Original Articles. Calne, resting tremor. Mortimer, Pirozzolo, Hansch, & Webster, postural disturbance III

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1 Original Articles III I II muscular rigidity postural disturbance resting tremor bradykinesia Calne, 2001 Mortimer, Pirozzolo, Hansch, & Webster, 1982 Tel: huams@ntu.edu.tw 106 1

2 98 Zetusky, Jankovic, & Pirozzolo, 1985 Alexander DeLong Strick Lichter & Cummings, 159 Cooper, Sagar, Jordan, Harvey, & Sullivan, 1991; Dubois & Pillon, 1997; Levin & Katzen, 1995; Levin, Maria, & Weiner, 1989; Stern, Mayeux, Hermann, & Rosen, 1988 duration; Levin, Llabre, Ansley, Weiner, & Sanchez-Ramos, 1990 Hoehn Yahr 1967 Hoehn and Yahr stage Van Spaendonck, Berger, Horstink, Buytenhuijs, & Cools, 1996 frontal-striatal circuit; Dubois & Pillon, 1997 confusional state Clinical Dementia Rating; Morris, Symptoms Check List-90-Revised, SCL-90-R; MMSE; Folstein, Folstein, & McHugh, Cummings & Huber, 1992 Levin, Llabre, Reisman, Weiner, Sanchez-Ramos, & Singer, 1991 Brown & Marsden, 1986 Pai & Chan, 2001 Cognitive Ability Screening Instrument, CASI ( Hsieh & Lee, 1999) Unified Parkinson's Disease Rating Scale, UPDRS; Fahn & Elton, 1987 UPDRS Mentation, Behavior and Mood Activities of Daily Living Motor Examination Complications of Therapy Modified Hoehn and Yahr Stage Schwab and England Schwab and England's Activities of Daily Living Scale; Schwab & England, 1961 gait postural stability speech UPDRS Vakil &

3 99 ( ) Herishanu-Naaman, 1998; Van Spaendonck et al., N = 10 N = 32 Dubois & Pillon, 1997 N = Temporal Orientation, TO; Benton, Sivan, Hamsher, Varney, & Spreen, 1994 Orientation to Personal Information and Place, OPIP; Hamsher, Benton Visual Retention Test, BVRT; Benton, 1974 Judgment of Line Orientation, JLO; Benton et al., 1994 Facial Recognition Test, FRT; Benton et al., 1994 Three-Dimensional Block Construction Test; Benton et al., 1994 Modified Wisconsin Card Sorting Test; Nelson, 1976 Semantic Association of Verbal Fluency Test; Hua, Chang, & Chen, 1997 A Trail Making Test A; Reitan & Wolfson, 1993 Line Cancellation Test, Hamsher, ANOVA 2. Scheffe's method 3. Polyserial correlation coeffi cient, r p <.01 r =.367; r = [F(1, 66) = 2.36, p =.129; F(1, 66) =

4 , p =.150) A r =.613 A - Kruskal-Wallis one-way analysis of variance by ranks WAIS-R.207] A [F(1, 66) = 1.62, p = A III I II A ( )

5 101 [ F (3, 64) = 1.90, p =.139] [F(3, 64) = 1.44, p =.240] [F(3, 64) = 2.94, p =.040] [F(3, 64) = 4.89, p =.004] A [F(3, 64) = 1.76, p =.163] ( )

6 102 UPDRS r = -.341, p =.019 Lu, Hua, Lo, & Lo, 1994 Tsai, r = -.312, p =.033 = -.293, p =.045 r = -.337, p =.020 r = -.316, p =.030 r = -.350, p =.016 r = -.331, p =.023 N = 5 N = 10 N = 32 r Brown & Marsden, 1988 Canavan, Passingham, Marsden, Quinn, Wyke, & Polkey, 1989 Lees & Smith, 1983 Brown 1988 Canavan 1989 multiple system atrophy II Lees Smith (1983) Henry & Crawford, 2004

7 103 II III Smith 1983 Lees Nelson 1976 Katzen 1995 Levin Van Spaendonck NSC H- Vakil & Herishanu-Naaman, 1998; Van Spaendonck et al., III 1983 Alexander, G. E., DeLong, M. R., & Strick, P. L. (1986).

