Sandra Neargarder

The impact of sleep quality on cognitive functioning in Parkinson's disease.

In healthy individuals and those with insomnia, poor sleep quality is associated with decrements in performance on tests of cognition, especially executive function. Sleep disturbances and cognitive deficits are both prevalent in Parkinsons disease (PD). Sleep problems occur in over 75% of patients, with sleep fragmentation and decreased sleep efficiency being the most common sleep complaints, but their relation to cognition is unknown. We examined the association between sleep quality and cognition in PD. In 35 non-demented individuals with PD and 18 normal control adults (NC), sleep was measured using 24-hr wrist actigraphy over 7 days. Cognitive domains tested included attention and executive function, memory and psychomotor function. In both groups, poor sleep was associated with worse performance on tests of attention/executive function but not memory or psychomotor function. In the PD group, attention/executive function was predicted by sleep efficiency, whereas memory and psychomotor function were not predicted by sleep quality. Psychomotor and memory function were predicted by motor symptom severity. This study is the first to demonstrate that sleep quality in PD is significantly correlated with cognition and that it differentially impacts attention and executive function, thereby furthering our understanding of the link between sleep and cognition.

Superior encoding enhances recall in color-graphemic synesthesia

Synesthesia is a phenomenon in which particular stimuli, such as letters or sound, generate a secondary sensory experience in particular individuals. Reports of enhanced memory in synesthetes raise the question of its cognitive and neurological substrates. Enhanced memory in synesthetes could arise from the explicit or implicit use of a synesthetic cue to aid memory, from changes unique to the synesthete brain, or from both, depending on the task. To assess this question, we tested nine color-graphemic synesthetes using standardized neuropsychological measures that should not trigger color-graphemic synesthesia (visuo-spatial tests) and measures that should trigger color-graphemic synesthesia (verbal tasks). We found a synesthetic advantage on both types of tests, primarily in the initial encoding of information. The pattern of results adds to existing evidence of advantages in synesthetic memory, as well as provides novel evidence that synesthetes may have enhanced encoding rather than superior recall. Synesthetes learn more initially, rather than forgetting less over time.

Frontal and Posterior Subtypes of Neuropsychological Deficit in Parkinson's Disease

Mild cognitive impairment in Parkinsons disease (PD) is heterogeneous in regard to affected domains. Although patterns of cognitive performance that may predict later dementia are as yet undetermined, posterior- versus frontal-type assessments show promise for differential predictive value. The present study included 70 individuals: 42 with idiopathic PD without dementia and 28 age- and education-matched healthy control adults (HC). Participants completed assessments of cognition with emphasis on tests that are sensitive to frontal and posterior deficits. PD patients were classified into cognitive subgroups and the subgroups were compared on demographic and disease variables. Individual performance across neuropsychological tests was evaluated for the PD group. Patients with PD performed more poorly than HC on several measures of cognition, and they were classified into frontal (12), posterior (3), both (10) and neither subgroups (17), the latter two in reference to frontal- and posterior-type deficits. The neither subgroup was distinguished by less motor impairment than the both subgroup, but the four subgroups did not otherwise differ on demographic or disease variables. Across patients, the tests most sensitive to cognitive impairment included measures of attention and executive functioning (frontal-type tests). Examination of individual test performance for PD revealed substantial heterogeneity across tests with respect to number and severity of deficits. The current study provides insight into which commonly used neuropsychological tests are most sensitive to cognitive deficits (strictly defined) in a nondemented, well characterized PD sample, and into the relation of cognitive subgroups to demographic and disease-specific variables.

Vision-Fair Neuropsychological Assessment in Normal Aging, Parkinson’s Disease and Alzheimer’s Disease

We examined performance of healthy older and younger adults and individuals with Alzheimers disease (AD) and Parkinsons disease (PD) on digit cancellation, a task putatively sensitive to cognitive impairment, but possibly affected by visual impairment, particularly in contrast sensitivity. Critical contrast thresholds were established to create custom stimulus arrays that were proximally matched across individuals. Age- and PD-related differences in search were fully accounted for by the sensory deficit. Increased contrast benefited AD patients, but could not override cognitive impairment. We conclude that visually fair neuropsychological testing can effectively compensate for normal age- and PD-related visual changes that affect cognitive performance.

