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Everyday Action Impairment in Parkinson's Disease Dementia

Published online by Cambridge University Press:  24 May 2012

Tania Giovannetti*
Department of Psychology, Temple University, Philadelphia, Pennsylvania
Priscilla Britnell
Department of Psychology, Temple University, Philadelphia, Pennsylvania
Laura Brennan
Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
Andrew Siderowf
Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
Murray Grossman
Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
David J. Libon
Department of Neurology, Drexel University College of Medicine, Philadelphia, Pennsylvania
Brianne M. Bettcher
Memory and Aging Center, University of California San Francisco, San Francisco, California
Francesca Rouzard
Department of Psychology, Temple University, Philadelphia, Pennsylvania
Joel Eppig
Department of Psychology, Temple University, Philadelphia, Pennsylvania
Gregory A. Seidel
Department of Psychology, Temple University, Philadelphia, Pennsylvania
Correspondence and reprint requests to: Tania Giovannetti, Temple University, Psychology Department, 1701 N. 13th Street, Philadelphia, PA 19122, USA. E-mail:


This study examined everyday action impairment in participants with Parkinson's disease dementia (PDD) by comparison with participants with Parkinson's disease-no dementia (PD) or Alzheimer's disease (AD) and in reference to a neuropsychological model. Participants with PDD (n = 20), PD (n = 20), or AD (n = 20) were administered performance-based measures of everyday functioning that allowed for the quantification of overall performance and error types. Also, caregiver ratings of functional independence were obtained. On performance-based tests, the PDD group exhibited greater functional impairment than the PD group but comparable overall impairment relative to the AD group. Error patterns did not differ between PDD and PD participants but the PDD group demonstrated a higher proportion of commission errors and lower proportion of omission errors relative to the AD group. Hierarchical regression analyses showed omission errors were significantly predicted by neuropsychological measures of episodic memory, whereas commission errors were predicted by both measures of general dementia severity (MMSE) and executive control. Everyday action impairment in PDD differs quantitatively from PD but qualitatively from AD and may be characterized by a relatively high proportion of commission errors—an error type associated with executive control deficits. (JINS, 2012, 18, 1–12)

Research Articles
Copyright © The International Neuropsychological Society 2012

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Bangen, K.J., Jak, A.J., Schiehser, D.M., Delano-Wood, L., Tuminello, E., Han, D., Bondi, M.W. (2010). Complex activities of daily living vary by mild cognitive impairment subtype. Journal of the International Neuropsychological Society, 16(4), 630639. doi:10.1017/S1355617710000330CrossRefGoogle ScholarPubMed
Benedict, R.H., Schretlen, B., Groninger, L., Brandt, J. (1998). Hopkins Verbal Learning Test-Revised: Normative data and analysis of inter-form and test-retest reliability. The Clinical Neuropsychologist, 12, 4355.CrossRefGoogle Scholar
Bettcher, B.M., Giovannetti, T., Libon, D.J., Eppig, J., Wambach, D., Klobusicky, E. (2011). Improving everyday error detection, one picture at a time: A performance-based study of everyday task training. Neuropsychology, 25, 771783. doi:2011-11072-001 [pii]10.1037/a0024107CrossRefGoogle Scholar
Bialystok, E., Craik, F., Stefurak, T. (2008). Planning and task management in Parkinson's disease: Dfferential emphasis in dual-task performance. Journal of the International Neuropsychological Society, 14, 257265.CrossRefGoogle Scholar
Bickerton, W.L., Humphreys, G.W., Riddoch, J.M. (2006). The use of memorised verbal scripts in the rehabilitation of action disorganisation syndrome. Neuropsychological Rehabilitation, 16(2), 155177. doi:T073086400534717 [pii]10.1080/09602010500172277CrossRefGoogle ScholarPubMed
