Subjects suffering from Parkinson’s Disease (PD) are sometimes partially or completely unaware of the deficits caused by the disease. Specifically, PD patients may complain of drug-induced dyskinesias less than their caregivers. An improved understanding of unawareness of involuntary movements in PD is important in order to appreciate the impact of the disease and the side effects of pharmacological treatment. Since damage to prefrontal areas may cause a reduction in awareness of movement disorders and since PD patients have difficulty with executive tasks, the relationship between unawareness and executive dysfunction is an interesting association to be further analyzed. On the whole, three independent but correlated constructs could be involved: a) shifting between tasks or mental sets; b) updating and monitoring of working memory representation; c) inhibition of dominant or prepotent responses. Reduced awareness of movement disorders in cognitively preserved PD subjects also requires further analysis. In particular, this is the only way in which unawareness of dyskinetic movements can be considered specific and not secondary to cognitive impairment. Starting from these considerations, the study by Amanzio et al. (2010) assessed the awareness of motor deficits in non-demented PD subjects using an extensive executive and neuropsychological evaluation. This study addressed the question by comparing the on and off states and using specific evaluations of awareness of movement disorders. Their results led to the conclusion that reduced awareness of dyskinesias in the on state is not related to the general level of cognitive impairment but to executive dysfunction. In this chapter, we conduct an extensive investigation of unawareness of dyskinetic movements in PD subjects with the aim of analyzing the hypothesis that disruption of the orbito-frontal pathway may lead to a deficit in awareness, probably due to decreased attentional and self-monitoring abilities with an important role played by metacognitive processes.
Role of executive dysfunction in the unawareness of dyskinetic movements.
PALERMO, SARA;AMANZIO, Martina
2012-01-01
Abstract
Subjects suffering from Parkinson’s Disease (PD) are sometimes partially or completely unaware of the deficits caused by the disease. Specifically, PD patients may complain of drug-induced dyskinesias less than their caregivers. An improved understanding of unawareness of involuntary movements in PD is important in order to appreciate the impact of the disease and the side effects of pharmacological treatment. Since damage to prefrontal areas may cause a reduction in awareness of movement disorders and since PD patients have difficulty with executive tasks, the relationship between unawareness and executive dysfunction is an interesting association to be further analyzed. On the whole, three independent but correlated constructs could be involved: a) shifting between tasks or mental sets; b) updating and monitoring of working memory representation; c) inhibition of dominant or prepotent responses. Reduced awareness of movement disorders in cognitively preserved PD subjects also requires further analysis. In particular, this is the only way in which unawareness of dyskinetic movements can be considered specific and not secondary to cognitive impairment. Starting from these considerations, the study by Amanzio et al. (2010) assessed the awareness of motor deficits in non-demented PD subjects using an extensive executive and neuropsychological evaluation. This study addressed the question by comparing the on and off states and using specific evaluations of awareness of movement disorders. Their results led to the conclusion that reduced awareness of dyskinesias in the on state is not related to the general level of cognitive impairment but to executive dysfunction. In this chapter, we conduct an extensive investigation of unawareness of dyskinetic movements in PD subjects with the aim of analyzing the hypothesis that disruption of the orbito-frontal pathway may lead to a deficit in awareness, probably due to decreased attentional and self-monitoring abilities with an important role played by metacognitive processes.
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