Malene Flensborg Damholdt

Impulsive and compulsive behaviors among Danish patients with Parkinson's disease: Prevalence, depression, and personality

INTRODUCTION Dopaminergic medication administered to ameliorate motor symptoms of Parkinsons disease is associated with impulse control disorders, such as pathological gambling, hypersexuality, compulsive buying, and binge eating. Studies indicate a prevalence of impulse control disorders in Parkinsons disease of 6-16%. OBJECTIVE To estimate the prevalence of impulsive and compulsive behaviors among Danish patients with Parkinsons disease and to explore the relation of such behavioral disorders to depression and personality. METHODS 490 patients with Parkinsons disease (303 males), identified through the National Danish Patient Registry, were evaluated with: 1) the Questionnaire for Impulsive-Compulsive Disorders in Parkinsons Disease; 2) the Geriatric Depression Scale; and 3) the NEO-Personality Inventory. RESULTS 176 (35.9%) patients reported impulsive and compulsive behaviors sometime during Parkinsons disease (current symptoms in 73, 14.9%). Hereof, 114 (23.3%) reported multiple behavioral symptoms. Patients with behavioral symptoms were significantly younger, were younger at PD onset, had longer disease duration, displayed more motor symptoms, and received higher doses of dopaminergic medication than patients without behavioral symptoms. Furthermore, they reported significantly more depressive symptoms and scored significantly higher on neuroticism and lower on both agreeableness and conscientiousness than patients without behavioral symptoms. CONCLUSION A history of impulsive and compulsive behaviors are common in Danish patients with Parkinsons disease and have clinical correlates that may allow identification of patients at risk for developing these behaviors.

Odor identification deficits identify Parkinson's disease patients with poor cognitive performance†‡

Olfactory dysfunction is a prodromal and prevalent nonmotor symptom of Parkinsons disease. Unlike olfactory dysfunction in Alzheimers disease, it is believed to be unrelated to cognitive impairment. However, recent research has implicated cholinergic denervation in Parkinsons disease hyposmia and linked it to verbal memory. This research hypothesized that severe odor identification deficits may identify patients with Parkinsons disease at risk for cognitive impairment. The current study tested this hypothesis by comparing 24 functionally anosmic, nondemented patients with Parkinsons disease and 39 nonanosmic, nondemented patients with Parkinsons disease with 29 healthy control participants on composite scores of memory, processing speed, executive function, and language. The functionally anosmic group had significantly poorer visual and verbal memory than the nonanosmic group, which was indistinguishable from the control group. Furthermore, the functionally anosmic group had reduced processing speed compared with the nonanosmic patients with Parkinsons disease, who, in turn, were outperformed by the control group. On the composite language score, the score of the functionally anosmic group was significantly reduced compared with that of the control group, whereas the nonanosmic group scored in the medium range. The 2 patient groups did not differ on executive functioning. These findings demonstrate co‐occurrence between reduced cognitive function and olfactory deficits in functionally anosmic patients with Parkinsons disease and support the notion of more severe cognitive deficits in this group.

Web-based cognitive training for breast cancer survivors with cognitive complaints—a randomized controlled trial

Cognitive complaints are common amongst breast cancer survivors, and no standard treatment exists. The present study evaluates whether web‐based cognitive training can alleviate subjectively reported and objectively assessed cognitive complaints in a sample of breast cancer survivors. The primary and secondary outcomes were an objective measure of working memory and a measure of perceived cognitive functioning. Additional outcomes were neuropsychological tests of memory, executive function, working memory and questionnaire‐based assessment of anxiety, depression and somatization.

Evaluation of the noradrenergic system in Parkinson’s disease: an 11C-MeNER PET and neuromelanin MRI study

