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Objective To demonstrate the usefulness of incorporating the Executive and Social Cognition Battery (ESCB) to detect executive and social cognition deficits, which are otherwise not captured by more "classical" executive tests in early Parkinson disease (PD). Background PD is a neurodegenerative disorder that includes executive and social cognition deficits. While cognitive assessment in PD still relies on classical executive tasks to detect frontal deficits, these traditional tests often fail to uncover subtle, yet relevant, frontal impairment. Methods We evaluated 39 PD patients and 47 controls with a battery of classical executive tests and the ESCB. The ESCB includes a series of tasks that more closely resemble real-life activities and have been previously shown to be useful in detecting executive deficits in other neuropsychiatric disorders with frontal involvement. Results We observed that both batteries used in a complementary way yielded better results, as 15 of the 39 patients presented deficits only on some of the ESCB tests, but not on the classical battery, while 5 patients presented deficits only on some tests of the classical battery, but not on the ESCB. Fourteen patients presented deficits on some tests of either battery, and 5 patients did not present deficits on any of the tests. Conclusions We found that, used along with traditional neuropsychological tasks, the ESCB may be useful in providing a more comprehensive evaluation of frontal dysfunction among patients with PD, thus contributing to the early diagnosis of cognitive disorders in this patient population.

Background The diagnosis of Parkinson's disease (PD) is based exclusively on clinical criteria established by the Queen Square Brain Bank. On occasion, these clinical symptoms may be subtle and inconclusive; therefore, it becomes necessary to appeal to contributory criteria to establish a correct diagnosis. The authors propose the observation of palpebral fissure (PF) asymmetry as an additional criterion for the diagnosis of PD. Objectives The objectives of this study were to determine whether decreased PF (DPF) is more prevalent in patients with PD than in the general population and whether DPF in PD coincides with the side of onset of parkinsonian symptomatology. Methods In total, 112 consecutive patients with a diagnosis of PD and 112 control participants without PD were selected between April and June 2014. At the office visit, it was established through clinical observation whether DPF was present. In patients with PD, it was determined whether the DPF was consistent with the side of onset of parkinsonian symptomatology. Results Of 112 patients with PD, 39 (35%) had DPF clinically evident DPF, and, in 34 (87%), the DPF was consistent with the laterality of parkinsonian signs. In the control group, only 12% (14 of 112 controls) had PF asymmetry. The difference in prevalence of DPF between these groups was statistically significant (P < 0.0001), with an odds ratio of 3.7 (95% confidence interval, 1.8–7.3). Twenty-eight of the 39 patients with PD who had PF asymmetry were treated with levodopa. Conclusions Although the data are purely observational, it may be concluded that DPF coincidental with the side of initial parkinsonian symptomatology in patients with probable PD is an additional sign worth considering.

Pesticides have been associated with Parkinson's disease (PD), and protective gloves and workplace hygiene can reduce pesticide exposure. We assessed whether use of gloves and workplace hygiene modified associations between pesticides and PD. The Farming and Movement Evaluation (FAME) study is a nested case–control study within the Agricultural Health Study. Use of protective gloves, other PPE, and hygiene practices were determined by questionnaire (69 cases and 237 controls were included). We considered interactions of gloves and hygiene with ever-use of pesticides for all pesticides with ≥5 exposed and unexposed cases and controls in each glove-use stratum (paraquat, permethrin, rotenone, and trifluralin). 61% of respondents consistently used protective gloves and 87% consistently used ≥2 hygiene practices. Protective glove use modified the associations of paraquat and permethrin with PD: neither pesticide was associated with PD among protective glove users, while both pesticides were associated with PD among non-users (paraquat OR 3.9 [95% CI 1.3, 11.7], interaction p = 0.15; permethrin OR 4.3 [95% CI 1.2, 15.6] interaction p = 0.05). Rotenone was associated with PD regardless of glove use. Trifluralin was associated with PD among participants who used

