Raymon Durso

Pragmatic communication skills in patients with Parkinson's disease

BACKGROUND Pragmatic communication abilities may depend on intact frontal lobe systems. Independent evidence suggests that some persons with Parkinsons disease (PD) are impaired on measures of frontal lobe function. HYPOTHESIS We therefore hypothesized in Study 1 that pragmatic communication skills would be impaired in some persons with PD and would be linked to frontal dysfunction in these patients. In Study 2 we hypothesized that PD patients would be unaware of their pragmatic communication deficits. METHODS In Study 1 we administered tests of pragmatic abilities and frontal lobe functioning to twenty-two persons with Parkinsons disease (PD) and 10 healthy controls. In Study 2 we obtained self-ratings of pragmatic abilities from 11 PD patients and then checked these self-ratings against ratings of these same abilities by the patients spouses. RESULTS We found in Study 1 that patients with PD were: (a) significantly impaired on measures of pragmatic communication abilities, especially in the areas of conversational appropriateness, turn-taking, prosodics and proxemics, and that this impairment was significantly related to measures of frontal lobe function. In study 2 we found that PD patients overestimated their own abilities relative to spousal ratings of those abilities and thus were unaware of the extent of their problems with pragmatic social communication skills. CONCLUSION We conclude that pragmatic social communication skills are impaired in PD and that this impairment may be related to frontal lobe dysfunction.

Grammaticality judgments and sentence comprehension in Parkinson's disease : A comparison with Broca's aphasia

In order to test the hypothesis that significant linguistic deficits could be associated with predominantly subcortical dopaminergic pathways which projected to the frontal lobes (in patients with Parkinsons Disease-PD), we compared language performance in PD patients to that of Brocas aphasics with linguistic deficits. On tests of grammaticality judgements and sentence comprehension, performance by patients with Parkinsons Disease did not vary with different types of sentence structure (as was the case with the aphasics) and was instead, uniformly high (about 75% correct). Comprehension performance, however, did significantly decline in a subgroup of patients with PD who were tested when withdrawn from their dopaminergic medications. We conclude that patients with treated Parkinsons Disease evidence no selective linguistic dysfunction. When, however, they are withdrawn from dopaminergic medication language functions suffer.

Life goals of patients with Parkinson’s disease: a pilot study on correlations with mood and cognitive functions

Objective: To identify the life goals of people with Parkinson’s disease, to assess whether patients felt that these goals were ‘on track’, and to assess the relation of these life goals to neuropsychologic and mood function. Design: Cross-sectional descriptive study with an age-matched control group. Setting: Outpatient Movement Disorders Clinics Veterans Hospital. Subjects: Twenty-two patients with mid-stage Parkinson’s disease and 22 age-matched controls. Measures: Rivermead Life Goals Inventory, neuropsychological and mood scales. Results: People with Parkinson’s disease were less likely than age-matched controls to cite religion, social contacts, leisure activities and personal care as ‘extremely important life goals’. People with Parkinson’s disease assigned significantly lower ‘importance’ ratings to leisure activities and religion than did controls. In addition, people with Parkinson’s disease assigned significantly lower ‘on track’ ratings for leisure activities, work, social contacts, religion and financial affairs compared with controls’ rating on the same items. Although people with Parkinson’s disease showed significantly greater levels of cognitive and mood dysfunction than did controls, their mean importance ratings on life goals correlated only with mood function scores. Conclusions: The leisure activities, work, social contacts, religion and financial affairs of people with Parkinson’s disease are less ‘on track’ than are their personal and family relationships. Subjective importance ratings of particular life goals of people with Parkinson’s disease were found to be significantly related to mood function and not to cognitive function. Goal derailment ratings on the other hand were significantly related to both mood and cognitive impairment.

Hallucinations, Dreaming, and Frequent Dozing in Parkinson Disease: Impact of Right-hemisphere Neural Networks

ObjectiveTo relate sleep disturbances in Parkinson disease (PD) to hemispheric asymmetry of initial presentation. BackgroundSleep disturbances are common in PD arising from the neurodegenerative process underlying the disease, which is usually lateralized at onset. Patients with left-side Parkinson disease onset (LPD: right hemisphere dysfunction) exhibit reduced vigilance relative to those with right-side Parkinson disease onset (RPD: left hemisphere dysfunction), leading us to hypothesize that sleep-related disturbances, particularly excessive daytime sleepiness, would be more severe for LPD than for RPD. MethodsThirty-one nondemented participants with PD (17 RPD and 14 LPD) and 17 age-matched control (CO) participants with chronic health conditions were administered the Parkinson Disease Sleep Scale and polysomnography was performed on a subset of the PD participants. ResultsBoth PD subgroups exhibited more nighttime motor symptoms than the CO group, but only LPD endorsed more nocturnal hallucinations and daytime dozing. Controlling for mood additionally revealed more vivid dreaming in LPD than RPD. There were no significant differences between LPD and RPD on measures of sleep architecture. ConclusionsIncreased dreaming, hallucinations, and daytime somnolescence in LPD may be related to changes in right-hemisphere neural networks implicated in the generation and control of visual images, arousal, and vigilance. Our results underscore the need to consider side of onset in regard to sleep disturbances in PD.

