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The relationship of memory and cognition in Parkinson’s disease to lateralisation of motor symptoms
... On the other hand there are also studies that did not find differences between hemiparkinsonian groups in visual mem-ory, visuoconstruction, and other visuospatial areas (Agniel et al., 1991;Finali et al., 1995;Goldenberg, 1989;Hietanen & Teräväinen, 1989;Huber et al., 1989;Natsopoulos et al., 1993;Raskin et al., 1992;Riklan et al., 1990;Spicer et al., 1988). The few studies which also incorporated a control group mostly revealed inferior performance of the Parkinson groups compared to healthy controls. ...
... We therefore could not verify the assumption that the right basal ganglia might be involved in visuospatial processes. This confirms the results of several studies (Agniel et al., 1991;Amick et al., 2006;Finali et al., 1995;Hietanen & Teräväinen, 1989;Riklan et al., 1990). Other studies however found differences of right and left Hemiparkinson patients compared to controls (Blonder et al., 1989;Chouza et al., 1984;Huber et al., 1989). ...
Parkinsons disease is characterized by tremor, rigidity, and bradykinesia. The study of patients with predominant symp- toms on one side of the body (hemiparkinsonism) is clinically relevant for different disciplines. The predominantely affect- ed side of the dopamine system in patients with Parkinsons disease might have differential effects on certain functions. The functional architecture of the basal ganglia suggests their involvement in visuocognitive processes. Earlier studies have yielded mixed results. Only few studies examined differences in visuocognitive functions in hemiparkinsonism compared to a control group. The aim of our study was to examine such functions and their interrelations in hemiparkinsonism in comparison to a control group in detail. We compared 22 Par- kinson patients with predominantely right sided symptoms (Parkinson right), 22 Parkinson patients with predominantely left sided symptoms (Parkinson left) and 22 healthy controls on several visuocognitive measures. We found no significant differences between the three groups in visuoconstruction, visual memory, mental rotation, and movement imagery. Significant differences were found in a self-rating instrument of visual imagery. The control group generally has a clearer visual imagination than the Parkinson left group. On sub- scale level the control group has a clearer geometric-sche- matic imagery than the Parkinson right and the Parkinson left group. The control group further has a clearer phantasy imagery than the Parkinson left group. In the Parkinson right group there is a significant association of self-rated visual imagery and visual memory. In the Parkinson left group there are significant correlations between geometric-schematic im - agery on one side and visual memory and mental rotation on the other side. In the control group there are significant as - sociations between mental rotation and figural memory and between visuoconstruction and visual reproduction. These correlational patterns suggest that there are different under- lying mechanisms in the three groups that are relevant for performance in visuocognitive tasks. Our results suggest no differential role of the basal ganglia in objective neuropsy- chological measures of visual cognition. The self-rated visu- al imagery ability seems to be mainly mediated by the right basal ganglia because especially the Parkinson left group is impaired in this area. The definition of laterality of motor symptoms should be standardized.
... On the other hand there are also studies that did not find differences between hemiparkinsonian groups in visual mem-ory, visuoconstruction, and other visuospatial areas (Agniel et al., 1991;Finali et al., 1995;Goldenberg, 1989;Hietanen & Teräväinen, 1989;Huber et al., 1989;Natsopoulos et al., 1993;Raskin et al., 1992;Riklan et al., 1990;Spicer et al., 1988). The few studies which also incorporated a control group mostly revealed inferior performance of the Parkinson groups compared to healthy controls. ...
... We therefore could not verify the assumption that the right basal ganglia might be involved in visuospatial processes. This confirms the results of several studies (Agniel et al., 1991;Amick et al., 2006;Finali et al., 1995;Hietanen & Teräväinen, 1989;Riklan et al., 1990). Other studies however found differences of right and left Hemiparkinson patients compared to controls (Blonder et al., 1989;Chouza et al., 1984;Huber et al., 1989). ...