Bier, N., Macoir, J. (2011). How to make a spaghetti sauce with a dozen small things I cannot name: A review of the impact of semantic-memory deficits on everyday actions. Journal of Clinical and Experimental Neuropsychology, 32(2), 201211. doi:912289813 [pii]10.1080/13803390902927885CrossRefGoogle Scholar
Bouwens, S.F., van Heugten, C.M., Aalten, P., Wolfs, C.A., Baarends, E.M., van Menxel, D.A., Verhey, F.R. (2008). Relationship between measures of dementia severity and observation of daily life functioning as measured with the assessment of motor and process skills (AMPS). Dementia and Geriatric Cognitive Disorders, 25(1), 8187. doi:10.1159/000111694CrossRefGoogle Scholar
Bozeat, S., Patterson, K., Hodges, J. (2004). Relearning object use in semantic dementia. Neuropsychological Rehabilitation, 14, 351363.CrossRefGoogle Scholar
Brennan, L., Giovannetti, T., Libon, D.J., Bettcher, B.M., Duey, K. (2009). The impact of goal cues on everyday action performance in dementia. Neuropsychological Rehabilitation, 19(4), 562582. doi:904170388 [pii]10.1080/09602010802405623CrossRefGoogle ScholarPubMed
Bronnick, K., Ehrt, U., Emre, M., DeDeyn, P.P., Wesnes, K., Tekin, S., Aarsland, D. (2006). Attentional deficits affect activities of daily living in dementia associated with Parkinson's disease. Journal of Neurology, Neurosurgery, and Psychiatry, 77, 11361142.CrossRefGoogle ScholarPubMed
Buxbaum, L.J., Schwartz, M.F., Carew, T.G. (1997). The role of semantic memory in object use. Cognitive Neuropsychology, 14, 219254.CrossRefGoogle Scholar
Buxbaum, L., Schwartz, M., Coslett, H., Carew, T. (1995). Naturalistic action and praxis in callosal apraxia. Neurocase, 1, 317.CrossRefGoogle Scholar
Buxbaum, L., Schwartz, M., Montgomery, M. (1998). Ideational apraxia and naturalistic action. Cognitive Neuropsychology, 15, 617643.CrossRefGoogle ScholarPubMed
Cahn, D.A., Sullivan, E.V., Shear, P., Pfefferbaum, A., Heit, G., Silverberg, G. (1998). Differential contributions of cognitive and motor component processes to physical and instumental activities of daily living in Parkinson's disease. Archives of Clinical Neuropsychology, 13, 575583.Google Scholar
Calderon, J., Perry, R.J., Erzinclioglu, S.W., Berrios, G.E., Dening, T.R., Hodges, J.R. (2001). Perception, attention, and working memory are disproportionally impaired in dementia with Lewy bodies compared with Alzheimer's disease. Journal of Neurology, Neurosurgery, and Psychiatry, 62, 243252.Google Scholar
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Earlbaum.Google Scholar
Cosentino, S., Chute, D., Libon, D., Moore, P., Grossman, M. (2006). How does the brain support script comprehension? A study of executive processes and semantic knowledge in dementia. Neuropsychology, 20, 307318.CrossRefGoogle ScholarPubMed
Delis, D.C., Kaplan, E., Kramer, J.H. (2001). Delis Kaplan Executive Function System. San Antonio, TX: The Psychological Corporation.Google Scholar
Duncan, J. (1986). Disorganization of behaviour after frontal lobe damage. Cognitive Neuropsychology, 3, 271290.CrossRefGoogle Scholar
Farias, S.T., Harrell, E., Neumann, C., Houtz, A. (2003). The relationship between neuropsychological performance and daily functioning in individuals with Alzheimer's disease: Ecological validity of neuropsychological tests. Archives of Clinical Neuropsychology, 18, 655672.CrossRefGoogle ScholarPubMed
Farias, S.T., Mungas, D., Reed, B.R., Cahn-Weiner, D., Jagust, W., Baynes, K., DeCarli, C. (2008). The measurement of everyday cognition (ECog): Scale development and psychometric properties. Neuropsychology, 22(4), 531544. doi:2008-08178-012 [pii]10.1037/0894-4105.22.4.531CrossRefGoogle ScholarPubMed
Fuster, J.M. (1989). The prefrontal cortex (2nd ed.). New York: Raven Press.Google Scholar
Giovannetti, T., Bettcher, B.M., Brennan, L., Libon, D.J., Burke, M., Duey, K., Wambach, D. (2008). Characterization of everyday functioning in mild cognitive impairment: A direct assessment approach. Dementia and Geriatric Cognitive Disorders, 25(4), 359365. doi:10.1159/000121005CrossRefGoogle ScholarPubMed
