Abstract
Impairments in executive functioning are frequently observed in Parkinson's disease (PD). However, executive functioning needed in daily life is difficult to measure. Considering this difficulty the Cognitive Effort Test (CET) was recently developed. In this multi-task test the goals are specified but participants are free in their approach. This study applies the CET in PD patients and investigates whether initiative, planning and multi-tasking are associated with aspects of executive functions and psychomotor speed. Thirty-six PD patients with a mild to moderate disease severity and thirty-four healthy participants were included in this study. PD patients planned and demonstrated more sequential task execution, which was associated with a decreased psychomotor speed. Furthermore, patients with a moderate PD planned to execute fewer tasks at the same time than patients with a mild PD. No differences were found between these groups for multi-tasking. In conclusion, PD patients planned and executed the tasks of the CET sequentially rather than in parallel presumably reflecting a compensation strategy for a decreased psychomotor speed. Furthermore, patients with moderate PD appeared to take their impairments into consideration when planning how to engage the tasks of the test. This compensation could not be detected in patients with mild PD.
Highlights
Motor symptoms are the clinical hallmark of Parkinson’s disease (PD), non-motor symptoms are often present
This study examined and compared patients with mild to moderate PD, since limitations in executive functioning have already been described in early stages of the disease [6]
A more clinical approach which compares the performance of PD patients with published normative data revealed that only a small number of PD patients showed impairments on standard tests of executive functioning and psychomotor speed (Table 4)
Summary
Motor symptoms are the clinical hallmark of Parkinson’s disease (PD), non-motor symptoms are often present. Executive functioning comprises what individuals do, how they do it and whether they do it at all in non-routine situations [7] It can be defined as deliberate planning and regulation in situations in which previously learned behavioral patterns are not sufficient or not available. In patients with PD, impairments of working memory, planning, problem-solving, verbal fluency, cognitive flexibility and generating new rules have repeatedly been reported [9,10,11,12,13,14]. Besides these impairments, patients with PD often show a decreased psychomotor speed or bradyphrenia, which may influence executive functioning in daily life
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