Article

Impaired awareness of movement disorders in Parkinson's disease

Department of Psychology, University of Torino, Via Verdi 10, 10123 Torino, Italy
Brain and Cognition (Impact Factor: 2.68). 11/2009; 72(3):337-46. DOI: 10.1016/j.bandc.2009.10.011
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ABSTRACT This study analyzed the presence of awareness of movement disorders (dyskinesias and hypokinesias) in 25 patients with Parkinson's disease (PD) and motor fluctuations (dyskinesias, wearing off, on-off fluctuations). Of the few studies that have dealt with this topic, none have analyzed the differences in the awareness of motor deficits by comparing the on and off states using motor scales and an extensive battery of tests to assess cognitive and behavioral functioning.
PD patients were compared on three different scales that we have devised to measure awareness of movement disorders: Global Awareness of Movement (GAM) Disorders, dyskinesia/hypo-bradykinesia rating scales.
Data showed that PD patients had greater awareness and psychological suffering in the off state than in the on state. In particular, they were troubled by motor disabilities related to hypokinesias and had mood-related symptoms and a perception of disability in activities of daily living. Interestingly, patients only showed a selective reduction of awareness of movement disorders associated with executive functions and related to dyskinesias in the on state, compared to a preserved awareness of hypokinesias in the off state. On the contrary, no association with executive functions was found in the off state.
Our findings suggest that the dopaminergic overstimulation of mesocorticolimbic pathways may cause a dysfunction of prefrontal-subcortical connections related to the impaired insight.