Giovannetti, T., Bettcher, B.M., Brennan, L., Libon, D.J., Kessler, R.K., Duey, K. (2008). Coffee with jelly or unbuttered toast: Commissions and omissions are dissociable aspects of everyday action impairment in Alzheimer's disease. Neuropsychology, 22(2), 235245. doi:10.1037/0894-4105.22.2.235CrossRefGoogle ScholarPubMed
Giovannetti, T., Libon, D.J., Brennan, L., Bettcher, B.M., Sestito, N., Kessler, R.K. (2007). Environmental adaptations improve everyday action performance in Alzheimer's disease: Empirical support from performance-based assessment. Neuropsychology, 21, 448457.CrossRefGoogle ScholarPubMed
Giovannetti, T., Libon, D.J., Buxbaum, L.J., Schwartz, M.F. (2002). Naturalistic action impairments in dementia. Neuropsychologia, 40(8), 12201232.CrossRefGoogle ScholarPubMed
Giovannetti, T., Libon, D.J., Hart, T. (2002). Awareness of naturalistic action errors in dementia. Journal of the International Neuropsychological Society, 8(5), 633644.CrossRefGoogle ScholarPubMed
Giovannetti, T., Schmidt, K., Sestito, N., Libon, D.J., Gallo, J. (2006). Everyday action in dementia: Evidence for differential deficits in Alzheimer's disease versus subcortical vascular dementia. Journal of the International Neuropsychology Society, 12, 4553.CrossRefGoogle ScholarPubMed
Giovannetti, T., Schwartz, M.F., Buxbaum, L.J. (2007). The coffee challenge: A new method for the study of everyday action errors. Journal of Clinical and Experimental Neuropsychology, 29, 690705.CrossRefGoogle Scholar
Gitlin, L.N., Corcoran, M., Winter, L., Boyce, A., Hauk, W.W. (2001). A randomized, controlled trial of a home environmental intervention: Effect on efficacy and upset in caregivers and on daily function of persons with dementia. The Gerontologist, 41, 414.CrossRefGoogle ScholarPubMed
Grafman, J., Thompson, K., Weingarther, H., Martinez, R., Lawlor, B.A., Sunderland, T. (1991). Script generation as an indicator of knowledge representation in patients with Alzheimer's disease. Brain and Language, 40, 344358.CrossRefGoogle ScholarPubMed
Gure, T.R., Kabeto, M.U., Plassman, B.L., Piette, J.D., Langa, K.M. (2010). Differences in functional impairment across subtypes of dementia. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences,, 65(4), 434441. doi:10.1093/gerona/glp197CrossRefGoogle Scholar
Hartmann, K., Goldenberg, G., Daumuller, M., Hermsdorfer, J. (2005). It takes the whole brain to make a cup of coffee: The neuropsychology of naturalistic actions involving technical devices. Neuropsychologia, 43(4), 625637. doi:S0028-3932(04)00181-2 [pii]10.1016/j.neuropsychologia.2004.07.015CrossRefGoogle ScholarPubMed
Hobson, J.P., Edwards, N.I., Meara, R.J. (2001). The Parkinson's disease activities of daily living scale: A new simple and brief subjective measure of disability in Parkinson's disease. Clinical Rehabilitation, 15(3), 241246.CrossRefGoogle ScholarPubMed
Hughes, A.J., Daniel, S.E., Kilford, L., Lees, A.J. (1992). Accuracy of clincial diagnosis of ideopathic Parkinson's disease: A clinic-pathological study of 100 cases. Journal of Neurology, Neurosurgery, and Psychiatry, 55, 181184.CrossRefGoogle Scholar
Kessler, R.K., Giovannetti, T., MacMulen, L. (2007). Everyday action in schizophrenia: Performance patterns and neuropsychological correlates. Neuropsychology, 21, 448457.CrossRefGoogle Scholar
Knopman, D.S., Berg, J.D., Thomas, R. (1999). Nursing home placement is related to dementia progression: Evidence from a clinical trial. Neurology, 52, 714718.CrossRefGoogle Scholar
Kraybill, M.L., Larson, E.B., Tsuang, D.W., Teri, L., McCormick, W.C., Bowen, J.D., Cherrier, M.M. (2005). Cognitive differences in dementia patients with autopsy-verified AD, Lewy body pathology, or both. Neurology, 64, 20692073.CrossRefGoogle Scholar
Lambon Ralph, M.A., Powell, J., Howard, D., Whitworth, A.B., Garrard, P., Hodges, J.R. (2001). Semantic memory is impaired in both dementia with Lewy bodies and dementia of the Alzheimer's type: A comparative neuropsychological study and literature review. Journal of Neurology, Neurosurgery, and Psychiatry, 70, 149156.CrossRefGoogle ScholarPubMed
