Aim: Correlations between motor function and frontal-executive function in Parkinson's disease (PD) have been examined previously, but correlations with other cognitive domains remain unknown. We examined the correlation between motor dysfunction and cognitive impairment with regard to their precise domains. Methods: Motor and cognitive functions were assessed in 61 patients. To assess motor function, the Unified Parkinson's Disease Rating Scale (UPDRS) was administered. The UPDRS score was assessed as general motor function with a sum of Parts II and III, and as subscores of individual motor symptoms (rigidity, tremor, akinesia and postural instability). To assess cognitive function, the Montreal Cognitive Assessment (MoCA) and the Frontal Assessment Battery (FAB) were administered. MoCA was assessed by a total score and subscores of six cognitive subdomains: visuospatial, executive, attention/concentration/working memory, language, memory and orientation. The correlation coefficients of both MoCA and FAB with patient background and motor symptoms were compared using Spearman's correlation coefficient. Results: General motor function and the subscore of postural instability showed significant negative correlations with MoCA, FAB, and the subdomains of visuospatial, executive and orientation skills. Tremor and rigidity showed no significant correlation with any cognitive assessment. Akinesia showed significant negative correlation with MoCA, and the subdomains of visuospatial and orientation skills. Conclusions: In patients with PD, specific motor and cognitive functions correlate, with particular regard to postural instability and visuospatial skills. The correlations suggest functional links between a number of cerebral cortices and subcortical structures, and a common pathophysiology for motor and cognitive impairments in PD.

Background and aim Toxic oligomeric α-synuclein (αS; O-αS) has been suggested to play a central role in the pathogenesis of Lewy body diseases such as Parkinson’s disease (PD). Cerebrospinal fluid (CSF) levels of αS, O-αS, total and phosphorylated tau, and amyloid β 1–42 (Aβ1–42) are thought to reflect the pathophysiology or clinical symptoms in PD. In this study, we examined correlations of the CSF levels of these proteins with the clinical symptoms, and with each other in drug-naïve patients with PD. Methods Twenty-seven drug-naïve patients with PD were included. Motor and cognitive functions were assessed using the Unified Parkinson’s Disease Rating Scale (UPDRS), Montreal Cognitive Assessment (MoCA), and Neurobehavioral Cognitive Status Examination (COGNISTAT). CSF levels of total αS, O-αS, Aβ1–42, total tau and tau phosphorylated at threonine 181 (P-tau181p) were measured. CSF levels of these proteins were compared with clinical assessments from the UPDRS, MoCA and COGNISTAT using Spearman correlation analysis. Spearman correlation coefficients among CSF protein levels were also evaluated. Results CSF levels of αS were negatively correlated with UPDRS part III (motor score) ( p < 0.05) and bradykinesia ( p < 0.01), and positively correlated with COGNISTAT subtest of judgement ( p < 0.01) and CSF levels of Aβ1–42 ( p < 0.001), total tau ( p < 0.001) and P-tau181p ( p < 0.01). Lower CSF levels of Aβ1–42, total tau and P-tau181p were significantly related to worsening of some motor and/or cognitive functions. The CSF level of O-αS showed no correlation with any motor and cognitive assessments or with CSF levels of the other proteins. Conclusion CSF levels of αS are correlated with some clinical symptoms and CSF levels of other pathogenic proteins in drug-naïve PD patients. These correlations suggest a central role for interaction and aggregation of αS with Aβ1–42, tau, and phosphorylated tau in the pathogenesis of PD. Although O-αS has been shown to have neurotoxic effects, CSF levels do not reflect clinical symptoms or levels of other proteins in cross-sectional assessment. Electronic supplementary material The online version of this article (10.1186/s12883-019-1346-y) contains supplementary material, which is available to authorized users.

BackgroundEffects of dopaminergic medication on executive function in patients with Parkinson’s disease (PD) are inconsistent.ObjectiveWe examined the effect of dopaminergic medication on executive function in 24 drug-naïve PD patients (de novo group) and in 21 PD patients on chronic dopaminergic medication (chronic medication group).MethodsPD patients without dementia were included in this study. For the de novo group patients, dopaminergic medication was initiated, and the dose was increased to improve motor symptoms. For the chronic medication group patients, dopaminergic medication was adjusted to relieve clinical problems. All participants were tested prior to and at 4–7 months after the drug initiation/adjustment. Executive function was assessed by using the Behavioral Assessment of the Dysexecutive Syndrome (BADS). Motor function was assessed by using the Unified Parkinson’s Disease Rating Scale (UPDRS; part III). Improvement in executive function was compared with a simultaneous change in levodopa equivalent doses (LED) of dopaminergic medication and with improvement in motor functions.ResultsThe mean standardized BADS scores showed no significant improvement in both the groups. In the de novo group, percent improvement in the standardized BADS scores showed a significant positive correlation with the LED, but not with percent improvement in UPDRS part III. In the chronic medication group, percent improvement in the standardized BADS scores was negatively correlated with change in the LED, but not with percent improvement in UPDRS part III. Multiple regression analysis using improvement in the standardized BADS score as a dependent variable and patient’s background factors (ie, age, education, disease duration, and motor and executive assessments at baseline) as independent variable showed that improvement in the executive assessment is significantly correlated with the LED only in the de novo group.ConclusionEffects of dopaminergic drug adjustment on executive function differ according to the patient’s clinical stage and depend on LED in de novo stage.

