A novel framework for understanding reduced awareness of dyskinesias in Parkinson's Disease

Palermo, Sara; Lopiano, Leonardo; Zibetti, Maurizio; Rosato, Rosalba; Leotta, Daniela; Amanzio, Martina

doi:10.1016/j.parkreldis.2017.03.009

Cited by 20 publications

(58 citation statements)

References 30 publications

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“…Moreover, previous and current results consider the role of dopaminergic treatment on executive functions and metacognitive abilities in the medial prefrontal-ventral striatal non-depleted circuit [18], [19]. Those results underline how the unawareness of distinct pathologies may exhibit overlapping symptoms in the context of overlapping circuit-specific dysfunction [14].…”

Section: Discussionsupporting

confidence: 65%

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Impulse control disorder and response-inhibition alterations in Parkinson’s disease. A rare case of totally absent functionality of the medial-prefrontal cortex and review of literature

Palermo

Morese

Zibetti

et al. 2017

Journal of Advanced Research

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This report illustrates a Parkinson’s disease (PD) patient with impulse-control disorder (ICD) and selective impairment in response-inhibition abilities as revealed by the performance in a functional magnetic resonance imaging (fMRI) anterior cingulate cortex - sensitive go-nogo task. In line with hypothesis on the role of response-inhibition disabilities in the arising of impulsivity in PD, the patient completely failed the go-nogo task. Moreover, fMRI acquisition revealed absent task-sensitive activity in the anterior cingulate cortex, medial prefrontal, and orbitofrontal cortices for the contrast nogo versus go, which signifying that a hypo-function of this network could be associated with ICD. A fronto-striatal and cingulo-frontal dysfunction may reflect impairment in metacognitive-executive abilities (such as response-inhibition, action monitoring, and error awareness) and promote compulsive repetition of behavior. Response-inhibition tasks may be useful in PD post-diagnostic phase, to better identify individuals at risk of developing ICD with dopaminergic medication.

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Section: Discussionsupporting

confidence: 65%

“…1Structural MRI image (T1-weighted sequence) and fMRI results for the contrast nogo vs go conditions were shown. Maps were thresholded at p < 0.05 cluster-level corrected using a small volume correction [SVC] with a sphere of 10 mm radius centered on ACC according to the coordinates reported in Palermo et al [18] and Amanzio et al [19].…”

Section: Case Reportmentioning

confidence: 99%

Impulse control disorder and response-inhibition alterations in Parkinson’s disease. A rare case of totally absent functionality of the medial-prefrontal cortex and review of literature

Palermo

Morese

Zibetti

et al. 2017

Journal of Advanced Research

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“…Its construct is complex when considering an operational semantic level [28]. This term is used to describe the ability to identify, recognize, and evaluate a deficit in sensory, perceptual, motor, affective, or cognitive functioning and to consider the impact of these disturbances on the patient's daily life [8,[29][30][31][32][33][34].…”

Section: Dyskinesias-reduced-self-awareness (Drsa) In Parkinson's Dismentioning

confidence: 99%

“…The neurocognitive approach considers cognitive functions and behavior as closely linked to the function of single brain area, neural pathways, or cortical networks. This approach emphasizes how reduced self-awareness is associated to brain pathology, particularly concerning focal lesions, motivational and emotional factors, and concomitant cognitive disturbances [8,[29][30][31][32][33]36]. In particular, since the frontal lobes are involved in self-awareness and monitoring of cognitive functions, reduced self-awareness could be viewed as a deficit in selfmonitoring [37].…”

Section: Dyskinesias-reduced-self-awareness (Drsa) In Parkinson's Dismentioning

confidence: 99%

“…Moreover, two opposite issues can limit the adherence of patients to medical therapies in advanced PD phase. While for some patients, the need of dividing the levodopa daily dose in 5 or 6 administrations per day is considered a limitation, other patients develop a sort of craving for dopaminergic drugs, partly due to an impulse control disorder, and partly to a reduced awareness of therapy complications such as dyskinesia [8,9]. The subjective experience of what it is like to be a PD patient is fundamental for the treatment complaint that is put at risk in cases of poor awareness of symptoms.…”

Section: Introductionmentioning

confidence: 99%

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Levodopa-Induced Dyskinesias and Dyskinesias-Reduced-Self-Awareness in Parkinson’s Disease: A Neurocognitive Approach

Palermo¹,

Morese²,

Artusi³

et al. 2019

Parkinson's Disease and Beyond - A Neurocognitive Approach

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Levodopa-induced dyskinesias are one of the most common disabling motor complications in advanced Parkinson's disease. The subjective perception of motor impairment is a clinical phenomenon that needs to be adequately analyzed. Indeed, the determination of patient dyskinesias-reduced-self-awareness (DRSA) and of its relationship to daily dysfunction is an important aspect of the debate on the gold standard for treatment. As the association with executive dysfunction is a matter of debate and we hypothesize it plays an important role in DRSA, we analyzed metacognitive abilities related to action monitoring and other factors, such as response-inhibition and "Theory of Mind," which represent a novel explanation of the phenomenon. Moreover, we investigated whether and how a dysfunction in action monitoring related to the cingulo-frontal-ventral striatal circuit would be associated with DRSA using an event-related Go-NoGo fMRI experiment. Our findings suggest the presence of executive dysfunctions in DRSA pathogenesis, with a key leading role played by the cingulo-frontal network as part of a functionally impaired response-inhibition network.

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Altered awareness of motor symptoms in Parkinson's disease and Dementia with Lewy Bodies: A systematic review

Pennington

Duncan

Ritchie

2020

Int J Geriat Psychiatry

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Parkinson's disease and Dementia with Lewy Bodies, and may adversely affect quality of life and medication concordance. How symptom awareness is influenced by motor and cognitive disease severity, age and medication use is not fully understood. We carried out a systematic review of the literature on motor symptom awareness in Parkinson's disease and Dementia with Lewy Bodies. Methods: Pubmed and Wed of Science were searched for relevant articles published in or prior to March 2019. Data regarding participant demographics, diagnosis, cognitive status, method of assessing awareness and study findings were extracted from relevant publications. Results: Sixteen relevant publications were identified. Motor symptom awareness appears to decline over the course of Parkinson's disease. Imaging studies implicate the prefrontal cortex, with different mechanisms involved in hypokinesia and dyskinesia awareness. The hypothesis that people with right hemisphere based disease would have more severely reduced awareness is only weakly supported. Most studies focused on cognitively intact individuals, and on awareness of dyskinesia rather than hypokinesia. Conclusions: Whilst reduced awareness of dyskinesia and to a lesser extent hypokinesia is common, there is a lack of longitudinal data on how awareness changes over time, and how it interacts with global cognitive changes. Motor symptom awareness in Dementia with Lewy Bodies is understudied. Future studies of symptom awareness should include robust assessment of overall cognitive functioning, and use a longitudinal design to elucidate how awareness changes over time.

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A novel framework for understanding reduced awareness of dyskinesias in Parkinson's Disease

Cited by 20 publications

References 30 publications

Impulse control disorder and response-inhibition alterations in Parkinson’s disease. A rare case of totally absent functionality of the medial-prefrontal cortex and review of literature

Impulse control disorder and response-inhibition alterations in Parkinson’s disease. A rare case of totally absent functionality of the medial-prefrontal cortex and review of literature

Levodopa-Induced Dyskinesias and Dyskinesias-Reduced-Self-Awareness in Parkinson’s Disease: A Neurocognitive Approach

Altered awareness of motor symptoms in Parkinson's disease and Dementia with Lewy Bodies: A systematic review

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