Lawton, M.P., Brody, E.M. (1969). Assessment of old people: Self-maintaining and instrumental activities of daily living. The Gerontologist, 9, 179186.CrossRefGoogle Scholar
Levine, B., Robertson, I.H., Clare, L., Carter, G., Hong, J., Wilson, B.A., Stuss, D.T. (2000). Rehabiliation of executive functioning: An experimental-clinical validation of Goal Management Training. Journal of the International Neuropsychology Society, 6, 299312.CrossRefGoogle Scholar
Levine, B., Stuss, D.T., Winocur, G., Binns, M.A., Fahy, L., Mandic, M., Robertson, I.H. (2007). Cognitive rehabilitation in the elderly: Effect on strategic behavior in relation to goal management. Journal of the International Neuropsychology Society, 13, 143152.CrossRefGoogle Scholar
Libon, D.J., Bogdanoff, B., Leopold, N., Hurka, R., Bonavita, J., Ball, S.K. (2001). Neuropsychological profiles associated with subcortical white matter alterations and Parkinson's disease: Implications for the diagnosis of dementia. Archives of Clinical Neuropsychology, 16(1), 1932.CrossRefGoogle ScholarPubMed
Loewenstein, D.A., Amigo, E., Duara, R., Gutteman, A., Hurwitz, D., Berkowitz, D., Eisdorfer, C. (1989). A new scale for the assessment of functional stus in Alzheimer's disease and related disorders. The Journal of Gerontology, 4, 114121.CrossRefGoogle Scholar
Loewenstein, D.A., Duara, R., Rubert, M.P., Arguelles, T., Lapinski, K.J., Eisdorfer, C. (1995). Deterioration of functional capacities in Alzheimer's disease after a 1-year period. International Psychogeriatrics, 7, 495503.CrossRefGoogle ScholarPubMed
Loewenstein, D.A., Rubert, M.P., Berkowitz-Zimmer, N., Guterman, A., Morgan, R., Hayden, S. (1992). Neuropsychological test performance and prediction of functional capacities in dementia. Behavior, Health, and Aging, 2, 1992.Google Scholar
Luria, A.R. (1966). Higher cortical functions in man. New York: Basic Books.Google Scholar
Manly, T., Hawkins, K., Evans, J., Woldt, K., Robertson, I.H. (2002). Rehabiliation of executive function: Faclitation of effective goal management on complex tasks using periodic auditory alerts. Neuropsychologia, 40, 271281.CrossRefGoogle Scholar
Marcotte, T.D., Grant, I. (Eds.). (2009). Neuropsychology of everyday functioning. New York: Guilford Press.Google Scholar
Mattis, S. (2001). Dementia Rating Scale-2. Odessa, FL: Psychological Assessment Resources.Google Scholar
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D., Stadlan, E.M. (1984). Clinical diagnosis of Alzheimer's disease: Report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology, 34(7), 939944.CrossRefGoogle ScholarPubMed
McKeith, I.G., Dickson, D.W., Lowe, J., Emre, M., O'Brien, J.T., Feldman, H., … Consortium on DLB. (2005). Diagnosis and management of dementia with Lewy bodies: Third report of the DLB Consortium. Neurology, 65, 18631872.CrossRefGoogle ScholarPubMed
Nadler, J.D., Richardson, E.D., Malloy, P.F., Marran, M.E., Hosteller Brinson, M.E. (1993). The ability of the Dementia Rating Scale to predict everyday functioning. Archives of Clinical Neuropsychology, 8, 449460.CrossRefGoogle ScholarPubMed
Noale, M., Maggi, S., Minicuci, N. (2003). Dementia and disability: Impact on mortality. Dementia and Geriatric Cognitive Disorders, 16(1), 714.CrossRefGoogle ScholarPubMed
Norman, D.A., Shallice, T. (1980). Attention to action: Willed and automatic control of behavior. New York: University of California.Google Scholar
Riddoch, M.J., Humphreys, G.W. (1994). Cognitive neuropsychology and cognitive rehabilitation. Hove: Lawrence Earlbaum Associates.Google Scholar
Robertson, I.H. (1996). Goal management training: A clinical manual. Cambridge, UK: PsyConsult.Google Scholar
Rosenthal, E., Brennan, L., Xie, S., Hurtig, H., Milber, J., Weintraub, D., Siderowf, A. (2010). Association between cognition and function in patients with Parkinson disease with and without dementia. Movement Disorders, 25(9), 11701176. doi:10.1002/mds.23073CrossRefGoogle ScholarPubMed
