Communication strategies used by Parkinson's nurse specialists during healthcare interactions: A qualitative descriptive study.

AIM: To explore the range and use of communication strategies by Parkinson's nurse specialists, and describe key communication strategies, to support health professionals in their healthcare interactions with people with Parkinson's. DESIGN: A qualitative descriptive study. METHODS: Due to the COVID-19 pandemic, the study took place in an online setting. Online semi-structured interviews were conducted with eight Australian Parkinson's nurse specialists and one UK Parkinson's nurse between August and October of 2020. Interviews explored healthcare communication, specifically (1) ways Parkinson's nurse specialists support communication during healthcare interactions, (2) factors influencing the use of communication strategies, and (3) how the nurses learned to communicate effectively with people with Parkinson's disease. Reflexive thematic analysis was used to analyse the data. RESULTS: Parkinson's nurse specialists described the importance of establishing strong therapeutic relationships, the key role of the communication partner, adapting communication to reduce cognitive load, ensuring two-way understanding, and enabling expressive communication for people with Parkinson's. Knowing the person and family, knowing the disease and understanding the symptoms appeared to influence the choice of communication strategies in healthcare interactions. Learning through others, learning through experience and learning through education and research were considered important parts of becoming a skilled healthcare communicator when working with people with Parkinson's. CONCLUSION: Knowledge and use of effective communication strategies to support people with Parkinson's is crucial for all health professionals working with this population, in order to reduce the occurrence of poor healthcare outcomes. A deep understanding of how Parkinson's disease affects communication and experience in implementing communication strategies were reported as contributing to the success of Parkinson's nurses in communicating with their patients. IMPACT: This study provides a description of the key, translational communication strategies that can be used by all health professionals to support healthcare interactions with people with Parkinson's.

Cognitive profile and mild cognitive impairment in people with chronic lower back pain.

A growing body of evidence suggests Chronic Lower Back Pain (CLBP) is associated with cognitive dysfunction. Little is known, however, about the extent of cognitive impairment in CLBP. The present study explored the cognitive profile of people with CLBP and sought to determine the extent of Mild Cognitive Impairment (MCI) according to the DSM-V and the Movement Disorders Society criteria for MCI. Thirty-one participants with CLBP and 27 age and gender matched healthy controls completed a full neuropsychological battery, consisting of two tasks for each of the five cognitive domains (Executive Function, Attention/Working Memory, Memory, Language, and Visuospatial). Participants with CLBP performed worse, compared to controls, on measures of Attention/Working Memory, Memory, Language, and Visuospatial performance. Cognitive performance in CLBP was also compared to equivalent normative data to determine cognitive impairment. Sixteen CLBP participants were impaired on at least one cognitive measure, with 5 participants meeting criteria for MCI. MCI was not associated with pain-related experience, or psychological health. The present study supports and extends previous findings that CLBP is associated with cognitive dysfunction and some people with CLBP meet criteria for MCI. These findings support that rehabilitation in people with CLBP requires a multidisciplinary approach.

Retrospective assessment of movement disorder society criteria for mild cognitive impairment in Parkinson's disease.

A Movement Disorder Society (MDS) taskforce recently proposed diagnostic criteria for Parkinson's disease with features of mild cognitive impairment (PD-MCI). This study first examined the prevalence and nature of PD-MCI in a non-demented cohort using the MDS criteria. Using the generic Monte Carlo simulation method developed by Crawford and colleagues (2007), this study then estimated the base rate of the representative population who would demonstrate PD-MCI due to chance alone. A total of 104 participants with idiopathic PD underwent extensive motor and neuropsychological testing at baseline and 2 years later. The Unified Parkinson's Disease Rating Scale (UPDRS) was used to assess motor symptoms of PD and a range of established neuropsychological tests was used to assess PD-MCI in accord with MDS criteria. In accord with MDS criteria, 38% of this cohort demonstrated PD-MCI at baseline and 48% at follow-up. Of the 36 participants in the multiple-domain PD-MCI subtype at time-1, 9 (25%) demonstrated no PD-MCI at follow up. Analysis revealed that approximately 13% of the representative population would demonstrate abnormally low scores for 2 of the 9 tests used, thereby meeting MDS criteria for PD-MCI. Clinicians and researchers need to approach a single diagnosis (i.e., based on one assessment) of PD-MCI with considerable caution.

