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Reaction Time in Parkinson's, Huntington's and Cerebellar Disease

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Reaction Time in Parkinson's, Huntington's and Cerebellar Disease journal ofNeurology, Neurosurgery, and Psychiatry 1993;56:1 169-1177 1169 A comparative study of simple and choice J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.56.11.1169 on 1 November 1993. Downloaded from reaction time in Parkinson's, Huntington's and cerebellar disease Marjan Jahanshahi, Richard G Brown, C David Marsden Abstract similar. It may be concluded that similar The aim of the study was to compare the reaction time deficits are found in quantitative and qualitative similarities Parkinson's disease, in patients with and differences in the performance of other disorders of the basal ganglia patients with Parkinson's disease, (Huntington's disease), as well as those Huntington's disease and cerebellar dis- with a disease sparing the basal ganglia ease on a number of reaction time tasks. (cerebellar disease). The non-specific Simple reaction time (SRT), uncued and slowness observed at the behavioural fully cued four choice (CRT) tasks were level may, however, have diverse central performed by eight patients with mechanisms. Parkinson's disease after withdrawal of dopaminergic medication for an average (7 Neurol Neurosurg Psychiatry 1993;56:1169-1177) of 14-4 hours; by seven non-demented patients with Huntington's disease and by eight patients with cerebellar disease. A current hypothesis about the specific role of An S1 (warning signal/precue)-S2 the basal ganglia in motor control is that they (imperative stimulus) paradigm was are involved in motor programming.' A num- used in all tasks, with the S1-S2 interval ber of studies have examined this hypothesis randomly varying between 0, 200, 800, by assessing simple (SRT) and choice reac- 1600 and 3200 ms across trials. The tion time (CRT) in Parkinson's disease-for patients with Huntington's disease had a example, . Despite the inconsistencies in the significantly longer SRT than those with specific patterns of SRT and CRT deficit Parkinson's disease. None of the other found across these studies, there is general group differences in uncued and agreement that patients with Parkinson's dis- unwarned SRT and CRT was significant. ease have longer reaction times than age- For the patients with Parkinson's disease matched normals. Such prolongation, how- and those with cerebellar disease, ever, is not specific to Parkinson's disease. A unwarned SRT was faster than uncued body of evidence suggests that slowness is and unwarned CRT. For the patients present across a range of brain pathologies. with Huntington's disease, this CRT/SRT Prolonged SRT or CRT, or both, compared difference was not significant. A warning with normal subjects has been reported for http://jnnp.bmj.com/ signal before the imperative stimulus patients with epilepsy,7 Alzheimer's disease,8 resulted in a reduction of reaction time and various cases of head injury.9 Slowing is in all three groups. Advance information also observed in psychiatric conditions such Department of provided by SI about the response that as depression and schizophrenia,'0 as well as Clinical Neurology, would be required by S2 was used by in normal ageing."I Institute ofNeurology The National Hospital patients in all three groups, evident from From the available evidence, however, it reaction times in the fully cued CRT task could be argued that, although general slow- for Neurology and on October 1, 2021 by guest. Protected copyright. Neurosurgery, being faster than those in the uncued ing of reaction time may not be specific to London, United Kingdom CRT condition. Patients with cerebellar Parkinson's disease, these patients exhibit a M Jahanshahi disease had slower movement times in particular pattern of SRT/CRT impairment. C D Marsden the SRT and CRT conditions compared A number of studies have found, relative to Medical Research with the patients with Parkinson's dis- matched controls, that patients with Council Human ease and Huntington's disease, whose Parkinson's disease are differentially or Movement and Balance Unit times did not differ. In one SRT condi- selectively impaired on SRT but not CRT M Jahanshahi tion, when the absence of a warning sig- tasks.24- This pattern of deficit has been R G Brown nal was predictable, patients with interpreted as indicating that these patients C D Marsden cerebellar disease, and to a lesser extent fail to preprogramme-that is, fail to use the Correspondence to: Dr M Jahanshahi, Medical those with Huntington's disease, were advance information about the nature of the Research Council Human able to maintain a general motor readi- response available to them in a SRT or pre- Movement and Balance Unit, The National Hospital ness before the imperative stimulus. This cued CRT task to programme the response for Neurology and was not the case for the patients with before the onset of the imperative stimulus. Neurosurgery, Queen Square, London WC1N Parkinson's disease