8 104 Parallel organization of functionally segregated circuits linking basal ganglia and cortex. Annual Review of Neuroscience, 9, Benton, A. L. (1974). Revised Visual Retention Test (4 th ed.). New York: The Psychological Corporation. Benton, A. L., Sivan, A. B., Hamsher, K. d., Varney, N. R., & Spreen, O. (1994). Contributions to neuropsychological assessment: A clinical manual (2 nd ed.). New York: Oxford University Press. Brown, R. G., & Marsden, C. D. (1986). Visuospatial function in Parkinson's disease. Brain, 109, Brown, R. G., & Marsden, C. D. (1988). An investigation of the phenomenon of "set" in Parkinson's disease. Movement Disorders, 3, Calne, D. B. (2001). Parkinson's disease is not one disease. Parkinsonism & Related Disorders, 7, 3-7. Canavan, A. G., Passingham, R. E., Marsden, C. D., Quinn, N., Wyke, M., & Polkey, C. E. (1989). The performance on learning tasks of patients in the early stages of Parkinson's disease. Neuropsychologia, 27, Cooper, J. A., Sagar, H. J., Jordan, N., Harvey, N. S., & Sullivan, E. V. (1991). Cognitive impairment in early, untreated Parkinson's disease and its relationship to motor disability. Brain, 114, Cummings, J. L., & Huber, S. J. (1992). Visuospatial abnormalities in Parkinson's disease. In S. J. Huber & J. L. Cummings (Eds.), Parkinson's disease: Neurobehavioral aspects. New York: Oxford University Press. Dubois, B., & Pillon, B. (1997). Cognitive deficits in Parkinson's disease. Journal of Neurology, 244, 2-8. Fahn, S., & Elton, R. (1987). Unified Parkinson's disease rating scale. In S. Fahn, M. Goldstein, D. Marsden, & D. Calne (Eds.), Recent developments in Parkinson's disease (pp ). New Jersey: Mac- Millan. Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, Hamsher, K. d. (1979). Line Cancellation Test. Milwaukee: University of Wisconsin medical school, Department of Neurology. Hamsher, K. d. (1983). Orientation to Personal Information and Place. Milwaukee: University of Wisconsin medical school, Department of Neurology. Henry, J. D., & Crawford, J. R. (2004). Verbal fluency deficits in Parkinson's disease: A meta-analysis. Journal of the International Neuropsychological Society, 10, Hoehn, M. M., & Yahr, M. D. (1967). Parkinsonism: Onset, progression and mortality. Neurology, 17, Hsieh, S., & Lee, C. Y. (1999). Source memory in Parkinson's disease. Perceptual and Motor Skills, 89, Hua, M. S., Chang, S. H., & Chen, S. T. (1997). Factor structure and age effects with an aphasia test battery in normal Taiwanese adults. Neuropsychology, 11, Lees, A. J., & Smith, E. (1983). Cognitive deficits in the early stages of Parkinson's disease. Brain, 106, Levin, B. E., & Katzen, H. L. (1995). Early cognitive changes and nondementing behavioral abnormalities in Parkinson's disease. Advances in Neurology, 65, Levin, B. E., Llabre, M. M., Ansley, J., Weiner, W. J., & Sanchez-Ramos, J. (1990). Do parkinsonians exhibit visuospatial deficits? Advances in Neurology, 53, Levin, B. E., Llabre, M. M., Reisman, S., Weiner, W. J., Sanchez-Ramos, J., Singer, C., et al. (1991). Visuospatial impairment in Parkinson's disease. Neurology, 41, Levin, B. E., Maria, M. L., & Weiner, W. J. (1989). Cognitive impairments associated with early Parkinson's disease. Neurology, 39, Lichter, D. G., & Cummings, J. L. (2001). Frontal-subcortical circuits in psychiatric and neurological disorders. New York: Guilford Press. Morris, J. C. (1993). The Clinical Dementia Rating (CDR): Current version and scoring rules. Neurology, 43, Mortimer, J. A., Pirozzolo, F. J., Hansch, E. C., & Webster, D. D. (1982). Relationship of motor symptoms to intellectual deficits in Parkinson disease. Neurology, 32, Nelson, H. E. (1976). A modified card sorting test sensitive to frontal lobe defects. Cortex, 12,

