The impact of sleep quality on cognitive functioning in Parkinson's disease

In healthy individuals and those with insomnia, poor sleep quality is associated with decrements in performance on tests of cognition, especially executive function. Sleep disturbances and cognitive deficits are both prevalent in Parkinson's disease (PD). Sleep problems occur in over 75% of patients, with sleep fragmentation and decreased sleep efficiency being the most common sleep complaints, but their relation to cognition is unknown. We examined the association between sleep quality and cognition in PD. In 35 non-demented individuals with PD and 18 normal control adults (NC), sleep was measured using 24-hr wrist actigraphy over 7 days. Cognitive domains tested included attention and executive function, memory and psychomotor function. In both groups, poor sleep was associated with worse performance on tests of attention/executive function but not memory or psychomotor function. In the PD group, attention/executive function was predicted by sleep efficiency, whereas memory and psychomotor function were not predicted by sleep quality. Psychomotor and memory function were predicted by motor symptom severity. This study is the first to demonstrate that sleep quality in PD is significantly correlated with cognition and that it differentially impacts attention and executive function, thereby furthering our understanding of the link between sleep and cognition.Published versio

The impact of sleep quality on cognitive functioning in Parkinson's disease

In healthy individuals and those with insomnia, poor sleep quality is associated with decrements in performance on tests of cognition, especially executive function. Sleep disturbances and cognitive deficits are both prevalent in Parkinson's disease (PD). Sleep problems occur in over 75% of patients, with sleep fragmentation and decreased sleep efficiency being the most common sleep complaints, but their relation to cognition is unknown. We examined the association between sleep quality and cognition in PD. In 35 non-demented individuals with PD and 18 normal control adults (NC), sleep was measured using 24-hr wrist actigraphy over 7 days. Cognitive domains tested included attention and executive function, memory and psychomotor function. In both groups, poor sleep was associated with worse performance on tests of attention/executive function but not memory or psychomotor function. In the PD group, attention/executive function was predicted by sleep efficiency, whereas memory and psychomotor function were not predicted by sleep quality. Psychomotor and memory function were predicted by motor symptom severity. This study is the first to demonstrate that sleep quality in PD is significantly correlated with cognition and that it differentially impacts attention and executive function, thereby furthering our understanding of the link between sleep and cognition.Published versio

The impact of motor symptoms on self-reported anxiety in Parkinson's disease

OBJECTIVE: Anxiety is commonly endorsed in Parkinson's disease (PD) and significantly affects quality of life. The Beck Anxiety Inventory (BAI) is often used but contains items that overlap with common PD motor symptoms (e.g., “hands trembling”). Because of these overlapping items, we hypothesized that PD motor symptoms would significantly affect BAI scores. METHODS: One hundred non-demented individuals with PD and 74 healthy control participants completed the BAI. PD motor symptoms were assessed by the Unified Parkinson's Disease Rating Scale (UPDRS). Factor analysis of the BAI assessed for a PD motor factor, and further analyses assessed how this factor affected BAI scores. RESULTS: BAI scores were significantly higher for PD than NC. A five-item PD motor factor correlated with UPDRS observer-rated motor severity and mediated the PD-control difference on BAI total scores. An interaction occurred, whereby removal of the PD motor factor resulted in a significant reduction in BAI scores for PD relative to NC. The correlation between the BAI and UPDRS significantly declined when controlling for the PD motor factor. CONCLUSIONS: The results indicate that commonly endorsed BAI items may reflect motor symptoms such as tremor instead of, or in addition to, genuine mood symptoms. These findings highlight the importance of considering motor symptoms in the assessment of anxiety in PD and point to the need for selecting anxiety measures that are less subject to contamination by the motor effects of movement disorders.Published versio

Bistable perception in normal aging: perceptual reversibility and its relation to cognition

