Assessing the Executive Function Deficits of Patients with Parkinson’s Disease

Abstract

The aim of the study was to investigate the utility of the Tower of London-Drexel (TOL ^DX ) in assessing the executive deficits associated with Parkinson’s disease (PD). We sought to determine whether the TOL ^DX would differentiate between (a) patients with PD and healthy control participants (HCP), (b) demented and nondemented patients, and (c) depressed and nondepressed patients. A new TOL ^DX score, stimulus bound, was introduced to assess utilization behaviors. Furthermore, the convergent and divergent validity of the TOL ^DX was examined. The TOL ^DX total move, rule and time violation, and stimulus-bound scores of patients with PD significantly differed from the HCP. Demented and nondemented patients also differed significantly in their TO ^DX performance, with the stimulus-bound score being the most significantly differentiating score. However, the depressed and nondepressed patients did not differ in their TOL ^DX performance. Support was found for the convergent and divergent validity of the TOL ^DX. The clinical and theoretical implications of the findings are discussed.

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References

Archibald, S. J., Mateer, C. A., & Kerns, K. A. (2001). Utilization behavior: Clinical manifestations and neurological mechanisms . Neuropsychology Review, 11, 177-130 .

Baker, S. C., Rogers, R. D., Owen, A. M., Frith, C. D., Dolan, R. J., Frackowiak, R. S. J., et al. (1996). Neural systems engaged by planning: A PET study of the Tower of London task . Neuropsychologia, 34, 515-526 .

Brandt, J., & Benedict, R. H. B. (2001). The Hopkins Verbal Learning Test-Revised: Professional manual. Odessa, FL: Psychological Assessment Resources .

Bublak, P., Muller, U., Gron, G., Reuter, M., & von Cramon, D. Y. (2002). Manipulation of working memory information is impaired in Parkinson’s disease and related to working memory capacity . Neuro-psychology, 16, 577-592 .

Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum .

Crum, R. M., Anthony, J. C., Bassett, S. S., & Folstein, M. F. (1993). Population-based norms for the Mini-Mental State Examination by age and educational level . Journal of the American Medical Association, 269, 2386-2391 .

Culbertson, W. C., Moberg, P., Duda, J., & Stern, M. (2002). The relationship of executive function to the cognitive and adaptive status of Parkinson’s patients (abstract) . Archives of Clinical Neuro-psychology, 17, 721-722 .

Culbertson, W. C., & Zillmer, E. A. (1998a). The construct validity of the Tower of London DX as a measure of the executive functioning of ADHD Children . Assessment, 5(3), 215-226 .

Culbertson, W. C., & Zillmer, E. A. (1998b). The Tower of London DX:A standardized approach to assessing executive function in children . Archives of Clinical Neuropsychology, 13, 285-301 .

10.

Culbertson, W. C., & Zillmer, E. A. (2001). The Tower of London DX (TOL DX) manual. North Tonawanda, NY: Multi-Health Systems .

11.

Delis, D. C., Kaplan, E., & Krammer, J. H. (2001). Delis-Kaplan executive function system. San Antonio, TX: Psychological Corporation .

12.

Duda, J. E., Lee, V. M.-Y., & Trojanowski, J. Q. (2000). The neuropathology of synuclein aggregates: New insights into mechanisms of neurodegenerative diseases . Journal of Neuroscience Research, 61, 121-127 .

13.

Duke, L. A., & Kaszniak, A. W. (2000). Executive control functions in degenerative dementias: A comparative review . Neuropsychology Review, 10, 75-99 .

14.

Elias, J. W., & Treland, J. E. (1999). Executive function in Parkinson’s disease and subcortical disorders . Seminars in Clinical Neuropsychiatry, 4, 34-40 .

15.

Fahn, S., Elton, R., & Members of the UPDRS Development Corporation. (1987). Unified Parkinson’s disease rating scale. In S. Fahn, C. Marsden, D. Calne, & M. Goldstein (Eds.), Recent development in Parkinson’s disease (Vol. 2, pp. 153-164). Floraham Park, NJ: MacMillan Healthcare Information .

16.

Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). Mini-Mental state: Apractical method for grading the cognitive state of patients for the clinician . Journal of Psychiatric Research, 12, 189-198 .

17.

Freedman, M., Leach, L., Kaplan, E., Winocur, G., Shulman, K. I., & Delis, D. C. (1994). Clock drawing: A neuropsychological analysis. New York: Oxford University Press .

18.

Fuster, J. M. (1997). The prefrontal cortex: Anatomy, physiology, and neuropsychology of the frontal lobe (3rd ed.). New York: Lippincott-Raven .

19.

Gabrieli, J. D. E., Stebbins, G. T., Goetz, C. G., & Singh, J. (1996). Reduced working memory span in Parkinson’s disease: Evidence for the role of a frontostriatal system in working and strategic memory . Neuropsychology, 10, 322-332 .

20.