Pathological involvement of the noradrenergic locus coeruleus occurs early in Parkinsons disease, and widespread noradrenaline reductions are found at post-mortem. Rapid eye movement sleep behaviour disorder (RBD) accompanies Parkinsons disease and its presence predicts an unfavourable disease course with a higher propensity to cognitive impairment and orthostatic hypotension. MRI can detect neuromelanin in the locus coeruleus while 11C-MeNER PET is a marker of noradrenaline transporter availability. Here, we use both imaging modalities to study the association of RBD, cognition and autonomic dysfunction in Parkinsons disease with loss of noradrenergic function. Thirty non-demented Parkinsons disease patients [16 patients with RBD and 14 without RBD, comparable across age (66.6 ± 6.7 years), sex (22 males), and disease stage (Hoehn and Yahr, 2.3 ± 0.5)], had imaging of the locus coeruleus with neuromelanin sensitive MRI and brain noradrenaline transporter availability with 11C-MeNER PET. RBD was confirmed with polysomnography; cognitive function was assessed with a neuropsychological test battery, and blood pressure changes on tilting were documented; results were compared to 12 matched control subjects. We found that Parkinsons disease patients with RBD showed decreased locus coeruleus neuromelanin signal on MRI (P < 0.001) and widespread reduced binding of 11C-MeNER (P < 0.001), which correlated with amount of REM sleep without atonia. Parkinsons disease with RBD was also associated with a higher incidence of cognitive impairment, slowed EEG activity, and orthostatic hypotension. Reduced 11C-MeNER binding correlated with EEG slowing, cognitive performance, and orthostatic hypotension. In conclusion, reduced noradrenergic function in Parkinsons disease was linked to the presence of RBD and associated with cognitive deterioration and orthostatic hypotension. Noradrenergic impairment may contribute to the high prevalence of these non-motor symptoms in Parkinsons disease, and may be of relevance when treating these conditions in Parkinsons disease.

In Vivo cortical tau in Parkinson's disease using 18F-AV-1451 positron emission tomography

Background: Alzheimers disease copathology is common in PD at autopsy. In non‐PD subjects with mild cognitive impairment, tau depositions can be detected using 18F‐AV‐1451 PET. We hypothesized that 18F‐AV‐1451 PET would show tau aggregation in PD with mild cognitive impairment and correlate with cognitive dysfunction.

Intimacy in Phone Conversations: Anxiety Reduction for Danish Seniors with Hugvie.

There is a lack of physical contact in current telecommunications such as text messaging and Internet access. To challenge the limitation and re-embody telecommunication, researchers have attempted to introduce tactile stimulation to media and developed huggable devices. Previous experiments in Japan showed that a huggable communication technology, i.e., Hugvie decreased stress level of its female users. In the present experiment in Denmark, we aim to investigate (i) whether Hugvie can decrease stress cross-culturally, i.e., Japanese vs. Danish participants (ii), investigate whether gender plays a role in this psychological effect (stress reduction) and (iii) if there is a preference of this type of communication technology (Hugvie vs. a regular telephone). Twenty-nine healthy elderly participated (15 female and 14 male, M = 64.52 years, SD = 5.67) in Jutland, Denmark. The participants filled out questionnaires including State-Trait Anxiety Inventory, NEO Five Factor Inventory (NEO-FFI), and Becks Depression Inventory, had a 15 min conversation via phone or Hugvie and were interviewed afterward. They spoke with an unknown person of opposite gender during the conversation; the same two conversation partners were used during the experiment and the Phone and Hugvie groups were equally balanced. There was no baseline difference between the Hugvie and Phone groups on age or anxiety or depression scores. In the Hugvie group, there was a statistically significant reduction on state anxiety after meeting Hugvie (p = 0.013). The change in state anxiety for the Hugvie group was positively correlated with openness (r = 0.532, p = 0.041) as measured by the NEO-FFI. This indicates that openness to experiences may increase the chances of having an anxiety reduction from being with Hugvie. Based on the results, we see that personality may affect the participants’ engagement and benefits from Hugvie. We discuss the implications of the results and further elaborations.

Noradrenergic deficits in Parkinson disease imaged with 11C-MeNER

Degeneration of noradrenergic neurons may underlie the disabling nonmotor symptoms in patients with Parkinson disease (PD). Quantification of the loss of noradrenergic neurons by means of neuroimaging has been limited by the lack of radioligands that are selective for noradrenergic neurotransmission. The radioligand (S,S)-11C-2-(α-(2-methoxyphenoxy)benzyl)morpholine (11C-MeNER) is a highly selective inhibitor of noradrenaline transporters, and PET studies suggest that this radioligand is suitable for quantitative neuroimaging of noradrenergic deficits in human brain in vivo. In the present investigation, we used PET with 11C-MeNER to map the density of noradrenaline transporters in groups of patients with PD and age-matched healthy controls. Methods: After administration of 11C-MeNER, 15 nondemented patients with PD and 10 healthy subjects underwent 90-min dynamic PET. We determined 11C-MeNER binding potential relative to nondisplaceable binding potential (BPND) by multilinear analysis, simplified reference tissue model 2, and multilinear reference tissue model 2. Results: Metabolism of 11C-MeNER did not differ between groups. The simplified reference tissue model 2 and the multilinear reference tissue model 2 were used to determine 11C-MeNER BPND. 11C-MeNER BPND was reduced in the PD group compared with the control subjects, with regionally significant declines in the thalamus and nucleus ruber. Tremor was associated with higher tracer binding in the PD group on multivariate regression analysis. Conclusion: To our knowledge, this was the first specific quantification of noradrenergic denervation in PD patients in vivo. In agreement with predictions from determinations in vitro, we discovered a decline of noradrenergic projections in vivo in brain of PD patients.