Impaired savings despite intact initial learning of motor adaptation in Parkinson's disease.

In motor adaptation, the occurrence of savings (faster relearning of a previously learned motor adaptation task) has been explained in terms of operant reinforcement learning (Huang et al. in Neuron 70(4):787-801, 2011), which is thought to associate an adapted motor command with outcome success during repeated execution of the adapted movement. There is some evidence for deficient savings in Parkinson's Disease (PD), which might result from deficient operant reinforcement processes. However, this evidence is compromised by limited adaptation training during initial learning and by multi-target adaptation, which reduces the number of reinforced movement repetitions for each target. Here, we examined savings in PD patients and controls following overlearning with a single target. PD patients showed less savings than controls after successive adaptation and deadaptation blocks within the same test session, as well as less savings across test sessions separated by a 24-h delay. It is argued that impaired blunted dopaminergic signals in PD impairs the modulation of dopaminergic signals to the motor cortex in response to rewarding motor outcomes, thus impairing the association of the adapted motor command with rewarding motor outcomes. Consequently, the previously adapted motor command is not preferentially selected during relearning, and savings is impaired.

Assessing and treating conversations with partners in Parkinson's disease: A scoping review of the evidence.

Purpose: This is a scoping review of the methods used in published research to assess conversations and the interventions used to treat conversations between people with Parkinson's disease and their partners. Communication partners were defined as significant others or next-of-kin. The aims were to describe the assessment methods and interventions used, and to identify gaps in the literature.Method: Four online databases were used to identify peer reviewed journal articles in English, which assess and/or treat conversations in this population. The titles and abstracts of the obtained articles were screened and irrelevant articles were excluded. The full texts of the remaining articles were read to determine which studies met the inclusion/exclusion criteria of this review. The methods used, conversational aspects assessed, the treatments conducted and outcome measures used, and the speech and language domains targeted were charted in order to examine the extent of the evidence to inform future research directions.Result: Eight studies met inclusion criteria. "Conversation analysis" was the most widely used method to assess conversations. These studies assessed conversational aspects relating to the domains of pragmatics, fluency, prosody and semantics. They highlighted the role of communication partners to support conversational interactions by using repair strategies during a communication breakdown. Only one study treated conversations by implementing communication partner training.Conclusion: The findings of this review emphasise gaps in the literature. It highlights the need for future research implementing communication partner training. There is also a need to assess conversation skills of partners in order to determine which strategies would be most effective to support their interaction. It highlights the importance of incorporating a participation-based approach to assessment and intervention involving all communication partners. This may lead to enhanced support for people with Parkinson's disease and their families, thus improving their quality of life.

Anodal-TDCS over Left-DLPFC Modulates Motor Cortex Excitability in Chronic Lower Back Pain.

Chronic pain is associated with abnormal cortical excitability and increased pain intensity. Research investigating the potential for transcranial direct current stimulation (tDCS) to modulate motor cortex excitability and reduce pain in individuals with chronic lower back pain (CLBP) yield mixed results. The present randomised, placebo-controlled study examined the impact of anodal-tDCS over left-dorsolateral prefrontal cortex (left-DLPFC) on motor cortex excitability and pain in those with CLBP. Nineteen participants with CLBP (Mage = 53.16 years, SDage = 14.80 years) received 20-min of sham or anodal tDCS, twice weekly, for 4 weeks. Short interval intracortical inhibition (SICI) and intracortical facilitation (ICF) were assessed using paired-pulse Transcranial Magnetic Stimulation prior to and immediately following the tDCS intervention. Linear Mixed Models revealed no significant effect of tDCS group or time, on SICI or ICF. The interactions between tDCS group and time on SICI and ICF only approached significance. Bayesian analyses revealed the anodal-tDCS group demonstrated higher ICF and SICI following the intervention compared to the sham-tDCS group. The anodal-tDCS group also demonstrated a reduction in pain intensity and self-reported disability compared to the sham-tDCS group. These findings provide preliminary support for anodal-tDCS over left-DLPFC to modulate cortical excitability and reduce pain in CLBP.