Line Bisection in Parkinson's Disease: Investigation of Contributions of Visual Field, Retinal Vision, and Scanning Patterns to Visuospatial Function

Parkinsons disease (PD) is characterized by disorders of visuospatial function that can impact everyday functioning. Visuospatial difficulties are more prominent in those whose motor symptoms begin on the left body side (LPD) than the right body side (RPD) and have mainly been attributed to parietal dysfunction. The source of visuospatial dysfunction is unclear, as in addition to subcortical-cortical changes, there are irregularities of visual scanning and potentially of retinal-level vision in PD. To assess these potential contributors, performance on a visuospatial task--line bisection--was examined together with retinal structure (nerve fiber layer thickness, measured by optical coherence tomography [OCT]), retinal function (contrast sensitivity, measured by frequency-doubling technology [FDT]), and visual scanning patterns. Participants included 20 nondemented patients (10 LPD, 10 RPD) and 11 normal control (NC) adults. Relative to the other groups, LPD were expected to show rightward bias on horizontal line bisection, especially within the left visual hemispace, and downward bias on vertical bisection. LPD relative rightward bias was confirmed, though not mainly within the left hemispace and not correlated with retinal structure or function. Retinal thinning was seen in LPD relative to RPD. Qualitative visualization of eye movements suggested greater LPD exploration of the right than left side of the line during horizontal bisection, and some overall compression of scanning range in RPD (both orientations) and LPD (primarily vertical). Results indicated that rightward visuospatial bias in our LPD sample arose not from abnormalities at the retinal level but potentially from attentional biases, reflected in eye movement patterns.

Perceptual, Cognitive, and Personality Rigidity in Parkinson’s Disease

Parkinsons disease (PD) is associated with motor and non-motor rigidity symptoms (e.g., cognitive and personality). The question is raised as to whether rigidity in PD also extends to perception, and if so, whether perceptual, cognitive, and personality rigidities are correlated. Bistable stimuli were presented to 28 non-demented individuals with PD and 26 normal control adults (NC). Necker cube perception and binocular rivalry were examined during passive viewing, and the Necker cube was additionally used for two volitional-control conditions: Hold one percept in front, and Switch between the two percepts. Relative to passive viewing, PD were significantly less able than NC to reduce dominance durations in the Switch condition, indicating perceptual rigidity. Tests of cognitive flexibility and a personality questionnaire were administered to explore the association with perceptual rigidity. Cognitive flexibility was not correlated with perceptual rigidity for either group. Personality (novelty seeking) correlated with dominance durations on Necker passive viewing for PD but not NC. The results indicate the presence in mild-moderate PD of perceptual rigidity and suggest shared neural substrates with novelty seeking, but functional divergence from those supporting cognitive flexibility. The possibility is raised that perceptual rigidity may be a harbinger of cognitive inflexibility later in the disease course.

Mapping mental number line in physical space: Vertical and horizontal visual number line orientation in asymptomatic individuals with HIV

