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: 2.48). 11/2009; 72(3):337-46. DOI: 10.1016/j.bandc.2009.10.011
Source: PubMed


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
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    • "This last factor provides a possible reason for the lack of a relationship between reduced LIDs self-awareness and ED that do not take into account executive models of self-awareness. The latter should focus on the disruption of hypothetical higher order executive processes of self-monitoring and control (Amanzio et al., 2010, 2011, 2013; Palermo, Leotta, et al., 2014; Schacter, 1990; Stuss & Levine, 2002). "
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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
    Full-text · Article · Dec 2014 · Brain and Cognition
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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.
    Full-text · Chapter · Mar 2014
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    • "In contrast, Funkiewiez and colleagues [64] reported that both stimulation and medication were able to improve subjective feelings of well-being, euphoria and motivation, and to decrease anxiety and fatigue. Similarly, Amanzio and collaborators [23] showed that lower scores of depression and anxiety were reported by patients when psychological questionnaires were administered on medication as compared to their off medication state. Although we did not use questionnaires specifically designed for the administration in the short time (such as the Addiction Research Center Inventory, ARCI, [65] that was used in [64]), we explicitly asked patients to report how they felt in that particular condition of stimulation, thus ensuring that the scores really reflected their feelings in the on and off stimulation states. "
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    ABSTRACT: Deep Brain Stimulation (DBS) of the Subthalamic Nucleus (STN) improves motor symptoms in Parkinson's disease (PD), but can exert detrimental effects on impulsivity. These effects are especially related to the inability to slow down when high-conflict choices have to be made. However, the influence that DBS has on delay aversion is still under-investigated. Here, we tested a group of 21 PD patients on and off stimulation (off medication) by using the Cambridge Gamble Task (CGT), a computerized task that allows the investigation of risk-related behaviours and delay aversion, and psychological questionnaires such as the Barratt Impulsiveness Scale (BIS), the Sensitivity to Punishment and to Reward Questionnaire (SPSRQ), and the Quick Delay Questionnaire (QDQ). We found that delay aversion scores on the CGT were no higher when patients were on stimulation as compared to when they were off stimulation. In contrast, PD patients reported feeling more impulsive in the off stimulation state, as revealed by significantly higher scores on the BIS. Higher scores on the sensitivity to punishment subscale of the SPSRQ highlighted that possible punishments influence patients' behaviours more than possible rewards. Significant correlations between delay aversion scores on the CGT and QDQ delay aversion subscale suggest that these two instruments can be used in synergy to reach a convergent validity. In conclusion, our results show that not all impulsivities are detrimentally affected by DBS of the STN and that the joint use of experimental paradigms and psychological questionnaires can provide useful insights in the study of impulsivity.
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