Joan C. Borod

A review of the cognitive and behavioral sequelae of Parkinson's disease: relationship to frontostriatal circuitry.

BackgroundParkinsons disease is a neurodegenerative hypokinetic movement disorder presenting with subcortical pathology and characterized by motor deficits. However, as is frequently reported in the literature, patients with Parkinsons disease can also exhibit cognitive and behavioral impairments. These impairments may be attributed to dysfunction of multiple systems associated with the disease process in Parkinsons disease that are not necessarily related to motor symptoms. In recent years, considerable attention has addressed the circuits connecting the frontal cortical regions and the basal ganglia (i.e., frontostriatal circuits) and how they mediate cognition and behavior in humans. It has been suggested that these same circuits are disrupted in Parkinsons disease and may be responsible for the frontal/executive deficits predominantly reported in this patient population. ObjectiveThe current survey of the literature provides a critique and analysis of the neuropsychological profile of Parkinsons disease, including cognitive impairments, behavioral alterations, and emotional processing deficits. A special feature of this paper is to ascertain how frontostriatal circuitry might provide the substrate for the neuropsychological impairments exhibited in Parkinsons disease. In so doing, studies involving nonhuman subjects, neurologically healthy adults, brain-lesioned individuals, and patients with Parkinsons disease are reviewed to provide a novel perspective in conceptualizing and categorizing the cognitive and behavioral sequelae concomitant to specific frontostriatal circuit dysfunction in Parkinsons disease. ConclusionsThe current review suggests that the neuropsychological profile of Parkinsons disease, which predominantly reflects frontal/executive dysfunction, may be attributed to disruption of the frontostriatal circuitry. The information generated from this review can serve as a guide in the assessment of frontal/executive dysfunction in Parkinsons disease with suggestions for a clinical neuropsychological test battery.

A Meta-Analysis of the Effects of Written Emotional Disclosure on the Health Outcomes of Clinical Populations

A meta-analysis was conducted to examine the effects of the written emotional disclosure paradigm on health outcomes of people with physical or psychiatric disorders. After nine studies were meta-analyzed, it was determined that expressive writing significantly improved health (d = .19; p < .05). However, this positive relationship (r = .10) was not moderated by any systemic variables because of the nonsignificant test of homogeneity (Qw = 5.27; p = .73). Nonetheless, a planned contrast illustrated that expressive writing is more effective on physical (d = .21; p = .01) than on psychological (d = .07; p = .17) health outcomes (Qb > 10.83; p < .001). One explanation for the small effect size (ES) results and the nonsignificant test of homogeneity may be the small and heterogeneous samples used in some of the studies within this research synthesis. Future research with expressive writing should be tested with randomized controlled trials to increase the likelihood of detecting a larger treatment effect.

Normative data on the boston diagnostic aphasia examination, parietal lobe battery, and the boston naming Test

Abstract This report describes normative data for the Boston Diagnostic Aphasia Examination, the “Parietal Lobe Battery” (Goodglass & Kaplan, 1972), and the Boston Naming Test (Kaplan, Goodglass, & Weintraub, 1978). These tests were administered to 147 neurologically normal adult males, who were right-handed and native English-speaking. For each age and education group, means, standard deviations, and the range are reported. The lowest score for each group is suggested as a cut-off below which impairment may be suspected. Differences among age and education groups are specified and briefly discussed.

The expression and perception of facial emotion in brain-damaged patients

This study examined the expression and perception of facial emotion in patients with unilateral cerebrovascular pathology. Subjects were 12 right brain-damaged (RBD), 15 left brain-damaged (LBD) aphasic, and 16 normal control (NC) right-handed males. Expressions were elicited during posed and spontaneous conditions. Both positive and negative emotions were studied. RBDs were significantly impaired, relative to LBDs and NCs, in expressing and perceiving facial emotion. There were no group differences as a function of condition, but there were differences as a function of emotional valence. Qualitative performance differences also were observed. There was no evidence that the ability to produce a particular emotion was related to the ability to identify the same emotion. Overall, these findings support the notion that the right cerebral hemisphere is dominant for expressing and perceiving facial emotion.

Neuropsychological aspects of facial asymmetry during emotional expression: A review of the normal adult literature

This review focuses on facial asymmetries during emotional expression. Facial asymmetry is defined as the expression intensity or muscular involvement on one side of the face (“hemiface”) relative to the other side and has been used as a behavioral index of hemispheric specialization for facial emotional expression. This paper presents a history of the neuropsychological study of facial asymmetry, originating with Darwin. Both quantitative and qualitative aspects of asymmetry are addressed. Next, neuroanatomical bases for facial expression are elucidated, separately for posed/voluntary and spontaneous/involuntary elicitation conditions. This is followed by a comprehensive review of 49 experiments of facial asymmetry in the adult literature, oriented around emotional valence (pleasantness/unpleasantness), elicitation condition, facial part, social display rules, and demographic factors. Results of this review indicate that the left hemiface is more involved than the right hemiface in the expression of facial emotion. From a neuropsychological perspective, these findings implicate the right cerebral hemisphere as dominant for the facial expression of emotion. In spite of the compelling evidence for right-hemispheric specialization, some data point to the possibility of differential hemispheric involvement as a function of emotional valence.

