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Awareness of Executive Deficits in People with Parkinson's Disease

Published online by Cambridge University Press:  15 February 2013

Aleksandra Kudlicka ,
Linda Clare  and
John V. Hindle
Aleksandra Kudlicka
Affiliation:
School of Psychology, Bangor University, Bangor, United Kingdom
Linda Clare*
Affiliation:
School of Psychology, Bangor University, Bangor, United Kingdom
John V. Hindle
Affiliation:
School of Medical Sciences, Bangor University, Bangor, United Kingdom Department of Care of the Elderly, Betsi Cadwaladr University Health Board, Llandudno Hospital, Conwy, United Kingdom
*
Correspondence and reprint requests to: Linda Clare, School of Psychology, Bangor University, Bangor, Gwynedd, LL57 2AS, UK. E-mail: l.clare@bangor.ac.uk
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Abstract

Executive functioning is frequently impaired among people with Parkinson's disease (PD). Little is known about awareness of executive functioning, in the sense of being able to accurately appraise functioning or performance, in people with PD, or about whether awareness is particularly affected in those who have impaired executive functioning. This study explored awareness of executive functioning at the levels of evaluative judgment (comparison of self- and informant ratings of executive functioning), and performance monitoring (comparison of performance on cognitive tests and self-ratings of that performance). Awareness levels were assessed in people with PD with and without executive deficits, and in healthy controls. When the level of agreement between self- and informant ratings was considered, people with PD in both groups appeared as accurate in evaluating their overall executive functioning as healthy controls. When appraising their performance as the specific tasks were completed, people with PD who had impairments in executive functioning appeared less accurate than controls and people with PD without executive impairments. People with PD who have executive deficits may lack the ability to recognize their limitations while performing specific tasks, which may have implications for their functional abilities. (JINS, 2013, 19, 1–12.)

Keywords

Self-appraisalPerformance monitoringAnosognosiaInsightMetacognition
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 19 , Issue 5 , May 2013 , pp. 559 - 570
Copyright
Copyright © The International Neuropsychological Society 2013

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References

Aalten, P., van Valen, E., Clare, L., Kenny, G., Verhey, F. (2005). Awareness in dementia: A review of clinical correlates. Aging and Mental Health, 9(5), 414–422. doi:10.1080/13607860500143075CrossRefGoogle ScholarPubMed
Arbuthnott, K., Frank, J. (2000). Trail Making Test, part B as a measure of executive control: Validation using a set-switching paradigm. Journal of Clinical and Experimental Neuropsychology, 22(4), 518–528. doi:10.1076/1380-3395(200008)22:4;1-0;FT518CrossRefGoogle ScholarPubMed
Bender, R., Lange, S. (2001). Adjusting for multiple testing – When and how? Journal of Clinical Epidemiology, 54(4), 343–349. doi:10.1016/S0895-4356(00)00314-0CrossRefGoogle ScholarPubMed
Bettcher, B.M., Giovannetti, T., Macmullen, L., Libon, D.J. (2008). Error detection and correction patterns in dementia: A breakdown of error monitoring processes and their neuropsychological correlates. Journal of International Neuropsychological Society, 14(2), 199–208. doi:10.10170S1355617708080193CrossRefGoogle ScholarPubMed