Measuring General Expectations of Advanced Stage Treatment Outcomes in Parkinson's Disease.

BACKGROUND: Recent research suggests that a significant number of those who receive advanced treatments for Parkinson's disease (PD) do not report improvements for some symptoms, which may relate to their pre-treatment expectations. It is important that expectations of treatment are measured and discussed prior to advanced treatment. OBJECTIVE: The primary aim of this study was to develop a measure of treatment expectations of two advanced-stage treatments in PD, deep brain stimulation (DBS), and Levodopa/Carbidopa Intestinal Gel (LCIG). A secondary aim was to explore potential predictors of treatment expectations. METHODS: The questionnaire-based measure was developed by researchers in conjunction with a highly experienced clinician, and evaluated treatment expectations in 189 people aged 46-91 years (M = 71.35, SD = 8.73; 61% male) with idiopathic PD. RESULTS: The overall measure demonstrated excellent internal consistency (α= 0.96). Exploratory factor analysis suggested the scale was unidimensional for both DBS and LCIG. Participant expectations of the two treatments differed significantly, with expectations being higher for DBS. Perceived symptom severity was the strongest predictor of treatment expectations. CONCLUSION: This scale has potential to inform clinicians about client expectations prior to advanced stage therapy for PD, with a view to the management of these expectations. Further evaluation of the scale is required across different treatment contexts.

Cognitive Reserve, Executive Function, and Memory in Parkinson's Disease.

Cognitive impairment is acknowledged as a feature of Parkinson's disease (PD), and the most common cognitive declines are in executive function (EF) and memory. Cognitive reserve (CR) may offer some protection against cognitive dysfunction in PD. The present study used two proxies of CR (years of education, premorbid IQ) to examine the relationship between CR and (i) EF (ii) memory in a large PD sample (n = 334). Two aspects of EF were examined, including verbal fluency and planning skills. Two aspects of verbal memory were examined, including immediate recall and delayed recall. For EF, both CR proxies significantly predicted verbal fluency, but only years of education predicted planning skills. Years of education significantly predicted immediate recall, but premorbid IQ did not. Neither CR proxy predicted delayed recall. These findings suggest that CR, in particular years of education, may contribute to EF and memory function in those with PD. A key finding of this study is the varying contribution of CR proxies to different aspects of the same cognitive domain. The findings indicate that using only one proxy has the potential to be misleading and suggest that when testing the relationship between CR and cognition, studies should include tasks that measure different aspects of the cognitive domain(s) of interest.

Prism adaptation overcomes pseudoneglect for the greyscales task.

Visuomotor adaptation to left-shifting prisms can affect performance for a variety of tasks in neurologically intact (normal) participants. This study examined whether visuomotor adaptation affects performance on the greyscales task in normal participants. Forty-two normal participants completed a greyscales task before and after adaptation to either: left-shifting prisms, right-shifting prisms or control spectacles that did not shift the visual scene. Participants demonstrated a leftward bias (i.e., selected the stimulus that was darker on the left as being darker overall) that was reversed by a short period of visuomotor adaptation to left-shifting prisms. In contrast, this bias was unaffected by adaptation to right-shifting prisms and control spectacles. The findings demonstrate that a simple visuomotor task can alter the distribution of spatial attention for the greyscales task in normal participants.

Left to right: representational biases for numbers and the effect of visuomotor adaptation.

Adaptation to right-shifting prisms improves left neglect for mental number line bisection. This study examined whether adaptation affects the mental number line in normal participants. Thirty-six participants completed a mental number line task before and after adaptation to either: left-shifting prisms, right-shifting prisms or control spectacles that did not shift the visual scene. Participants viewed number triplets (e.g. 16, 36, 55) and determined whether the numerical distance was greater on the left or right side of the inner number. Participants demonstrated a leftward bias (i.e. overestimated the length occupied by numbers located on the left side of the number line) that was consistent with the effect of pseudoneglect. The leftward bias was corrected by a short period of visuomotor adaptation to left-shifting prisms, but remained unaffected by adaptation to right-shifting prisms and control spectacles. The findings demonstrate that a simple visuomotor task alters the representation of space on the mental number line in normal participants.