Study Objectives To evaluate the utility of multimodal low-cost approaches including actigraphy, a wrist-worn device monitoring rest/activity cycles, in identifying patients with idiopathic REM sleep behavior disorder (iRBD). Methods Seventy patients diagnosed with sleep disorders causing different motor manifestations during sleep (iRBD, sleep apnea, restless legs syndrome) and 20 subjects without any relevant motor manifestation during sleep, underwent video-polysomnography (vPSG) and 2 week actigraphy, completed six validated RBD screening questionnaires, and sleep apps use was assessed. Actigraphy was analyzed automatically, and visually by seven blinded sleep medicine experts who rated as “no,” “possible,” and “probable” RBD. Results Quantitative actigraphy analysis distinguished patients from controls, but not between patients with different types of motor activity during sleep. Visual actigraphy rating by blinded experts in sleep medicine using pattern recognition identified vPSG confirmed iRBD with 85%–95% sensitivity, 79%–91% specificity, 81%–91% accuracy, 57.7% ± 11.3% positive predictive value, 95.1% ± 3.3% negative predictive value, 6.8 ± 2.2 positive likelihood ratio, 0.14 ± 0.05 negative likelihood ratio and 0.874–0.933 area under the ROC curve (AUC). AUC of the best performing questionnaire was 0.868. Few patients used sleep apps; therefore, their potential utility in the evaluated patients’ groups is limited. Conclusions Visual analysis of actigraphy using pattern recognition can identify subjects with iRBD, and is able to distinguish iRBD from other motor activities during sleep, even when patients are not aware of the disease in contrast to questionnaires. Therefore, actigraphy can be a reliable screening instrument for RBD potentially useful in the general population.

Background: Dietary fat intake may modify Parkinson’s disease (PD) risk directly or by altering the response to environmental neurotoxicants including pesticides. Methods: We conducted a case-control study of PD nested in the Agricultural Health Study (AHS), a cohort of pesticide applicators and spouses. We evaluated diet and pesticide use before diagnosis in 89 PD cases, confirmed by movement disorder specialists, or a corresponding date in 336 frequencymatched controls. Associations were evaluated using multivariate logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results: In the AHS, PD was inversely associated with N-3 polyunsaturated fatty acids (PUFAs) (OR 0.4, 95% CI 0.2e0.8 for highest vs. lowest tertile) and the N-3 precursor a-linolenic acid (0.4, 0.2e0.8). In a meta-analysis of nine studies, including the present one, PD was inversely associated with a-linolenic acid (0.81, 0.68e0.96). In the AHS, associations of PD with the pesticides paraquat and rotenone were modified by fat intake. The OR for paraquat was 4.2 (1.5e12) in individuals with PUFA intake below the median but 1.2 (0.4e3.4) in those with higher intake (p-interaction ¼ 0.10). The OR for rotenone was 5.8 (2.3e15) in those with saturated fat intake above the median but 1.5 (0.5e4.2) in those with lower intake (p-interaction ¼ 0.02). Conclusions: PUFA intake was consistently associated with lower PD risk, and dietary fats modified the association of PD risk with pesticide exposure. If confirmed, these findings suggest that a diet high in PUFAs and low in saturated fats might reduce risk of PD. Published by Elsevier Ltd.

BACKGROUND: The Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS‐UPDRS) is a newly developed tool to assess Parkinson's disease (PD). Changes in scores on the scale over the course of PD, including increasing disease duration and Hoehn and Yahr (HY) stages, have not been described. The objectives of this study were to analyze MDS‐UPDRS scores on Parts I through IV and their differences based on HY stage and disease duration in a large cohort of patients with PD. METHODS: For this cross‐sectional study, demographic data and MDS‐UPDRS scores were collected, including HY stage. Subscores on MDS‐UPDRS Parts I through IV were analyzed using 1‐way analyses of variance for each HY stage and in 5‐year increments of disease duration. Part III (motor assessment) scores were analyzed separately for on and off states. RESULTS: The mean age of the 3206 patients was 65.8 ± 10.6 years, 53.3% were men, the mean disease duration was 11.5 ± 4.6 years, and the median HY stage was 2 (range, 0–5); 2156 patients were examined in an on state and 987 were examined in an off state. Scores for all MDS‐UPDRS parts increased significantly through HY stages 1 through 5, with an average increase of 3.8, 7.7, 14.6, and 2.0 points consecutively for parts I through IV, respectively. For the 5‐year increments of disease duration, MDS‐UPDRS subscores increased by an average of 1.6, 3.3, 4.2, and 1.4 points consecutively for parts I through IV, respectively. This increase was significant only during the first 15 years of disease for all 4 parts, including part III scores evaluated in both on and off states. CONCLUSIONS: MDS‐UPDRS scores for all 4 parts increase significantly with every HY stage and also with 5‐year increments of disease duration in the first 15 years of the disease.

