Relation of Parkinson's Disease Subtypes to Visual Activities of Daily Living

Department of Psychology, Boston University, Boston, MA02215, USA.
Journal of the International Neuropsychological Society (Impact Factor: 2.96). 08/2011; 17(5):841-52. DOI: 10.1017/S1355617711000853
Source: PubMed


Visual perceptual problems are common in Parkinson's disease (PD) and often affect activities of daily living (ADLs). PD patients with non-tremor symptoms at disease onset (i.e., rigidity, bradykinesia, gait disturbance or postural instability) have more diffuse neurobiological abnormalities and report worse non-motor symptoms and functional changes than patients whose initial symptom is tremor, but the relation of motor symptom subtype to perceptual deficits remains unstudied. We assessed visual ADLs with the Visual Activities Questionnaire in 25 non-demented patients with PD, 13 with tremor as the initial symptom and 12 with an initial symptom other than tremor, as well as in 23 healthy control participants (NC). As expected, the non-tremor patients, but not the tremor patients, reported more impairment in visual ADLs than the NC group, including in light/dark adaptation, acuity/spatial vision, depth perception, peripheral vision and visual processing speed. Non-tremor patients were significantly worse than tremor patients overall and on light/dark adaptation and depth perception. Environmental enhancements especially targeted to patients with the non-tremor PD subtype may help to ameliorate their functional disability.

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    • "Additional PD subgroups are described by the initial motor symptom, referred to as tremor-dominant (TD) and nontremor-dominant (NTD: rigidity, akinesia, and disordered gait, posture, and balance). Relative to TD, NTD patients exhibit more pronounced visual difficulties, greater Lewy body pathology load, more extensive and rapid cognitive impairment, and heightened risk for dementia (Alves, Larsen, Emre, Wentzel-Larsen, & Aarsland, 2006;Lewis et al., 2005;Seichepine et al., 2011;Selikhova et al., 2009;Taylor et al., 2008). It is critical for researchers and clinicians to determine different neurocognitive profiles by subgroup as this would guide disease management and treatment more effectively than is possible at present. "
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    ABSTRACT: 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.
    Full-text · Article · Feb 2014 · Journal of Clinical and Experimental Neuropsychology
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    • "For example, Vakil and Herishanu- Naaman (1998) found that tremor-dominant patients are less impaired at procedural learning tasks than akinesia-dominant patients. Studies also showed that PD patients with tremor are less impaired than PD patients with other motor subtypes on perceptual tasks, including peripheral vision and visual processing speed (Seichepine et al., 2011). Interestingly, we also found that akinesia-dominant patients were more impaired than tremordominant patients at various working memory (Moustafa et al., 2013a) and learning (Moustafa et al., 2013b) measures. "
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    ABSTRACT: Parkinson's disease (PD) is a neurological disorder, associated with rigidity, bradykinesia, and resting tremor, among other motor symptoms. In addition, patients with PD also show cognitive and psychiatric dysfunction, including dementia, mild cognitive impairment (MCI), depression, hallucinations, among others. Interestingly, the occurrence of these symptoms-motor, cognitive, and psychiatric-vary among individuals, such that a subgroup of PD patients might show some of the symptoms, but another subgroup does not. This has prompted neurologists and scientists to subtype PD patients depending on the severity of symptoms they show. Neural studies have also mapped different motor, cognitive, and psychiatric symptoms in PD to different brain networks. In this review, we discuss the neural and behavioral substrates of most common subtypes of PD patients, that are related to the occurrence of: (a) resting tremor (vs. nontremor-dominant); (b) MCI; (c) dementia; (d) impulse control disorders (ICD); (e) depression; and/or (f) hallucinations. We end by discussing the relationship among subtypes of PD subgroups, and the relationship among motor, cognitive, psychiatric factors in PD.
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    • "Larger samples would enable analysis by subgroups, which may be informative. For example, we recently reported that self-identified impairments in visual ADLs were more extensive in PD patients whose initial motor symptom was not tremor than in those whose initial symptom was tremor [33]. In particular, future work should focus on expanding the range of PD severity to include participants with milder and more severe motor impairment than were assessed here. "
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