate cues helped PD but not NC hold one perceptual interpretation. By contrast, in the Switch condition, NC and YA decreased dominance durations relative to PD, meaning that the use of cues helped NC but not PD in expediting the switch between percepts. Provision of low-level cues has effects on volitional control in PD that are different from in normal aging, and only under task-specific conditions does the use of such cues facilitate the resolution of perceptual ambiguity.Published versio

Author response: Effects of orthostatic hypotension on cognition in Parkinson disease

OBJECTIVE: To investigate the relation between orthostatic hypotension (OH) and posture-mediated cognitive impairment in persons with Parkinson's disease (PD) without dementia. METHODS: There were 55 participants: 37 non-demented individuals with idiopathic PD, including 18 with OH (PDOH), and 19 without (PDWOH), and18 control participants (C). All participants completed neuropsychological tests in the supine and in the upright tilted position. Blood pressure was assessed in each posture using a standardized oscillometric cuff at the right brachial artery. RESULTS: The two PD groups performed similarly while supine, with a profile notable for executive dysfunction consisting of deficits in sustained attention, response inhibition, and semantic verbal fluency, as well as reduced verbal memory encoding and retention. When upright, these deficits were exacerbated and broadened to include additional cognitive functions in the PDOH group: deficits in phonemic verbal fluency, psychomotor speed, and both basic and complex aspects of auditory working memory. When group-specific supine scores were used as baseline anchors, both PD groups showed cognitive changes following tilt, though the PDOH group had a wider range of deficits in the executive functioning and memory domains and was the only group to show significant changes in visuospatial skills. CONCLUSIONS: Cognitive deficits in idiopathic PD have been widely reported, though assessments are typically performed in the supine position. While both PD groups had supine deficits that aligned with prior studies and clinical findings, we demonstrated that those with PD and orthostatic hypotension had transient, posture-mediated changes in excess of those found in PD without autonomic failure. These observed changes suggest an acute, reversible effect, and as orthostatic hypotension is a significant comorbid factor in PD, an independent target for clinical intervention. Further understanding of the effects of autonomic failure on cognition in other disorders is desirable, particularly in the context of neuroimaging studies and clinical assessments where data are collected only in the supine or seated positions. Identification of a distinct neuropsychological profile in PD with autonomic failure also has implications for functional activities of daily living and overall quality of life.Accepted manuscrip

Effects of orthostatic hypotension on cognition in Parkinson's disease

OBJECTIVE: To investigate the relation between orthostatic hypotension (OH) and posture-mediated cognitive impairment in Parkinson disease (PD) using a cross-sectional and within-group design. METHODS: Individuals without dementia with idiopathic PD included 18 with OH (PDOH) and 19 without OH; 18 control participants were also included. Neuropsychological tests were conducted in supine and upright-tilted positions. Blood pressure was assessed in each posture. RESULTS: The PD groups performed similarly while supine, demonstrating executive dysfunction in sustained attention and response inhibition, and reduced semantic fluency and verbal memory (encoding and retention). Upright posture exacerbated and broadened these deficits in the PDOH group to include phonemic fluency, psychomotor speed, and auditory working memory. When group-specific supine scores were used as baseline anchors, both PD groups showed cognitive changes following tilt, with the PDOH group exhibiting a wider range of deficits in executive function and memory as well as significant changes in visuospatial function. CONCLUSIONS: Cognitive deficits in PD have been widely reported with assessments performed in the supine position, as seen in both our PD groups. Here we demonstrated that those with PDOH had transient, posture-mediated changes in excess of those found in PD without OH. These observed changes suggest an acute, reversible effect. Understanding the effects of OH due to autonomic failure on cognition is desirable, particularly as neuroimaging and clinical assessments collect data only in the supine or seated positions. Identification of a distinct neuropsychological profile in PD with OH has quality of life implications, and OH presents itself as a possible target for intervention in cognitive disturbance.Accepted manuscriptAccepted manuscrip

Randomized controlled trial of a home-based action observation intervention to improve walking in Parkinson disease