Numerical processing overcomes left neglect for the greyscales task.

This study examined whether numerical cues affect spatial attention in left neglect. Patients with right parietal damage (four with neglect, three without) completed a dual task. Stimuli consisted of two greyscales overlayed with high numbers (8, 9), low numbers (1, 2) or neutral stimuli (musical sharp, &). Participants identified if the overlay was high, low or neutral and then made a relative luminance judgement for the greyscales. Neglect patients demonstrated a rightward greyscales bias in the neutral overlay condition, which was overcome by processing low numbers. Control patients showed a leftward bias in the neutral condition, which was overcome by processing high numbers. The results demonstrate that the spatial architecture of numbers induces shifts of attention, which can overcome left neglect.

Pseudoneglect for mental alphabet lines is affected by prismatic adaptation.

While patients with right parietal damage and spatial neglect bisect lines to the right, the general population bisects lines to the left; a phenomenon known as pseudoneglect. The leftward bias also occurs for mental representations, such as number and alphabet lines. Prismatic adaptation can have a dramatic effect on attentional bias and corrects neglect and pseudoneglect for physical and mental number lines. This study examined whether prismatic adaptation can correct leftward bisection biases for alphabet lines, which may have a different spatial arrangement compared to number lines. In pre-adaptation testing, students (n = 42) were shown letter trigrams (e.g. C H P) and judged whether the alphabetical distance before or after the inner-letter was larger. Participants were then split into three groups and were adapted to left-shifting, control or right-shifting prims. After adaptation, the mental alphabet bisection task was re-administered. The length of left side of the alphabet lines was overestimated by all three groups in the pre-adaptation phase. Right-shifting prisms and control spectacles had no effect on the leftward bias whereas exposure to left-shifting prisms corrected the bias. The results replicate an effect observed for mental number lines and demonstrate that low-level sensory-motor shifts can correct attentional biases associated with high-level representations, such as letters.

Rightward collisions and their association with pseudoneglect.

Whereas right parietal damage can result in left hemineglect, the general population shows a subtle neglect of the right hemispace-known as pseudoneglect. A recent study has demonstrated that people collide to the right more often and attributed this bias to pseudoneglect. [Nicholls, M. E. R., Loftus, A., Meyer, K., & Mattingley, J.B. (2007). Things that go bump in the right: The effect of unimanual activity on rightward collisions. Neuropsychologia, 45, 1122-1126]. Nicholls examined the effect of unimanual activation by requiring participants to fire projectiles at a target whilst walking and found that the rightward bias was exaggerated or reversed when the left and right hands were active, respectively. However, the act of aiming at a target may have inadvertently biased walking trajectory to the right. The current study addressed this issue by requiring participants (n=149) to walk through a narrow doorway three times whilst entering text into a phone using the (a) left, (b) right or (c) both hands. Despite the fact that entering text into a phone should produce no rightward bias, participants bumped to the right more often. Unlike previous research, no effect of unimanual activation was observed. This lack of effect was attributed to the smaller hand movements for entering numbers compared to firing a toy gun. Finally, this study showed an association for the first time between biases in observable bumping and line bisection performance-suggesting that unilateral bumping is related to pseudoneglect.

Look, no hands: a perceptual task shows that number magnitude induces shifts of attention.

The mental representation of numbers along a line oriented left to right affects spatial cognition, facilitating responses in the ipsilateral hemispace (the spatial-numerical association of response codes [SNARC] effect). We investigated whether the number/space association is the result of an attentional shift or response selection. Previous research has often introduced covert left/right response cues by presenting targets to the left or the right. The present study avoided left/right cues by requiring forced choice upper/lower luminance discriminations to two mirror-reversed luminance gradients (the grayscale task). The grayscale stimuli were overlaid with strings of (1) low numbers, (2) high numbers, and (3) nonnumerical characters. In Experiment 1, 20 dextrals judged the number's magnitude and then indicated whether the upper/lower grayscale was darker. Results showed leftward and rightward attentional biases for low and high numbers, respectively. Demands to process numbers along a left/right line were made less explicit in Experiment 2 (N = 18 dextrals), using (1) a parity judgment and (2) arbitrary linguistic labels for top/bottom. Once again, a spatial congruency effect was observed. Because the response (up/down) was orthogonal to the dimension of interest (left/right), the effect of number cannot be attributed to late-stage response congruencies. This study required unspeeded responses to stimuli presented in free vision, whereas other experiments have used speeded responses. Understanding the time course of number-space effects may, therefore, be important to the debate associated with response selection.