9 105 Pai, M. C., & Chan, S. H. (2001). Education and cognitive decline in Parkinson's disease: A study of 102 patients. Acta Neurologica Scandinavica, 103, Reitan, R. M., & Wolfson, D. (1993). The Halstead- Reitan neuropsychological test battery: Theory and clinical interpretation (2 nd ed.). S. Tucson, Ariz.: Neuropsychology Press. Schwab, R. S., & England, A. C., Jr. (1961). Parkinson's disease: Rehabilitation aspects. Rehabilitation literature, 22, Stern, Y., Mayeux, R., Hermann, A., & Rosen, J. (1988). Prism adaptation in Parkinson's disease. Journal of Neurology, Neurosurgery, and Psychiatry, 51, Tsai, C. H., Lu, C. S., Hua, M. S., Lo, W. L., & Lo, S. K. (1994). Cognitive dysfunction in early onset parkinsonism. Acta Neurologica Scandinavica, 89, Vakil, E., & Herishanu-Naaman, S. (1998). Declarative and procedural learning in Parkinson's disease patients having tremor or bradykinesia as the predominant symptom. Cortex, 34, Van Spaendonck, K. P., Berger, H. J., Horstink, M. W., Buytenhuijs, E. L., & Cools, A. R. (1996). Executive functions and disease characteristics in Parkinson's disease. Neuropsychologia, 34, Zetusky, W. J., Jankovic, J., & Pirozzolo, F. J. (1985). The heterogeneity of Parkinson's disease: Clinical and prognostic implications. Neurology, 35,

10 106 The Relationship between Neuropsychological Functions and Motor Symptoms in Low-educated Nondemented Patients with Parkinson's Disease: A Preliminary Study Cheng-Chang Yang 1, Mau-Sun Hua 2, Yih-Ru Wu 3, and Lung Yu 1 1 Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University 2 Department of Psychology, National Taiwan University 3 Department of Neurology, Chang Gung Memorial Hospital Abstract Objective: Method: Results: Conclusion: Key words: In the western literature, cognitive decline in the patients with rigidity and bradykinesia features has been noted to be more remarkable than those with a predominant motor symptom of tremor. Accordingly, it has been suggested that these patients with various predominant motor symptoms might have heterogeneous neuropathological involvements. Nevertheless, few studies have investigated these issues in Taiwan. In addition, most of our patients are low-educated and incompatible with those with high education level in western societies. Thus, our study attempted to examine the relationship between neuropsychological function and motor symptoms in low-educated patients with Parkinson's disease (PD). Forty-seven nondemented PD patients with low education level received Unified Parkinson Disease Rating Scale (UPDRS) for rating their motor severity under "on" condition. Twenty-two healthy subjects, matched for age and education level, served as normal controls. Both groups received a series of neuropsychological tests consisting of mainly memory, visuospatial and executive functions. Data analysis revealed that there was no significant correlation between patients' motor severity and performance on neuropsychological tests. However, patients with a predominant symptom of rigidity showed impaired performance on the cognitive tests while there were no significant differences between patients with a remarkable symptom of tremor or bradykinesia and normal controls in cognitive performance. There were no significant differences between performance of patients with motor staging I and that of normal controls on the neurocognitive tests. However, patients with the stagings II and III performed significantly poorer on the executive function and/or memory tests. Based on our preliminary results, we noted that only patients with a predominant motor symptom of rigidity evidenced remarkable neurocognitive deficits. This result seems to further support findings in western literature. We thus suggest that there is a remarkable relationship between the severity of rigidity and neurocognitive impairments regardless of educational levels. However, since our results were based on a small sample, further investigation on a large scale to re-examine this issue is necessary. Parkinson's Disease; Neuropsychological Function; Motor Disability