Bramham, J., Morris, R.G., Hornak, J., Bullock, P., Polkey, C.E. (2009). Social and emotional functioning following bilateral and unilateral neurosurgical prefrontal cortex lesions. Journal of Neuropsychology, 3(1), 125–143. doi:10.1348/174866408×293994CrossRefGoogle ScholarPubMed
Burgess, P.W., Alderman, N., Evans, J., Emslie, H., Wilson, B.A. (1998). The ecological validity of tests of executive function. Journal of the International Neuropsychological Society, 4(5), 547–558. doi:10.1017/S1355617798466037CrossRefGoogle ScholarPubMed
Burke, W.J., Roccaforte, W.H., Wengel, S.P. (1991). The short form of the Geriatric Depression Scale: A comparison with the 30-item form. Journal of Geriatric Psychiatry and Neurology, 4(3), 173–178. doi:10.1177/089198879100400310CrossRefGoogle Scholar
Cahn, D.A., Sullivan, E.V., Shear, P.K., Pfefferbaum, A., Heit, G., Silverberg, G. (1998). Differential contributions of cognitive and motor component processes to physical and instrumental activities of daily living in Parkinson's disease. Archives of Clinical Neuropsychology, 13(7), 575–583. doi:10.1093/arclin/13.7.575Google ScholarPubMed
Clare, L. (2004). Awareness in early-stage Alzheimer's disease: A review of methods and evidence. British Journal of Clinical Psychology, 43(2), 177–196. doi:10.1348/014466504323088042CrossRefGoogle ScholarPubMed
Clare, L., Marková, I.S., Roth, I., Morris, R.G. (2011). Awareness in Alzheimer's disease and associated dementias: Theoretical framework and clinical implications. Aging and Mental Health, 15(8), 936–944. doi:10.1080/13607863.2011.583630CrossRefGoogle ScholarPubMed
Clare, L., Nelis, S.M., Martyr, A., Roberts, J., Whitaker, C.J., Markova, I.S., Morris, R.G. (2012). The influence of psychological, social and contextual factors on the expression and measurement of awareness in early-stage dementia: Testing a biopsychosocial model. International Journal of Geriatric Psychiatry, 27(2), 167–177. doi:10.1002/gps.2705CrossRefGoogle ScholarPubMed
Clare, L., Whitaker, C.J., Nelis, S.M. (2010). Appraisal of memory functioning and memory performance in healthy ageing and early-stage Alzheimer's disease. Aging Neuropsychology and Cognition, 17(4), 462–491. doi:10.1080/13825580903581558CrossRefGoogle ScholarPubMed
Cools, R., Stefanova, E., Barker, R.A., Robbins, T.W., Owen, A.M. (2002). Dopaminergic modulation of high-level cognition in Parkinson's disease: The role of the prefrontal cortex revealed by PET. Brain, 125(3), 584–594. doi:10.1093/brain/awf052CrossRefGoogle ScholarPubMed
Crawford, J.R., Henry, J.D., Crombie, C., Taylor, E.P. (2001). Normative data for the HADS from a large non-clinical sample. British Journal of Clinical Psychology, 40(4), 429–434. doi:10.1348/014466501163904CrossRefGoogle ScholarPubMed
Dalla Barba, G., Parlato, V., Iavarone, A., Boller, F. (1995). Anosognosia, intrusions and “frontal” functions in Alzheimer's disease and depression. Neuropsychologia, 33(2), 247–259. doi:10.1016/0028-3932(94)00091-3CrossRefGoogle ScholarPubMed
Daniel, S.E., Lees, A.J. (1993). Parkinson's Disease Society Brain Bank, London: Overview and research. Journal of Neural Transmission Supplementum, 39, 165–172Google Scholar
Delis, D.C., Kaplan, E., Kramer, J.H. (2001). The Delis-Kaplan Executive Function System: Examiner's manual. San Antonio, TX: The Psychological CorporationGoogle Scholar
Devos, H., Vandenberghe, W., Nieuwboer, A., Tant, M., Baten, G., De Weerdt, W. (2007). Predictors of fitness to drive in people with Parkinson disease. Neurology, 69(14), 1434–1441. doi:10.1212/01.wnl.0000277640.58685.fcCrossRefGoogle ScholarPubMed
Folstein, M.F., Folstein, S.E., McHugh, P.R. (1975). Mini-Mental State: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198. doi:10.1016/0022-3956(75)90026-6CrossRefGoogle Scholar