A new means of measuring index/ring finger (2D:4D) ratio and its association with gender and hand preference.

Relative finger length can predict a person's gender or their hand preference. We measured finger length using a new "tubes" test, which required participants to slide a clear plastic tube over their fingers and read the length from an attached mm scale. Data collected from 600 students demonstrated that the right fingers are longer than the left for dextrals, but not for non-dextrals. Examination of the relative length of the index and ring fingers revealed a clear gender effect. There was also an effect of hand preference on index/ring finger ratio whereby non-dextrals showed a more masculine pattern compared to dextrals. For non-dextrals, prenatal exposure to high testosterone levels may have caused both a shift away from dextrality and a more masculine pattern of finger ratio. In the second experiment, finger length was measured by the tubes test and by photocopying the hands in 124 undergraduates. The tubes test yielded a longer estimate of ring finger length compared to the photocopy method. Despite this, there was a strong correlation between the tests and both showed an association with gender. Finally, test-retest scores for 45 participants showed a high level of reliability for absolute and relative finger measures. We conclude that the tubes technique provides an effective and easy-to-use means of measuring finger length, which can be administered in a classroom setting.

Cognitive Training and Transcranial Direct Current Stimulation for Mild Cognitive Impairment in Parkinson's Disease: A Randomized Controlled Trial.

This study examined whether standard cognitive training, tailored cognitive training, transcranial direct current stimulation (tDCS), standard cognitive training + tDCS, or tailored cognitive training + tDCS improved cognitive function and functional outcomes in participants with PD and mild cognitive impairment (PD-MCI). Forty-two participants with PD-MCI were randomized to one of six groups: (1) standard cognitive training, (2) tailored cognitive training, (3) tDCS, (4) standard cognitive training + tDCS, (5) tailored cognitive training + tDCS, or (6) a control group. Interventions lasted 4 weeks, with cognitive and functional outcomes measured at baseline, post-intervention, and follow-up. The trial was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR: 12614001039673). While controlling for moderator variables, Generalized Linear Mixed Models (GLMMs) showed that when compared to the control group, the intervention groups demonstrated variable statistically significant improvements across executive function, attention/working memory, memory, language, activities of daily living (ADL), and quality of life (QOL; Hedge's g range = 0.01 to 1.75). More outcomes improved for the groups that received standard or tailored cognitive training combined with tDCS. Participants with PD-MCI receiving cognitive training (standard or tailored) or tDCS demonstrated significant improvements on cognitive and functional outcomes, and combining these interventions provided greater therapeutic effects.

Factor Structure of the Ways of Coping Questionnaire in Parkinson's Disease.

The Ways of Coping Questionnaire (WCQ) is used extensively in health research, but the measurement properties and suitability of the WCQ for people with Parkinson's disease (PD) have not been psychometrically assessed. If the WCQ does not align with its original 8-factor structure in a PD population, the use of the WCQ subscales may not be appropriate. The present study used confirmatory factor analysis (CFA), exploratory factor analysis (EFA), and multiple-group EFA to determine the ideal factor structure of the WCQ in a PD sample. The original 8 factors of the WCQ were not reproduced. EFA revealed a 6-factor structure, including Distancing, Faith, Avoidance, Seeking Social Support, Planful Problem Solving, and Confrontive coping. As motor symptom severity may impact coping, the stability of the 6-factor structure was examined across motor symptom severity (mild and moderate), remaining consistent. Higher levels of overall motor severity were associated with increased use of faith and avoidance style coping. These findings suggest that the 6-factor structure of the WCQ may be more appropriate for assessing coping styles in PD.

Beyond factor analysis: Multidimensionality and the Parkinson's Disease Sleep Scale-Revised.

