title: Poor self-awareness of levodopa-induced dyskinesias in Parkinson's disease: clinical features and mechanisms.
abstract: OBJECTIVE
  To study the factors and possible mechanisms associated with decreased self-awareness of levodopa-induced dyskinesias (LIDs) in patients with Parkinson's disease (PD).
  
  
  METHODS
  We enrolled 30 PD patients with LIDs. Patients were video-recorded in an "on" phase while experiencing LIDs. LIDs were objectively rated by means of the Unified Dyskinesias Rating Scale (UDyRS) by two movement disorders specialists while examining the patients. Patients were asked to rate the body site and the severity of their LIDs according to the 5-point UDyRS. Patients then rated their own LIDs while watching the video recording of themselves. Lastly, the patients rated the LIDs of other reference PD patients on a video recording. The same reference video recordings were shown to 15 healthy individuals matched for age, gender and education.
  
  
  RESULTS
  Seven of the 30 PD patients investigated were subjectively unaware of the presence of their LIDs. The majority of patients, however, recognized their LIDs when watching video recording of themselves. Patients displayed a specific poor self-awareness of trunk LIDs, in both the subjective evaluation and in the video recording-based subjective evaluation. By contrast PD patients correctly recognized LIDs in video recordings of reference PD patients. Poor self-awareness correlated with predominance of motor symptoms on the left body side.
  
  
  CONCLUSIONS
  Poor self-awareness of LIDs is present in a proportion of PD patients as a form of anosognosia. The poor self-awareness of LIDs in the trunk is likely to be due to a complex interplay involving both anosognosic mechanisms and deficits in proprioceptive axial kinesthesia.
authors.affiliation: Department of Neurology and Psychiatry, Sapienza University of Rome, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Pietracupa
authors.forename: Alfonso
authors.initials: A
authors.lastname: Fasano
authors.forename: Giovanni
authors.initials: G
authors.lastname: Fabbrini
authors.forename: Marianna
authors.initials: M
authors.lastname: Sarchioto
authors.forename: Maria
authors.initials: M
authors.lastname: Bloise
authors.forename: Anna
authors.initials: A
authors.lastname: Latorre
authors.forename: Marta
authors.initials: M
authors.lastname: Altieri
authors.forename: Matteo
authors.initials: M
authors.lastname: Bologna
authors.forename: Alfredo
authors.initials: A
authors.lastname: Berardelli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001364:Awareness; D059026:Diagnostic Self Evaluation; D004409:Dyskinesia, Drug-Induced / Q000175:diagnosis / Q000523:psychology*; D005260:Female; D006801:Humans; D007980:Levodopa / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology*; D014741:Video Recording / Q000379:methods
chemical_list: D007980:Levodopa
keywords: Aanosognosia; Dyskinesias; Parkinson disease