title: Behavioural and neuroimaging correlates of impaired self-awareness of hypo- and hyperkinesia in Parkinson's disease.
abstract: Anosognosia or impaired self-awareness of motor symptoms (ISAm) has been rarely investigated in Parkinson's disease (PD). We here studied the relationship between ISAm during periods with and without dopaminergic medication (ON- and OFF-state), and clinical, neuropsychological, and neuroimaging data to further elucidate behavioural aspects and the neurobiological underpinnings of ISAm.
  
  
  
  Thirty-one right-handed, non-demented, non-depressed PD patients were included. ISAm was evaluated using a recently developed scale that assesses awareness of dyskinesia, resting tremor, and bradykinesia. The test was applied during both ON- and OFF-states. Multiple correlation analyses between ISAm and behavioural data were conducted. In addition, imaging of glucose metabolism using 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) was performed to investigate the neural basis of ISAm. A multiple regression approach was applied to investigate metabolism alterations related to ISAm.
  
  
  
  In the OFF-state, higher ISAm was associated with left-sided disease onset, older age, and shorter disease duration. Concerning FDG-PET data, there was a significant negative correlation between higher OFF-state ISAm and decreased glucose metabolism in the right inferior frontal gyrus (IFG). In the ON-state, ISAm was not significantly correlated with clinical or behavioural data. However, there was a significant correlation between higher ISAm and an increased metabolism in the bilateral medial frontal gyrus, left IFG, right superior frontal gyrus and right precentral gyrus.
  
  
  
  The results support the role of the right hemisphere in awareness of motor symptoms in the OFF-state. In the ON-state, dopaminergic medication and dyskinesia influence ISAm and relate to metabolism changes in bilateral frontal regions.
authors.affiliation: Department of Neurology, University Hospital of Cologne, Germany. Electronic address: franziska.maier@uk-koeln.de.
authors.forename: Franziska
authors.initials: F
authors.lastname: Maier
authors.affiliation: Department of Neurology, University Hospital of Cologne, Germany.
authors.forename: Kim L
authors.initials: KL
authors.lastname: Williamson
authors.affiliation: Department of Neurology, University Hospital of Cologne, Germany; Department of Nuclear Medicine, University Hospital Cologne, Cologne, Germany; National Brain Mapping Center, Shahid Beheshti University, General and Medical Campus, Tehran, Iran.
authors.forename: Masoud
authors.initials: M
authors.lastname: Tahmasian
authors.affiliation: Department of Neurology, University Hospital of Cologne, Germany.
authors.forename: Luisa
authors.initials: L
authors.lastname: Rochhausen
authors.affiliation: Department of Neurology, University Hospital of Cologne, Germany.
authors.forename: Anna L
authors.initials: AL
authors.lastname: Ellereit
authors.affiliation: Department of Clinical Neuropsychology, Barrow Neurological Institute, St. Joseph's Hospital & Medical Center, Phoenix, AZ, USA.
authors.forename: George P
authors.initials: GP
authors.lastname: Prigatano
authors.affiliation: Department of Nuclear Medicine, University Hospital Cologne, Cologne, Germany; Max-Planck Institute for Metabolism Research, Cologne, Germany.
authors.forename: Lutz
authors.initials: L
authors.lastname: Kracht
authors.affiliation: Center for Neurosciences, The Feinstein Institute for Medical Research, Manhasset, NY, USA.
authors.forename: Chris C
authors.initials: CC
authors.lastname: Tang
authors.affiliation: Medical Research Council Brain Network Dynamics Unit at the University of Oxford, Oxford, United Kingdom; Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom.
authors.forename: Damian M
authors.initials: DM
authors.lastname: Herz
authors.affiliation: Department of Neurology, University Hospital of Cologne, Germany; Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM3), Research Center Juelich, Germany.
authors.forename: Gereon R
authors.initials: GR
authors.lastname: Fink
authors.affiliation: Department of Neurology, University Hospital of Cologne, Germany.
authors.forename: Lars
authors.initials: L
authors.lastname: Timmermann
authors.affiliation: Department of Neurology, University Hospital of Cologne, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Eggers
mesh_terms: D000368:Aged; D000377:Agnosia / Q000150:complications / Q000000981:diagnostic imaging / Q000523:psychology*; D001364:Awareness; D001921:Brain / Q000000981:diagnostic imaging*; D001931:Brain Mapping; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D006948:Hyperkinesis / Q000150:complications / Q000000981:diagnostic imaging / Q000523:psychology*; D018476:Hypokinesia / Q000150:complications / Q000000981:diagnostic imaging / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000523:psychology*; D049268:Positron-Emission Tomography
chemical_list: D019788:Fluorodeoxyglucose F18
keywords: Anosognosia; Dyskinesia; Neurodegenerative disorder; Parkinson's disease; Self-awareness