Goldberg, E., Podell, K. (2000). Adaptive decision making, ecological validity, and the frontal lobes. Journal of Clinical and Experimental Neuropsychology, 22(1), 56–68. doi:10.1076/1380-3395(200002)22:1;1-8;FT056CrossRefGoogle ScholarPubMed
Graham, D.P., Kunik, M.E., Doody, R., Snow, A.L. (2005). Self-reported awareness of performance in dementia. Cognitive Brain Research, 25(1), 144–152. doi:10.1016/j.cogbrainres.2005.05.001CrossRefGoogle ScholarPubMed
Grosset, K.A., Bone, I., Grosset, D.G. (2005). Suboptimal medication adherence in Parkinson's disease. Movement Disorders, 20(11), 1502–1507. doi:10.1002/mds.20525CrossRefGoogle ScholarPubMed
Grosset, K.A., Bone, I., Reid, J.L., Grosset, D. (2006). Measuring therapy adherence in Parkinson's disease: A comparison of methods. Journal of Neurology, Neurosurgery and Psychiatry, 77(2), 249–251. doi:10.1136/jnnp.2005.064709CrossRefGoogle ScholarPubMed
Hoehn, M., Yahr, M.D. (1967). Parkinsonism: Onset, progression and mortality. Neurology, 17(5), 427–442. doi:10.1212/WNL.17.5.427CrossRefGoogle ScholarPubMed
Ivory, S.J., Knight, R.G., Longmore, B.E., Caradoc-Davies, T. (1999). Verbal memory in non-demented patients with idiopathic Parkinson's disease. Neuropsychologia, 37(7), 817–828. doi:10.1016/S0028-3932(98)00131-6CrossRefGoogle ScholarPubMed
Jorm, A.F., Christensen, H., Henderson, A.S., Korten, A.E., Mackinnon, A.J., Scott, R. (1994). Complaints of cognitive decline in the elderly: A comparison of reports by subjects and informants in a community survey. Psychological Medicine, 24(2), 365–374. doi:10.1017/S0033291700027343CrossRefGoogle Scholar
Klepac, N., Trkulja, V., Relja, M., Babic, T. (2008). Is quality of life in non-demented Parkinson's disease patients related to cognitive performance? A clinic-based cross-sectional study. European Journal of Neurology, 15(2), 128–133. doi:10.1111/j.1468-1331.2007.02011.xCrossRefGoogle ScholarPubMed
Koerts, J., van Beilen, M., Leenders, K.L., Brouwer, W.H., Tucha, L., Tucha, O. (2012). Complaints about impairments in executive functions in Parkinson's disease: The association with neuropsychological assessment. Parkinsonism and Related Disorders, 18(2), 194–197. doi:10.1016/j.parkreldis.2011.10.002CrossRefGoogle ScholarPubMed
Kudlicka, A., Clare, L., Hindle, J.V. (2011). Executive functions in Parkinson's disease: Systematic review and meta-analysis. Movement Disorders, 26(13), 2305–2315. doi:10.1002/mds.23868CrossRefGoogle ScholarPubMed
Kulkarni, A.S., Balkrishnan, R., Anderson, R.T., Edin, H.M., Kirsch, J., Stacy, M.A. (2008). Medication adherence and associated outcomes in medicare health maintenance organization-enrolled older adults with Parkinson's disease. Movement Disorders, 23(3), 359–365. doi:10.1002/mds.21831CrossRefGoogle ScholarPubMed
Leh, S.E., Petrides, M., Strafella, A.P. (2010). The neural circuitry of executive functions in healthy subjects and Parkinson's disease. Neuropsychopharmacology, 35(1), 70–85. doi:10.1038/npp.2009.88CrossRefGoogle ScholarPubMed
Leopold, N.A., Polansky, M., Hurka, M.R. (2004). Drug adherence in Parkinson's disease. Movement Disorders, 19(5), 513–517. doi:10.1002/mds.20041CrossRefGoogle ScholarPubMed
Manchester, D., Priestley, N., Jackson, H. (2004). The assessment of executive functions: Coming out of the office. Brain Injury, 18(11), 1067–1081. doi:10.1080/02699050410001672387CrossRefGoogle ScholarPubMed
Martyr, A., Clare, L., Nelis, S.M., Marková, I.S., Roth, I., Woods, R.T., Morris, R.G. (2012). Verbal fluency and awareness of functional deficits in early-stage dementia. The Clinical Neuropsychologist, 26(3), 501–519. doi:10.1080/13854046.2012.665482CrossRefGoogle ScholarPubMed