Gauntlett-Gilbert, J., Roberts, R. C., & Brown, V. J. (1999). Mechanisms underlying attentional set-shifting in Parkinson’s disease . Neuropsychologia, 37, 605-616 .

21.

Gelb, D. J., Oliver, E., & Gilman, S. (1999). Diagnostic criteria for Parkinson’s disease . Archives of Neurology, 56, 33-39 .

22.

George, M. S., Ketter, T. A., Parekh, P. I., Rosinsky, N., Ring, H. A., Pazzaglia, P. J., et al. (1997). Blunted left cingulate activation in mood disorder subjects during a response interference task (the Stroop) . Journal of Neuropsychiatry and Clinical Neurosciences, 9, 55-63 .

23.

Golden, C. (1994). The Stroop Color and Word Test. Wood Dale, IL: Stoelting .

24.

Grodzinsky, G. M., & Diamond, R. (1992). Frontal lobe functioning in boys with attention-deficit hyperactivity disorder . Developmental Neuropsychology, 8, 427-445 .

25.

Heaton, R. K., Chelune, G. J., Talley, J. L., Kay, G. G., & Curtis, G. (1993). Wisconsin Card Sorting Test manual: Revised and expanded. Odessa, FL: Psychological Assessment Resources .

26.

Hoehn, M. M., & Yahr, M. D. (1967). Parkinsonism: Onset, progression, and mortality . Neurology, 17, 427-442 .

27.

Ketter, T. A., George, M. S., Kimbrell, T. A., Benson, B. E., & Post, R. M. (1996). Functional brain imaging, limbic function, and affective disorders . The Neuroscientist, 2, 55-65 .

28.

Knight, R. T., & Grabowecky, M. (1995). Escape from linear time: Pre-frontal cortex and conscious experience. In M. S. Gazzaniga (Ed.), The cognitive neurosciences (pp. 1357-1371). Cambridge, MA: MIT Press .

29.

Knight, R. T., & Stuss, D. T. (2002). Prefrontal cortex: The present and the future. In D. T. Stuss & R. T. Knight (Eds.), Principles of frontal lobe function (pp. 573-597). New York: Oxford University Press .

30.

Lamar, M., Zonderman, A. B., & Resnick, S. (2002). Contribution of specific cognitive processes to executive functioning in an aging population . Neuropsychology, 16, 156-162 .

31.

Levin, H. S., Fletcher, J. M., Kufera, J. A., Harward, H., Lilly, M. A., Mendelsohn, D., et al. (1996). Dimensions of cognition measured by the Tower of London and other cognitive tasks in head-injured children and adolescents . Developmental Neuropsychology, 12, 17-34 .

32.

Lezak, M. D. (1995). Neuropsychological assessment (3rd ed.). New York: Oxford University Press .

33.

Libon, D. J., Malamut, B. L., Swenson, R., Sands, L. P., & Cloud, B. S. (1996). Further analyses of clock drawings among demented and nondemented older subjects . Archives of Clinical Neuropsychology, 11, 193-205 .

34.

Libon, D. J., Swenson, R. A., Barnoski, E. J., & Sands, L. P. (1993). Clock drawing as an assessment tool for dementia . Archives of Clinical Neuropsychology, 8, 405-415 .

35.

Lichter, D. G. (2001). Movement disorders and frontal-subcortical circuits. In D. G. Lichter & J. L. Cummings (Eds.), Frontal-subcortical circuits in psychiatric and neurological disorders (pp. 260-313). New York: Guilford .

36.

Mayberg, H. (2001). Depression and frontal-subcortical circuits: Focus on prefrontal-limbic interactions. In D. G. Lichter & J. L. Cummings (Eds.), Frontal-subcortical circuits in psychiatric and neurological disorders (pp. 177-206). New York: Guilford .

37.

Mayberg, H. S., Mahurin, R. K., Brannan, S. K., Glass, T. G., Solomon, D., New, P., et al. (1995). Parkinson’s depression: Discrimination of mood-sensitive and mood-insensitive cognitive deficits using fluoxetine and FDG PET . Neurology, 45, A166 .

38.

Mesulam, M. M. (2002). Principles of behavioral and cognitive neurology (2nd ed.). New York: Oxford University Press .

39.

Nelson, H. E., & Willison, J. (1991). National Adult Reading Test (NART): Test manual (2nd ed.). Windsor, UK: NFER Nelson .

40.

Nolan, K. A., & Mohs, R. C. (1994). Screening for dementia in family practice. In R. W. Richter & J. P. Blass (Eds.), Alzheimer’s disease: A guide to practical management, Part II (pp. 81-95). St. Louis, MO: Mosby .

41.

Owen, A. M. (1997). Cognitive planning in humans: Neuropsychological, neuroanatomical and neuropharmacological perspectives . Progress in Neurobiology, 53, 431-450 .

42.