Background Theory of mind (ToM) refers to the ability to infer others' mental states, including intentions and feelings, and is considered to be a critical part of social cognition. Earlier studies in individuals with Parkinson disease (PD) have shown ToM deficits in the more advanced stages of the disease. There is currently no evidence of social cognition deficits in patients in the early stages of PD. Methods In this study, we compared patients with early PD (n=36) and a control group of healthy subjects (n=36). Patients were assessed with 2 ToM tasks designed to differentially detect subtle deficits in the affective and cognitive aspects of ToM. Patients were also assessed with a complete neuropsychologic battery which included classic executive tests aimed at investigating the relationship between ToM and executive functions. Performance of medicated (n=16) and unmedicated (n=20) patients was also compared. Results Our results are the first to indicate that ToM is affected in the early stages of PD. As has already been reported in more advanced stages of PD, such deficits seem to be related to the cognitive aspects of this domain. In our study, these deficits were not related with performance on executive functioning, depression, or medication usage. Conclusions These results provide evidence for ToM impairments early in the course of PD. Recognition of ToM impairments in early PD is important, as these deficits may impact patients' social interactions and quality of life.

The phonological verbal fluencytestcan actasafast screeningtesttodetectcognitive deficits in neurological conditions. In the present study, its utility in the detection of executive deficits in patients with early Parkinson’sdisease is demonstrated. Fil: Torralva, Teresa. Instituto de Neurología Cognitiva; Argentina. Universidad Favaloro; Argentina. Universidad Diego Portales; Chile Fil: Laffaye, Teresa. Instituto de Neurología Cognitiva; Argentina Fil: Báez, Sandra. Universidad Diego Portales; Chile Fil: Gleichgerrcht, Ezequiel. Instituto de Neurología Cognitiva; Argentina Fil: Bruno, Diana. Instituto de Neurología Cognitiva; Argentina Fil: Chade, Anabel. Universidad Favaloro; Argentina. Instituto de Neurología Cognitiva; Argentina Fil: Ibáñez Barassi, Agustín Mariano. Universidad Favaloro; Argentina. Universidad Diego Portales; Chile. Instituto de Neurología Cognitiva; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Manes, Facundo Francisco. Instituto de Neurología Cognitiva; Argentina. Universidad Favaloro; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Gershanik, Oscar Samuel. Instituto de Neurología Cognitiva; Argentina. Universidad Favaloro; Argentina Fil: Roca, María. Instituto de Neurología Cognitiva; Argentina. Universidad Favaloro; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Diego Portales; Chile

Pesticides have been associated with Parkinson’s disease (PD), and protective gloves and workplace hygiene can reduce pesticide exposure. We examined whether such practices modified the pesticide-P...

Background: Parkinson’s Disease (PD) alters perception and somatosensory information integration, including visual dependency and judgment of body position in space. PD may be associated with Pisa syndrome (PS), a lateral deviation of the longitudinal body axis (LBA) of unknown origin. We tested whether this inclination is associated with an altered perception of the subjective visual vertical (SVV) and if these alterations are secondary effects of the LBA deviation or of a primary perceptual dysfunction. Furthermore, we investigated the contribution of different sensory modalities and dopaminergic medication. Methods: Seventeen PD patients (8 with PS, 9 without PS) and 18 healthy controls were tested. The SVV was assessed in a seated, in a lateral horizontal and e in PS patients e in a seated manually rectified position. Frame and moving-stimulus-patterns were used to test visual dependency. In PD and PS patients all trials were conducted in dopaminergic “on” and “off”. Results: When seated, SVV values on PD in “on” and PS in “on” and “off” differed significantly from controls. This difference remained in PS patients after manual rectification in “off”. The SVV in a lateral horizontal position was not significantly different between the three groups. When inclined, visual dependency was higher in PD “off” than in controls. Discussion: Both PS and PD patients showed SVV deviations compared to healthy controls. These cannot be explained by their intrinsic lateral deviation in PS patients. They must be secondary to either a primary perceptual dysfunction or alterations of internal models of verticality due to re-weighting of perceptual afferences. 2014 Elsevier Ltd. All rights reserved.