Multiple studies have implicated frontostriatal dysfunction in human immunodeficiency virus (HIV) and described cognitive deficits with a focus on executive function and memory. Remarkably little is known about visuospatial and number processing in HIV, though these capacities are also supported by frontostriatal circuits and their parietal connections. We investigated the relation of numerical and spatial cognition in asymptomatic individuals with HIV and explored physical and mental number orientation using several modes of presentation and response: mental number line bisection, physical line bisection, and physical number line orientation on visually-presented horizontal and vertical number lines. The asymptomatic HIV+ group was significantly slower and produced more errors on visuospatial and number processing tasks than the HIV- group (n=37/group). Both groups showed significant correlations between number processing and visuospatial performance. These findings demonstrate that HIV-related brain damage early in the disease course can alter the spatial representation of numerical distance, providing evidence for disruption of frontostriatal circuits and their parietal projections underlying numerical processing in HIV. Besides disease-related effects, this study demonstrates that the physical number line preserves its numerical and spatial integrity in both the vertical and horizontal physical dimensions, as all participants exhibited underestimation of numerical distance, i.e. leftward bias (for horizontal presentation) and downward bias (for vertical). Our results also revealed a dissociation between the processing components of numerical distance and physical space, suggesting differentiation between the neural networks involved in number lines and physical line orientation.

Luminance affects age-related deficits in object detection: Implications for computerized psychological assessments.

As psychological instruments are converted for administration on computers, differences in luminance and contrast of these displays may affect performance. Specifically, high-luminance assessments may mask age-group differences that are apparent under lower luminance conditions. We examined the effects of luminance and contrast on object detection using computerized and naturalistic assessments. Younger and older adults displayed more differences in performance across differing contrast levels in conditions that were matched for luminance, despite the conditions appearing perceptually different. These findings indicate that computerized assessments should be created with luminance levels that are similar to those of the tasks they purport to simulate in order to enhance their validity.

The effect of Parkinson’s disease subgroups on verbal and nonverbal fluency

Background. Parkinson’s disease (PD) leads to deficits in executive function, including verbal and nonverbal fluency, as a result of compromised frontostriatal circuits. It is unknown whether deficits in verbal and nonverbal fluency in PD are driven by certain subgroups of patients, or how strategy use may facilitate performance. Participants. Sixty-five nondemented individuals with PD, including 36 with right-body onset (RPD; 20 with tremor as their initial symptom, 16 nontremor) and 29 with left-body onset (LPD; 14 with tremor as their initial symptom, 15 nontremor), and 52 normal control participants (NC) took part in the study. Measurements. Verbal fluency was assessed using the FAS and Animals tests. Nonverbal fluency was assessed using the Ruff Figural Fluency Test. Results. Both RPD and LPD were impaired in generating words and in using clustering and switching strategies on phonemic verbal fluency, whereas different patterns of impairment were found on nonverbal fluency depending on the interaction of side of onset and initial motor symptom (tremor vs. nontremor). Strategy use correlated with number of correct responses on verbal fluency in LPD, RPD, and NC. By contrast, on nonverbal fluency, strategy use correlated with correct responses for RPD and LPD, but not for NC. Conclusion. Our findings demonstrate the importance of considering subgroups in PD and analyzing subcomponents of verbal and nonverbal fluency (correct responses, errors, and strategies), which may depend differently on the integrity of dorsolateral prefrontal cortex, inferior frontal cortex, and anterior cingulate cortex.

Web-based assessment of visual and visuospatial symptoms in Parkinson's disease.

Visual and visuospatial dysfunction is prevalent in Parkinsons disease (PD). To promote assessment of these often overlooked symptoms, we adapted the PD Vision Questionnaire for Internet administration. The questionnaire evaluates visual and visuospatial symptoms, impairments in activities of daily living (ADLs), and motor symptoms. PD participants of mild to moderate motor severity (n = 24) and healthy control participants (HC, n = 23) completed the questionnaire in paper and web-based formats. Reliability was assessed by comparing responses across formats. Construct validity was evaluated by reference to performance on measures of vision, visuospatial cognition, ADLs, and motor symptoms. The web-based format showed excellent reliability with respect to the paper format for both groups (all P′s < 0.001; HC completing the visual and visuospatial section only). Demonstrating the construct validity of the web-based questionnaire, self-rated ADL and visual and visuospatial functioning were significantly associated with performance on objective measures of these abilities (all P′s < 0.01). The findings indicate that web-based administration may be a reliable and valid method of assessing visual and visuospatial and ADL functioning in PD.