title: Patterns of Neuropsychological Profile and Cortical Thinning in Parkinson's Disease with Punding.
abstract: BACKGROUND
  Punding, one of dopamine replacement treatment related complications, refers to aimless and stereotyped behaviors. To identify possible neural correlates of punding behavior in patients with Parkinson's disease (PD), we investigated the patterns of cognitive profiles and cortical thinning.
  
  
  METHODS
  Of the 186 subjects with PD screened during the study period, we prospectively enrolled 10 PD patients with punding and 43 without punding on the basis of a structured interview. We performed comprehensive neuropsychological tests and voxel-based and regions-of-interest (ROIs)-based cortical thickness analysis between PD patients with and without punding.
  
  
  RESULTS
  The prevalence of punding in patients with PD was 5.4%. Punding behaviors were closely related to previous occupations or hobbies and showed a temporal relationship to changes of levodopa-equivalent dose (LED). Significant predisposing factors were a long duration of PD and intake of medications of PD, high total daily LED, dyskinesia, and impulse control disorder. Punding severity was correlated with LED (p = 0.029). The neurocognitive assessment revealed that PD patients with punding showed more severe cognitive deficits in the color Stroop task than did those without punding (p = 0.022). Voxel-based analysis showed that PD-punders had significant cortical thinning in the dorsolateral prefrontal area relative to controls. Additionally, ROI-based analysis revealed that cortical thinning in PD-punders relative to PD-nonpunders was localized in the prefrontal cortices, extending into orbitofrontal area.
  
  
  CONCLUSIONS
  We demonstrated that PD patients with punding performed poorly on cognitive tasks in frontal executive functions and showed severe cortical thinning in the dorsolateral prefrontal and orbitofrontal areas. These findings suggest that prefrontal modulation may be an essential component in the development of punding behavior in patients with PD.
authors.affiliation: Department of Neurology and Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Han Soo
authors.initials: HS
authors.lastname: Yoo
authors.affiliation: Department of Biomedical Engineering, Hanyang University, Seoul, South Korea.
authors.forename: Hyuk Jin
authors.initials: HJ
authors.lastname: Yun
authors.affiliation: Department of Neurology and Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Seok Jong
authors.initials: SJ
authors.lastname: Chung
authors.affiliation: Department of Neurology and Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Mun Kyung
authors.initials: MK
authors.lastname: Sunwoo
authors.affiliation: Department of Biomedical Engineering, Hanyang University, Seoul, South Korea.
authors.forename: Jong-Min
authors.initials: JM
authors.lastname: Lee
authors.affiliation: Department of Neurology and Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Young Ho
authors.initials: YH
authors.lastname: Sohn
authors.affiliation: Department of Neurology and Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea; Severance Biomedical Science Institute, Seoul, South Korea.
authors.forename: Phil Hyu
authors.initials: PH
authors.lastname: Lee
mesh_terms: D000368:Aged; D002540:Cerebral Cortex / Q000473:pathology*; D003072:Cognition Disorders / Q000209:etiology / Q000523:psychology*; D056344:Executive Function / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000150:complications* / Q000523:psychology; D011446:Prospective Studies; D013239:Stereotyped Behavior