Background and purpose: The Movement Disorder Society sponsored version of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) is a comprehensive instrument for assessing Parkinson’s disease (PD). The present study was aimed at determining the relationships between MDS-UPDRS components and health-related quality of life (HRQoL) evaluations in PD patients. Methods: An international, multicenter, cross-sectional study was carried out of 435 PD patients assessed with the MDS-UPDRS, Hoehn and Yahr (HY), Clinical Impression Severity for PD, EQ-5D and PD Questionnaire eight items (PDQ-8). Spearman’s rank correlation coefficients, exploratory factor analysis and multiple linear regression models (dependent variables EQ-5D and PDQ-8) were performed. Results: The participants’ age was 66.71 10.32 years (51.5% men). PD duration was 8.52 6.14, and median HY was 2 (range 1–5). The correlation between the EQ-5D index and the MDS-UPDRS ranged from 0.46 (Part IV) to 0.72 (Part II) and for the PDQ-8 index from 0.47 (Part III) to 0.74 (Part II). In multiple regression models with the MDS-UPDRS domains as independent variables, the main determinant for both the EQ-5D index and the PDQ-8 was Part II followed by Part I. After factorial grouping of the cardinal PD manifestations embedded in the MDS-UPDRS Parts III and IV for inclusion into multiple regression models, a factor formed by M-EDL, nM-EDL and fluctuations was the main determinant for both the EQ-5D and PDQ-8 indexes. Conclusions: The MDS-UPDRS component most tightly related with the HRQoL measures was a combination of motor and non-motor experiences of daily living.

Objective: To evaluate the motor experiences of daily living section of the Movement Disorders SocietyUnified Parkinson’s Disease Rating Scale (MDS-UPDRS M-EDL) for assessing disability in PD patients; to determine the association between disability and quality of life; and to identify cut-off score ranges for no, mild, moderate and severe disability with this measure. Methods: International, observational, cross-sectional study of 435 PD patients, assessed with: MDSUPDRS, Hoehn and Yahr staging, Rapid Assessment of Disability Scale, Clinical Impression of Severity Index for PD, Parkinson’s Disease Questionnaire-8 and EQ-5D. Descriptive statistics, Spearman’s rank correlation coefficients, KruskaleWallis test for group comparisons, ordinal logistic regression analysis for setting cut-off values and a step-wise multiple linear regression model were calculated. Results: MDS-UPDRS M-EDL correlated 0.70e0.80 with other disability measures, and � 0.46 to 0.74 with quality of life scales. Scores significantly increased with higher disease duration and severity (p < 0.001). Cut-off values for the M-EDL were: 0e2 points, no disability; 3e16, mild; 17e31, moderate; and 32 points or more, severe. Linear regression analysis identified the MDS-UPDRS nM-EDL section as the main determinant of M-EDL, followed by the rest of MDS-UPDRS sections (explained variance: 59%). Conclusions: MDS-UPDRS M-EDL proved to be useful for assessing disability in PD.

Background and purpose Although Parkinson's disease (PD) is characterized by typical motor manifestations, non-motor symptoms (NMS) are an outstanding part of the disease. At present, several specific instruments for assessment of NMS are available. The objective of our study was to determine the performance of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS): Part I – Non-Motor Aspects of Experiences of Daily Living (nM-EDL) compared with the Non-Motor Symptoms Scale (NMSS). Methods To this purpose, 434 consecutive patients with PD were included in an international, observational, cross-sectional study. The association between scores of both scales was determined by the Spearman rank correlation coefficient. Equations for transformation of total score of a scale to the other were constructed from weighted regression models and both, transformed and observed score, contrasted by means of the Lin's Concordance Correlation Coefficient (LCCC) and Bland–Altman plot. Results As a whole, the prevalence of the NMS according to each scale was quite similar, and most of the correlations between their corresponding components were high (rS > 0.60). The total score correlation of the MDS-UPDRS Part I with the NMSS was high (rS = 0.81). Concerning the transformed scores, estimated scores only partially approach the observed ones (sharing about 60–64% of the variance) because residual variance increased with increasing magnitudes of the scores, i.e. the most severe patients (Bland–Altman plot; LCCC