The effects of age on the ability to resolve perceptual ambiguity are unknown, though it depends on fronto-parietal attentional networks known to change with age. We presented the bistable Necker cube to 24 middle-aged and older adults (OA; 56–78 years) and 20 younger adults (YA; 18–24 years) under passive-viewing and volitional control conditions: Hold one cube percept and Switch between cube percepts. During passive viewing, OA had longer dominance durations (time spent on each percept) than YA. In the Hold condition, OA were less able than YA to increase dominance durations. In the Switch condition, OA and YA did not differ in performance. Dominance durations in either condition correlated with performance on tests of executive function mediated by the frontal lobes. Eye movements (fixation deviations) did not differ between groups. These results suggest that OA’s reduced ability to hold a percept may arise from reduced selective attention. The lack of correlation of performance between Hold and executive-function measures suggests at least a partial segregation of underlying mechanisms.Published versionAccepted manuscrip

Perceived stigma and quality of life in Parkinson's disease with additional health conditions

BACKGROUND: Parkinson's disease (PD) is associated with perceived stigma and affects quality of life (QoL). Additional health conditions may influence these consequences of PD. AIMS: This study assessed the impact of health conditions on perceived stigma and QoL in persons with PD. We hypothesised that individuals with more health conditions would report more stigma and poorer QoL. We also examined the contributions of demographic and clinical characteristics to the correlations between health conditions and perceived stigma/QoL. METHODS: We identified 196 eligible participants from the Boston University Online Survey Study of Parkinson's Disease and examined their health history, performance on multiple stigma measures, and scores on the 39-item Parkinson's Disease Questionnaire assessing QoL. RESULTS: At least one health condition was reported by 79% of the sample, with a median of 2 and a range of 0-7 health conditions. More perceived stigma and poorer QoL were associated with thyroid disease, depression, anxiety, and the total number of health conditions. These correlations were related to younger age, less education, and earlier disease onset. Other health conditions (high blood pressure, back/leg surgery, headache, cancer/tumours, and heart disease) were not significantly correlated with stigma or QoL. CONCLUSIONS: Having more health conditions, or thyroid disease, depression, or anxiety, was associated with more perceived stigma and poorer QoL, with younger age, less education, and earlier disease onset affecting the associations. It is important to consider the burden of health conditions and how they affect persons with PD with specific clinical characteristics.Published versio

Visual exploration of emotional facial expressions in Parkinson\u27s disease

Parkinson\u27s disease (PD) is associated with impairments in facial emotion recognition as well as visual and executive dysfunction. We investigated whether facial emotion categorization impairments in PD are attributable to visual scanning abnormalities by recording the eye movements of 16 non-demented PD and 20 healthy control (HC) participants during an emotion recognition task. We examined the influence of several factors that can affect visual scanning, including oculomotor, basic visual, and cognitive abilities (executive function). Increases in the number and duration of fixations in the top regions of surprise facial expressions were related to increases in recognition accuracy for this emotion in PD participants with left-sided motor-symptom onset. Compared to HC men, HC women spent less time fixating on fearful expressions. PD participants displayed oculomotor abnormalities (antisaccades), but these were unrelated to scanning patterns. Performance on visual measures (acuity, contrast sensitivity) correlated with scanning patterns in the PD group only. Poorer executive function was associated with longer fixation times in PD and with a greater number of fixations in HC. Our findings indicate a specific relation between facial emotion categorization impairments and scanning of facial expressions in PD. Furthermore, PD and HC participants’ scanning behaviors during an emotion categorization task were driven by different perceptual processes and cognitive strategies. Our results underscore the need to consider differences in perceptual and cognitive abilities in studies of visual scanning, particularly when examining this ability in patient populations for which both vision and cognition are impaired

Specific impairments in the recognition of emotional facial expressions in Parkinson\u27s disease

