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Cognitive Slowing in Parkinson's Disease

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Cognitive Slowing in Parkinson's Disease The Journal of Neuroscience, June 15, 2002, 22(12):5198–5203 Cognitive Slowing in Parkinson’s Disease: A Behavioral Evaluation Independent of Motor Slowing Nobukatsu Sawamoto,1 Manabu Honda,1,2,3 Takashi Hanakawa,1 Hidenao Fukuyama,1 and Hiroshi Shibasaki,1 1Department of Brain Pathophysiology, Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan, 2Laboratory of Cerebral Integration, National Institute for Physiological Sciences, Okazaki 444-8585, Japan, and 3PRESTO, Japan Science and Technology Corporation, Kawaguchi 332-0012, Japan Parkinson’s disease (PD) is attributable primarily to depletion of mental-operation task that required serial updating of mental rep- dopamine in the basal ganglia, but the full effects of this deple- resentations in response to a series of visual stimuli. By changing tion are unknown. It is well known that PD involves motor the speed of visual presentation and evaluating performance ac- slowing, and although it is not easy to distinguish between the curacy, the speed of cognitive processing was assessed indepen- motor and cognitive components of behavior, clinical observa- dently of motor slowing. Cognitive impairment in PD became tions suggest that cognitive processing may also be compro- evident when higher speeds of cognitive processing (verbal more mised. However, it remains unclear whether such cognitive so than spatial) were required. In addition, cognitive slowing and involvement exists, and if so, to what extent. Previous studies motor slowing were significantly correlated. The results of the of cognitive slowing in PD have yielded conflicting results. This present study suggest that slowing in PD is not restricted to the may be attributable to variations in experimental procedures, be- motor domain but can be generally observed in other domains of cause most of the experiments used reaction-time tasks, which behavior, including cognitive mental operations. are inevitably confounded by motor components. In the present Key words: Parkinson’s disease; mental-operation task; study, we evaluated the speed of cognitive processing in patients reaction-time task; cognitive slowing; bradykinesia; cognitive- with PD without bradykinesia as a variable. We developed a motor interaction Slowing of movement, or bradykinesia, is one of the characteris- basal ganglia has been demonstrated in nonmotor cognitive op- tics of Parkinson’s disease (PD). The slowing appears to be erations as well as in motor control (Middleton and Strick, 1994), attributable primarily to a deficit in cognitive motor control (i.e., previous studies have produced conflicting results on the presence an ability to arrange complex movement), rather than simply an of cognitive slowing in PD (Rafal et al., 1984; Ransmayr et al., impairment in motor initiation and execution (Marsden, 1982). 1990; Poewe et al., 1991; Revonsuo et al., 1993; Berry et al., 1999). Slowing in imagery of movements and mental rotation of objects The results of some studies support the presence of slowing has also been suggested to occur in PD (Dominey et al., 1995; Lee (Wilson et al., 1980; Pillon et al., 1989; Cooper et al., 1994; Pate et al., 1998). Although it is not easy to distinguish between the and Margolin, 1994; Lee et al., 1998), whereas the results of motor and cognitive components of behavior, clinical observa- others do not (Lafleche et al., 1990; Duncombe et al., 1994; tions indicate that slowing in PD is not restricted to motor Howard et al., 1994). This conflict may arise, at least in part, from functioning but also involves cognitive functioning (Naville, 1922; differences in the experimental procedure used. To measure Rogers, 1986). cognitive speed, most of the studies followed a reaction-time The presence of cognitive slowing has been tested not only to paradigm that used an identical motor response after a simple or clarify this aspect of PD itself but also to understand the function complex cognitive task. This method carries the assumption that a of the basal ganglia. Striatal dysfunction is coupled with motor difference in reaction time between the two tasks would corre- slowing in PD (Vingerhoets et al., 1997). Although a role of the spond to the time required for cognitive processing, because the time required for the motor response is identical. However, this is Received Oct. 22, 2001; revised March 21, 2002; accepted March 29, 2002. This work was supported in part by a Grant-in-Aid for Scientific Research for debatable, because cognitive and motor processing may interact Future Program JSPS-RFTF97L00201 from the Japan Society for the Promotion of (Georgopoulos, 2000). In fact, previous studies of patients with PD Science; by