Marchiafava-Bignami disease (MBD) is a rare alcohol-associated disorder. Clinical features include not only disturbed consciousness, dysarthria, tetraparesis, astasia-abasia, and symptoms of interhemispheric disconnection as initial symptoms but also cognitive deficits as clinical outcomes. The clinical significance of cerebral microhemorrhage (CMH) has been recognized in patients with cognitive deficits; however, the presence of CMH in patients with MBD has not been emphasized. The aim of the present study was to clarify the relationship between CMH and MBD. For this purpose, we report four patients with MBD, who showed asymmetrical hypointense areas in multiple cortico-subcortical regions on susceptibility-weighted imaging (SWI). All cases had a history of chronic alcohol abuse and symmetrical lesions in the entire corpus callosum. These patients' clinical symptoms included not only coma, dysarthria, and astasia-abasia as initial symptoms but also dementia as a clinical outcome. SWI showed asymmetrical hypointense areas in the multiple cortico-subcortical regions, indicating the presence of CMH. Compared with patients with normal cognitive function, demented patients showed higher severity of CMH. Our report would indicate that CMH is an important factor indicating the severity of dementia in patients with MBD.

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Background In patients with Parkinson's disease, executive deficits are known to correlate with motor dysfunctions, such as gait and postural instability. However executive deficits are sometimes difficult to detect using common frontal assessment batteries. Behavioral Assessment of Dysexecutive Syndrome includes six subtests to evaluate different aspects of executive function required in daily life. Among these the Modified Six Elements Test examines higher levels of executive function with regard to prospective memory and organization of behavior. Aim Using Behavioral Assessment of Dysexecutive Syndrome we examined which types of executive dysfunction correlate with motor symptoms in Parkinson's disease without apparent dementia. Methods A total of 54 Parkinson's disease patients with Mini‐Mental State Examination scores over 24 were assessed with the Unified Parkinson's Disease Rating Scale (total score of parts II and III as general motor function, subscores of tremor, rigidity, bradykinesia, gait disturbance and postural instability) for motor assessment, and both the Behavioral Assessment of Dysexecutive Syndrome (total raw score of all subtests and subscores of each of the 6 subtests) and Frontal Assessment Battery for executive function. Correlation coefficients for executive and motor assessments were compared. Results Among the Behavioral Assessment of Dysexecutive Syndrome subtests, the Modified Six Elements Test showed the strongest correlation with the Unified Parkinson's Disease Rating Scale subscore of gait disturbance, but did not correlate with patient background factors, such as age. Conclusion Even in Parkinson's disease without apparent dementia, deficits in complex executive functions, such as prospective memory and organization of behavior, correlate with motor dysfunctions, especially gait. We believe the Modified Six Elements Test is useful to evaluate early executive deficits.

Background: In clinical practice, assessment of the striatal accumulation in 123I-ioflupane single photon emission computed tomography (SPECT) is commonly performed calculating the specific binding ratio (SBR) for the whole striatum. On the other hand, visual assessment of striatal accumulation in the SPECT was recently established. However, correlations of visual assessment with motor and cognitive functions in Parkinson’s disease (PD) have rarely been examined. Differences in the usefulness of these assessments at clinics are uncertain.Objective: We performed this study to compare correlations of cognitive and motor functions in drug-naive PD between the SBR and visual assessment using 123I-ioflupane SPECT.Methods: Cognitive and motor assessments and 123I-ioflupane SPECT were performed in 47 drug-naïve PD patients with Mini-mental State Examination scores of ≥25. Cognitive function was assessed using the total score and 6 subscores of the Montreal Cognitive Assessment (MoCA) and 10 separate subtests of the Neurobehavioral Cognitive Status Examination (COGNISTAT). Motor function was assessed using the Hoehn and Yahr scale and Unified Parkinson’s Disease Rating Scale. Accumulation of 123I-ioflupane was determined by visual assessment based on five grades: 1, burst striatum; 2, egg-shaped; 3, mixed type; 4, eagle wing; 5, normal striatum; and by calculating SBR averaged for the bilateral striatum using the DaTView computer software commonly used in clinical practice. Each SPECT assessment was compared with each subscore for cognitive and motor assessments.Results: Spearman correlation analysis showed SBR was significantly correlated with the MoCA subscores of visuospatial function and attention, and with COGNISTAT subtests of attention. Visual assessment showed significant negative correlation with the Hoehn and Yahr scale. Mean score of postural instability in patients with visual grade of 1 was significantly higher than those in patients with visual grades of 2 and 3.Conclusion: Clinical symptoms reflected by 123I-ioflupane SPECT differ between the SBR and visual assessment. SBR reflects some cognitive functions, whereas a visual assessment grade of 1, which signifies decreased uptake of 123I-Ioflupane in the caudate nucleus, reflects postural instability. Thus, the caudate nucleus may play an important role in posture maintenance. Our results suggest that performing both assessments is of value.