... Others found widespread cognitive deficits in participants with worse left-sided dysfunction while participants with worse rightsided dysfunction were relatively cognitively spared (Direnfeld et al., 1984; Tomer, Levin, & Weiner, 1993). Still others found no cognitive differences in regard to motor asymmetry (Barber, Tomer, Sroka, & Myslobodsky, 1985; Huber, Freidenberg, Shuttleworth, Paulson, & Clapp, 1989; St. Clair, Borod, Sliwinski, Cote, & Stern, 1998) or suggest that type, rather than side, of predominant or initial motor manifestation is the most important factor (Riklan, Stellar, & Reynolds, 1990; Zetusky & Jankovic, 1985). Some of this work was limited by use of non-specific or poorly validated tasks, small sample sizes or participants in varied stages of disease progression. ...
... Additionally, researchers used different scales for measuring motor deficits and based group inclusion criteria on different aspects of asymmetry, which may contribute to the controversy. For example, some investigators chose to categorize participants according to initial side of symptom onset (Amick et al., 2006; Katzen, Levin, & Weiner, 2006; Tomer et al., 1993) while others used current ratings of absolute motor asymmetry (Barber et al., 1985; Blonder et al., 1989; Riklan et al., 1990); relatively little attention has been paid to the degree of motor asymmetry at the time of cognitive testing (Huber et al., 1992; Tomer et al., 1993). The purpose of this study was to determine whether PD asymmetry affects short term spatial memory performance. ...
Studies suggest motor deficit asymmetry may help predict the pattern of cognitive impairment in individuals with Parkinson disease (PD). We tested this hypothesis using a highly validated and sensitive spatial memory task, spatial delayed response (SDR), and clinical and neuroimaging measures of PD asymmetry. We predicted SDR performance would be more impaired by PD-related changes in the right side of the brain than in the left. PD (n=35) and control (n=28) participants performed the SDR task. PD participants either had worse motor deficits on the right (RPD) or left (LPD) side of the body. Some participants also had magnetic resonance imaging for measurement of their substantia nigra (SN) volumes. The LPD group performed worse on the SDR task than the RPD and control groups. Right SN volume accounted for a unique and significant portion of the variance in SDR error, with smaller volume predicting poorer performance. In conclusion, left motor dysfunction and smaller right SN volume are associated with poorer spatial memory.
... By contrast, other studies have found either no association with lateralization of motor deficits and cognition (Riklan, Stellar, & Reynolds, 1990) or that individuals with rightsided symptoms show sparing of performances across cognitive tasks (Direnfeld et al., 1984) and those with left sided symptoms show more widespread cognitive deficits (Tomer et al., 1993). Discrepancies across studies might relate to methodological differences, sample size, and disease severity of participants. ...
Objective:
A 71-year-old (MN) with an 11-year history of left onset tremor diagnosed as Parkinson's disease (PD) completed longitudinal brain magnetic resonance imaging (MRI) and neuropsychological testing. MRI scans showed an asymmetric caudate nucleus (right < left volume). We describe this asymmetry at baseline and the progression over time relative to other subcortical gray, frontal white matter, and cortical gray matter regions of interest. Isolated structural changes are compared to MN's cognitive profiles.
Method:
MN completed yearly MRIs and neuropsychological assessments. For comparison, left onset PD (n = 15) and non-PD (n = 43) peers completed the same baseline protocol. All MRI scans were processed with FreeSurfer and the FMRIB Software Library to analyze gray matter structures and frontal fractional anisotropy (FA) metrics. Processing speed, working memory, language, verbal memory, abstract reasoning, visuospatial, and motor functions were examined using reliable change methods.
Results:
At baseline, MN had striatal volume and frontal lobe thickness asymmetry relative to peers with mild prefrontal white matter FA asymmetry. Over time only MN's right caudate nucleus showed accelerated atrophy. Cognitively, MN had slowed psychomotor speed and visuospatial-linked deficits with mild visuospatial working memory declines longitudinally.
