Natacha Deroost

Conflict and freezing of gait in Parkinson's disease: support for a response control deficit.

We investigated response activation and suppression processes in Parkinsons disease patients with freezing of gait (FOG). Fourteen freezers, 14 nonfreezers, and 14 matched healthy controls performed the attention network task (ANT) and the Stroop task. The former task has more stimulus-response overlap and is expected to elicit stronger irrelevant response activation, requiring more inhibition. Congruency effects were used as a general measure of conflict resolution. Supplementary reaction time (RT) distribution analyses were utilized to calculate conditional accuracy functions (CAFs) and delta plots to measure response activation and suppression processes. In agreement with previous research, freezers showed a general conflict resolution deficit compared with nonfreezers and healthy controls. Moreover, CAFs pointed to a strong initial incorrect response activation in FOG. As expected, conflict resolution impairment was only apparent in the ANT, and not in the Stroop task. These results suggest an imbalance between automatic and controlled processes in FOG, leading to a breakdown in both motor and cognitive response control.

Freezing of Gait in Parkinson Disease Is Associated With Impaired Conflict Resolution

Background. Freezing of gait (FOG) in Parkinson disease (PD) may involve executive dysfunction. This study examined whether executive functioning and attention are more affected in patients with FOG compared with those without and determined whether these processes are influenced by anti-Parkinson medication. Methods. A total of 11 PD patients with FOG, 11 without FOG, and 10 healthy control subjects, matched for age, gender, and education, participated. General motor, mental and cognitive screening tests, as well as specific neuropsychological assessment of executive functions and the Attention Network Test (ANT) were administered. The ANT was conducted in both ON and OFF phases in a counterbalanced design to determine medication-specific effects. Results. FOG showed a clear association with impairment in the executive control network for conflict resolution (inhibition of unwanted responses and impaired response selection), compared with nonfreezers and healthy controls, F(2, 28) = 5.41, P = .01. Orienting and alerting function did not differ between groups, F < 1. Other executive functions, such as abstract problem solving and mental flexibility were not associated with FOG (P > .10). Anti-Parkinson medication did not ameliorate conflict resolution (P > .10), although orienting attention improved with medication, F(1, 17) = 9.81, P < .01. Conclusions. This study shows an association between impaired conflict resolution and FOG, important in understanding the interplay between cognitive and motor problems, which can lead to specific rehabilitation strategies.

Freezing of gait in Parkinson's disease: disturbances in automaticity and control

Recent studies emphasize a key role of controlled operations, such as set-shifting and inhibition, in the occurrence of freezing of gait (FOG) in Parkinsons disease (PD). However, FOG can also be characterized as a de-automatization disorder, showing impairments in both the execution and acquisition of automaticity. The observed deficits in automaticity and executive functioning indicate that both processes are malfunctioning in freezers. Therefore, to explain FOG from a cognitive-based perspective, we present a model describing the pathways involved in automatic and controlled processes prior to a FOG episode. Crucially, we focus on disturbances in automaticity and control, regulated by the frontostriatal circuitry. In complex situations, non-freezing PD patients may compensate for deficits in automaticity by switching to increased cognitive control. However, as both automatic and controlled processes are more severely impaired in freezers, this hampers cognitive compensation in FOG, resulting in a potential breakdown. Future directions for cognitive rehabilitation are proposed, based on the cognitive model we put forward.

Cognitive aspects of freezing of gait in Parkinson’s disease: a challenge for rehabilitation

Freezing of gait (FOG) is a very disabling symptom affecting up to half of the patients with Parkinson’s disease (PD). Evidence is accumulating that FOG is caused by a complex interplay between motor, cognitive and affective factors, rather than being a pure motor phenomenon. In the current paper, we review the evidence on the specific role of cognitive factors in FOG. Results from behavioral studies show that patients with FOG experience impairments in executive functioning and response selection which predict that motor learning may be compromised. Brain imaging studies strengthen the neural basis of a potential association between FOG and cognitive impairment, but do not clarify whether it is a primary or secondary determinant of FOG. A FOG-related reduction of cognitive resources implies that adaptation of rehabilitation interventions is indicated for patients with FOG to promote the consolidation of learning.

The role of response selection in sequence learning

We investigated the role of response selection in sequence learning in the serial reaction time (SRT) task, by manipulating stimulus–response compatibility. Under conditions in which other types of learning, like perceptual, response-based, and response-effect learning, were unaffected, sequence learning was better with an incompatible than with a compatible stimulus–response mapping. Stimulus discriminability, on the other hand, had no influence on the amount of sequence learning. This indicates that the compatibility effects cannot be accounted for by a different level of task difficulty. Relating our results to the dimensional overlap model (Kornblum, Hasbroucq, & Osman, 1990), which assumes that incompatible stimulus–response mappings require more controlled response selection than do compatible stimulus–response mapping, we suggest that sequence learning in the SRT task is particularly effective when response selection occurs in a controlled way.

Learning sequence movements in a homogenous sample of patients with Parkinson's disease

We investigated the acquisition of sequence movements in Parkinsons disease (PD) by means of the serial reaction time (SRT) task. To this end, we used a sample of PD patients that fell within the same stage of the disease. Sixteen PD patients and 16 age-, sex- and education-matched control subjects performed the SRT task with a first-order conditional (FOC) sequence and with a second-order conditional (SOC) sequence. The results showed that the group of PD patients could be divided into two distinct subgroups: a fast PD patient subgroup (n=11) and a slow PD patient subgroup (n=5). FOC and SOC sequence learning in faster PD patients proved to be highly comparable to the group of controls. In contrast, learning of FOC and SOC sequences was severely impaired in slower PD patients. Since slow PD patients also scored lower on measures of cognitive functioning than faster PD patients, we assume that the deficits in SRT learning of the former reflect some more general cognitive impairment. This indicates that SRT performance can provide additional information about the cognitive abilities of PD patients, and accordingly may contribute to disease screening.

