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      The Epidemiology and Clinical Manifestations of Dysexecutive Syndrome in Parkinson’s Disease

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          Abstract

          This mini-review summarizes the evidence of the cognitive and behavioral features of dysexecutive syndrome in Parkinson’s disease (PD). Deficits in response inhibition, set-shifting, mental flexibility, and strategy have been frequently described from the earliest stages of PD, although there are inconsistencies in study findings due to the complexity of the executive function (EF) construct and methodological limitations. Behavioral disorders of PD, e.g., apathy, distractibility, perseverative behavior, and impulse-control disorders, may be viewed as the other side of dysexecutive syndrome. Despite the interrelationship between the cognitive and behavioral domains, some reports reveal that the two syndromes may be dissociated, suggesting that both aspects must be clinically assessed. EFs are widely associated with the prefrontal areas, although dysexecutive syndrome may be observed in patients with damage to other brain regions. EFs drive numerous abilities essential to daily life, such as prospective remembering and language comprehension, which may be impaired in PD subjects. Considering the impact of dysexecutive syndrome on independence and quality of life, early detection of executive impairment is crucial in the management of PD.

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          Parallel organization of functionally segregated circuits linking basal ganglia and cortex.

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            Frontal-subcortical circuits and human behavior.

            This synthetic review was performed to demonstrate the utility of frontal-subcortical circuits in the explanation of a wide range of human behavioral disorders. Reports of patients with degenerative disorders or focal lesions involving frontal lobe or linked subcortical structures were chosen from the English literature. Individual case reports and group investigations from peer-reviewed journals were evaluated. Studies were included if they described patient behavior in detail or reported pertinent neuropsy-chological findings and had compelling evidence of a disorder affecting frontal-subcortical circuits. Information was used if the report from which it was taken met study selection criteria. Five parallel segregated circuits link the frontal lobe and subcortical structures. Clinical syndromes observed with frontal lobe injury are recapitulated with lesions of subcortical member structures of the circuits. Each prefrontal circuit has a signature behavioral syndrome: executive function deficits occur with lesions of the dorsolateral prefrontal circuit, disinhibition with lesions of the orbitofrontal circuit, and apathy with injury to the anterior cingulate circuit. Depression, mania, and obsessive-compulsive disorder may also be mediated by frontal-subcotical circuits. Movement disorders identify involvement of the basal ganglia component of frontal-subcortical circuits. Frontal-subcortical circuits mediate many aspects of human behavior.
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              Cognitive profile of patients with newly diagnosed Parkinson disease.

              To determine the frequency and pattern of cognitive dysfunction in patients with newly diagnosed Parkinson disease (PD) and to identify its demographic and clinical correlates. A cohort of 115 consecutive patients with newly diagnosed PD and 70 healthy controls underwent a comprehensive neuropsychological assessment including tests of psychomotor speed, attention, language, memory, executive and visuospatial functions, as well as measures of affective status. Patients also received quantitative ratings of motor symptom severity and functional status. Neuropsychological performance of PD patients was compared with that of healthy controls and with available normative data. Independent demographic and clinical predictors of cognitive impairment were identified with multiple logistic regression analysis. Relative to controls, PD patients performed significantly worse on most cognitive measures. However, further analysis revealed that group differences in cognitive performance could mainly be explained by measures of immediate memory and executive function. Comparison with normative data showed that impairments were most frequent on measures of executive function, memory and psychomotor speed. In all, 24% of PD patients (4% of controls) displayed defective performance on at least three neuropsychological tests and were classified as cognitively impaired. Late onset of disease was an independent predictor of cognitive dysfunction in PD. Cognitive impairments are common even in newly diagnosed Parkinson disease patients, with deficits being most prominent in the domains of memory and executive functions. Older age at disease onset is likely to be an important determinant of cognitive dysfunction in Parkinson disease.
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                Author and article information

                Journal
                Front Neurol
                Front Neurol
                Front. Neur.
                Frontiers in Neurology
                Frontiers Media S.A.
                1664-2295
                08 November 2012
                2012
                : 3
                : 159
                Affiliations
                [1] 1Department of Neuroscience, University of Pisa Pisa, Italy
                Author notes

                Edited by: Giovanni Albani, Istituto Auxologico Italiano, IRCCS, Italy

                Reviewed by: Cristian F. Pecurariu, University of Transylvania, Romania; Benzi Kluger, University of Colorado Denver, USA

                *Correspondence: Roberto Ceravolo, Department of Neuroscience, University of Pisa, via Roma 67, Pisa 56126, Italy. e-mail: r.ceravolo@ 123456neuro.med.unipi.it

                This article was submitted to Frontiers in Movement Disorders, a specialty of Frontiers in Neurology.

                Article
                10.3389/fneur.2012.00159
                3497716
                23162529
                6c8cce60-8167-4241-a8af-d6d70a2ace87
                Copyright © 2012 Ceravolo, Pagni, Tognoni and Bonuccelli.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in other forums, provided the original authors and source are credited and subject to any copyright notices concerning any third-party graphics etc.

                History
                : 15 April 2012
                : 21 October 2012
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 131, Pages: 7, Words: 7056
                Categories
                Neuroscience
                Mini Review

                Neurology
                dysexecutive syndrome,neuropsychological test,cognitive impairment,executive function,parkinson’s disease

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