Conclusions:
This is a unique report using normative neuroimaging and neuropsychology to describe an individual diagnosed with PD who had striking striatal asymmetry followed secondarily by cortical thickness asymmetry and possible frontal white matter asymmetry. His decline and variability in visual working memory could be linked to ongoing atrophy of his right caudate nucleus.
... La presencia de aluminio tanto en las placas amiloides como en los ovillos de degeneración neurofibrilar en la EA ha despertado el interés de la relación entre la exposición al aluminio y el desarrollo de EA. Se ha encontrado una posible relación entre ambos en estudios sobre el empleo de antitranspirantes que contienen aluminio (Van Duijn et al., 1991), o sobre las cantidades de aluminio en el agua destinada al consumo por el hombre en diferentes áreas geográficas (Doll, 1993;Flaten, 1989;Jacquim, 1994;Martyn et al., 1989), o en estudios que evidenciaron una disminución de los rendimientos cognitivos en aquellos mineros que habían sido tratados con inhalaciones de polvo de aluminio como profilaxis de la silicosis, con respecto a los que no habían recibido dicho tratamiento (Riklan, Stellar y Reynolds, 1990). El reanálisis del EURODEM no mostró relación entre disolventes industriales o plomo con el desarrollo de la EA (Van Duijn et al., 1991). ...
... Dopamine neuromodulation is intrinsic to processes of movement and motor learning, cognition, reward processing, food intake, nociception, and endocrine and autonomic regulation. Studies on the lateralization of cognitive functions in patients with PD yielded conflicting results: some reported that neuropsychological deficits are consistent with the lateralization of motor symptoms [4][5][6][7][8][9][10], whilst others failed to find a correlation [11][12][13][14][15]. A limitation of several of these studies is that they prevalently investigated global lateralized brain functions in patients with variable disease severity. ...
Dopamine neurotransmission plays a key role in several brain activities, including motor, cognitive, and behavioral functions. Parkinson's disease (PD) typically begins with asymmetrical motor features related to asymmetrical dopamine denervation. This study was designed to examine whether distinct cognitive, behavioral, and personality features are related to this asymmetry.
Fifty-six patients with mild PD and lateralized motor features were grouped according to dominant side of motor features and evaluated using a neuropsychological assessment focused on attention and executive functions, impulse control disorders, and personality inventory.
There were no differences in neuropsychological functions between patients with right and left lateralized PD, but differences occurred in personality features. Patients with motor impairment predominant on the left-hand side had prevalence of hypomania and conversion profile.
This study suggests that side dominance of dopaminergic denervation may be related to personality features in patients with PD that could influence behavioral aspects.
... 48 Other studies, however, have suggested a more global cognitive impairment with left sided motor symptoms 50 51 and some have found no evidence of functional asymmetry. 52 Interpretation of these studies is complicated by the differing stages of disease of the patients involved. To minimise bias towards lateralisation, we recruited eight PD patients with right and eight with left predominant motor symptoms for the TOL analysis. ...
The aetiology of the cognitive changes seen in Parkinson's disease (PD) is multifactorial but it is likely that a significant contribution arises from the disruption of dopaminergic pathways. This study aimed to investigate the contribution of the dopaminergic system to performance on two executive tasks using (18)F-6-fluorodopa positron emission tomography ((18)F-dopa PET) in PD subjects with early cognitive changes.
16 non-demented, non-depressed PD subjects were evaluated with the Tower of London (TOL) spatial planning task, a verbal working memory task (VWMT) and (18)F-dopa PET, all known to be affected in early PD. Statistical parametric mapping (SPM) localised brain regions in which (18)F-dopa uptake covaried with performance scores. Frontal cortical resting glucose metabolism was assessed with (18)F-fluoro-2-deoxy-D-glucose ((18)F-FDG) PET.
SPM localised significant covariation between right caudate (18)F-dopa uptake (Ki) and TOL scores and between left anterior putamen Ki and VWMT performance. No significant covariation was found between task scores and (18)F-dopa Ki values in either limbic or cortical regions. Frontal cortical glucose metabolism was preserved in all cases.
