Multiculturalism and reported cognitive change in Parkinson's disease.

OBJECTIVE: Subjective cognitive decline (SCD) and how much cognitive decline impacts one's ability to perform instrumental activities of daily living (iADLs) are necessary elements of neuropsychological assessment when diagnosing mild cognitive impairment (MCI) and dementia. Though limited, the literature suggests that culture and self-appraisal of cognitive abilities are related. However, it is unclear if differences exist in the subjective elements of neuropsychological assessments between patients born in Anglosphere countries (Canada, the USA, and the UK) versus immigrants born elsewhere (International Group). METHOD: We conducted a retrospective chart review of advanced Parkinson's disease (PD) patients (n = 764). Reports of SCD and iADL difficulties were extracted from neuropsychological reports and coded by two independent raters. We also examined responses on self- and family-rated questionnaires of executive functioning and iADL difficulties. RESULTS: Anglosphere and International patients did not differ on overall, memory, or attention SCD, or overall iADL difficulties based on interviews. Anglosphere patients reported more executive and language SCD during the interview but International care-partners reported more current executive dysfunction on a questionnaire. International patients and care-partners reported more iADL difficulties on a questionnaire, which they ascribed to motor (not cognitive) symptoms. The effects on questionnaires were small and persisted after accounting for depression severity ratings. CONCLUSION: There were no consistent group differences in the number or pervasiveness of SCD or iADL difficulties reported by Anglosphere versus International groups. Immigration status has limited effect on these subjective elements and they should be given significant weight when diagnosing cognitive dysfunction in PD.

Axial Impairment Following Deep Brain Stimulation in Parkinson's Disease: A Surgicogenomic Approach.

BACKGROUND: Postoperative outcome following deep brain stimulation (DBS) of the subthalamic nucleus is variable, particularly with respect to axial motor improvement. We hypothesized a genetic underpinning to the response to surgical intervention, termed "surgicogenomics". OBJECTIVE: We aimed to identify genetic variants associated with clinical heterogeneity in DBS outcome of Parkinson's disease (PD) patients that could then be applied clinically to target selection leading to improved surgical outcome. METHODS: Retrospective clinical data was extracted from 150 patient's charts. Each individual was genotyped using the genome-wide NeuroX array tailored to study neurologic diseases. Genetic data were clustered based on surgical outcome assessed by comparing pre- and post-operative scores of levodopa equivalent daily dose and axial impairment at one and five years post-surgery. Allele frequencies were compared between patients with excellent vs. moderate/poor outcomes grouped using a priori defined cut-offs. We analyzed common variants, burden of rare coding variants, and PD polygenic risk score. RESULTS: NeuroX identified 2,917 polymorphic markers at 113 genes mapped to known PD loci. The gene-burden analyses of 202 rare nonsynonymous variants suggested a nominal association of axial impairment with 14 genes (most consistent with CRHR1, IP6K2, and PRSS3). The strongest association with surgical outcome was detected between a reduction in levodopa equivalent daily dose and common variations tagging two linkage disequilibrium blocks with SH3GL2. CONCLUSION: Once validated in independent populations, our findings may be implemented to improve patient selection for DBS in PD.

Multiculturalism: A Challenge for Cognitive Screeners in Parkinson's Disease.

BACKGROUND: The Montreal Cognitive Assessment (MoCA) and the Dementia Rating Scale-2 (DRS-2) are recommended screeners for Parkinson's disease mild cognitive impairment (PD-MCI). Cross-cultural studies examining their diagnostic precision have not addressed cultural bias in a multicultural setting. OBJECTIVES: To compare DRS-2 and MoCA performance between patients born in Canada, the USA, and the UK (Anglosphere group) and immigrant patients born elsewhere (International group). To identify sources of cultural bias by comparing group characteristics, and by assessing the relationships between performance and immigration and socio-development variables. To examine the diagnostic precision of both tools in detecting PD-MCI in each group. METHODS: We conducted a clinical chart review of advanced PD patients who completed cognitive screeners (MoCA: n = 288, 30% International group; DRS-2: n = 426, 31% International group). All completed a comprehensive neuropsychological assessment to apply Level II PD-MCI diagnostic criteria. RESULTS: The International group performed worse than the Anglosphere group on the MoCA and DRS-2, and the only variable that accounted for some of the group difference was the Historical Index of Human Development, a societal variable, which fully mediated the group effect on the DRS-2. Diagnostic precision of the MoCA was at chance level in the International group, and was poorer than that of the DRS-II in this group and that of the MoCA in the Anglosphere group, although these were considered poor. CONCLUSIONS: Our results support the recommendation to exert caution in using cognitive screeners to capture PD-MCI in all patients and particularly with first generation immigrants.

Altruism in Parkinson's disease.

