Shibley Rahman

Publications

• 4.01

  Impact points

  Quality of life in Parkinson's disease: The relative importance of the symptoms.

  Shibley Rahman, Harry J Griffin, Niall P Quinn, Marjan Jahanshahi

  Movement disorders : official journal of the Movement Disorder Society. 07/2008;

  A body of literature now exists, which demonstrates that idiopathic Parkinson's disease (PD) has a major negative impact on quality of life (QoL), and that depression and cognitive impairment are among the main predictors of poor QoL in this disorder. Relatively little work has been done to asse... [more] A body of literature now exists, which demonstrates that idiopathic Parkinson's disease (PD) has a major negative impact on quality of life (QoL), and that depression and cognitive impairment are among the main predictors of poor QoL in this disorder. Relatively little work has been done to assess the differential contribution of the specific symptoms of PD to QoL, which was the aim of this study. One hundred thirty patients with PD completed a booklet of questionnaires, which included the PDQ39 as a disease-specific measure of QoL, a symptom checklist, a mobility checklist, as well as patient ratings of disease stage and disability. The results indicated that the contribution of physical, medication-related, and cognitive/psychiatric symptoms to QoL can be significant. Sudden unpredictable on/off states, difficulty in dressing, difficulty in walking, falls, depression, and confusion were PD symptoms, which significantly influenced QoL scores. Among the mobility problems associated with PD, start hesitation, shuffling gait, freezing, festination, propulsion, and difficulty in turning had a significant effect on QoL scores. In addition to depression and anxiety, the major predictors of QoL were shuffling, difficulty turning, falls, difficulty in dressing, fatigue, confusion, autonomic disturbance particularly urinary incontinence, unpredictable on/off fluctuations, and sensory symptoms such as pain. The implications of these results for the medical management of PD are discussed. (c) 2007 Movement Disorder Society.
• 6.99

  Impact points

  Methylphenidate ('Ritalin') can ameliorate abnormal risk-taking behavior in the frontal variant of frontotemporal dementia.

  Shibley Rahman, Trevor W Robbins, John R Hodges, Mitul A Mehta, Peter J Nestor, Luke Clark, Barbara J Sahakian

  Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology. 04/2006; 31(3):651-8.

  The frontal variant of frontotemporal dementia is a significant neurological condition worldwide. There exist few treatments available for the cognitive and behavioural sequelae of fvFTD. Previous research has shown that these patients display risky decision-making, and numerous studies have now dem... [more] The frontal variant of frontotemporal dementia is a significant neurological condition worldwide. There exist few treatments available for the cognitive and behavioural sequelae of fvFTD. Previous research has shown that these patients display risky decision-making, and numerous studies have now demonstrated pathology affecting the orbitofrontal cortex. The present study uses a within-subjects, double-blind, placebo-controlled procedure to investigate the effects of a single dose of methylphenidate (40 mg) upon a range of different cognitive processes including those assessing prefrontal cortex integrity. Methylphenidate was effective in 'normalizing' the decision-making behavior of patients, such that they became less risk taking on medication, although there were no significant effects on other aspects of cognitive function, including working memory, attentional set shifting, and reversal learning. Moreover, there was an absence of the normal subjective and autonomic responses to methylphenidate seen in elderly subjects. The results are discussed in terms of the 'somatic marker' hypothesis of impaired decision-making following orbitofrontal dysfunction.
• 4.10

  Impact points

  Paroxetine does not improve symptoms and impairs cognition in frontotemporal dementia: a double-blind randomized controlled trial.

  J B Deakin, S Rahman, P J Nestor, J R Hodges, B J Sahakian

  Psychopharmacology. 05/2004; 172(4):400-8.

