Parkinson’s Disease as a Disconnection Syndrome

Department of Psychology, Boston University, 648 Beacon Street, Boston, MA 02215, USA.
Neuropsychology Review (Impact Factor: 4.59). 04/2010; 20(2):191-208. DOI: 10.1007/s11065-010-9128-8
Source: PubMed


Parkinson's disease (PD) is a major neurodegenerative disorder that is usually considered in terms of midbrain and basal ganglia dysfunction. Regarding PD instead as a disconnection syndrome may prove beneficial to understanding aspects of cognition, perception, and other neuropsychological domains in the disease. PD is usually of unilateral onset, providing evidence of intrahemispheric dissociations and an imbalance in the usual relative strengths of the right and left hemispheres. Hence, in order to appreciate the neuropsychology of PD, it is important to apply to this disease our understanding of hemispheric lateralization effects and within-hemisphere circuitry from brainstem to higher-order association cortex. The focus of this review is on the relevance of PD-related disconnections among subcortical and cortical structures to cognition, perception, emotion, and associated brainstem-based domains such as sleep and mood disturbance. Besides providing information on disease characteristics, regarding PD as a disconnection syndrome allows us to more completely understand normal brain-behavior relations in general.

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Available from: Alice Cronin-Golomb
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    • "However, none of these studies used dynamic facial expressions and none differentiated between LPD and RPD. A recent EEG study reported reduced interhemispheric coherence during dynamic audio-visual emotion processing in PD (Yuvaraj et al., 2014), which is in line with the description of PD as a disconnection syndrome (Cronin-Golomb, 2010). "
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    ABSTRACT: Parkinson's disease (PD) affects patients beyond the motor domain. According to previous evidence, one mechanism that may be impaired in the disease is face processing. However, few studies have investigated this process at the neural level in PD. Moreover, research using dynamic facial displays rather than static pictures is scarce, but highly warranted due to the higher ecological validity of dynamic stimuli. In the present study we aimed to investigate how PD patients process emotional and non-emotional dynamic face stimuli at the neural level using event-related potentials. Since the literature has revealed a predominantly right-lateralized network for dynamic face processing, we divided the group into patients with left (LPD) and right (RPD) motor symptom onset (right versus left cerebral hemisphere predominantly affected, respectively). Participants watched short video clips of happy, angry, and neutral expressions and engaged in a shallow gender decision task in order to avoid confounds of task difficulty in the data. In line with our expectations, the LPD group showed significant face processing deficits compared to controls. While there were no group differences in early, sensory-driven processing (fronto-central N1 and posterior P1), the vertex positive potential, which is considered the fronto-central counterpart of the face-specific posterior N170 component, had a reduced amplitude and delayed latency in the LPD group. This may indicate disturbances of structural face processing in LPD. Furthermore, the effect was independent of the emotional content of the videos. In contrast, static facial identity recognition performance in LPD was not significantly different from controls, and comprehensive testing of cognitive functions did not reveal any deficits in this group. We therefore conclude that PD, and more specifically the predominant right-hemispheric affection in left-onset PD, is associated with impaired processing of dynamic facial expressions, which could be one of the mechanisms behind the often reported problems of PD patients in their social lives.
    Full-text · Article · Jan 2016 · Neuropsychologia
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    • "By contrast individuals with RPD perceive visual stimuli more like healthy control adults, who have been reported to bisect lines slightly to the left (''pseudoneglect " ) (Jewell & McCourt, 2000). It appears that the consequences of right hemisphere damage (LPD) contribute to more severe visuospatial impairments than damage to the left hemisphere (RPD), as the right hemisphere mediates more visuospatial processing than the left in the general population and also in PD (Cronin-Golomb, 2010). "
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    ABSTRACT: Veering while walking is often reported in individuals with Parkinson's disease (PD), with potential mechanisms being vision-based (asymmetrical perception of the visual environment) or motoric (asymmetry in stride length between relatively affected and non-affected body side). We examined these competing hypotheses by assessing veering in 13 normal control participants (NC) and 20 non-demented individuals with PD: 9 with left-side onset of motor symptoms (LPD) and 11 with right-side onset (RPD). Participants walked in a corridor under three conditions: eyes-open, egocentric reference point (ECRP; walk toward a subjectively perceived center of a target at the end of the corridor), and vision-occluded. The visual hypothesis predicted that LPD participants would veer rightward, in line with their rightward visual-field bias, whereas those with RPD would veer leftward. The motor hypothesis predicted the opposite pattern of results, with veering toward the side with shorter stride length. Results supported the visual hypothesis. Under visual guidance, RPD participants significantly differed from NC, veering leftward despite a shorter right- than left-stride length, whereas LPD veered rightward (not significantly different from NC), despite shorter left- than right-stride length. LPD participants showed significantly reduced rightward veering and stride asymmetry when they walked in the presence of a visual landmark (ECRP) than in the eyes-open condition without a target. There were no group differences in veering in the vision-occluded condition. The findings suggest that interventions to correct walking abnormalities such as veering in PD should incorporate vision-based strategies rather than solely addressing motor asymmetries, and should be tailored to the distinctive navigational profiles of LPD and RPD. Copyright © 2015. Published by Elsevier Ltd.
    Full-text · Article · Aug 2015 · Vision research
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    • "However, the inter-hemispheric coordination in PD is still an unexplored field. PD is usually of unilateral onset, providing evidence of inter-hemispheric dissociations and an imbalance between activity of the left and right hemisphere [9]. Abnormalities in the corpus callosum and widely impaired white matter integrity in the frontal, temporal, and parietal lobes have been reported in PD patients, which may affect inter-hemispheric functional coordination [10] [11] [12]. "
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    ABSTRACT: Background. Abnormalities in white matter integrity and specific functional network alterations have been increasingly reported in patients with Parkinson’s disease (PD). However, little is known about the inter-hemispheric interaction in PD. Methods. Fifty-one drug naive patients with PD and 51 age- and gender-matched healthy subjects underwent resting-state functional magnetic resonance imaging (rs-fMRI) scans. We compared the inter-hemispheric resting-state functional connectivity between patients with PD and healthy controls, using the voxel-mirrored homotopic connectivity (VMHC) approach. Then, we correlated the results from VMHC and clinical features in PD patients. Results. Relative to healthy subject, patients exhibited significantly lower VMHC in putamen and cortical regions associated with sensory processing and motor control (involving sensorimotor and supramarginal cortex), which have been verified to play a critical role in PD. In addition, there were inverse relationships between the UPDRS motor scores and VMHC in the sensorimotor, and between the illness duration and VMHC in the supramarginal gyrus in PD patients. Conclusions. Our results suggest that the functional coordination between homotopic brain regions is impaired in PD patients, extending previous notions about the disconnection of corticostriatal circuit by providing new evidence supporting a disturbance in inter-hemispheric connections in PD.
    Full-text · Article · Jul 2015
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