Many studies have sought to describe the relationship between sleep disturbance and cognition in Parkinson's disease (PD). The Parkinson's Disease Sleep Scale (PDSS) and its variants (the Parkinson's disease Sleep Scale-Revised; PDSS-R, and the Parkinson's Disease Sleep Scale-2; PDSS-2) quantify a range of symptoms impacting sleep in only 15 items. However, data from these scales may be problematic as included items have considerable conceptual breadth, and there may be overlap in the constructs assessed. Multidimensional measurement models, accounting for the tendency for items to measure multiple constructs, may be useful more accurately to model variance than traditional confirmatory factor analysis. In the present study, we tested the hypothesis that a multidimensional model (a bifactor model) is more appropriate than traditional factor analysis for data generated by these types of scales, using data collected using the PDSS-R as an exemplar. 166 participants diagnosed with idiopathic PD participated in this study. Using PDSS-R data, we compared three models: a unidimensional model; a 3-factor model consisting of sub-factors measuring insomnia, motor symptoms and obstructive sleep apnoea (OSA) and REM sleep behaviour disorder (RBD) symptoms; and, a confirmatory bifactor model with both a general factor and the same three sub-factors. Only the confirmatory bifactor model achieved satisfactory model fit, suggesting that PDSS-R data are multidimensional. There were differential associations between factor scores and patient characteristics, suggesting that some PDSS-R items, but not others, are influenced by mood and personality in addition to sleep symptoms. Multidimensional measurement models may also be a helpful tool in the PDSS and the PDSS-2 scales and may improve the sensitivity of these instruments.

Auditory and Cognitive Training for Cognition in Adults With Hearing Loss: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis examined the efficacy of auditory training and cognitive training to improve cognitive function in adults with hearing loss. A literature search of academic databases (e.g., MEDLINE, Scopus) and gray literature (e.g., OpenGrey) identified relevant articles published up to January 25, 2018. Randomized controlled trials (RCTs) or repeated measures designs were included. Outcome effects were computed as Hedge's g and pooled using random-effects meta-analysis (PROSPERO: CRD42017076680). Nine studies, five auditory training, and four cognitive training met the inclusion criteria. Following auditory training, the pooled effect was small and statistically significant for both working memory ( g = 0.21; 95% CI [0.05, 0.36]) and overall cognition ( g = 0.19; 95% CI [0.07, 0.31]). Following cognitive training, the pooled effect for working memory was small and statistically significant ( g = 0.34; 95% CI [0.16, 0.53]), and the pooled effect for overall cognition was large and significant ( g = 1.03; 95% CI [0.41, 1.66]). However, this was dependent on the classification of training approach. Sensitivity analyses revealed no statistical difference between the effectiveness of auditory and cognitive training for improving cognition upon removal of a study that used a combined auditory-cognitive approach, which showed a very large effect. Overall certainty in the estimation of effect was "low" for auditory training and "very low" for cognitive training. High-quality RCTs are needed to determine which training stimuli will provide optimal conditions to improve cognition in adults with hearing loss.

Pseudoneglect and neglect for mental alphabet lines.

While patients with right parietal damage neglect the left side of stimuli, the intact-brain population shows a slight neglect of the right side--known as pseudoneglect. Although pseudoneglect occurs for physical stimuli, it is not certain whether the bias extends to mental representations. To investigate this issue, we examined spatial distortions in the representation of length for mental alphabet lines, which are thought to have a left-to-right arrangement. In Expt. 1, participants (n=10) were presented with letter strings (e.g. C_H_P) and estimated whether the letter length was greater on the left or right side of the inner-letter. The strings were presented simultaneously along a line or sequentially in the centre of the screen in either an ascending (i.e. A-Z) or descending (i.e. Z-A) sequence. Participants reliably overestimated the length on the left regardless of presentation mode. In Expt. 2, participants (n=20) judged whether the inner-letter was the true centre. Responses were biased such that inner-letters shifted to the left of true centre were perceived to be the centre. Combined, both studies demonstrate that the length on left side of the mental alphabet line is overestimated relative to the right. In Expt. 3, a reversal of the bias towards the right was found for a group of neglect patients. The data demonstrate that letters have a left-to-right mental representation and that the left side of this representation is overrepresented in a manner similar to the overestimation associated with pseudoneglect for physical stimuli.