  RATIONALE: Patients with frontal variant frontotemporal dementia (fvFTD) present with disinhibition, impulsiveness, apathy, altered appetite and stereotypic behaviors. A non-randomized clinical trial found improvement in these symptoms after treatment with a selective serotonin reuptake inhibitor (S... [more] RATIONALE: Patients with frontal variant frontotemporal dementia (fvFTD) present with disinhibition, impulsiveness, apathy, altered appetite and stereotypic behaviors. A non-randomized clinical trial found improvement in these symptoms after treatment with a selective serotonin reuptake inhibitor (SSRI). OBJECTIVES: We aimed to subject a SSRI, paroxetine, to a more rigorous test of its efficacy using a double-blind, placebo-controlled experimental design. METHODS: Ten subjects meeting the consensus criteria for FTD were entered into a double-blind, placebo-controlled crossover trial. Doses of paroxetine were progressively increased to 40 mg daily. The same regimen was used for placebo capsules. Subjects were assessed with a battery of cognitive tests in the sixth week of paroxetine and placebo treatment. At each assessment, caregivers were interviewed using the Neuropsychiatric Inventory and asked to complete the Cambridge Behavioral Inventory. RESULTS: There were no significant differences on the Neuropsychiatric Inventory or the Cambridge Behavioral Inventory. Paroxetine caused a decrease in accuracy on the paired associates learning task, reversal learning and a delayed pattern recognition task. There were no changes on the decision-making task, in spatial span, spatial recognition, spatial working memory, digit span and verbal fluency. CONCLUSIONS: This study finds no evidence for the efficacy of paroxetine in the treatment of fvFTD. The results suggest that a chronic course of paroxetine may selectively impair paired associates learning, reversal learning and delayed pattern recognition. This pattern of deficits closely resembles that seen after tryptophan depletion. Results are discussed with respect to current theories on serotonergic modulation of orbitofrontal/ventromedial prefrontal cortex.
• 3.42

  Impact points

  Associative and recognition memory for novel objects in dementia: implications for diagnosis.

  Andy C H Lee, Shibley Rahman, John R Hodges, Barbara J Sahakian, Kim S Graham

  The European journal of neuroscience. 10/2003; 18(6):1660-70.

  It has been demonstrated that patients with dementia of the Alzheimer's type show particular difficulties with a task that measures memory for object locations [R. Swainson et al. (2001) Dement. Geriatr. Cogn. Disord. 12, 265-80]. The present study followed on from this report by asking whether ... [more] It has been demonstrated that patients with dementia of the Alzheimer's type show particular difficulties with a task that measures memory for object locations [R. Swainson et al. (2001) Dement. Geriatr. Cogn. Disord. 12, 265-80]. The present study followed on from this report by asking whether the deficits seen in dementia of the Alzheimer's type were specific to this condition, or whether they would also be seen in another common neurodegenerative syndrome, frontotemporal dementia. To investigate this important issue, we examined memory for object-location pairs and visual recognition memory for novel patterns using two tests, the Paired Associates Learning and Matching to Sample tasks, from the Cambridge Neuropsychological Testing Automated Battery. The performance of a subset of the patients with dementia of the Alzheimer's type described by Swainson et al., selected on the basis of age and education, was compared with matched groups of frontal variant frontotemporal dementia, semantic dementia and control subjects. In contrast to the patients with dementia of the Alzheimer's type, who showed significant impairment on both memory tests, the two frontotemporal dementia groups did not perform significantly poorer compared with control subjects on nearly all memory measures, other than 'memory score' from the paired associates learning task. These findings confirm that tests of episodic memory, especially for the location of objects in space, may be useful in the early diagnosis and differentiation of dementia of the Alzheimer's type.

• Therapeutic interventions in dementia

  S Rahman, Gregory, BJ CA Sahakian

  09/2001;

  ISBN: 978-0192630346

• Cognitive deficits in frontal lobe dementia

  Shibley Rahman

  01/2001

  Degree: Doctor of Philosophy

  Supervisor: Prof Barbara Sahakian
• 9.49

  Impact points

  Specific cognitive deficits in mild frontal variant frontotemporal dementia.

  S Rahman, B J Sahakian, J R Hodges, R D Rogers, T W Robbins

  Brain : a journal of neurology. 09/1999; 122 ( Pt 8):1469-93.

