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Hallmark Feature of Cognitive Dysfunction in Parkinson's Disease

Erin Foster, OTD, MSCI, OTR/L

April 4, 2013

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Question

What is the hallmark feature of cognitive dysfunction in clients with Parkinson's Disease without dementia?

Answer

 

Executive dysfunction is considered the hallmark feature of cognitive impairment in Parkinson's disease.  Executive dysfunction means impairment in the cognitive processes that are involved in planning, carrying out, and regulating complex goal-directed behavior.  Executive functions are particularly important when habitual responses or thought processes cannot be used or need to be suppressed.  Executive functions are particularly important for novel situations or context where you cannot rely on habits, procedural memory or even stored knowledge in memory.   Executive functions can also be thought of as higher order cognitive processes that control lower order cognitive functions like memory and sensory perceptual functions.  Your executive functions allow you to organize and coordinate the information stored and/or generated by those lower level functions, and then use them in an efficient way.  Executive functions orchestrate many of our daily occupations particularly more complex activities like instrumental ADLs, social interactions, and leisure pursuits.  These are things that tend to be different every time you do them.  Although you need your whole brain for executive functioning, executive functioning is thought to be mediated primarily by the prefrontal cortex. 

If the primary brain region affected by Parkinson's disease is the basal ganglia, why are these prefrontal mediated functions impaired?  This is because of corticobasal ganglia thalamocortical loops, or the frontostriatal circuitry.  What happens is the basal ganglia receive input from most of the cerebral cortex and then the basal ganglia, in turn, project back out to many frontal lobe regions by the thalamus.  The primary cause of the cognitive impairment that is observed in early non-demented Parkinson's disease is thought to be dysfunction in these frontostriatal circuits due to dopamine depletion in the basal ganglia and also in the prefrontal cortex.  The degeneration of the dopamine neurons in the basal ganglia affects cognitive functioning through its connections with these important prefrontal cortical regions. 


erin foster

Erin Foster, OTD, MSCI, OTR/L

Dr. Foster is an Assistant Professor in Occupational Therapy, Neurology and Psychiatry at Washington University School of Medicine (WUSM).  She received her Doctorate in Occupational Therapy and completed postdoctoral training in clinical neuroscience and cognitive neuropsychology at WUSM. During her postdoctoral fellowship, she was selected for a multi-disciplinary clinical investigation training program and received her Master’s of Science in Clinical Investigation (MSCI) in May 2009. She is a current recipient of an NIH-K23 Career Development Award and several other research grants related to cognitive rehabilitation for individuals with Parkinson disease (PD). Dr. Foster’s primary research focus is on understanding everyday cognitive functioning in PD and its relevance to occupational performance, participation and quality of life. She studies how cognitive dysfunction in PD impacts everyday life and how occupational therapy can best address it. Clinically, Dr. Foster is involved with the Program in Occupational Therapy’s Community and In-Home Services as a consultant for therapists treating clients with PD or related movement disorders.


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