Mathias, J.L. (2003). Neurobehavioral functioning of persons with Parkinson's disease. Applied Neuropsychology, 10(2), 57–68. doi:10.1207/S15324826AN1002_01CrossRefGoogle ScholarPubMed
McKinlay, A., Grace, R.C., Dalrymple-Alford, J.C., Anderson, T.J., Fink, J., Roger, D. (2008). Neuropsychiatric problems in Parkinson's disease: Comparisons between self and caregiver report. Aging and Mental Health, 12(5), 647–653. doi:10.1080/13607860802343225CrossRefGoogle ScholarPubMed
McLoughlin, D.M., Cooney, C., Holmes, C., Levy, R. (1996). Carer informants for dementia sufferers: Carer awareness of cognitive impairment in an elderly community-resident sample. Age and Ageing, 25(5), 367–371. doi:10.1093/ageing/25.5.367CrossRefGoogle Scholar
Mioshi, E., Dawson, K., Mitchell, J., Arnold, R., Hodges, J.R. (2006). The Addenbrooke's Cognitive Examination Revised (ACE-R): A brief cognitive test battery for dementia screening. International Journal of Geriatric Psychiatry, 21(11), 1078–1085. doi:10.1002/gps.1610CrossRefGoogle ScholarPubMed
Muslimovic, D., Schmand, B., Speelman, J.D., De Haan, R.J. (2007). Course of cognitive decline in Parkinson's disease: A meta-analysis. Journal of the International Neuropsychological Society, 13(6), 920–932. doi:10.1017/S1355617707071160CrossRefGoogle ScholarPubMed
Nelis, S.M., Clare, L., Martyr, A., Markova, I., Roth, I., Woods, R.T., Morris, R.G. (2011). Awareness of social and emotional functioning in people with early-stage dementia, and implications for carers. Aging and Mental Health, 15(8), 1–9. doi:10.1080/13607863.2011.575350CrossRefGoogle ScholarPubMed
Nelson, H.E., Willison, J. (1991). National Adult Reading Test Manual (2nd ed). Windsor: NFER-NelsonGoogle Scholar
Novak, M., Guest, C. (1989). Application of a multidimensional Caregiver Burden Inventory. The Gerontologist, 29(6), 798–803. doi:10.1093/geront/29.6.798CrossRefGoogle ScholarPubMed
Perneger, T.V. (1998). What's wrong with Bonferroni adjustments. British Medical Journal, 316(7139), 1236–1238CrossRefGoogle ScholarPubMed
Rabin, L.A., Roth, R.M., Isquith, P.K., Wishart, H.A., Nutter-Upham, K.E., Pare, N. (2006). Self- and informant reports of executive function on the BRIEF-A in MCI and older adults with cognitive complaints. Archives of Clinical Neuropsychology, 21(7), 721–732. doi:10.1016/j.acn.2006.08.004CrossRefGoogle ScholarPubMed
Ridderinkhof, K.R., Van Den Wildenberg, W.P.M., Segalowitz, S.J., Carter, C.S. (2004). Neurocognitive mechanisms of cognitive control: The role of prefrontal cortex in action selection, response inhibition, performance monitoring, and reward-based learning. Brain and Cognition, 56(2), 129–140. doi:10.1016/j.bandc.2004.09.016CrossRefGoogle ScholarPubMed
Rizzo, M., Uc, E.Y., Dawson, J., Anderson, S., Rodnitzky, R. (2010). Driving difficulties in Parkinson's disease. Movement Disorders, 25(Suppl. 1), 136–140. doi:10.1002/mds.22791CrossRefGoogle ScholarPubMed
Roth, R.M., Isquith, P.K., Gioia, G.A. (2005). BRIEF-A: Behavior Rating Inventory of Executive Function—Adult Version. Lutz, FL: Psychological Assessment ResourcesGoogle Scholar
Royall, D.R., Lauterbach, E.C., Cummings, J.L., Reeve, A., Rummans, T.A., Kaufer, D.I., Coffey, C.E. (2002). Executive control function: A review of its promise and challenges for clinical research. Journal of the Neuropsychiatry and Clinical Neuroscience, 14, 377–405. doi:10.1176/appi.neuropsych.14.4.377CrossRefGoogle ScholarPubMed
Rymer, S., Salloway, S., Norton, L., Malloy, P., Correia, S., Monast, D. (2002). Impaired awareness, behavior disturbance, and caregiver burden in Alzheimer disease. Alzheimer Disease and Associated Disorders, 16(4), 248–253. doi:10.1097/00002093-200210000-00006CrossRefGoogle ScholarPubMed