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Available from: Martina Amanzio, Jul 27, 2015
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    • "In conclusion, the present study has also taken into account a measure of awareness of hypokinetic disorders, as we did in our previous work (Amanzio et al., 2010). In particular, we found patients only showed a selective reduction of awareness of movement disorders associated with metacognitive functions and related to dyskinesias in the on-state, compared to a preserved awareness of hypokinesias and no relationship with WCST metacognitive variables in the off-state. "
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    ABSTRACT: The study analyzes the presence of dyskinesias-reduced-self-awareness in forty-eight patients suffering from Parkinson’s disease (PD). As the association with executive dysfunction is a matter of debate and we hypothesize it plays an important role in dyskinesias self-unawareness, we analyzed the role of dopaminergic treatment on the medial-prefrontal-ventral-striatal circuitry using a neurocognitive approach. Special attention was given to metacognitive abilities related to action-monitoring that represent a novel explanation of the phenomenon. PD patients were assessed using different rating scales that we devised to measure movement awareness disorders. In order to ascertain whether each variable measured at a cognitive-clinical level contributes to predicting the scores of the movement-disorder-awareness-scales, we conducted multiple logistic regression models using the latter as binary dependent variables. We used the Wisconsin Card Sorting Test-metacognitive-version to assess the executive functions of the prefrontal-ventral-striatal circuitry. Data showed that a reduction of self-awareness using the Dyskinesia rating scale was associated with global monitoring (p=.04), monitoring resolution (p=.04) and control sensitivity (p=.04). Patients failed to perceive their performance, distinguish between correct and incorrect sorts, be confident in their choice and consequently decide to gamble during the task. We did not find any association with executive functions using the Hypo-Bradykinesia rating scale. Our findings indicate that when the comparator mechanism for monitoring attentive performance is compromised at a prefrontal striatal level, patients lose the ability to recognize their motor disturbances that do not achieve conscious awareness. Key words: awareness of movement disorders, dyskinesias, Parkinson’s disease, self-awareness, metacognitive functions
    Brain and Cognition 12/2014; 90. DOI:10.1016/j.bandc.2014.06.014 · 2.68 Impact Factor
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    • "ACC as target region is studied using functional and structural neuroimaging methods. The first approach evaluates response inhibition task with neuropsychological batteries and fMRI (Amanzio et al., 2010, 2011, 2013), the second is a lesional study of a selective ACC brain injured patient (Palermo et al., Neurocase in press). "
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    ABSTRACT: The monitoring attentional system represented by the Anterior Cingulate Cortex serves to ensure that the elaboration processes in other brain regions are of the highest efficiency, in relation to the demands of the tasks that are taking place. The interactions with the prefrontal cortex can select the buffer of the working memory. The interactions with the posterior cortices may serve to amplify the activity of a particular form of perception compared to others and may be directed or mediated by connections with the prefrontal cortex. The kind of self-regulation mediated by the ACC concerns anticipated actions, and its role is often construed in terms of action monitoring. The dorsal division of ACC has been implicated in the monitoring of action across several studies. Action monitoring is particularly important in situations involving response conflicts, requiring response inhibition and in response selection. Interestingly, we observed reduced task-sensitive activity in response conflict monitoring in the right anterior cingulate area and in the rostral prefrontal cortex in early AD patients with reduced awareness of their disease in an fMRI-response-inhibition-task. In the present chapter we will relate the role of the monitoring attentional system represented by the ACC in tasks requiring response inhibition and set-shifting with the phenomenon of the reduced awareness of illness in patients with early Alzheimer disease. The findings outlined will help clinicians in both the diagnostic phase and the treatment process of the Alzheimer Disease. Indeed, the unawareness assessment can assist in enabling better and earlier differential diagnosis. Moreover clinicians may improve adherence to health treatment in patients who are more likely to refuse such care using the proper strategies of engagement. This would mean improving the course of recovery.
    Horizons in Neuroscience Research. Vol 13, Edited by Andres Costa, Eugenio Villalba, 03/2014: chapter 7; Nova Science Publishers Inc New York., ISBN: 978-1-62948-427-3
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    • "In particular, reduced awareness of LID in the on state appears to be related to metacognitive deficits in the self-monitoring system. (Amanzio et al., 2010). To date, only a few studies have investigated unawareness of LID in PD: further studies are needed in view of the important implications for the clinical management of such disorders. "
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    ABSTRACT: Subjects suffering from Parkinson’s Disease (PD) are sometimes partially or completely unaware of the deficits caused by the disease. Specifically, PD patients may complain of drug-induced dyskinesias less than their caregivers. An improved understanding of unawareness of involuntary movements in PD is important in order to appreciate the impact of the disease and the side effects of pharmacological treatment. Since damage to prefrontal areas may cause a reduction in awareness of movement disorders and since PD patients have difficulty with executive tasks, the relationship between unawareness and executive dysfunction is an interesting association to be further analyzed. On the whole, three independent but correlated constructs could be involved: a) shifting between tasks or mental sets; b) updating and monitoring of working memory representation; c) inhibition of dominant or prepotent responses. Reduced awareness of movement disorders in cognitively preserved PD subjects also requires further analysis. In particular, this is the only way in which unawareness of dyskinetic movements can be considered specific and not secondary to cognitive impairment. Starting from these considerations, the study by Amanzio et al. (2010) assessed the awareness of motor deficits in non-demented PD subjects using an extensive executive and neuropsychological evaluation. This study addressed the question by comparing the on and off states and using specific evaluations of awareness of movement disorders. Their results led to the conclusion that reduced awareness of dyskinesias in the on state is not related to the general level of cognitive impairment but to executive dysfunction. In this essay we conduct an extensive investigation of unawareness of dyskinetic movements in PD subjects with the aim of analyzing the hypothesis that disruption of the orbito-frontal pathway may lead to a deficit in awareness, probably due to decreased attentional and self-monitoring abilities with an important role played by metacognitive processes.
    Parkinson’s Disease: Diagnosis, Treatment and Prognosis, Neurodegenerative Diseases - Laboratory and Clinical Research Neurology - Laboratory and Clinical Research Developments 07/2012: chapter Role of executive dysfunctions in unawareness of Parkinson’s Disease.: pages 147-164; Eds Nova Science Publishers, Hauppauge, NY., ISBN: 978-1-61942-830-0
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