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Parkinson's disease is primarily considered to be a movement disorder and is defined by its motor signs. Yet, the behavioral manifestations of the disease are often more debilitating than its motor complications. This review will focus on the non-motor aspects of Parkinson's disease, including mood, psychosis, cognitive, sleep, fatigue, apathy, delirium, and repetitive disorders, that may occur. The phenomenology, pathology, and treatment of the behavioral symptoms of Parkinson's disease will be discussed.
Individuals with post-traumatic stress disorder (PTSD) show a cognitive bias for threatening information, reflecting dysregulated executive control for affective stimuli. This study examined whether comorbid mild Traumatic Brain Injury (mTBI) with PTSD exacerbates this bias. A computer-administered Affective Go/No-Go task measured reaction times (RTs) and errors of omission and commission to words with a non–combat-related positive or negative valence in 72 deployed United States service members from the wars in Iraq and Afghanistan. Incidents of military-related mTBI were measured with the Boston Assessment of Traumatic Brain Injury-Lifetime. PTSD symptoms were measured with the Clinician-Administered PTSD Scale. Participants were divided into those with (mTBI+, n = 34) and without a history of military-related mTBI (mTBI−, n = 38). Valence of the target stimuli differentially impacted errors of commission and decision bias (criterion) in the mTBI+ and mTBI− groups. Specifically, within the mTBI+ group, increasing severity of PTSD symptoms was associated with an increasingly liberal response pattern (defined as more commission errors to negative distractors and greater hit rate for positive stimuli) in the positive compared to the negative blocks. This association was not observed in the mTBI− group. This study underscores the importance of considering the impact of a military-related mTBI and PTSD severity upon affective executive control. (JINS, 2013, 19, 1–10)
Neuropsychological and motor deficits in Parkinson's disease that
may contribute to driving impairment were examined in a cohort study
comparing patients with Parkinson's disease (PD) to patients with
Alzheimer's disease (AD) and to healthy elderly controls. Nondemented
individuals with Parkinson's disease [Hoehn & Yahr (H&Y)
stage I–III], patients with Alzheimer's disease
[Clinical Demetia Rating scale (CDR) range 0–1], and
elderly controls, who were actively driving, completed a
neuropsychological battery and a standardized road test administered by a
professional driving instructor. On-road driving ability was rated on
number of driving errors and a global rating of safe, marginal, or unsafe.
Overall, Alzheimer's patients were more impaired drivers than
Parkinson's patients. Parkinson's patients distinguished
themselves from other drivers by a head-turning deficiency. Drivers with
neuropsychological impairment were more likely to be unsafe drivers in
both disease groups compared to controls. Compared to controls, unsafe
drivers with Alzheimer's disease were impaired across all
neuropsychological measures except finger tapping. Driving performance in
Parkinson's patients was related to disease severity (H&Y),
neuropsychological measures [Rey Osterreith Complex Figure (ROCF),
Trails B, Hopkins Verbal List Learning Test (HVLT)-delay], and
specific motor symptoms (axial rigidity, postural instability), but not to
the Unified Parkinson Disease Rating Scale (UPDRS) motor score.
Multifactorial measures (ROCF, Trails B) were useful in distinguishing
safe from unsafe drivers in both patient groups. (JINS, 2005,
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