Studies investigating the ability to recognize emotional facial expressions in non-demented individuals with Parkinson\u27s disease (PD) have yielded equivocal findings. A possible reason for this variability may lie in the confounding of emotion recognition with cognitive task requirements, a confound arising from the lack of a control condition using non-emotional stimuli. The present study examined emotional facial expression recognition abilities in 20 non-demented patients with PD and 23 control participants relative to their performance on a non-emotional landscape categorization test with comparable task requirements. We found that PD participants were normal on the control task but exhibited selective impairments in the recognition of facial emotion, specifically for anger (driven by those with right hemisphere pathology) and surprise (driven by those with left hemisphere pathology), even when controlling for depression level. Male but not female PD participants further displayed specific deficits in the recognition of fearful expressions. We suggest that the neural substrates that may subserve these impairments include the ventral striatum, amygdala, and prefrontal cortices. Finally, we observed that in PD participants, deficiencies in facial emotion recognition correlated with higher levels of interpersonal distress, which calls attention to the significant psychosocial impact that facial emotion recognition impairments may have on individuals with PD

The impact of acuity on performance of four clinical measures of contrast sensitivity in Alzheimer\u27s disease

Investigations of contrast sensitivity losses in Alzheimer\u27s disease (AD) have yielded mixed findings, with some investigators reporting deficits and others not. Potential reasons for these discrepancies include differences between samples and assessments utilized and the failure of some investigators to account for acuity differences between groups. To investigate these issues, we administered four clinical contrast sensitivity assessments to the same group of AD patients and elderly control participants and examined the impact of acuity on performance for each assessment. Results revealed group differences across the spatial frequency range. Further, group acuity differences significantly affected performance on two of the four measures (the Regan and the Vistech but not on the Pelli-Robson or Freiburg assessments). Information regarding the availability of established age norms, test–retest reliability data, and other factors including the time, cost, and training needed to administer each measure is provided to aid clinicians and researchers in their search for an effective measure of contrast sensitivity

Enhanced stimulus contrast normalizes visual processing of rapidly presented letters in Alzheimer\u27s disease

Deficient perception and cognition in Alzheimer’s disease (AD) has been attributed to slow information processing and attentional disturbance, but an additional explanation may be reduced signal strength. In 21 individuals with probable AD, 29 healthy older and 54 younger adults, we enhanced the contrast level of rapidly-flashed masked letters. The AD group reached identification criterion (80% accuracy), but required significantly higher contrast than the control groups. A source of the prevalent masking deficit may be reduced signal strength arising from dysfunction of retina or visual cortex. Increasing stimulus contrast may be an effective means of enhancing cognitive performance in AD

Enhanced stimulus strength improves visual cognition in aging and Alzheimer\u27s disease

Deficits in visual cognition in Alzheimer\u27s disease (AD) arise from neuropathological changes in higher-order association areas of the cortex and from defective input from lower-level visual processing areas. We investigated whether enhanced signal strength may lead to improvement of visual cognition in AD. We tested 35 individuals with probable AD, 35 age-matched elderly control (EC) and 58 young control (YC) adults on letter identification, word reading, picture naming, discrimination of unfamiliar faces, and pattern completion. The contrast sensitivity step-difference across an independent sample of AD and EC groups was used in calculating an image filter, from which we produced stimulus- strength conditions of low-degraded, medium-normal, and high-enhanced. Using this filter we created a hypothetical proximal-strength equivalence between AD at medium strength and EC at low strength, and between AD at high strength and EC at medium strength. For letter identification, word reading, picture naming, and face discrimination, medium strength elicited AD accuracy levels and reaction times that were similar to those of EC at low strength. On picture naming, increased strength reduced perceptual-type errors for EC and AD and random errors for AD. For word reading, high strength elicited AD accuracy levels and reaction times that were equivalent to those of EC at medium strength. We saw no effect of signal-strength manipulation on performance of pattern completion, possibly owing to the complex cognitive demands of that task or to the inadequacy of the filter for its images. The results indicate that putative AD-EC differences in cognition directly reflect contrast sensitivity differences between the groups. Enhancement of stimulus strength can ameliorate vision-based deficits and lead to improvement in some aspects of cognitive performance. These results suggest new non-pharmacological avenues to explore in the attempt to improve cognition in elderly adults and especially in individuals with AD