Objective: Reward-based decision-making is a growing area of research in Parkinson's disease (PD), a disorder characterized by alterations in dopamine and cortico-striatal circuits. While reward is typically operationalized as a gain, altruistic decisions also engage the reward system in fMRI studies. Although altruism comes at a cost, individuals may be motivated by the social reward associated with benefitting another. At present, it is unclear how PD affects altruism because both increased egoistic tendencies and increased generosity have been documented. Method: To address this, 32 individuals with PD and 32 age-matched healthy controls completed two tasks of implicit and explicit altruism. First, in an intertemporal choice task, participants chose between a smaller immediate or larger later outcome. Outcome types included gains, losses, and donations, and an implicit altruism measure was derived. Second, participants completed two versions of the dictator game, which assesses nonreciprocal giving and yields an explicit measure of altruism. Results: Patients and controls showed similar altruism in the intertemporal choice task and in a dictator game for a charity, but patients were more generous than controls in the dictator game in which the recipient was a stranger. Among patients, altruism measures were moderated by laterality of hemispheric burden and medication type. Conclusions: This study was the first to examine altruistic decision-making in PD patients using both implicit and explicit measures. PD patients were neither overly generous nor egoistic in their decisions, although some disease and treatment characteristics may have a modest association with altruism in PD. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Origins Matter: Culture Impacts Cognitive Testing in Parkinson's Disease.

Cognitive decline is common in Parkinson's disease (PD), and precise cognitive assessment is important for diagnosis, prognosis, and treatment. To date, there are no studies in PD investigating cultural bias on neuropsychological tests. Clinical practice in multicultural societies such as, Toronto Canada where nearly half of the population is comprised of first generation immigrants, presents important challenges as most neuropsychological tools were developed in Anglosphere cultures (e.g., USA, UK) and normed in more homogeneous groups. We examine total scores and rates of deficits on tests of visuoperceptual/visuospatial, attention, memory, and executive functions in Canadians with PD born in Anglosphere countries (n = 248) vs. in Canadians with PD born in other regions (International group; n = 167). The International group shows lower scores and greater rates of deficits on all visuoperceptual and some executive function tasks, but not on attention or memory measures. These biases are not explained by demographic and clinical variables as groups were comparable. Age at immigration, years in Canada, and English proficiency also do not account for the observed biases. In contrast, group differences are strongly mediated by the Historical Index of Human Development of the participants' country of birth, which reflects economic, health, and educational potential of a country at the time of birth. In sum, our findings demonstrate lasting biases on neuropsychological tests despite significant exposure to, and participation in, Canadian culture. These biases are most striking on visuoperceptual measures and non-verbal executive tasks which many clinicians still considered to be "culture-fair" despite the growing evidence from the field of cross-cultural neuropsychology to the contrary. Our findings also illustrate that socio-development context captures important aspects of culture that relate to cognition, and have important implications for clinical practice.

Automated Indices of Clustering and Switching of Semantic Verbal Fluency in Parkinson's Disease.

OBJECTIVES: Deficits in semantic verbal fluency (SVF) can stem from dysfunction of an executive control system and/or of semantic knowledge. Previous analyses of SVF responses were devised to characterize these two components including switching and mean cluster size (MCS) indices, but these rely on subjective experimenter-based assessment of the words' relatedness. To address this limitation, computational data-driven SVF indices have been developed. Our aim is to assess the validity and usefulness of these automated indices in the context of cognitive decline in Parkinson's disease (PD). METHODS: This is a retrospective study including 50 advanced PD patients with (n=28) or without (n=22) mild cognitive impairment (PD-MCI). We analyzed animal SVF outputs using an automated computational approach yielding switching, MCS, and cumulative relatedness (CuRel) indices. We compared these indices to the classic experimenter-based switching and MCS indices to assess concurrent validity, and against neuropsychological measures of executive functioning and semantic knowledge to assess construct validity. We also examined whether these indices were impaired and predicted PD-MCI. RESULTS: Automated switching indices, but not MCS or CuRel, showed evidence of concurrent and construct validity, and characterized individual difference in advanced PD. Automated switching indices also outperformed the experimenter-dependent index in predicting the presence of PD-MCI. CONCLUSION: Computational methods hold promise as fine-grained, unbiased indices reflecting the executive component of SVF, but none of the methods provided valid measures of semantic knowledge in PD. Our data also confirm that SVF are not adequate tests of semantic memory in patients with executive dysfunction such as PD. (JINS, 2018, 24, 1047-1056).

Facial affect recognition and social functioning among individuals with varying degrees of schizotypy.