These findings support a causative role of striatal dopaminergic depletion in the early impairment of executive functions seen in PD. They suggest that spatial and verbal executive tasks require integrity of the right and left striatum, respectively, and imply that the pattern of cognitive changes manifest by a patient with PD may reflect differential dopamine loss in the two striatal complexes.
Background
We previously demonstrated that parietal lobe white matter hyperintensities (WMH) increase the risk for Alzheimer's disease (AD). Here, we examined whether individuals with apolipoprotein E gene (APOE ε4) have increased parietal WMH volume.
Methods
Participants were from the Washington Heights-Inwood Columbia Aging Project (WHICAP; n = 694, 47 with dementia) in northern Manhattan and the Etude Santé Psychologique Prévalence Risques et Traitement study (ESPRIT; n = 539, 8 with dementia) in Montpellier. The association between regional WMH and APOE ε4 was examined separately in each group and then in a combined analysis.
Results
In WHICAP, ε4 carriers had higher WMH volume particularly in parietal and occipital lobes. In ESPRIT, ε4 carriers had elevated WMH particularly in parietal and temporal lobes. In the combined analysis, ε4 carriers had higher WMH in parietal and occipital lobes. Increased WMH volume was associated with increased frequency of dementia irrespective of APOE ε4 status; those with the ε4 were more likely to have dementia if they also had increased parietal WMH.
Conclusions
APOE ε4 is associated with increased parietal lobe WMH.
Visuospatial abilities play a pivotal role in our daily living. Indeed, our survival depends, to a great extent, on our ability
to navigate sensory space. This means our ability to use spatial maps dependent on visual, tactile, and auditory information
to form and guide motor programs. Visuospatial abilities are complex brain operations requiring integration of occipital,
parietal, and frontal lobe function, as well as the contribution of subcortical structures. Consequently, it is not surprising
that visuospatial skills are often impaired in diseases with movement disorders—an impairment that depends both on the type
and on the stage of the disease in question.
The destruction of the dopaminergic neurons in the substantia nigra (SN) and consequent depletion of striatal dopamine elicits the main movement deficits related to Parkinson's disease (PD). In the early stages of the illness, the motor symptoms are often exhibited asymmetrically. Thus, the onset of PD features starts on either the right or left side. The side of onset appears to determine the prognosis of the disorder and other features, such as right-side tremor dominance has a better prognosis in contrast to left-side dominant bradykinesia-rigidity. In addition, left-side onset of motor features is associated with cognitive decline. Therefore, an intricate relation appears to exist between the side of disease onset and progression/severity and other non-motor symptoms. Unilateral PD in turn corresponds to neuronal nigrostriatal degeneration in the contralateral hemisphere. Indeed positron emission tomography has demonstrated a positive correlation between symptom asymmetry and brain function (Hoorn et al. Parkinsonism Relat Disord 17:58-60, 2011), which corresponds to a unilateral pattern of degeneration. This phenomenon appears to be exclusive to PD. Additionally, the variation in motor symptom(s) dominance exhibited in the disorder conforms to the notion that PD is a spectrum disease with many sub-groups. Thus, clinical and post mortem studies on "lateralisation" may serve as a vital tool in understanding the mechanism(s) eliciting the characteristic destruction of the SN neurons. Additionally, it may be employed as a predictive indicator for the symptomology and prognosis of the illness thus allowing selective treatment strategies targeted at the pronounced hemispheric degeneration.