BackgroundWe recently demonstrated that decline in fluid intelligence is a substantial contributor to frontal deficits. For some classical ‘executive’ tasks, such as the Wisconsin Card Sorting Test (WCST) and Verbal Fluency, frontal deficits were entirely explained by fluid intelligence. However, on a second set of frontal tasks, deficits remained even after statistically controlling for this factor. These tasks included tests of theory of mind and multitasking. As frontal dysfunction is the most frequent cognitive deficit observed in early Parkinson's disease (PD), the present study aimed to determine the role of fluid intelligence in such deficits.MethodWe assessed patients with PD (n=32) and control subjects (n=22) with the aforementioned frontal tests and with a test of fluid intelligence. Group performance was compared and fluid intelligence was introduced as a covariate to determine its role in frontal deficits shown by PD patients.ResultsIn line with our previous results, scores on the WCST and Verbal Fluency were closely linked to fluid intelligence. Significant patient–control differences were eliminated or at least substantially reduced once fluid intelligence was introduced as a covariate. However, for tasks of theory of mind and multitasking, deficits remained even after fluid intelligence was statistically controlled.ConclusionsThe present results suggest that clinical assessment of neuropsychological deficits in PD should include tests of fluid intelligence, together with one or more specific tasks that allow for the assessment of residual frontal deficits associated with theory of mind and multitasking.

The Movement Disorder Society-UPDRS (MDS-UPDRS) was published in 2008, showing satisfactory clinimetric results and has been proposed as the official benchmark scale for Parkinson's disease. The present study, based on the official MDS-UPDRS Spanish version, performed the first independent testing of the scale and adds information on its clinimetric properties. The cross-culturally adapted MDS-UPDRS Spanish version showed a comparative fit index ≥ 0.90 for each part (I-IV) relative to the English-language version and was accepted as the Official MDS-UPDRS Spanish version. Data from this scale, applied with other assessments to Spanish-speaking Parkinson's disease patients in five countries, were analyzed for an independent and complementary clinimetric evaluation. In total, 435 patients were included. Missing data were negligible and moderate floor effect (30 %) was found for Part IV. Cronbach's α index ranged between 0.79 and 0.93 and only five items did not reach the 0.30 threshold value of item-total correlation. Test-retest reliability was adequate with only two sub-scores of the item 3.17, Rest tremor amplitude, reaching κ values lower than 0.60. The intraclass correlation coefficient was higher than 0.85 for the total score of each part. Correlation of the MDS-UPDRS parts with other measures for related constructs was high (≥ 0.60) and the standard error of measurement lower than one-third baseline standard deviation for all subscales. Results confirm those of the original study and add information on scale reliability, construct validity, and precision. The MDS-UPDRS Spanish version shows satisfactory clinimetric characteristics.