Published in final edited form as: Arch Phys Med Rehabil. 2016 May ; 97(5): 665–673. doi:10.1016/j.apmr.2015.12.029.OBJECTIVE: To examine the feasibility and efficacy of a home-based gait observation intervention for improving walking in Parkinson disease (PD). DESIGN: Participants were randomly assigned to an intervention or control condition. A baseline walking assessment, a training period at home, and a posttraining assessment were conducted. SETTING: The laboratory and participants' home and community environments. PARTICIPANTS: Nondemented individuals with PD (N=23) experiencing walking difficulty. INTERVENTION: In the gait observation (intervention) condition, participants viewed videos of healthy and parkinsonian gait. In the landscape observation (control) condition, participants viewed videos of moving water. These tasks were completed daily for 8 days. MAIN OUTCOME MEASURES: Spatiotemporal walking variables were assessed using accelerometers in the laboratory (baseline and posttraining assessments) and continuously at home during the training period. Variables included daily activity, walking speed, stride length, stride frequency, leg swing time, and gait asymmetry. Questionnaires including the 39-item Parkinson Disease Questionnaire (PDQ-39) were administered to determine self-reported change in walking, as well as feasibility. RESULTS: At posttraining assessment, only the gait observation group reported significantly improved mobility (PDQ-39). No improvements were seen in accelerometer-derived walking data. Participants found the at-home training tasks and accelerometer feasible to use. CONCLUSIONS: Participants found procedures feasible and reported improved mobility, suggesting that observational training holds promise in the rehabilitation of walking in PD. Observational training alone, however, may not be sufficient to enhance walking in PD. A more challenging and adaptive task, and the use of explicit perceptual learning and practice of actions, may be required to effect change

Perception of Communicative and Non-communicative Motion-Defined Gestures in Parkinson’s Disease

Objectives: Parkinson’s disease (PD) is associated with deficits in social cognition and visual perception, but little is known about how the disease affects perception of socially complex biological motion, specifically motion-defined communicative and non-communicative gestures. We predicted that individuals with PD would perform more poorly than normal control (NC) participants in discriminating between communicative and non-communicative gestures, and in describing communicative gestures. We related the results to the participants’ gender, as there are gender differences in social cognition in PD. Methods: The study included 23 individuals with PD (10 men) and 24 NC participants (10 men) matched for age and education level. Participants viewed point-light human figures that conveyed communicative and non-communicative gestures and were asked to describe each gesture while discriminating between the two gesture types. Results: PD as a group were less accurate than NC in describing non-communicative but not communicative gestures. Men with PD were impaired in describing and discriminating between communicative as well as non-communicative gestures. Conclusions: The present study demonstrated PD-related impairments in perceiving and inferring the meaning of biological motion gestures. Men with PD may have particular difficulty in understanding the communicative gestures of others in interpersonal exchanges

Effects of Parkinson’s disease on optic flow perception for heading direction during navigation

Visuoperceptual disorders have been identified in individuals with Parkinson’s disease (PD) and may affect the perception of optic flow for heading direction during navigation. Studies in healthy subjects have confirmed that heading direction can be determined by equalizing the optic flow speed (OS) between visual fields. The present study investigated the effects of PD on the use of optic flow for heading direction, walking parameters, and interlimb coordination during navigation, examining the contributions of OS and spatial frequency (dot density). Twelve individuals with PD without dementia, 18 age-matched normal control adults (NC), and 23 young control adults (YC) walked through a virtual hallway at about 0.8 m/s. The hallway was created by random dots on side walls. Three levels of OS (0.8, 1.2, and 1.8 m/s) and dot density (1, 2, and 3 dots/m2) were presented on one wall while on the other wall, OS and dot density were fixed at 0.8 m/s and 3 dots/m2, respectively. Three-dimensional kinematic data were collected, and lateral drift, walking speed, stride frequency and length, and frequency, and phase relations between arms and legs were calculated. A significant linear effect was observed on lateral drift to the wall with lower OS for YC and NC, but not for PD. Compared to YC and NC, PD veered more to the left under OS and dot density conditions. The results suggest that healthy adults perceive optic flow for heading direction. Heading direction in PD may be more affected by the asymmetry of dopamine levels between the hemispheres and by motor lateralization as indexed by handedness.Published versio

Web-Based Assessment of Visual and Visuospatial Symptoms in Parkinson's Disease

Visual and visuospatial dysfunction is prevalent in Parkinson's disease (PD). To promote assessment of these often overlooked symptoms, we adapted the PD Vision Questionnaire for Internet administration. The questionnaire evaluates visual and visuospatial symptoms, impairments in activities of daily living (ADLs), and motor symptoms. PD participants of mild to moderate motor severity (n = 24) and healthy control participants (HC, n = 23) completed the questionnaire in paper and web-based formats. Reliability was assessed by comparing responses across formats. Construct validity was evaluated by reference to performance on measures of vision, visuospatial cognition, ADLs, and motor symptoms. The web-based format showed excellent reliability with respect to the paper format for both groups (all P′s < 0.001; HC completing the visual and visuospatial section only). Demonstrating the construct validity of the web-based questionnaire, self-rated ADL and visual and visuospatial functioning were significantly associated with performance on objective measures of these abilities (all P′s < 0.01). The findings indicate that web-based administration may be a reliable and valid method of assessing visual and visuospatial and ADL functioning in PD