title: Self-unawareness of levodopa induced dyskinesias in patients with Parkinson's disease.
abstract: The study analyzes the presence of dyskinesias-reduced-self-awareness in forty-eight patients suffering from Parkinson's disease (PD). As the association with executive dysfunction is a matter of debate and we hypothesize it plays an important role in dyskinesias self-unawareness, we analyzed the role of dopaminergic treatment on the medial-prefrontal-ventral-striatal circuitry using a neurocognitive approach. Special attention was given to metacognitive abilities related to action-monitoring that represent a novel explanation of the phenomenon. PD patients were assessed using different rating scales that we devised to measure movement awareness disorders. In order to ascertain whether each variable measured at a cognitive-clinical level contributes to predicting the scores of the movement-disorder-awareness-scales, we conducted multiple logistic regression models using the latter as binary dependent variables. We used the Wisconsin Card Sorting Test-metacognitive-version to assess the executive functions of the prefrontal-ventral-striatal circuitry. Data showed that a reduction of self-awareness using the Dyskinesia rating scale was associated with global monitoring (p=.04), monitoring resolution (p=.04) and control sensitivity (p=.04). Patients failed to perceive their performance, distinguish between correct and incorrect sorts, be confident in their choice and consequently decide to gamble during the task. We did not find any association with executive functions using the hypo-bradykinesia rating scale. Our findings indicate that when the comparator mechanism for monitoring attentive performance is compromised at a prefrontal striatal level, patients lose the ability to recognize their motor disturbances that do not achieve conscious awareness.
authors: Department of Psychology, University of Turin, Via Verdi 10, 10123 Turin, Italy; Centro Interdipartimentale di Studi Avanzati in Neuroscienze - National Institute of Turin (NIT), Regione Gonzole 10, 10043 Orbassano, Italy; National Institute of Neuroscience (INN), Turin, Italy. Electronic address: martina.amanzio@unito.it.
authors: Martina
authors: M
authors: Amanzio
authors: Department of Neuroscience, Via Cherasco 15, 10126 Turin, Italy.
authors: Sara
authors: S
authors: Palermo
authors: Department of Neuroscience, Via Cherasco 15, 10126 Turin, Italy.
authors: Maurizio
authors: M
authors: Zibetti
authors: Martini Hospital, Via Tofane 71, 10141 Turin, Italy.
authors: Daniela
authors: D
authors: Leotta
authors: Department of Psychology, University of Turin, Via Verdi 10, 10123 Turin, Italy; Cancer Epidemiology Unit, "Città della Salute e della Scienza" Hospital, Turin, Italy.
authors: Rosalba
authors: R
authors: Rosato
authors: Department of Psychology, University of Turin, Via Verdi 10, 10123 Turin, Italy; Centro Interdipartimentale di Studi Avanzati in Neuroscienze - National Institute of Turin (NIT), Regione Gonzole 10, 10043 Orbassano, Italy; National Institute of Neuroscience (INN), Turin, Italy.
authors: Giuliano
authors: G
authors: Geminiani
authors: Centro Interdipartimentale di Studi Avanzati in Neuroscienze - National Institute of Turin (NIT), Regione Gonzole 10, 10043 Orbassano, Italy; National Institute of Neuroscience (INN), Turin, Italy; Department of Neuroscience, Via Cherasco 15, 10126 Turin, Italy.
authors: Leonardo
authors: L
authors: Lopiano
mesh_terms: D000368:Aged; D001364:Awareness; D015259:Dopamine Agents / Q000009:adverse effects; D004409:Dyskinesia, Drug-Induced / Q000523:psychology*; D056344:Executive Function; D005260:Female; D006801:Humans; D007980:Levodopa / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications* / Q000188:drug therapy; D012649:Self Concept
chemical_list: D015259:Dopamine Agents; D007980:Levodopa
keywords: Awareness of movement disorders; Dyskinesias; Metacognitive functions; Parkinson’s disease; Self-awareness