Sartori, G., Miozzo, M., Job, R. (1994). Rehabilitation of Semantic Memory Impairments. In M.J. Riddoch & G.W. Humphreys (Eds.), Cognitive neuropsychology and cognitive rehabilitation (pp. 103–119). Hove: Lawrence Earlbaum Associates.Google Scholar
Schank, R.C., Abelson, R. (1977). Scripts, plans, and understanding. Hillsdale: Lawrence Erlbaum Associates Inc.Google Scholar
Schwartz, M.F., Buxbaum, L. (1997). Naturalistic action. In L.J. G. Rothi & K.M. Heilman (Eds.), Apraxia: The neuropsychology of action. Hove, East Sussex: Psychology Press.Google Scholar
Schwartz, M.F., Buxbaum, L.J., Ferraro, M., Veramonti, T., Segal, M. (2003). The naturalistic action test. Bury St. Edmunds: Thames Valley Test Company.Google Scholar
Schwartz, M.F., Buxbaum, L.J., Montgomery, M.W., Fitzpatrick-DeSalme, E., Hart, T., Ferraro, M., Coslett, H.B. (1999). Naturalistic action production following right hemisphere stroke. Neuropsychologia, 37, 5166.CrossRefGoogle ScholarPubMed
Schwartz, M.F., Montgomery, M.W., Buxbaum, L.J., Lee, S.S., Carew, T.G., Coslett, H.B., Mayer, N. (1998). Naturalistic action impairment in closed head injury. Neuropsychology, 12, 1327.CrossRefGoogle ScholarPubMed
Schwartz, M.F., Segal, M., Veramonti, T., Ferraro, M., Buxbaum, L.J. (2002). The Naturalistic Action Test: A standardised assessment for everyday action impairment. Neuropsychological Rehabilitation, 12(4), 311339.CrossRefGoogle Scholar
Sestito, N., Schmidt, K.S., Gallo, J., Giovannetti, T., Libon, D.J. (2005). Using the Naturalistic Action Test (NAT) to assess everyday action in healthy older adults and patients with dementia. Journal of the International Neuropsychological Society, 11(Suppl. 1), 9091.Google Scholar
Seter, C., Giovannetti, T., Britnell, P.L., Brennan, L., Rosenthal, E., Grossman, M., Siderowf, A. (2010). Everyday task knowledge and executive control: A model for omision and commission errors. Journal of the International Neuropsychological Society, S1, 168.Google Scholar
Shulman, L.M., Pretzer-Aboff, I., Anderson, K.E., Stevenson, R., Vaughan, C.G., Gruber-Baldini, A.L., Weiner, W.J. (2006). Subjective report versus objective measurement of activities of daily living in Parkinson's disease. Movement Disorders, 21(6), 794799. doi:10.1002/mds.20803.CrossRefGoogle ScholarPubMed
Sirigu, A., Zalla, T., Pillon, B., Grafman, J., Agid, Y., Dubois, B. (1995). Selective impairments in managerial knowledge following pre-frontal cortex damage. Cortex, 31, 301316.CrossRefGoogle ScholarPubMed
Sirigu, A., Zalla, T., Pillon, B., Grafman, J., Agid, Y., Dubois, B. (1996). Encoding of sequence and boundaries of scripts following prefrontal lesions. Cortex, 32, 297310.CrossRefGoogle ScholarPubMed
Sohlberg, M.M., Mateer, C.A. (2001). Cognitive rehabilitation: An integrative neuropsychological approach. New York: Guilford Press.Google Scholar
Task Force on DSM-IV. (2000). Diagnostic and Statistical Manual of Mental Disorders IV Text Revision (DSM-IV-TR). Washington, DC: American Psychiatric Association.Google Scholar
Walker, Z., Allen, R.L., Shergill, S., Katona, C.L. (1998). Neuropsychological performance in Lewy body demenita and Alzheimer's disease. British Journal of Psychiatry, 170, 156158.CrossRefGoogle Scholar
Warrington, E.K. (1984). Recognition Memory Test. Los Angeles: Western Psychlogical Services.Google Scholar
Wechsler, D. (1997). Wechsler Adult Intelligence Scale-Third Edition. San Antonio, TX: The Psychological Corporation.Google Scholar
Wilson, B.A. (1999). Case studies in neuropsychological rehabilitation. New York: Oxford University Press.Google Scholar
Zalla, T., Sirigu, A., Pillon, B., Dubois, B., Agid, Y., Grafman, J. (2000). How patients with Parkinson's disease retrieve and manage cognitive event knowledge. Cortex, 36, 163179.CrossRefGoogle ScholarPubMed
Zanetti, O., Geroldi, C., Frisoni, G.B., Bianchetti, A., Trabucchi, M. (1999). Contrasting results between caregiver's report and direct assessment of activities of daily living in patients affected by mild and very mild dementia: The contribution of the caregiver's personal characteristics. Journal of the American Geriatrics Society, 47(2), 196202.CrossRefGoogle ScholarPubMed