  Eight patients with relatively mild frontal variant frontotemporal dementia (fvFTD) were compared with age- and IQ-matched control volunteers on tests of executive and mnemonic function. Tests of pattern and spatial recognition memory, spatial span, spatial working memory, planning, visual discrimin... [more] Eight patients with relatively mild frontal variant frontotemporal dementia (fvFTD) were compared with age- and IQ-matched control volunteers on tests of executive and mnemonic function. Tests of pattern and spatial recognition memory, spatial span, spatial working memory, planning, visual discrimination learning/attentional set-shifting and decision-making were employed. Patients with fvFTD were found to have deficits in the visual discrimination learning paradigm specific to the reversal stages. Furthermore, in the decision-making paradigm, patients were found to show genuine risk-taking behaviour with increased deliberation times rather than merely impulsive behaviour. It was especially notable that these patients demonstrated virtually no deficits in other tests that have also been shown to be sensitive to frontal lobe dysfunction, such as the spatial working memory and planning tasks. These results are discussed in relation to the possible underlying neuropathology, the anatomical connectivity and the hypothesized heterogeneous functions of areas of the prefrontal cortex. In particular, given the nature of the cognitive deficits demonstrated by these patients, we postulate that, relatively early in the course of the disease, the ventromedial (or orbitofrontal) cortex is a major locus of dysfunction and that this may relate to the behavioural presentation of these patients clinically described in the individual case histories.
• 2.58

  Impact points

  Comparative cognitive neuropsychological studies of frontal lobe function: implications for therapeutic strategies in frontal variant frontotemporal dementia.

  S Rahman, T W Robbins, B J Sahakian

  Dementia and geriatric cognitive disorders. 02/1999; 10 Suppl 1:15-28.

  Patients with mild frontal variant frontotemporal dementia (fvFTD) who attend the clinic are usually unaware of the pervasive changes in their personality and behaviour, despite the fact it is these changes which have prompted the referral from the patient's spouse or carer. Comparative studies ... [more] Patients with mild frontal variant frontotemporal dementia (fvFTD) who attend the clinic are usually unaware of the pervasive changes in their personality and behaviour, despite the fact it is these changes which have prompted the referral from the patient's spouse or carer. Comparative studies across various species offer unique insights into the heterogeneous structure and functions of the prefrontal cortex, and can allow a novel approach to the precise identification of the neuropsychological deficits present in these patients. We have found that they may show marked deficits on tests sensitive to ventromedial prefrontal or orbitofrontal function, in the relative absence of impairments on tests sensitive to dorsolateral prefrontal function. We highlight important differences in the neurocognitive profile of these patients with that of patients with other neurodegenerative conditions, including basal ganglia diseases and dementia of the Alzheimer type. The specific nature of these neuropsychological deficits, together with converging evidence from clinical and neuropathological studies, may provide useful clues about the predominant locus of dysfunction in the early stages of fvFTD and possible underlying neurotransmitter abnormalities. This is important for the successful development of therapeutic intervention strategies for both cognitive and behavioural symptoms in fvFTD. Finally, we evaluate critically the rationales for therapeutic modulation of noradrenergic, serotonergic and dopaminergic neurotransmitter systems at various stages of disease.

• Decision making and neuropsychiatry

  Shibley Rahman, Barbara J. Sahakian, Rudolf N. Cardinal, Robert D. Rogers, Trevor W. Robbins

  Trends in Cognitive Sciences.

  Abnormal decision making is a central feature of neuropsychiatric disorders. Recent investigations of the neural substrates underlying decision making have involved qualitative assessment of the cognition of decision making in clinical lesion studies (in patients with frontal lobe dementia) and neur... [more] Abnormal decision making is a central feature of neuropsychiatric disorders. Recent investigations of the neural substrates underlying decision making have involved qualitative assessment of the cognition of decision making in clinical lesion studies (in patients with frontal lobe dementia) and neuropsychiatric disorders such as mania, substance abuse and personality disorders. A neural network involving the orbitofrontal cortex, ventral striatum and modulatory ascending neurotransmitter systems has been identified as having a fundamental role in decision making and in the neural basis of neuropsychiatric diseases. This network accounts for the dissociations among decision-making deficits in different clinical populations. Ultimately, a more refined and sophisticated characterization of such deficits might guide the early diagnosis and cognitive and therapeutic rehabilitation of these patients.