Article

Learning and consolidation of visuo-motor adaptation in Parkinson's disease

Department of Physiology & Pharmacology, CUNY Medical School, New York, NY 100031, USA.
Parkinsonism & Related Disorders (Impact Factor: 3.97). 05/2008; 15(1):6-11. DOI: 10.1016/j.parkreldis.2008.02.012
Source: PubMed

ABSTRACT

We have previously shown in normal subjects that motor adaptation to imposed visual rotation is significantly enhanced when tested few days later. This occurs through a process of sleep-dependent memory consolidation. Here we ascertained whether patients with Parkinson's disease (PD) learn, improve, and retain new motor skills in the same way as normal subjects. We tested 16 patients in early stages of PD and 21 control subjects over two days. All subjects performed reaching movements on a digitizing tablet. Vision of the limb was precluded with an opaque screen; hand paths were shown on the screen with the targets' position. Unbeknownst to the subjects, the hand path on the screen was rotated by 30 degrees . In experiment 1, patients taking dopaminergic treatment and controls adapted to rotation with targets appearing in an unpredictable order. In experiment 2, drug-naïve patients and controls adapted to rotation in a less challenging task where target's appearance was predictable. Patients and controls made similar movements and adapted to rotation in the same way. However, when tested again over the following days, controls' performance significantly improved compared to training, while patients' performance did not. This lack of consolidation, which is present in the early stages of the disease and is independent from therapy, may be due to abnormal homeostatic processes that occur during sleep.

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    • "Taken together, our findings indicate that[1]even though STN stimulation can partially improve PD performance in our memory tasks, it has less impact than dopaminergic medication on the retention or recall of the previously learnt skill,[2]oppositely dopaminergic medication significantly improves PD ability to learn visual associations especially for spatial cues and might contribute to a retention in the previously learnt skills. Distinct effects of DOPA vs STN DBS therapy have previously been described in cognitive function in PD, including working memory, learning, planning and decision making[1,7,8,14,16,21,22,24,33]. Overall, STN DBS has been reported in PD patients to have small impact on all cognitive functions except for executive functions that can be altered, including memory[14,40]and more recently decision making[29,41,42]. "
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    ABSTRACT: Evidence has been provided in Parkinson's disease patients of cognitive impairments including visual memory and learning which can be partially compensated by dopamine medication or subthalamic nucleus stimulation. The effects of these two therapies can differ according to the learning processes involving the dorsal versus ventral part of the striatum. Here we aimed to investigate and compare the outcomes of dopamine versus stimulation treatment in Parkinson patient's ability to acquire and maintain over successive days their performance in visual working memory. Parkinson patients performed conditional associative learning embedded in visual (spatial and non spatial) working memory tasks over two consecutive days either ON or OFF dopaminergic drugs or STN stimulation depending on the group of patients studied. While Parkinson patients were more accurate and faster in memory tasks ON versus OFF stimulation independent of the day of testing, performance in medicated patients differed depending on the medication status during the initial task acquisition. Patients who learnt the task ON medication the first day were able to maintain or even improve their memory performance both OFF and ON medication on the second day after consolidation. These effects were observed only in patients with dopamine replacement with or without motor fluctuations. This enhancement in memory performance after having learnt under dopamine medication and not under STN stimulation was mostly significant in visuo-spatial working memory tasks suggesting that dopamine replacement in the depleted dorsal striatum is essential for retention and consolidation of learnt skill.
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    • "It is also evident that learning ability in PD is positively influenced by the use of " augmented feedback " which, however, implies potential deterioration of performance when the augmented cues are removed or the environmental conditions are changed. On the other hand, consolidation and retention are significantly impaired in PD subjects [15]. The RESCUE trial [16] documented a limited retention and transfer ability of learning. "
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    • "With regards to the pattern of within and between session performance, it appears that different processes may be underlying these different stages of motor skill learning. A similar pattern of intact learning within sessions, but impaired retention between-sessions, has been reported previously in individuals with PD (Bédard and Sanes, 2011; Leow et al., 2012; Marinelli et al., 2009; Mochizuki-Kawai et al., 2004). In terms of processes, it has been argued that the cortico-cerebellar circuit along with the hippocampus and frontal regions are primarily involved in early stages of learning and therefore, may support initial skill learning, but that the striatal system is particularly critical for long-term retention of motor skills after initial training (Albouy et al., 2013; Doyon et al., 2009; Mochizuki-Kawai et al., 2004). "
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