Language and action systems are functionally coupled in the brain as demonstrated by converging evidence using Functional magnetic resonance imaging (fMRI), electroencephalography (EEG), transcranial magnetic stimulation (TMS), and lesion studies. In particular, this coupling has been demonstrated using the action-sentence compatibility effect (ACE) in which motor activity and language interact. The ACE task requires participants to listen to sentences that described actions typically performed with an open hand (e.g., clapping), a closed hand (e.g., hammering), or without any hand action (neutral); and to press a large button with either an open hand position or closed hand position immediately upon comprehending each sentence. The ACE is defined as a longer reaction time (RT) in the action-sentence incompatible conditions than in the compatible conditions. Here we investigated direct motor-language coupling in two novel and uniquely informative ways. First, we measured the behavioural ACE in patients with motor impairment (early Parkinson’s disease – EPD), and second, in epileptic patients with direct electrocorticography (ECoG) recordings. In experiment 1, EPD participants with preserved general cognitive repertoire, showed a much diminished ACE relative to non-EPD volunteers. Moreover, a correlation between ACE performance and action-verb processing (kissing and dancing test – KDT) was observed. Direct cortical recordings (ECoG) in motor and language areas (experiment 2) demonstrated simultaneous bidirectional effects: motor preparation affected language processing (N400 at left inferior frontal gyrus and middle/superior temporal gyrus), and language processing affected activity in movement-related areas (motor potential at premotor and M1). Our findings show that the ACE paradigm requires ongoing integration of preserved motor and language coupling (abolished in EPD) and engages motor-temporal cortices in a bidirectional way. In addition, both experiments suggest the presence of a motor-language network which is not restricted to somatotopically defined brain areas. These results open new pathways in the fields of motor diseases, theoretical approaches to language understanding, and models of action-perception coupling. Fil: Ibanez Barassi, Agustin Mariano. Instituto de Neurologia Cognitiva. Laboratorio de Psicologia Experimental y Neurociencia; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Diego Portales; Chile. Instituto de Neurología Cognitiva; Argentina Fil: Cardona, Juan F.. Instituto de Neurologia Cognitiva. Laboratorio de Psicologia Experimental y Neurociencia; Argentina. Universidad de Buenos Aires. Facultad de Psicologia; Argentina. Instituto de Neurología Cognitiva; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Dos Santos, Yamil Vidal. Instituto de Neurologia Cognitiva. Laboratorio de Psicologia Experimental y Neurociencia; Argentina. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Física. Laboratorio de Neurociencia Integrativa; Argentina Fil: Blenkmann, Alejandro Omar. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Favaloro; Argentina. Universidad Nacional de la Plata. Facultad de Ingenieria. Departamento de Electrotecnia. Laboratorio de Electronica Ind., Control E Instrumentac.; Argentina. Universidad de Buenos Aires. Facultad de Medicina; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital Gral.de Agudos "ramos Mejia"; Argentina Fil: Aravena, Pía. Institut des Sciences Cognitives; Francia Fil: Roca, María. Instituto de Neurología Cognitiva; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto de Neurologia Cognitiva. Laboratorio de Psicologia Experimental y Neurociencia; Argentina Fil: Hurtado, Esteban. Pontificia Universidad Católica de Chile; Chile Fil: Nerguizian, Mirna. Instituto de Neurología Cognitiva; Argentina. Universidad Favaloro; Argentina. Instituto de Neurologia Cognitiva. Laboratorio de Psicologia Experimental y Neurociencia; Argentina Fil: Amoruso, Lucía. Instituto de Neurología Cognitiva; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto de Neurologia Cognitiva. Laboratorio de Psicologia Experimental y Neurociencia; Argentina Fil: Gómez Arévalo, Gonzalo. Instituto de Neurología Cognitiva; Argentina. Instituto de Neurologia Cognitiva. Laboratorio de Psicologia Experimental y Neurociencia; Argentina Fil: Chade, Anable. Instituto de Neurología Cognitiva; Argentina. Instituto de Neurologia Cognitiva. Laboratorio de Psicologia Experimental y Neurociencia; Argentina Fil: Dubrovsky, Alberto. Instituto de Neurología Cognitiva; Argentina. Instituto de Neurologia Cognitiva. Laboratorio de Psicologia Experimental y Neurociencia; Argentina Fil: Gershanik, Oscar. Instituto de Neurología Cognitiva; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto de Neurologia Cognitiva. Laboratorio de Psicologia Experimental y Neurociencia; Argentina Fil: Kochen, Sara Silvia. Gobierno de la Ciudad de Buenos Aires. Hospital Gral.de Agudos "ramos Mejia"; Argentina. Universidad de Buenos Aires. Facultad de Medicina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Glenberg, Arthur. Arizona State University; Estados Unidos. University Of Wisconsin; Estados Unidos Fil: Manes, Facundo Francisco. Instituto de Neurologia Cognitiva. Laboratorio de Psicologia Experimental y Neurociencia; Argentina. Instituto de Neurología Cognitiva; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Bekinschtein, Tristán Andrés. Instituto de Neurologia Cognitiva. Laboratorio de Psicologia Experimental y Neurociencia; Argentina. Instituto de Neurología Cognitiva; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Medical Research Council. Cognition and Brain Sciences Unit; Reino Unido