Personality Characteristics of Depressed and Non-Depressed Patients With Parkinson’s Disease

Depression and a specific personality profile are often outlined as premorbid characteristics of Parkinsons disease (PD). However, few studies have explored possible relations between personality and depression in PD despite research in non-parkinsonian samples identifying specific personality traits as risk factors for depression. The personality profiles of 290 non-depressed and 119 depressed patients with PD were compared. The depressed patients were characterized by elevated neuroticism, reduced extroversion, and reduced conscientiousness and less convincing findings of reduced openness and agreeableness. The largest unique contribution to a regression analysis predicting depression was greater number of motor symptoms, increased neuroticism, and reduced extroversion.

Internet-delivered cognitive-behavioral therapy for insomnia in women treated for breast cancer: a randomized controlled trial

Abstract Background Insomnia is two to three times more prevalent in cancer survivors than in the general population, where it is estimated to be 10% to 20%. Cognitive-behavioral therapy for insomnia (CBT-I) is the recommended treatment for chronic insomnia, but meeting survivor needs remains a challenge. Internet-delivered CBT-I (iCBT-I) has been shown efficacious in otherwise healthy adults. We tested the efficacy of iCBT-I in breast cancer survivors with clinically significant sleep disturbance. Methods Women from a national sample of Danish breast cancer survivors who experienced clinically significant sleep disturbance were randomly allocated to iCBT-I or waitlist control (55:45). The fully automated iCBT-I program consisted of six cores. Online measures of insomnia severity, sleep quality, and fatigue were collected at baseline, postintervention (nine weeks), and follow-up (15 weeks). Online sleep diaries were completed over two-week periods pre- and postintervention. Intention-to-treat analyses (time × group interactions) were conducted with mixed linear models and corrected for multiple outcomes. All statistical tests were two-sided. Results A total of 255 women were randomly allocated to iCBT-I (n = 133) or waitlist control (n = 122). Statistically significant (P ≤ .02) time × group interactions were found for all sleep-related outcomes from pre- to postintervention. Effect sizes (Cohen’s d) ranged from 0.33 (95% confidence interval [CI] = 0.06 to 0.61) for wake after sleep onset to 1.17 (95% CI = 0.87 to 1.47) for insomnia severity. Improvements were maintained for outcomes measured at follow-up (d = 0.66–1.10). Conclusions iCBT-I appears to be effective in breast cancer survivors, with additional benefit in terms of reduced fatigue. This low-cost treatment could be incorporated in cancer rehabilitation programs.

Attitudinal Change in Elderly Citizens Toward Social Robots: The Role of Personality Traits and Beliefs About Robot Functionality.

Attitudes toward robots influence the tendency to accept or reject robotic devices. Thus it is important to investigate whether and how attitudes toward robots can change. In this pilot study we investigate attitudinal changes in elderly citizens toward a tele-operated robot in relation to three parameters: (i) the information provided about robot functionality, (ii) the number of encounters, (iii) personality type. Fourteen elderly residents at a rehabilitation center participated. Pre-encounter attitudes toward robots, anthropomorphic thinking, and personality were assessed. Thereafter the participants interacted with a tele-operated robot (Telenoid) during their lunch (c. 30 min.) for up to 3 days. Half of the participants were informed that the robot was tele-operated (IC) whilst the other half were naïve to its functioning (UC). Post-encounter assessments of attitudes toward robots and anthropomorphic thinking were undertaken to assess change. Attitudes toward robots were assessed with a new generic 35-items questionnaire (attitudes toward social robots scale: ASOR-5), offering a differentiated conceptualization of the conditions for social interaction. There was no significant difference between the IC and UC groups in attitude change toward robots though trends were observed. Personality was correlated with some tendencies for attitude changes; Extraversion correlated with positive attitude changes to intimate-personal relatedness with the robot (r = 0.619) and to psychological relatedness (r = 0.581) whilst Neuroticism correlated negatively (r = -0.582) with mental relatedness with the robot. The results tentatively suggest that neither information about functionality nor direct repeated encounters are pivotal in changing attitudes toward robots in elderly citizens. This may reflect a cognitive congruence bias where the robot is experienced in congruence with initial attitudes, or it may support action-based explanations of cognitive dissonance reductions, given that robots, unlike computers, are not yet perceived as action targets. Specific personality traits may be indicators of attitude change relating to specific domains of social interaction. Implications and future directions are discussed.