At disease onset, patients with Parkinson's disease (PD) typically report one side of the body to be more affected than the other. Previous studies have reported that this motor symptom asymmetry is associated with asymmetric dopaminergic degeneration in the brain. Research on the cognitive repercussions of this asymmetric degeneration has yielded inconsistent results. Here, we review studies that reported on the cognitive performance of patients with left-sided (LPD) or right-sided (RPD) motor symptom predominance. We present evidence that patients with RPD typically experience problems with language-related tasks and verbal memory, whereas patients with LPD more often perform worse on tasks of spatial attention, visuospatial orienting and memory and mental imagery. In general, no differences were found between both groups on tasks measuring attention and executive function. The association between motor asymmetry and cognitive performance indicates that PD does not lead to one typical cognitive profile. The effect of symptom laterality on the cognitive complaints should be considered in the assessment and treatment of each individual patient.
Eleven patients with Parkinson's disease (PD) and predominantly right-sided motor signs, 12 patients with PD and predominantly left-sided signs, and 11 demographically matched healthy controls were compared on tests assessing a range of cognitive and affective functions. Assuming a novel approach, our test battery was composed of measures drawn from ones previously used in the hemiparkinson' s disease and lateralized PD literature. The two patient groups were similar in illness duration, severity of motor signs, and degree of lateralized motor deficits. Statistical analyses did not reveal significant differences between patient groups, consistent with other studies that have failed to find differences in neuropsychological functioning between PD patients with right- and left-sided motor signs.
• We examined the relationship of disease laterality to neuropsychological and neurochemical features in patients with idiopathic Parkinson's disease (PD). We tested patients with PD, patients with Alzheimer's type of senile dementia, and a control group neuropsychologically, and we determined their CSF levels of homovanillic acid, 3,4-dihydroxyphenylacetic acid, 3-methoxy-4-hydroxyphenylglycol, 5-hydroxyindolacetic acid, serotonin, and acetylcholinesterase. The patients with PD were divided into two groups depending on the side of the body with greater disease involvement. Both parkinsonian groups, those more affected on the left (group L) and those more affected on the right (group R), were otherwise similar in all other clinical and historical features. Group L patients showed greater neuropsychological impairments than group R patients. Group L also had significantly higher CSF levels of homovanillic acid and acetylcholinesterase than group R. These findings of neuropsychological and neurochemical differences between groups L and R suggest functional or anatomic asymmetries of dopaminergic systems in the CNS.
Presents the prototype of a new clinical test of memory function with an analysis of initial data. This measurement instrument, which has 5 alternative forms, is specifically designed for longitudinal studies in those with mild to moderate deficits in storage and retrieval from secondary (long-term) episodic memory. Preliminary results with 119 adults 20–79 yrs old suggest that this test is an improvement over existing memory scales as they are used in this segment of the population. (43 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Nine patients with inflammatory demyelinating polyneuropathies (IDP) were found to have human T-cell lymphotropic virus type III (HTLV-III) infection. The 8 men, 6 of whom were homosexual, and 1 woman, a former intravenous drug user, presented with progressive weakness. Two had lymphadenopathy but all were otherwise asymptomatic. Six had chronic IDP and 3 had Guillain-Barré syndrome. In addition to an elevated cerebrospinal fluid (CSF) protein level (mean, 193 mg/dl), most patients had cerebrospinal fluid pleocytosis (mean, 23 cells/mm3), a distinctive feature. All had reduced T4:T8 T-cell ratios. Results of nerve conduction studies were characteristic of demyelination. Nerve biopsies revealed intense inflammatory cell infiltrates and macrophage-mediated demyelination. The patients recovered either spontaneously or following treatment with corticosteroids or plasmapheresis. During a mean interval of 20 months after presentation, only 1 patient had developed acquired immune deficiency syndrome. Patients with HTLV-III infection have disordered immune function, and the mechanism of the development of the IDP is likely to be immunopathogenic. As a result of our experience, we suggest that all patients with IDP be tested for evidence of HTLV-III infection. We also found, although in uncontrolled trials, that treatment with either prednisone or plasmapheresis was followed by clinical improvement; since plasmapheresis is not likely to further depress cell-mediated immunity, we suggest that it be the initial therapy.
