Performance of Patients with Early Parkinson Disease on an Executive and Social Cognition Battery.

OBJECTIVE: To demonstrate the usefulness of incorporating the Executive and Social Cognition Battery (ESCB) to detect executive and social cognition deficits, which are otherwise not captured by more "classical" executive tests in early Parkinson disease (PD). BACKGROUND: PD is a neurodegenerative disorder that includes executive and social cognition deficits. While cognitive assessment in PD still relies on classical executive tasks to detect frontal deficits, these traditional tests often fail to uncover subtle, yet relevant, frontal impairment. METHODS: We evaluated 39 PD patients and 47 controls with a battery of classical executive tests and the ESCB. The ESCB includes a series of tasks that more closely resemble real-life activities and have been previously shown to be useful in detecting executive deficits in other neuropsychiatric disorders with frontal involvement. RESULTS: We observed that both batteries used in a complementary way yielded better results, as 15 of the 39 patients presented deficits only on some of the ESCB tests, but not on the classical battery, while 5 patients presented deficits only on some tests of the classical battery, but not on the ESCB. Fourteen patients presented deficits on some tests of either battery, and 5 patients did not present deficits on any of the tests. CONCLUSIONS: We found that, used along with traditional neuropsychological tasks, the ESCB may be useful in providing a more comprehensive evaluation of frontal dysfunction among patients with PD, thus contributing to the early diagnosis of cognitive disorders in this patient population.

Decreased Palpebral Fissure in Patients with Parkinson's Disease.

BACKGROUND: The diagnosis of Parkinson's disease (PD) is based exclusively on clinical criteria established by the Queen Square Brain Bank. On occasion, these clinical symptoms may be subtle and inconclusive; therefore, it becomes necessary to appeal to contributory criteria to establish a correct diagnosis. The authors propose the observation of palpebral fissure (PF) asymmetry as an additional criterion for the diagnosis of PD. OBJECTIVES: The objectives of this study were to determine whether decreased PF (DPF) is more prevalent in patients with PD than in the general population and whether DPF in PD coincides with the side of onset of parkinsonian symptomatology. METHODS: In total, 112 consecutive patients with a diagnosis of PD and 112 control participants without PD were selected between April and June 2014. At the office visit, it was established through clinical observation whether DPF was present. In patients with PD, it was determined whether the DPF was consistent with the side of onset of parkinsonian symptomatology. RESULTS: Of 112 patients with PD, 39 (35%) had DPF clinically evident DPF, and, in 34 (87%), the DPF was consistent with the laterality of parkinsonian signs. In the control group, only 12% (14 of 112 controls) had PF asymmetry. The difference in prevalence of DPF between these groups was statistically significant (P < 0.0001), with an odds ratio of 3.7 (95% confidence interval, 1.8-7.3). Twenty-eight of the 39 patients with PD who had PF asymmetry were treated with levodopa. CONCLUSIONS: Although the data are purely observational, it may be concluded that DPF coincidental with the side of initial parkinsonian symptomatology in patients with probable PD is an additional sign worth considering.

Motor-language coupling: direct evidence from early Parkinson's disease and intracranial cortical recordings.

Language and action systems are functionally coupled in the brain as demonstrated by converging evidence using Functional magnetic resonance imaging (fMRI), electroencephalography (EEG), transcranial magnetic stimulation (TMS), and lesion studies. In particular, this coupling has been demonstrated using the action-sentence compatibility effect (ACE) in which motor activity and language interact. The ACE task requires participants to listen to sentences that described actions typically performed with an open hand (e.g., clapping), a closed hand (e.g., hammering), or without any hand action (neutral); and to press a large button with either an open hand position or closed hand position immediately upon comprehending each sentence. The ACE is defined as a longer reaction time (RT) in the action-sentence incompatible conditions than in the compatible conditions. Here we investigated direct motor-language coupling in two novel and uniquely informative ways. First, we measured the behavioural ACE in patients with motor impairment (early Parkinson's disease - EPD), and second, in epileptic patients with direct electrocorticography (ECoG) recordings. In experiment 1, EPD participants with preserved general cognitive repertoire, showed a much diminished ACE relative to non-EPD volunteers. Moreover, a correlation between ACE performance and action-verb processing (kissing and dancing test - KDT) was observed. Direct cortical recordings (ECoG) in motor and language areas (experiment 2) demonstrated simultaneous bidirectional effects: motor preparation affected language processing (N400 at left inferior frontal gyrus and middle/superior temporal gyrus), and language processing affected activity in movement-related areas (motor potential at premotor and M1). Our findings show that the ACE paradigm requires ongoing integration of preserved motor and language coupling (abolished in EPD) and engages motor-temporal cortices in a bidirectional way. In addition, both experiments suggest the presence of a motor-language network which is not restricted to somatotopically defined brain areas. These results open new pathways in the fields of motor diseases, theoretical approaches to language understanding, and models of action-perception coupling.

Typical and atypical neuroleptics.

Neuroleptics having dopamine receptor-blocking properties are frequently responsible for the development of movement disorders. This has been known for many years as these adverse events were identified soon after the introduction of these drugs for the treatment of psychiatric disorders. Parkinsonism, acute dystonic reactions, akathisia, and tardive dyskinesias are the different clinical presentations of these disorders. Tardive dyskinesia is the most problematic among them as it may persist even after discontinuation of the offending drug, and become an irreversible phenomenon. The term "tardive dyskinesia" encompasses a variety of clinical phenomena including stereotypic behaviors, dystonia, myoclonus, and tics. Stereotypies and orobuccolingual dyskinesias are the most frequently observed tardive disorders, particularly in the elderly population exposed to neuroleptics, while dystonic phenomena are more prevalent in younger individuals. The development of these disorders is dependent on the potency of the drug, duration of exposure, and a number of predisposing factors, including age, gender, and presence of organic brain disease. The pathophysiology is rather complex and involves changes in the dopamine synapse both at the pre- and postsynaptic level, as well as plastic changes involving transcription factors and activation of different molecular cascades downstream of the dopamine receptor. The introduction of more novel pharmacological agents, like the so-called atypical neuroleptics, has significantly reduced the incidence of these disorders; however, the prescribing physician has to be aware that a lower risk is not synonymous with absence of risk.