An Examination of Cognitive Heterogeneity in Parkinson Disease: The Dual-Syndrome Hypothesis.

PURPOSE: Cognitive impairment is one of the most debilitating nonmotor symptoms in Parkinson disease (PD), and its presentation is heterogeneous. One proposed model to explain cognitive variability in PD is the dual-syndrome hypothesis. This hypothesis delineates two cognitive profiles, a "fronto-striatal" profile and a "posterior cortical" profile according to symptom presentation, associated motor phenotype, and risk for dementia. The current study examined the dual-syndrome hypothesis in individuals with idiopathic PD to evaluate the existence of these profiles, determine the association with the motor phenotype (tremor dominant vs. postural instability/gait disorder), and assess the relative risk for dementia. METHOD: A retrospective examination was conducted using data from the Parkinson's Progression Markers Initiative database at baseline (within 2 years of diagnosis) and 5 years after baseline. Descriptive categorizations, cluster analyses, generalized linear mixed models, and logistic regressions were used to address the research questions. RESULTS: There was emerging evidence of cognitive profiles; however, these were not fully supported by cluster analyses. Baseline cognitive profile was associated with later motor phenotype, and as predicted, dementia risk was greatest in persons with baseline posterior cortical impairments. CONCLUSION: The current results provide mixed support for the dual-syndrome hypothesis, with some evidence that the posterior cortical cognitive profile is associated with postural instability and gait disorder as well as greater dementia risk.

Prolonged Processing Time for Manual and Vocal Responses in Parkinson Disease: A Psychological Refractory Period Paradigm Study.

PURPOSE: The purpose of this study was to examine a potential increased cognitive processing bottleneck within Parkinson disease (PD) by extending a previous overlapping task methodology. Additionally, this study extends previous overlapping task methodology in PD to examine the influence of modality (vocal vs. manual) on response delays in overlapping tasks in PD. METHOD: This study used the psychological refractory period (PRP) paradigm (overlapping-task paradigm) to study processing limitations as participants complete two tasks that increasingly overlap in time. Three levels of temporal overlap of tasks were utilized to vary cognitive demands on manual and vocal response time tasks. Ten participants with PD (PwPD) and 12 participants without PD were included in this study. RESULTS: Participants with PD demonstrated response time delays across temporal overlap conditions (likely indicating motor deficits) along with a larger increase in response delays in the most overlapped, cognitively taxing condition (likely indicating longer central processing bottleneck). Additionally, modality did not influence response times differently in overlapping task conditions or within participant groups. CONCLUSION: An extension of previous overlapping task methodologies within a complex task was successful in demonstrating an increased central processing deficit across manual and vocal response delays in PD, regardless of modality of response.