“Machiavellianism” and frontal dysfunction: Evidence from Parkinson's disease

Introduction. A number of reports have identified significant personality differences in patients with Parkinsons disease (PD) when compared with age-matched controls. We hypothesised that these differences may be related to impairment in prefrontal inhibitory functions resulting in the expression of new “Machiavellian” personality traits. Methods. Thirty-five patients with PD and 17 age-matched controls were assessed with a set of neuropsychologic, personality and mood tests as well as the Mach IV scale, which measures a set of “Machiavellian” personality characteristics. Results. PD patients with elevated Machiavellian traits (“high Machs”) were selectively impaired on tests of prefrontal function relative to “low Mach” patients. In addition, while high Machs did not differ from low Machs in terms of age, educational level, Hoehn-Yahr stage, mood function, or Mini Mental State Exam score, they indicated greater willingness to affiliate with a fictional Machiavellian character and scored significantly lower on the “cooperativeness” and “self-directedness” subscales of the Cloninger Temperament and Character Inventory. Conclusions. We suggest that (1) PD patients with frontal impairment are vulnerable to dramatic personality change, and (2) the frontal lobes are required for maintenance of prosocial personality traits.

Mood, side of motor symptom onset and pain complaints in Parkinson's disease

Patients with Parkinsons disease (PD) present with a variety of non‐motor symptoms including sensory complaints and mood disturbances. In the current pilot study, we aimed to explore pain complaints and the association between mood and pain in PD. We hypothesized that pain ratings would be elevated in patients with PD relative to controls. As PD is lateralized at onset and studies have found lateralization of some non‐motor symptoms in PD, we also hypothesized that PD patients would exhibit differing pain profiles depending on side of onset of the disease.

Reversible Pathologic Jealousy (Othello Syndrome) Associated With Amantadine

We describe a case of pathologic jealousy (Othello syndrome) in a patient with Parkinson disease, which abated after discontinuing amantadine. We indicate that early recognition and treatment of the syndrome in this disease may avert physical violence. We also believe that our report further suggests a link between this specific behavioral disorder and dopaminergic activity. (J Geriatr Psychiatry Neurol 1991;4:157-159).

Deficits in the automatic activation of religious concepts in patients with Parkinson's disease

Religion is central to the lives of billions of people worldwide. To probe processing dynamics of religious cognition and its potential brain correlates, we used a novel priming procedure to assess the integrity of religious and control semantic networks in patients with Parkinsons disease (PD) and controls. Priming for control, but not religious, concepts was intact in PD patients. Patients with left-onset (right-forebrain disease) evidenced severe impairment activating religious concepts. We next modeled the priming performance with modified cable equations. These analyses suggested that deficient performance of PD patients on activation of religious concepts was due to a change in the time constants governing gain and rate of decay of activation in these semantic networks. These modeling results are consistent with dopaminergic dysfunction in right-sided striatal-prefrontal networks. We conclude that right striatal-prefrontal dopaminergic networks support activation of complex religious concepts but not equally complex and related control concepts.

Variable Absorption of Carbidopa Affects Both Peripheral and Central Levodopa Metabolism

Carbidopa (CD), a competitive inhibitor of aromatic l‐amino acid decarboxylase that does not cross the blood‐brain barrier, is routinely administered with levodopa (LD) to patients with Parkinson disease (PD) to reduce the peripheral decarboxylation of LD to dopamine. Using a stable isotope‐labeled form of LD, the authors examined in 9 PD patients the effects of variable CD absorption on peripheral and central LD metabolism. Subjects were administered orally 50 mg of CD followed in 1 hour by a slow bolus intravenous infusion of 150 mg stable isotope‐labeled LD (ring 1′,2′,3′,4′,5′,6′‐13C). Eight patients underwent a lumbar puncture 6 hours following the infusion. Blood and cerebrospinal fluid (CSF) samples were analyzed for labeled and unlabeled metabolites using a combination of high‐performance liquid chromatography and mass spectrometry. When patients were divided into “slow” and “rapid” CD absorption groups, significantly greater peripheral LD decarboxylation (as measured by area under the curve [AUC]‐labeled serum HVA) was noted in the poor absorbers (p = 0.05, Mann‐Whitney U test). Elimination half‐lives for serum LD did not differ between groups, suggesting a further capacity for decarboxylation inhibition in the “rapid” absorbers. A significant correlation between AUC serum CD and percent‐labeled HVA in CSF was found for all patients (R = 0.786, p = 0.02). “Rapid” as compared to “slow” CD absorbers had significantly more percent‐labeled CSF HVA (60 vs. 49, p = 0.02, Mann‐Whitney U test), indicating greater central‐labeled DA production in the better CD absorbers. The data suggest that peripheral aromatic l‐amino acid decarboxylase activity is not saturated at CD doses used in current practice. The authors believe that future studies to better examine a dose dependence of CD on peripheral LD decarboxylation and LD brain uptake are warranted.

Relation of sense of self to executive function performance in Parkinson's disease

BackgroundRecent reports have linked impairment of various aspects of the sense of self to frontal brain dysfunction. Independent evidence suggests that patients with Parkinsons disease exhibit impairment on cognitive tasks that depend on the frontal lobes. ObjectiveTo test the hypothesis (1) that the sense of self would be impaired in some persons with Parkinsons disease and (2) that this impairment would be linked to frontal dysfunction. MethodsSentence completion tests of identity development (“self-test”) and measures of frontal and temporal lobe functioning were administered to 20 people with Parkinsons disease and to 10 age-matched healthy controls. ResultsWhile self-test responses significantly correlated with performance scores on tests of executive function (for Parkinsons disease patients only) but not temporal lobe function (as measured by “clustering” rates on a fluency task), we found no significant differences in mean self-test scores between persons with Parkinsons disease and age-matched controls. Analysis of the 160 self-test responses revealed a shift toward conformist responses in Hoehn-Yahr stage III as compared with stage II Parkinsons disease patients. ConclusionsWhile the sense of self changes as a function of disease stage, the core experience of self in Parkinsons disease is intact but may depend, in part, on frontal lobe function.