We hold that the intra-blood-brain-barrier (BBB) IgG synthesis (SYN) rate can be quantitated reliably and validly. Although several formulas distinguish patients with multiple sclerosis from normal controls equally well, only the SYN rate formula has been validated in humans using isotopic tracer techniques. Our formula for the IgG SYN rate is reducible to Reiber's formula; therefore, both can be used to quantify the IgG SYN rate in a manner not possible using the IgG index. Although our SYN rate formula has been validated for a modest range of BBB abnormalities (cerebrospinal fluid/serum albumin ratios), there is evidence to suggest that it may be used even in patients having severe BBB damage. We question the acceptance of unique cerebrospinal fluid IgG bands as indisputable evidence of intra-BBB IgG SYN in the presence of a modest to severely damaged BBB. Finally, the utility of quantitation and detection of intra-BBB IgG SYN by standardized methods in a group of asymptomatic, normal individuals compared with a group of patients with clinical definite multiple sclerosis is presented.
To the Editror.
—Direnfeld and colleagues1 suggested a relationship of laterality of motor signs to neuropsychological and neurochemical abnormalities in Parkinson's disease (PD). By comparing nine patients with PD who had asymmetric motor findings, the authors concluded that patients more affected on the left side (PDL, N=5) had more neuropsychological impairment than those predominantly affected on the right side (PDR, N=4). Unfortunately, the population sample was small, the selection criteria were not defined, and the degree of asymmetry was not stated. The laterality of the clinical manifestations was established by asking the patients which side they believed was more affected and by rating (on a scale of 0 to 4) tremor, rigidity, and bradykinesia. Of these motor signs, bradykinesia was given the most weight, although the weighing criteria were not specified.In most clinical studies the bradykinesia score represents an overall assessment of slowness and poverty of
We examined the relationship of disease laterality to neuropsychological and neurochemical features in patients with idiopathic Parkinson's disease (PD). We tested patients with PD, patients with Alzheimer's type of senile dementia, and a control group neuropsychologically, and we determined their CSF levels of homovanillic acid, 3,4-dihydroxyphenylacetic acid, 3-methoxy-4-hydroxyphenylglycol, 5-hydroxyindolacetic acid, serotonin, and acetylcholinesterase. The patients with PD were divided into two groups depending on the side of the body with greater disease involvement. Both parkinsonian groups, those more affected on the left (group L) and those more affected on the right (group R), were otherwise similar in all other clinical and historical features. Group L patients showed greater neuropsychological impairments than group R patients. Group L also had significantly higher CSF levels of homovanillic acid and acetylcholinesterase than group R. These findings of neuropsychological and neurochemical differences between groups L and R suggest functional or anatomic asymmetries of dopaminergic systems in the CNS.
Chronic relalpsing polyneuropathy is a distinct dysschwannian/demyelinating polyneuropathy characterized by usually slow onset, progressive or relapsing-remitting course, elevated cerebrospinal fluid (CSF) protein, marked slowing of nerve conduction velocity, segmental demyelination demonstrable in sural nerve biopsies, and absence of systemic illness or abnormal serum immunoglobulins The cause of the disorder and the mechanisms underlying its chronicity and relapsing-remitting course are not clear. Immunoglobulin deposition observed in sural nerve biopsies and abnormal immunoglobulin patterns in the CSF in some cases suggest a dysimmune pathogenesis; thus the term chronic relapsing (dysimmune) polyneuropathy (CRDP) is preferred.
The disease is a treatable form of idiopathic polyneuropathy. In our series of 25 patients with CRDP, treatment with high-single-dose daily prednisone, slowly tapered to an alternate-day program, has been very successful in the majority. A low (10 to 20 mg) alternate-day single-dose program, maintained indefintely, seems to be required to prevent future recurrences. Evidence is provided that other immunosuppressants (azathioprine, cyclophosphamide, Poly-ICLC) and possibly plasmapheresis, alone or in conjunction with corticosteroids, may have a beneficial role in controlling difficult cases of chronic relapsing polyneuropathy.