Priority Areas (C) Advanced Brain Science 12210012 from the Japan suggest that there are impairments in the cognitive–motor inter- Ministry of Education, Science, Sports, and Culture to H.S.; by Special Coordination Funds for Promoting Science and Technology and a Grant-in-Aid for Scientific action specifically (Schwab et al., 1954; Benecke et al., 1986, 1987; Research on Priority Areas (C) Advanced Brain Science 13210143 to M.H.; and by Agostino et al., 1992; Georgiou et al., 1993; Majsak et al., 1998). a Grant-in-Aid from the Japan Society for the Promotion of Science Research The aim of the present study is to examine the speed of Fellows to N.S. N.S. is supported by Research Fellowships of the Japan Society for the Promotion of Science for Young Scientists. We thank Drs. J. Oita (Hikone City cognitive processing in patients with PD without motor response Hospital, Hikone, Japan), N. Kohara (Kobe City General Hospital, Kobe, Japan), rate as a variable. For this purpose, we developed a mental- M. Kanda, K. Terada, and A. Ohtsuka (Takeda General Hospital, Kyoto, Japan) for their support. We also thank Dr. T. Hamada (Kyoto University, Kyoto, Japan) for operation task that required serial updating of a mental repre- statistical advice and Dr. J. Kahle for skillful editing. sentation in response to a series of visual stimuli without involv- Correspondence should be addressed to Dr. Manabu Honda, Laboratory of ing any overt movement (Honda et al., 1998). The speed of visual Cerebral Integration, National Institute for Physiological Sciences, 38 Nishigonaka, Myodaiji, Okazaki 444-8585, Japan. E-mail: [email protected]. presentation was systematically changed, and the accuracy of Copyright © 2002 Society for Neuroscience 0270-6474/02/225198-06$15.00/0 performance was evaluated as a function of the presentation Sawamoto et al. • Cognitive Slowing in Parkinson’s Disease J. Neurosci., June 15, 2002, 22(12):5198–5203 5199 Table 1. Clinical profiles and intelligence scales of patients and normal subjects WAIS-R Sex Education Group n Age (male:female) (years) MMSE IQ VIQ PIQ PD 23 63.6 Ϯ 6.0 13:10 11.7 Ϯ 2.9 28.6 Ϯ 1.6 102.8 Ϯ 8.6 104.3 Ϯ 10.8 100.1 Ϯ 9.0 Controls 25 63.5 Ϯ 5.3 12:13 11.5 Ϯ 2.5 28.8 Ϯ 1.7 102.4 Ϯ 8.0 101.5 Ϯ 8.9 102.5 Ϯ 9.5 Mean Ϯ SD. IQ, Total IQ; VIQ, verbal IQ; PIQ, performance IQ. of the week mentally in a serial manner, according to the instruction (23 ؍ Table 2. Disease severity of PD patients (n stimuli. In the example shown in Figure 1B, the subjects advanced the Duration L-dopa daily dose UPDRS day from Friday to Saturday in response to the number 1, and from (years) (mg)a H&Y total score Saturday to Tuesday in response to the number 3. Although it is possible to add up all seven numbers and to advance the day by the remainder of 3.5 Ϯ 2.2 (1–8) 296 Ϯ 150 (0–600) 2.1 Ϯ 0.7 (1–3) 23.4 Ϯ 8.5 (8–41) division of the sum by 7, subjects were explicitly asked to avoid this particular strategy. Special caution was given not to move the mouth or Ϯ Mean SD (range). tongue during the session. After completing each trial, the day of the a L-dopa was prescribed in combination with peripheral decarboxylase inhibitors. week they finally reached was verbally reported. To test cognitive speed, the instructional stimulus frequency was speed. This approach enabled us to evaluate the speed of cogni- systematically changed across the trials. Eight different stimulus frequen- tive processing in patients with PD without motor slowing as a cies (from 0.4 to 1.8 Hz in 0.2 Hz steps) were used for each of the two tasks. The perception of visual stimuli itself has been shown to be confounding factor. primarily intact in PD, at least within the range of the stimulus presen- MATERIALS AND METHODS tation rate used in this study (Revonsuo et al., 1993). Ten trials were tested for each stimulus frequency, and the accuracy of the answer was Subjects. Twenty-three mildly impaired patients with PD and 25 age-, evaluated for each trial. If the subjects were not able to follow the speed education-, and sex-matched, healthy volunteers (controls) participated of visual presentation of the instruction stimuli, this was reflected in a in the present study (Table 1). All of the subjects were younger than 75 lower performance accuracy. Thus, the speed of cognitive processing was years, and none of them had a history of treatment for neurological or evaluated without measuring reaction time. psychiatric disorders other than PD. The patients were evaluated for After full instruction about the procedures, the MO-s and MO-v were parkinsonian symptoms using both the Hoehn and Yahr rating scale tested. The order of the two tasks tested was balanced across the subjects (H&Y) and the Unified Parkinson’s Disease Rating Scale (UPDRS) in each group. Each task consisted of six blocks (Fig.
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