who seemed more This pattern of deficits, however, does not 3BG, United Kingdom. dependent on the presence of a warning have universal support-for example,3 62. Received 14 July 1992 signal to reduce their reaction time. With Furthermore, the inability to benefit from and in revised form 8 February 1993. a few exceptions, the pattern of results advance information in a precued CRT Accepted 16 February 1993 of the three groups were qualitatively condition (taken as equivalent to SRT) has 17010ahanshahi, Brown, Marsden J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.56.11.1169 on 1 November 1993. Downloaded from been reported for patients with frontal lobe from advanced information about the damage,'3 lesions of the supplementary motor required response, whereas the patient with a area,14 and Alzheimer's disease8 and is not right-sided lesion did not. specific to Parkinson's disease. To date, no study has simultaneously Most published reports on reaction time in addressed these two aspects of the specificity Parkinson's disease have been concerned with question: firstly whether the obtained pat- the issue of normality-that is, whether the terns of reaction time deficit are specific to pattern of reaction times and use of advance Parkinson's disease or are also present in information in patients with Parkinson's dis- other disorders of the basal ganglia; and ease differ from those of matched normal secondly, whether they are also a feature of subjects. A second and important question other movement disorders involving patho- that arises is one of specificity-that is, logy outside the basal ganglia. The aim of the whether the particular pattern of deficits is present study was to compare the pattern of specific to Parkinson's disease or is also performance of patients with Parkinson's, present in other disorders of the basal ganglia. Huntington's and cerebellar disease. To date, only a handful of studies has The following questions were addressed. addressed this question. In the study of Firstly, how does the performance of patients Girotti et al,'5 Huntington's disease patients with Parkinson's disease compare with that of had significantly longer CRT compared with patients with Huntington's or cerebellar dis- patients with Parkinson's disease. Halsband et ease on SRT and CRT tasks? Secondly, are al'6 compared the performance of 14 patients there differences between the three groups in with Huntington's disease, nine with the ability to increase general alertness with a Parkinson's disease, and 20 normal controls warning signal presented before the impera- on two tasks, one requiring precise aiming tive stimulus? Thirdly, are there differences movements and the other involving idio- between the three groups in terms of their graphic writing. On the aiming tasks, the ability to develop an anticipatory set for the patients with Parkinson's and Huntington's occurrence of the imperative stimulus and disease showed similar increases in movement increase their general readiness to respond? time as a function of the difficulty of the task, Finally, are there differences between the relative to normal subjects. On the writing three groups in the use of advance movement task, however, the patients with Huntington's parameter information for preprogramming disease showed disproportionate increases in of motor responses? writing time when letter size was increased. Viallet et al17 found that the SRTs of six patients with progressive supranuclear palsy Method were significantly longer than those of 13 SUBJECTS patients with Parkinson's disease. Similarly, Three groups of patients took part in the Dubois et al 'I reported that 10 patients with study: eight patients with idiopathic progressive supranuclear palsy were signifi- Parkinson's disease, seven patients with cantly slower than the 33 patients with Huntington's disease (all with a documented Parkinson's disease on SRT as well as go-no family history) and eight cases of idiopathic go CRT. The results of these studies suggest cerebellar degeneration with a late onset in that reaction time deficits may not be specific most cases. Table 1 provides demographic to Parkinson's disease but also may be pre- and illness-related information of the groups. http://jnnp.bmj.com/ sent in other forms of striatal pathology. The All of the patients with Parkinson's disease relatively simple paradigms used, however, were receiving dopaminergic medication offer little opportunity for determining the (average levodopa dose 650 mg, SD 306 mg, processes that underlie the slowness observed with a peripheral decarboxylase inhibitor). In in the different groups. addition, two patients were on anticholiner- The other aspect of the specificity question gics, three were taking a monoamine oxidase the of reaction time is B is whether impairment inhibitor (selegeline/deprenyl), and three on October 1, 2021 by guest. Protected copyright. specific to disorders of the basal ganglia or is were taking amantadine. This group was also a feature of other movement disorders.
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