Effector-dependent and response location learning of probabilistic sequences in serial reaction time tasks

We investigated the contributions of the sequences of effectors and response locations to probabilistic sequence learning in the serial reaction time task by means of bimanual transfer. Participants, trained with the dominant hand, were either required to maintain responding with the dominant hand after transfer or to switch to the nondominant hand. For both groups, half of the participants were transferred to the originally trained sequence, whereas the other half was transferred to a mirror-ordered sequence. This way, the sequence of effectors varied independently of the sequence of response locations. Sequence learning was assessed with probabilistic sequences, composed of either first-order or second-order probabilities. Transfer of sequence knowledge to the nondominant hand was equally good for the originally trained sequence as for the mirrored sequence. This suggests that probabilistic sequence learning can be based on either the sequence of effectors or response locations. However, when participants responded with the dominant hand to a mirrored sequence, transfer performance was disturbed. This indicates that changing both the sequences of effectors and response locations has a disruptive effect on the learning performance.

Impaired implicit sequence learning in Parkinson's disease patients with freezing of gait.

OBJECTIVE Freezing of gait (FOG) in Parkinsons disease (PD) may involve specific impairments in acquiring automaticity under working memory load. This study examined whether implicit sequence learning, with or without a secondary task, is impaired in patients with FOG. METHOD Fourteen freezers (FRs), 14 nonfreezers (nFRs), and 14 matched healthy controls (HCs) performed a serial reaction time (SRT) task with a deterministic stimulus sequence under single-task (ST) and dual-task (DT) conditions. The increase in reaction times (RTs) for random compared with sequenced blocks was used as a measure of implicit sequence learning. Neuropsychological tests assessing global cognitive functioning and executive dysfunction were administered in order to investigate their relation to sequence learning. RESULTS nFRs and HCs showed significant implicit sequence learning effects (p < 0.001). FRs demonstrated a tendency to learn sequence-specific information in the SRT-ST task (p = 0.07) but not in the SRT-DT task (p = 0.69). Severity of FOG, however, correlated positively with SRT-DT task performance (r = -0.56; p < 0.05). CONCLUSIONS The present results suggest that PD patients suffering from FOG pathology exhibit a specific impairment in the acquisition of automaticity. When working memory capacity is supplementarily loaded by adding a DT, sequence learning in FRs becomes increasingly impaired. These findings indicate that therapies should focus on extensive training in acquiring novel motor activities and reducing working memory load to improve learning in FOG.

Does implicit learning in non-demented Parkinson's disease depend on the level of cognitive functioning?

We investigated the influence of the level of cognitive functioning on sequence-specific learning in Parkinsons disease (PD). This was done by examining the relationship between the scales for outcomes in Parkinsons disease-cognition [SCOPA-COG, Marinus, J., Visser, M., Verwey, N. A., Verhey, F. R. J., Middelkoop, H. A. M.,Stiggelbout, A., et al. (2003). Assessment of cognition in Parkinsons disease. Neurology, 61, 1222-1228] and the serial reaction time (SRT) task [Nissen, M. J., & Bullemer, P. T. (1987). Attentional requirements for learning: Evidence from performance measures. Cognitive Psychology, 19, 1-32] in a homogeneous sample, consisting of 25 PD patients diagnosed in Stage 3 of the Hoehn and Yahr [Hoehn, M. M., & Yahr, M. D. (1967). Parkinsonism: onset, progression, and mortality. Neurology, 17, 427-442] scale. Six patients in the low scoring cognitive group, 11 patients in the average scoring and eight patients in the high scoring group, conducted a SRT task with a deterministic sequence. Sequence-specific learning was assessed by inserting a random block to determine whether the acquisition of sequence movements differed between groups. Our results indicate an association between cognitive functioning in PD patients and sequence learning. These findings emphasize the use of assessing cognition in addition to the well-known motor aspects in PD.

Intact first- and second-order implicit sequence learning in secondary-school-aged children with developmental dyslexia

We examined the influence of task complexity on implicit sequence learning in secondary-school-aged children with developmental dyslexia (DD). This was done to determine whether automatization problems in reading extend to the automatization of all skill and depend on the complexity of the to-be-learned skill. A total of 28 dyslexic children between 12 and 15 years and 28 matched control children carried out two serial reaction time tasks using a first-order conditional (FOC) and second-order conditional (SOC) sequence. In both tasks, children incidentally learned a sequence of hidden target positions, but whereas FOC sequence learning could be based on knowledge about the immediate preceding position, SOC sequence learning required more complex knowledge about the previous two positions. The results demonstrated that sequence learning was highly comparable in dyslexic and control children, regardless of the sequence complexity. This shows that implicit sequence learning, as manifested in the present study, is maintained in DD and is unrelated to task complexity. We suggest that previous reports of sequence-learning deficits in DD can be accounted for by attenuated explicit sequence learning, possibly related to malfunctions in prefrontal processing. The present findings indicate that deficits in skill learning and automatization in DD are not general in nature, but task dependent.