Background. A “dysexecutive” group of patients with Alzheimer disease (AD) has been previously identified, and these patients have been found to present higher frequency of psychiatric symptoms and more pronounced functional impact. This study aimed at evaluating the frequency of neuropsychiatric symptoms in patients with early AD who present with impaired executive functioning.Methods. Thirty patients with early AD diagnosis were divided into a spared (SEF) and an impaired (IEF) executive functioning group according to their performance scores on neuropsychological tests. Their closest relatives or caregivers completed the Cambridge behavioral inventory (CBI), which assesses behavioral symptoms grouped into 13 categories.Results. A significant difference was exclusively found between SEF and IEF in terms of the frequency of stereotypies and repetitive motor behavior (U=60.5,P=.024).Conclusions. The presence of stereotypies could be associated with a dysexecutive profile in AD patients. These results shed light on the role of frontal circuitry in the expression of motor symptoms in AD and prompt for further research that will contribute to the differential diagnosis both of different subtypes of AD and other types of dementia.

Detecting cognitive impairment in patients with Parkinson's disease is crucial for good clinical practice given the new therapeutic possibilities available. When full neuropsychological evaluations are not available, screening tools capable of detecting cognitive difficulties become crucial. Objective: The goal of this study was to investigate whether the Spanish version of the Addenbrooke's Cognitive Examination (ACE) is capable of detecting cognitive difficulties in patients with Parkinson's disease and discriminating their cognitive profile from patients with dementia. Methods: 77 early dementia patients (53 with Alzheimer's Disease and 24 with Frontotemporal Dementia), 22 patients with Parkinson's disease, and 53 healthy controls were evaluated with the ACE. Results: Parkinson's disease patients significantly differed from both healthy controls and dementia patients on ACE total score. Conclusions: This study shows that the Spanish version of the ACE is capable of detecting patients with cognitive impairment in Parkinson's disease and is able to differentiate them from patients with dementia based on their general cognitive status. Resumo A detecção de comprometimento cognitivo em pacientes com doença de Parkinson é crucial para uma boa prática clínica devido às novas possibilidades terapêuticas disponíveis. Quando uma avaliação neuropsicológica completa não está disponível, instrumentos de rastreio capazes de detectar dificuldades cognitivas tornam-se cruciais. Objetivo: Investigar se a versão espanhola do Addenbrooke´s Cognitive Examination (ACE) é capaz de detectar dificuldades cognitivas em pacientes com doença de Parkinson e discriminar seu perfil cognitivo de pacientes com demência. Métodos: 77 pacientes com demência leve (53 com doença de Alzheimer e 24 com demência frontotemporal), 22 pacientes com doença de Parkinson e 53 controles saudáveis foram avaliados com a ACE. Resultados: Os pacientes com doença de Parkinson significativamente diferiram de controles saudáveis e pacientes com demência no escore total do ACE. Conclusões: Este estudo mostra que a versão espanhola do ACE é capaz de detectar pacientes com comprometimento cognitivo na doença de Parkinson e de diferenciá-los de pacientes com demência baseados no seu estado cognitivo geral.

Background A reliable and valid questionnaire for screening restless legs syndrome (RLS) is essential for determining accurate estimates of disease frequency. In a 2002 NIH-sponsored workshop, experts suggested three mandatory questions for identifying RLS in epidemiologic studies. We evaluated the reliability and validity of this RLS-NIH questionnaire in a community-based sample and concurrently developed and evaluated the utility of an expanded screening questionnaire, the RLS-EXP. Methods The study was conducted at Kaiser Permanente of Northern California and the Stanford University Sleep Clinic. We evaluated test–retest reliability in a random sample of subjects with prior physician-assigned RLS ( n =87), subjects with conditions frequently misclassified as RLS ( n =31), and healthy subjects ( n =9). Validity of both instruments was evaluated in a random sample of 32 subjects, and in-person examination by two RLS specialists was used as the gold standard. Results For the first three RLS-NIH questions, the kappa statistic for test–retest reliability ranged from 0.5 to 1.0, and sensitivity and specificity was 86% and 45%, respectively. For the subset of five questions on RLS-EXP that encompassed cardinal features for diagnosing RLS, kappas were 0.4–0.8, and sensitivity and specificity were 81% and 73%, respectively. Conclusions Sensitivity of RLS-NIH is good; however, the specificity of the instrument is poor when examined in a sample that over-represents subjects with conditions that are commonly misclassified as RLS. Specificity can be improved by including separate questions on cardinal features, as used in the RLS-EXP, and by including a few questions that identify RLS mimics, thereby reducing false positives.