Postle, B. R., Jonides, J., Smith, E. E., Corkin, S, & Growdon, J. H. (1997). Spatial, but not object, delayed response is impaired in early Parkinson’s disease . Neuropsychology, 11, 171-179 .

43.

Rainville, C., Amieva, H., Lafont, S., Dartigues, J., & Fabrigoule, C. (2002). Executive function deficits in patients with dementia of the Alzheimer’s type: A study with a Tower of London task . Archives of Clinical Neuropsychology, 17, 513-530 .

44.

Ravnkilde, B., Videbech, P., Rosenberg, R., Gjedde, A., & Gade, A. (2002). Putative tests of frontal lobe function: A PET-study of brain activation during Stroop’s test and verbal fluency . Journal of Clinical and Experimental Neuropsychology, 24, 534-547 .

45.

Reitan, R. (1992). Trail Making Test: Manual for administration and scoring. Tucson, AZ: Reitan Neuropsychological Laboratory .

46.

Royall, D. R. (1999). Frontal systems impairment in major depression . Seminars in Clinical Neuropsychiatry, 4, 13-23 .

47.

Salmon, D. P., Heindel, W. C., & Hamilton, J. M. (2001). Cognitive abilities mediated by frontal-subcortical circuits. In D. G. Lichter & J. L. Cummings (Eds.), Frontal-subcortical circuits in psychiatric and neurological disorders (pp. 114-150). New York: Guilford .

48.

Sano, M., Marder, K., & Dooneief, G. (1996). Basal ganglia disease. In B. S. Fogel, R. B. Schiffer, & S. M. Rao (Eds.), Neuropsychiatry (pp. 805-826). Baltimore: Williams & Williams .

49.

Shallice, T. (1982). Specific impairments of planning . Philosophical Transactions of the Royal Society of London, B 298, 199-209 .

50.

Sheikh, J. L., & Yesavage, J. A. (1986). Geriatric Depression Scale (GDS): Recent evidence and development of a shorter version. In T. L. Brink (Ed.), Clinical gerontology: A guide to assessment and intervention (pp. 165-173). New York: Haworth .

51.

Soukup, V. M., & Adams, R. L. (1996). Parkinson’s disease. In R. L. Adams, O. A. Parsons, J. L. Culbertson, & S. J. Nixon (Eds.), Neuropsychology for clinical practice: Etiology, assessment, and treatment of common neurological disorders (pp. 243-267). Washington, DC: American Psychological Association .

52.

SPSS. (1999). SPSS for Windows (Version 10.0) [Computer software]. Chicago: Author .

53.

Starkstein, S. E., & Merello, M. (2002). Psychiatric and cognitive disorders in Parkinson’s disease. New York: Cambridge University Press .

54.

Stroop, J. R. (1935). Studies of interference in serial verbal reactions . Journal of Experimental Psychology, 18, 643-662 .

55.

Taylor, S. F., Kornblum, S., Lauber, E. J., Minoshima, S., & Koeppe, R. A. (1997). Isolation of specific interference processing in the Stroop task: PET activation studies . NeuroImage, 6, 81-92 .

56.

Tröster, A. I. (1998). Assessment of movement and demyelinating disorders. In P. J. Snyder & P. D. Nussbaum (Eds.), Clinical neuropsychology: A pocket handbook for assessment (pp. 266-303). Washington, DC: American Psychological Association .

57.

Victor, M., & Ropper, A. H. (2001). Adams and Victor’s principles of neurology (7th ed.). New York: McGraw-Hill .

58.

Watkins, L. H. A., Rogers, R. D., Lawrence, A. D., Sahakian, B. J., Rosser, A. E., & Robbins, T. W. (2000). Impaired planning but intact decision making in early Huntington’s disease: Implications for specific fronto-striatal pathology . Neuropsychologia, 38, 1112-1125 .

59.

Wechsler, D. (1981). Manual for the Wechsler Adult Intelligence Scale-Revised. New York: Psychological Corporation .

60.

West, R., Ergis, A. M., Winocur, G., & Saint-Cyr, J. (1998). The contributions of impaired working memory monitoring to performance of the self-ordered pointing task in normal aging and Parkinson’s disease . Neuropsychology, 12, 546-554 .

61.

White, R. F., Au, R., Durso, R., & Moss, M. B. (1992). Neuropsychological function in Parkinson’s disease. In R. F. White (Ed.), Clinical syndromes in adult neuropsychology: The practitioner’s handbook (pp. 253-286). New York: Elsevier Science .

62.

Yesavage, J. A., Brink, T. L., Rose, T. L., Lum, O., Huang, V., Adey, M. B., et al. (1983). Development and validation of a geriatric depression screening scale: A preliminary report . Journal of Psychiatric Research, 17, 37-49 .

63.

Zakzanis, K. K., & Freedman, M. (1999). A neuropsychological comparison of demented and nondemented patients with Parkinson’s disease . Applied Neuropsychology, 6, 129-146 .