Diego Ricciardi

Facial Emotion Recognition and Expression in Parkinson's Disease: An Emotional Mirror Mechanism?

Background and aim Parkinson’s disease (PD) patients have impairment of facial expressivity (hypomimia) and difficulties in interpreting the emotional facial expressions produced by others, especially for aversive emotions. We aimed to evaluate the ability to produce facial emotional expressions and to recognize facial emotional expressions produced by others in a group of PD patients and a group of healthy participants in order to explore the relationship between these two abilities and any differences between the two groups of participants. Methods Twenty non-demented, non-depressed PD patients and twenty healthy participants (HC) matched for demographic characteristics were studied. The ability of recognizing emotional facial expressions was assessed with the Ekman 60-faces test (Emotion recognition task). Participants were video-recorded while posing facial expressions of 6 primary emotions (happiness, sadness, surprise, disgust, fear and anger). The most expressive pictures for each emotion were derived from the videos. Ten healthy raters were asked to look at the pictures displayed on a computer-screen in pseudo-random fashion and to identify the emotional label in a six-forced-choice response format (Emotion expressivity task). Reaction time (RT) and accuracy of responses were recorded. At the end of each trial the participant was asked to rate his/her confidence in his/her perceived accuracy of response. Results For emotion recognition, PD reported lower score than HC for Ekman total score (p<0.001), and for single emotions sub-scores happiness, fear, anger, sadness (p<0.01) and surprise (p = 0.02). In the facial emotion expressivity task, PD and HC significantly differed in the total score (p = 0.05) and in the sub-scores for happiness, sadness, anger (all p<0.001). RT and the level of confidence showed significant differences between PD and HC for the same emotions. There was a significant positive correlation between the emotion facial recognition and expressivity in both groups; the correlation was even stronger when ranking emotions from the best recognized to the worst (R = 0.75, p = 0.004). Conclusions PD patients showed difficulties in recognizing emotional facial expressions produced by others and in posing facial emotional expressions compared to healthy subjects. The linear correlation between recognition and expression in both experimental groups suggests that the two mechanisms share a common system, which could be deteriorated in patients with PD. These results open new clinical and rehabilitation perspectives.

Dopaminergic Agents and Nutritional Status in Parkinson's Disease

Malnutrition has been found in up to 24% of patients with Parkinsons disease; dopaminergic drugs might impair nutritional status. We evaluated the association of nutritional status with the use of dopaminergic agents.

Impulsive compulsive behaviours in Parkinson's disease: patients' versus caregivers' perceptions.

Impulsive compulsive behaviours (ICB) are neuropsychiatric disorders that can complicate Parkinson’s disease (PD). ICB include pathological gambling, compulsive sexual behaviour, compulsive buying, and binge eating, together with punding and dopamine dysregulation syndrome [1]. The PD Impulsive-Compulsive Disorders Questionnaire (QUIP) is a validated instrument to assess the presence of ICB in PD [2, 3]. A recent study has showed that the QUIP scale is a sensitive instrument whether completed by the patients or by their informants and that when comparing the QUIP completed by the patients to the one completed by their informant, the patient/informant agreement in referring the presence of ICD was moderate [4]. Here we describe our experience and we aimed to evaluate the patients and their carers’ agreement in reporting the presence of ICB. Forty-six patients and their carers were evaluated before attending a conference on non-motor symptoms in PD held by experts in the matter. They all agreed to participate, provided informed consent and were included in the study. Patient’s demographical and clinical data were collected. Patients and their carers were asked to complete the QUIP separately and they were instructed to refer to patient’s behaviour in the past year, considering behavioural changes lasting for at least four consecutive weeks. We performed statistical analysis by means of SPSS version 21 (Statistical Package for Social Science). The degree of agreement between each patient and his/her carer was calculated using the Cohen’s K. Forty-six patients (37 % females; mean age 66.4 years, SD 7.4 years, range 47–78 years; disease duration 6.16 years, SD 2.97 years, range 2–14 years; mean Levodopa equivalent daily dose 698.8, SD 375.8) and 46 carers (63 % females; mean age 63.2 years, SD 8.3 years, range 45–76 years) were included in the study. The prevalence of compulsive gambling, sexual behaviour, buying, eating, hobbyism/punding, walkabout and medication overuse according to patients’ and their carers’ QUIPs are shown in Table 1. According to patients’ QUIP, 31 patients (67.3 %) reported the presence of at least one ICB. The same percentage was found analysing carers’ QUIP. The degree of agreement between each patient and his/ her carer was then calculated. We found 26 couples to have poor agreement (Cohen’s K\ 0.41) (Table 1). Within these 26 couples where the agreement was poor, we analysed the single sub-items of the QUIP to define for each couple: (a) for which item there was a poor agreement; and (b) in which direction was the disagreement (patient saying ‘yes’, caregiver ‘no’ or vice versa) (Table 1). In the 26 couples where the agreement was poor, patients tend to report more often than carers the presence of compulsive sexual behaviour, hobbyism/punding, walkabout and medication overuse. Viceversa compulsive gambling, buying and eating were more reported by caregivers than patients. The lowest degree of agreement was found for compulsive eating and hobbism/punding. & B. Demartini bennidemartini@hotmail.it

Prevalence of Impulsive-Compulsive Symptoms in Elderly Parkinson’s Disease Patients: A Case-Control Study

BACKGROUND Impulse-control disorders (ICDs) are frequently described in patients with Parkinsons disease (PD), particularly among those treated with dopaminergic medications, but data on the prevalence of ICDs in elderly populations are lacking. OBJECTIVE The aim of this study was to estimate the prevalence of ICDs by using an Italian validation of the Questionnaire for Impulsive-Compulsive Disorders in Parkinsons Disease (QUIP) and to identify associated sociodemographic and clinical factors in a sample of elderly PD patients and in a control group of similarly aged healthy volunteers. METHODS Using the United Kingdom Parkinsons Disease Society Brain Bank diagnostic criteria, we included 115 consecutive PD and 105 healthy controls. They were recruited from June 2014 to December 2015. All participants completed the self-administered QUIP-Anytime for assessment of ICDs occurring any time during the course of PD. RESULTS Mean ± SD age was 75.7 ± 7.0 years in the PD patients and 76.1 ± 7.0 years in the control group. The mean disease duration was 6.8 years (range, 1-26 years). Among the PD patients, 44.7% (n = 51) had at least 1 ICD or related disorder compared to 25.2% (n = 26) in the control group (between-group difference: P = .003). Hypersexuality and compulsive shopping were significantly more common in the PD group than in the control group (P < .05). The prevalence of other compulsive behaviors was 42.5% in the PD group and 38.9% in the control group (P = NS). The Italian version of the QUIP-Anytime showed high test-retest reliability (κ > 0.70 for all items). CONCLUSIONS Our data confirm a high prevalence of ICD symptoms in elderly PD patients, approximately twice that seen in the general population.