Study of the nongenetic causes of Parkinson’s disease (PD) was encouraged by discovery of a cluster of parkinsonism produced by neurotoxic pyridine 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) in the 1980s. Since that time, epidemiologic investigations have suggested risk factors, though their results do not establish causality. Pesticide exposure has been associated with increased risk in many studies. Other proposed risks include rural residence and certain occupations. Cigarette smoking, use of coffee/caffeine, and non-steroidal antiinflammatory drugs (NSAIDs) all appear to lower risk of PD, while dietary lipid and milk consumption, high caloric intake, and head trauma may increase risk. The cause of PD is likely multifactorial. Underlying genetic susceptibility and combinations of risk and protective factors likely all contribute. The combined research effort by epidemiologists, geneticists, and basic scientists will be needed to clarify the cause(s) of PD.

Objective: Evaluate associations of PD with paraquat exposure and dietary PUFA intake, separately and in combination. Background PD risk may be associated with exposure to the herbicide paraquat, possibly through a mechanism involving oxidative stress. Dietary intake of PUFAs may reduce oxidative stress, potentially modifying the association of PD risk with paraquat. Design/Methods: We recruited PD cases and controls from the Agricultural Health Study, a cohort including 84,739 private pesticide applicators and spouses. Diagnosis was confirmed by movement disorder specialists. Using a food frequency questionnaire, we collected information from 89 cases on diet before diagnosis and from 336 matched controls on diet before a corresponding date. We also collected information on lifetime use of paraquat in agriculture. Data were analyzed using logistic regression. Results: After adjusting for age, sex, state, smoking, and total energy intake, PD risk was inversely associated with intake of PUFAs (highest vs lowest tertile: OR 0.6, 95% CI 0.3-1.1), particularly the two essential fatty acids linoleic acid (0.6, 0.3-1.2) and alpha-linolenic acid (0.4, 0.2-0.8). Compared to individuals with high linoleic acid intake and no exposure, the increase in PD risk was modest in those with either low intake and no exposure (1.3, 0.7-2.5) or high intake and paraquat exposure (1.4, 0.5-3.9) but substantial in those with both low intake and paraquat exposure (4.5, 1.7-12). Similar results were observed with alpha-linolenic acid (ORs 1.2, 1.2, and 3.6 respectively). Conclusions: PD risk associated with paraquat was lower in individuals with high intake of PUFAs, consistent with the hypothesis that the mechanism of paraquat toxicity involves oxidative stress. These results may suggest approaches to preventing or modifying progression of PD. Supported by: NIEHS R01-ES10803, Intramural Research Program of the NIH (NIEHS Z01-ES044007 and Z01-ES049030, NCI Z01-CP010119), and James and Sharron Clark. Disclosure: Dr. Kamel has nothing to disclose. Dr. Richardson has nothing to disclose. Dr. Umbach has nothing to disclose. Dr. Richards has nothing to disclose. Dr. Bhudhikanok has nothing to disclose. Dr. Blair has nothing to disclose. Dr. Chade has nothing to disclose. Dr. Comyns has nothing to disclose. Dr. Goldman has nothing to disclose. Dr. Hoppin has nothing to disclose. Dr. Kasten has nothing to disclose. Dr. Korell has nothing to disclose. Dr. Marras has received personal compensation for activities with Solvay Pharmaeuticals as a consultant. Dr. Meng has nothing to disclose. Dr. Ross has nothing to disclose. Dr. Langston has nothing to disclose. Dr. Sandler has nothing to disclose. Dr. Tanner has received personal compensation for activities with Impax Pharmaceuticals, Allergan, Inc. & Genentech, Inc. as a consultant. Dr. Tanner has received research support from Michael J. Fox Foundation, Department of Defense, Parkinson9s Disease Foundation, Parkinson9s Institute, Unity Walk and Brin Foundation.