Schrag, A., Barone, P., Brown, R.G., Leentjens, A.F.G., McDonald, W.M., Starkstein, S., Goetz, C.G. (2007). Depression rating scales in Parkinson's disease: Critique and recommendations. Movement Disorders, 22(8), 1077–1092. doi:10.1002/mds.21333CrossRefGoogle ScholarPubMed
Schrag, A., Jahanshahi, M., Quinn, N. (2000). What contributes to quality of life in patients with Parkinson's disease. Journal of Neurology, Neurosurgery and Psychiatry, 69(3), 308–312. doi:10.1136/jnnp.69.3.308CrossRefGoogle ScholarPubMed
Seltzer, B., Vasterling, J.J., Mathias, C.W., Brennan, A. (2001). Clinical and neuropsychological correlates of impaired awareness of deficits in Alzheimer disease and Parkinson disease: A comparative study. Neuropsychiatry, Neuropsychology and Behavioral Neurology, 14(2), 122–129. doi:10.1016/S0197-4580(00)82779-7Google ScholarPubMed
Sheikh, J.I., Yesavage, J.A. (1986). Geriatric Depression Scale (GDS): Recent evidence and development of a shorter version. Clinical Gerontologist, 5(1–2), 165–173. doi:10.10.17/S1041610291000480Google Scholar
Sitek, E.J., Soltan, W., Wieczorek, D., Robowski, P., Slawek, J. (2011). Self-awareness of memory function in Parkinson's disease in relation to mood and symptom severity. Aging and Mental Health, 15(2), 150–156. doi:10.1080/13607863.2010.508773CrossRefGoogle ScholarPubMed
Snaith, R.P., Zigmond, A.S. (1994). HADS: Hospital Anxiety and Depression Scale. Windsor: NFER-NelsonGoogle Scholar
Stolwyk, R.J., Charlton, J.L., Triggs, T.J., Iansek, R., Bradshaw, J.L. (2006). Neuropsychological functioning and driving ability in people with Parkinson's disease. Journal of Clinical and Experimental Neuropsychology, 28(6), 898–913. doi:10.1080/13803390591000909CrossRefGoogle ScholarPubMed
Stuss, D.T., Picton, T.W., Alexander, M.P. (2001). Consciousness, self-awareness and the frontal lobes. In S. Salloway, P. Malloy, J. D. Duffy, (Eds.), The frontal lobes and neuropsychiatric illness. (pp. 101–109). Washington, DC: American Psychiatric PressGoogle Scholar
Tomlinson, C.L., Stowe, R., Patel, S., Rick, C., Gray, R., Clarke, C.E. (2010). Systematic review of levodopa dose equivalency reporting in Parkinson's disease. Movement Disorders, 25(15), 2649–2653. doi:10.1002/mds.23429CrossRefGoogle ScholarPubMed
Trosset, M.W., Kaszniak, A.W. (1996). Measures of deficit unawareness for predicted performance experiments. Journal of the International Neuropsychological Society, 2(1), 315–322. doi:10.1017/S1355617700001338CrossRefGoogle ScholarPubMed
Uc, E.Y., Rizzo, M., Anderson, S.W., Sparks, J.D., Rodnitzky, R.L., Dawson, J.D. (2007). Impaired navigation in drivers with Parkinson's disease. Brain, 130(9), 2433–2440. doi:10.1093/brain/awm178CrossRefGoogle ScholarPubMed
West, R., Ergis, A., Winocur, G., Saint-Cyr, J. (1998). The contribution of impaired working memory monitoring to performance of the self-ordered pointing task in normal aging and Parkinson's disease. Neuropsychology, 12(4), 546–554. doi:10.1037/0894-4105.12.4.546CrossRefGoogle ScholarPubMed
Wheeler, M.A., Stuss, D.T., Tulving, E. (1997). Toward a theory of episodic memory: The frontal lobes and autonoetic consciousness. Psychological Bulletin, 121(3), 331–354. doi:10.1037//0033-2909.121.3.331CrossRefGoogle Scholar
Zgaljardic, D.J., Borod, J.C., Foldi, N.S., Mattis, P.J., Gordon, M.F., Feigin, A., Eidelberg, D. (2006). An examination of executive dysfunction associated with frontostriatal circuitry in Parkinson's disease. Journal of Clinical and Experimental Neuropsychology, 28(7), 1127–1144. doi:10.1080/13803390500246910CrossRefGoogle ScholarPubMed