title: Attentional set-shifting in Parkinson's disease patients with freezing of gait-acquisition and discrimination set learning deficits at the background?
abstract: Cognitive loading aggravates the freezing of gait (FoG), which is observed in approximately 50% of patients with Parkinson's disease (PD) in the advanced stages. To investigate whether a specific pattern of executive deficits, that is, attentional set-shifting and/or inhibitory control, are associated with FoG in PD, 30 PD patients with FoG (PD-FoG+) and 36 PD patients without FoG (PD-FoG-) and 22 control healthy subjects were examined with a comprehensive neuropsychological battery. Intra-Extra Dimensional Set shifting Test (IED) and Stop Signal Task (SST), selected from the Cambridge Automated Neuropsychological Battery (CANTAB battery), were administered to analyze set-shifting and motor inhibition, respectively. The IED task was significantly sensitive for differentiating between PD-FoG+ and PD-FoG- groups (p<.01), as well Adenbrook's clock drawing task (p=.033). By contrast, no differences emerged on any aspect of the SST task and other cognitive tasks. The attrition rate during the IED task showed that the problem in the PD-FoG+ group appeared at the pre-ID level, on the discrimination-learning set; the 32% PD-FoG+ subjects did not achieve the ID level of the task in comparison to negligible 4% of the PD-FoG- patients (p=.011). The logistic regression analysis, indicated the higher the IED stage successfully completed, the less likely presence of FoG in PD subjects. These results demonstrate that the complex cognitive-motor interplay might be responsible for FoG in PD and have had real life implication for the patients.
authors.affiliation: 1Faculty of Medicine,University of Belgrade,Belgrade,Serbia.
authors.forename: Elka
authors.initials: E
authors.lastname: Stefanova
authors.affiliation: 2Clinic of Neurology,CCS,Belgrade,Serbia.
authors.forename: Milica
authors.initials: M
authors.lastname: Ječmenica Lukić
authors.affiliation: 3Faculty of Philology,University of Belgrade,Belgrade,Serbia.
authors.forename: Ljubomir
authors.initials: L
authors.lastname: Ziropadja
authors.affiliation: 2Clinic of Neurology,CCS,Belgrade,Serbia.
authors.forename: Vladana
authors.initials: V
authors.lastname: Marković
authors.affiliation: 2Clinic of Neurology,CCS,Belgrade,Serbia.
authors.forename: Tanja
authors.initials: T
authors.lastname: Stojković
authors.affiliation: 2Clinic of Neurology,CCS,Belgrade,Serbia.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Tomić
authors.affiliation: 1Faculty of Medicine,University of Belgrade,Belgrade,Serbia.
authors.forename: Nataša
authors.initials: N
authors.lastname: Dragašević Mišković
authors.affiliation: 1Faculty of Medicine,University of Belgrade,Belgrade,Serbia.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Kostić
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis* / Q000209:etiology*; D016009:Chi-Square Distribution; D004193:Discrimination Learning / Q000502:physiology*; D005260:Female; D020233:Gait Disorders, Neurologic / Q000150:complications*; D006801:Humans; D007859:Learning Disabilities / Q000150:complications*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000150:complications*; D012718:Set, Psychology