Differential amygdala activation during emotional decision and recognition memory tasks using unpleasant words: an fMRI study

This study used fMRI to examine the response of the amygdala in the evaluation and short-term recognition memory of unpleasant vs. neutral words in nine right-handed healthy adult women. To establish specificity of the amygdala response, we examined the fMRI BOLD signal in one control region (visual cortex). Alternating blocks of unpleasant and neutral trials were presented. During the emotional decision task, subjects viewed sets of three unpleasant or three neutral words while selecting the most unpleasant or neutral word, respectively. During the memory task, subjects identified words that were presented during the emotional decision task (0.50 probability). Images were detrended, filtered, and coregistered to standard brain coordinates. The Talairach coordinates for the center of the amygdala were chosen before analysis. The BOLD signal at this location in the right hemisphere revealed a greater amplitude signal for the unpleasant relative to the neutral words during the emotional decision but not the memory task, confirmed by Time Course x Word Condition ANOVAs. These results are consistent with the memory modulatory view of amygdala function, which suggests that the amygdala facilitates long-term, but not short-term, memory consolidation of emotionally significant material. The control area showed only an effect for Time Course for both the emotional decision and memory tasks, indicating the specificity of the amygdala response to the evaluation of unpleasant words. Moreover, the right-sided amygdala activation during the unpleasant word condition was strongly correlated with the BOLD response in the occipital cortex. These findings corroborate those by other researchers that the amygdala can modulate early processing of visual information in the occipital cortex. Finally, an increase in subjects state anxiety (evaluated by questionnaire) while in the scanner correlated with amygdala activation under some conditions.

Perception of facial emotion in schizophrenic and right brain-damaged patients

Deficits in the perception of facial emotion have been demonstrated in patients with rightsided brain damage (RBD) and schizophrenia (SZ). Furthermore, recent speculations have implicated right-hemisphere dysfunction in Type II schizophrenics, especially those with a preponderance of “negative symptoms” and flat affect. The performance of SZ, RBD, and normal control subjects was compared on measures assessing facial emotional perception. Both identification and discrimination paradigms were used, with positive/pleasant and negative/unpleasant emotions. To examine the effects of visuospatial and facial processing on facial emotion tasks, the Visual Matrices Test and the Benton Facial Recognition Test were administered. On both facial emotion tests, SZ and RBD patients were significantly impaired relative to normal subjects, but not different from each other. The SZ and RBD patients were also impaired on the matrices and facial recognition tests. When the effects of the matrices and neutral face recognition tests were statistically controlled, significant group differences remained for the identification task but not for the discrimination task. Thus, methodologies are presented for the neuropsychological study of facial emotional perception, and some support is provided for the notion that negative-symptom schizophrenia is associated with right hemisphere dysfunction.

Parameters of emotional processing in neuropsychiatric disorders: conceptual issues and a battery of tests.

Components of emotional processing were examined in psychiatric and neurological populations: communication channel (face/voice), processing mode (expression/perception), and emotional valence (positive/negative). These were assessed with an experimental affect battery which was administered to schizophrenic, unipolar depressive, right-brain-damaged, Parkinsons disease, and normal control right-handed adults. For expression, subjects were taped while producing facial and vocal emotional expressions. Judges rated the expressions for accuracy and intensity. For perception, subjects were asked to identify and discriminate facial and vocal emotions. Using correlational techniques, relationships between facial and vocal channels and between expressive and perceptual modes were explored. The test battery has good psychometric properties and discriminates among diagnostic groups.

Facedness and emotion related to lateral dominance, sex and expression type ☆

Abstract Facial asymmetry or “facedness” was reliably rated for nine different videotaped facial expressions of emotion, produced by 51 adults, and was significantly left-sided. This finding was related to right hemisphere dominance for emotion and for facial movement. No overall differences occurred for expression type or sex and handedness of subjects, but there were interactions.

An Examination of Executive Dysfunction Associated with Frontostriatal Circuitry in Parkinson's Disease

Parkinsons disease (PD) is a neurodegenerative movement disorder presenting with subcortical pathology and characterized by motor deficits. However, as is frequently reported in the literature, patients with PD can also exhibit cognitive and behavioral (i.e., nonmotor) impairments, cognitive executive deficits and depression being the most prominent. Considerable attention has addressed the role that disruption to frontostriatal circuitry can play in mediating nonmotor dysfunction in PD. The three nonmotor frontostriatal circuits, which connect frontal cortical regions to the basal ganglia, originate from the dorsolateral prefrontal cortex (DLPFC), anterior cingulate cortex (ACC), and orbitofrontal cortex (OFC). The objective of the current study was to use our understanding of frontostriatal circuit function (via literature review) to categorize neuropsychological measures of cognitive and behavioral executive functions by circuit. To our knowledge, such an approach has not been previously attempted in the study of executive dysfunction in PD. Neuropsychological measures of executive functions and self-report behavioral inventories, categorized by circuit function, were administered to 32 nondemented patients with Parkinsons disease (NDPD) and to 29 demographically matched, healthy normal control participants (NC). Our findings revealed significant group differences for each circuit, with the PD group performing worse than the NC group. Among the patients with PD, indices of impairment were greater for tasks associated with DLPFC function than with OFC function. Further, only an index of DLPFC test performance was demonstrated to significantly discriminate individuals with and without PD. In conclusion, our findings suggest that nondemented patients with PD exhibit greater impairment on neuropsychological measures associated with DLPFC than with ACC or OFC circuit function.