Facial affect recognition (FAR) accuracy is impaired in schizophrenia and, to a lesser extent, in individuals at-risk for psychosis. Reduced reaction time and negative bias on FAR tasks are also evident in schizophrenia, though few studies have examined these measures in at-risk samples. Social dysfunction is associated with FAR deficits in schizophrenia and at-risk individuals. We aimed to elucidate the nature of FAR and social functioning among individuals from a non-clinical population reporting a range of schizotypal traits (i.e., risk for psychosis), and to examine whether FAR mediates the relationship between schizotypal traits and social functioning. Participants completed self-report measures assessing schizotypal traits and social functioning, and a computerized FAR task remotely via the Internet. High schizotypy individuals performed significantly worse than low schizotypy individuals on FAR total and neutral accuracy, demonstrated a negative bias, and reported significantly worse social functioning. Schizotypal traits were also negatively correlated with FAR performance and social functioning in the total sample. FAR accuracy did not mediate the direct relationship between schizotypal traits and social functioning. FAR may be an important social-cognitive endophenotype of psychosis risk with implications for understanding etiology of psychotic spectrum disorders, improving ways of identifying at-risk individuals, and developing preventive strategies.

Efficacy of social cognition remediation programs targeting facial affect recognition deficits in schizophrenia: a review and consideration of high-risk samples and sex differences.

Schizophrenia patients suffer from significant social functioning deficits. Social cognition, particularly facial affect recognition (FAR), is an important predictor of functional outcome. Recently, investigators developed numerous social cognition remediation programs targeting FAR deficits with the goal of improving social functioning and quality of life in schizophrenia patients. This article builds on Horan et al.'s (2008) comprehensive review and Kurtz and Richardson's (2012) meta-analysis of a broad range of social cognition remediations, by systematically reviewing efficacy of empirically based remediations in schizophrenia specifically targeting FAR (across 23 studies), and their potential functional benefits. We describe each FAR-based social cognition remediation program, which may aid clinical scientists and clinicians in selecting programs for further study and practice. We critically evaluate limitations of FAR remediation programs and applications. Our review concludes FAR remediation programs are strongly efficacious in improving FAR performance and functional status in schizophrenia. Importantly, we provide rationale for and recommend that future research consider (as yet underexplored) sexual dimorphisms in FAR remediation effects, and examine FAR remediation in clinical high-risk for psychosis populations. The goal is to mitigate deficits, perhaps hinder illness onset, and individually tailor treatments across the psychosis continuum in a way that maximally aids those in greatest need.

Biological sex and menstrual cycle phase modulation of cortisol levels and psychiatric symptoms in a non-clinical sample of young adults.

Prior research examined the complex, bidirectional interplay of the hypothalamic-pituitary-adrenal (HPA) and hypothalamic-pituitary-gonadal axes and their roles in (clinical) cognitive/behavioral functions. Less well understood are contemporaneous relationships in non-clinical samples. This pilot study explored cortisol in relation to psychiatric symptoms/personality as a function of self-reported menstrual cycle phase and sex differences in a non-clinical, young adult sample. Consistent with literature and hypotheses, cortisol levels were lowest during early-follicular, intermediary during late-follicular, and highest during mid-luteal phases (not significant), and greater among males than early-follicular females. An acute stressor uniformly affected cortisol across phases and sex, though magnitude and time course differed. Psychiatric symptoms were greater among early-follicular/late-follicular females versus males, and early-follicular and/or late-follicular versus mid-luteal. Contrary to hypotheses, positive psychotic-like symptoms were greater among males than (mid-luteal) females. Cortisol inversely related to early-follicular symptoms, and directly related to late-follicular/mid-luteal symptoms. Results suggest menstrual cycle phase modulates non-clinical psychiatric symptomatology and HPA activity. Findings tentatively bolster a dimensional/continuum model of psychopathology with implications for understanding neurobiological underpinnings and risk/protective factors for mental/physical health conditions, particularly those marked by sex differences and neuroendocrine dysfunction (depression/schizophrenia/Alzheimer's/multiple sclerosis). We speculate a dose-response cortisol effect on symptoms, modulated by endogenous gonadal hormones via gene expression.

The University of California Performance Skills Assessment (UPSA) in schizophrenia.

This study evaluated the University of California Performance-based Skills Assessment (UPSA) in a Canadian outpatient schizophrenia setting. The UPSA was administered to 64 patients with schizophrenia and schizoaffective disorder and to 42 nonpsychiatric controls. Patient and control samples did not differ in age, gender composition, first language or country of birth. Patients demonstrated significantly lower performance than healthy participants on 3 of 5 UPSA subscales as well as on a summary index. Moreover, performance varied significantly with patients' support requirements in the community. In contrast, the Household Management and Transportation subscales yielded non-significant group differences and failed to correlate with community support requirements. Examination of score distributions raised the possibility of a ceiling effect that limited the discriminating power of UPSA subscales, thus imposing qualifications on clinical interpretations of this instrument. Performance-based assessment of life skills provides an important new perspective on functional outcome in schizophrenia and serious mental illness. However, psychometric properties, task difficulty and the nature of different mental health settings, populations and communities must be considered in the design and application of these instruments.