RELATORE Palermo Sara

Ridotta consapevolezza delle discinesie nella malattia di Parkinson.

Ruolo delle funzioni esecutive e delle componenti affettive della ToM  

 Gruppo di Ricerca

Neuropsicologia del deterioramento cognitivo e delle patologie degenerative del Sistema Nervoso Centrale

Coordinatore: Martina Amanzio

 Gruppo di Ricerca

Neuropsicologia del deterioramento cognitivo e delle patologie degenerative del Sistema Nervoso Centrale

Componenti Coordinatore Amanzio Martina Membro Geminiani Giuliano Carlo Membro Rosato Rosalba Membro Palermo Sara Dottorando Barbiani Diletta Dottorando Bartoli Massimo

Tematiche di Ricerca •  Fragilità dell’anziano •  Disfunzioni esecutive e funzionali nelle patologie

neurodegenerative •  Effetto Placebo e Nocebo

Settore ERC •  SH4_3 Neuropsychology and clinical psychology •  SH4_4 Cognitive and experimental psychology:

perception, action, and higher cognitive processes

Impatto della Ricerca e opportunità di implementazione con le Imprese Coaching, Matching, Networking

A1 Group Synergy on ICT and adherence in ageing population with chronic diseases and polypharmacy A3 Group Functional decline and Frailty Commitment Screening and early diagnosis of MCI and Cognitive Frailty

 Gruppo di Ricerca

Neuropsicologia del deterioramento cognitivo e delle patologie degenerative del Sistema Nervoso Centrale

Coordinatore: Martina Amanzio

Screening and early diagnosis of MCI and Cognitive Frailty

18 September 2017

Technology Enabled Care (TEC) to be used for Intermediate Care

(IC)

Signs and symptoms in Parkinson’s Disease

Ø  Parkinson’s disease (PD) is the second most prevalent neurodegenerative disease in the world. Ø  PD is characterized by a large number of motor and non-motor features that can impact on function to a variable

degree. Ø  PD can also be associated with neurobehavioural disorders, cognitive impairment, and autonomic dysfunctions.

Kalia  &  Lang,  The  Lancet  2015  

The neurocognitive approach in Parkinson’s Disease

PD is primarily caused by a loss of dopaminergic neurons in the nigrostriatal tract, producing a reduction in dopamine levels in the striatum. This dopamine depletion impacts the functioning of four frontostriatal circuits involved in different motor, cognitive, affective, and motivational aspects of behavior.                          

Alexander    et  al.,    Annu  Rev  Neurosci.  1986;  Chudasama  &  Robbins,  Biol  Psychol.  2006;  PoleI  et  al.,  Behavioural  Brain  2011    

Levodopa-induced dyskinesias (LIDs)

As LIDs are considered as one of the significant complications of pharmacotherapy, the determination of patient self-awareness of dyskinesias and of their relationship to daily dysfunction is an important aspect of the debate on the gold standard for treatment in PD, especially in newly-diagnosed patients.                          

Our study was the first attempt to demonstrate the hypothesis that long-term dopaminergic treatment, can lead to mesocorticolimbic dopaminergic depletion involving the ventral striatum, and might cause self-awareness of LIDs. We hypothesize that self-awareness of LIDs arises from disrupted EFs or metacognitive abilities, such as the new ones measured for the very first time in patients with PD using the metacognitive version of the WCST. In particular, we hypothesize action monitoring plays a special role, whereas other cognitive functions are preserved.

Procedures

Partecipants • Forty-eight patients (22 women, 26 men) with idiopathic PD receiving levodopa treatment, and presenting motor fluctuations

Assessment • Awareness of movement disorders and motor assessment

• Neuropsychological assessment

Statistical analysis • Multiple logistic regression models were used to estimate the impact of metacognitive disabilities on GAM, DS-I and HS-I outcomes.

QUANTO È SICURO/A DELL’ABBINAMENTO PROPOSTO?

0-10 HO TIRATO A INDOVINARE

11-30 POCO SICURO/A

31-50 NON MOLTO SICURO/A

51-70 ABBASTANZA SICURO/A

71-90 MOLTO SICURO/A

91-100 È SENZ’ALTRO CORRETTO

POSSIAMO CALCOLARE LA SUA RISPOSTA NEL PUNTEGGIO TOTALE?

SI NO

     85 %

Metacognitive-WCST

ToM has been a topic of interest in recent studies on unawareness of disease in neuropsychiatric disorders such as schizophrenia.

Bora  et  al.,  Clin.  Neurosci.  2007;  Pousa  et  al.,  Cogn.  Neuropsychiatry  2008   A reduction in self-awareness may be considered a critical manifestation of impaired ToM abilities, in terms of meta-representation in this kind of disorder. […]Second-order false belief tasks seem to be of critical importance for awareness of the disorder

 Bora  et  al.,  Clin.  Neurosci.  2007

Moreover, a study on the awareness of illness in bipolar disorder reported an association between a decreased awareness and a selective disability on affective ToM tasks.

Palermo  et  al.,  Neurocase,  2015  

Although ToM and recognition of facial emotion are impaired in PD patients, no previous studies have investigated the ToM components in self-awareness of motor deficits in PD patients.

Procedures

Partecipants •  Forty-one patients (18 women, 23 men) with idiopathic PD receiving levodopa treatment, and presenting motor fluctuations

Assessment • Awareness of movement disorders and motor assessment

• Neuropsychological assessment

Statistical analysis • Multiple logistic regression models were used to estimate the impact of ToM disabilities on GAM and DS-I outcomes.

second-type Theory of Mind and Reading the Mind in the Eyes tasks

1.  Domanda del test di falsa credenza: Il padre, dove crede che il figlio cercherà l’agenda?

2.  Domanda di controllo (comprensione): Il figlio, dove crede che si trovi l’agenda?

3.  Domanda di controllo (comprensione): Dove si trova l’agenda?

4.  Domanda di controllo (memoria): Dove si trovava l’agenda all’inizio della storia?

Role of dopaminergic treatment on EFs and Theory of Mind ToM

Dopaminergic stimulation improves EFs related to the cortical-subcortical network, from the DLPFC to the dorsal

caudate nucleus, which is dopamine depleted (in light blue).

On the contrary, the same dopaminergic treatment impairs functions connected to the medial prefrontal-ventral striatal

non-depleted circuit, such as on tasks of response monitoring and inhibition and affective ToM

(in red solid lines).

Conclusions •  Our findings indicate that when the comparator mechanism for monitoring attentive performance

is compromised at a prefrontal striatal level, patients lose the ability to recognize their motor disturbances that do not achieve conscious awareness.

•  DRSA was related with affective component of ToM and executive functions, thus caused by a

complex interplay between specific neuropsychological and motor factors.

Best Practice in EU It is important to consider the specific neuropsychological characteristics along with the neurological symptoms in order to define tailored interventions in the unawareness of movement disorders and adopt a personalized clinical approach avoiding increased doses of dopaminergic drugs, which would in turn enhance the risk of side effects.

Thank  you!  https://ec.europa.eu/eip/ageing/home_en  

 Gruppo di Ricerca

Neuropsicologia del deterioramento cognitivo e delle patologie degenerative del Sistema Nervoso Centrale

Coordinatore: Martina Amanzio