Anxiety, Depression, and Apathy as Predictors of Cognitive Decline in Patients With Parkinson's Disease-A Three-Year Follow-Up Study.

OBJECTIVE: Anxiety, depression, and apathy are the most common neuropsychiatric symptoms in Parkinson's disease (PD) patients. They impair cognitive functioning and have a profound impact on quality of life. This follow-up study aims to investigate the predictive value of anxiety, depression, and apathy on the development of Mild Cognitive Impairment (MCI) in PD patients. METHODS: Twenty-nine cognitively unimpaired PD patients (mean age 68.2 SD ± 7.12 years; 13 women) participated in this study. At Baseline (BL) levels of apathy (Apathy Evaluation Scale, AES), depression (Beck Depression Inventory, BDI-II), and anxiety (Beck Anxiety Inventory, BAI), were assessed. Cognitive status was reassessed three years later according to MCI/non-MCI status. For statistics, we used binary logistic regression and receiver operating characteristic curve (ROC) analysis to examine anxiety, apathy, and depression at BL as a predictor of MCI status three years later. RESULTS: Eight of the 29 patients developed MCI. Anxiety level at BL was found to predict MCI status at three-year follow-up (OR = 1.20, CI = 1.02-1.41, p = 0.02), while depression (OR = 1.16, CI = 0.93-1.47, p = 0.20) and apathy (OR = 1.06, CI = 0.92-1.23, p = 0.40) did not predict MCI status. The area under the ROC curve (AUC) of BAI for discriminating PD-non-MCI from PD-MCI was 0.79 (CI = 0.61-0.98). The optimal classification threshold yielded a sensitivity of 75.0 % and a specificity of 76.2 %. Neither apathy nor depression at BL discriminated between PD-non-MCI patients from PD-MCI three years later. CONCLUSIONS: This study shows an association between anxiety and the development of MCI in PD patients, although the association between apathy, depression, and MCI did not reach a significant level.

Does Quantitative Electroencephalography Refine Preoperative Cognitive Assessment in Parkinson's Disease Patients Treated with Deep Brain Stimulation? A Follow-Up Study.

OBJECTIVE: Deep brain stimulation (DBS) in Parkinson's disease (PD) is associated with an increased risk of post-operative cognitive deterioration. Preoperative neuropsychological testing can be affected and limited by the patient's collaboration in advanced disease. The purpose of this study was to determine whether preoperative quantitative electroencephalography (qEEG) may be a useful complementary examination technique during preoperative assessment to predict cognitive changes in PD patients treated with DBS. METHODS: We compared the cognitive performance of 16 PD patients who underwent bilateral subthalamic nucleus DBS to the performance of 15 PD controls (matched for age, sex, and education) at baseline and at 24 months. Cognitive scores were calculated for all patients across 5 domains. A preoperative 256-channel resting EEG was recorded from each patient. We computed the global relative power spectra. Correlation and linear regression models were used to assess associations of preoperative EEG measures with post-operative cognitive scores. RESULTS: Slow waves (relative delta and theta band power) were negatively correlated with post-operative cognitive performance, while faster waves (alpha 1) were strongly positively correlated with the same scores (the overall cognitive score, attention, and executive function). Linear models revealed an association of delta power with the overall cognitive score (p = 0.00409, adjusted R2 = 0.6341). Verbal fluency (VF) showed a significant decline after DBS surgery, which was correlated with qEEG measures. CONCLUSIONS: To analyse the side effects after DBS in PD patients, the most important parameter is verbal fluency capacity. In addition, correlation with EEG frequency bands might be useful to detect particularly vulnerable patients for cognitive impairment and be supportive in the selection process of patients considered for DBS.

Valence-Dependent Coupling of Prefrontal-Amygdala Effective Connectivity during Facial Affect Processing.

Despite the importance of the prefrontal-amygdala (AMY) network for emotion processing, valence-dependent coupling within this network remains elusive. In this study, we assessed the effect of emotional valence on brain activity and effective connectivity. We tested which functional pathways within the prefrontal-AMY network are specifically engaged during the processing of emotional valence. Thirty-three healthy adults were examined with functional magnetic resonance imaging while performing a dynamic faces and dynamic shapes matching task. The valence of the facial expressions varied systematically between positive, negative, and neutral across the task. Functional contrasts determined core areas of the emotion processing circuitry, comprising the medial prefrontal cortex (MPFC), the right lateral prefrontal cortex (LPFC), the AMY, and the right fusiform face area (FFA). Dynamic causal modelling demonstrated that the bidirectional coupling within the prefrontal-AMY circuitry is modulated by emotional valence. Additionally, Bayesian model averaging showed significant bottom-up connectivity from the AMY to the MPFC during negative and neutral, but not positive, valence. Thus, our study provides strong evidence for alterations of bottom-up coupling within the prefrontal-AMY network as a function of emotional valence. Thereby our results not only advance the understanding of the human prefrontal-AMY circuitry in varying valence context, but, moreover, provide a model to examine mechanisms of valence-sensitive emotional dysregulation in neuropsychiatric disorders.

Emotions experienced during the shedding of the first primary tooth.

AIM: To examine the different emotions expressed by children exfoliating their first primary tooth, evaluate their proportional distribution, and reveal possible influences of child- and parent-related variables on the reported emotions. DESIGN: A cross-sectional questionnaire was directed to parents of children who had recently shed at least one primary tooth. Primary outcome variables were the child's emotions at the time of exfoliation. Child-related determinants were sex, duration of tooth wiggle, previous accident- or caries-related visits at dentist, and having witnessed tooth exfoliation in older siblings. Parent-related determinants included socio-economic variables (education, religion, country of origin). RESULTS: One thousand two hundred and seventy-four of 3617 questionnaires were returned and analysed (35.2%). 82.0% of the parents reported positive, and 22.0% negative emotions in their child. Previous caries-related visits at the dentist diminished the likelihood of positive emotions (OR = 0.65), and accident-related visits increased the odds of positive emotions (OR = 1.57), as did an extended duration of tooth wiggle (OR = 1.98). Higher education of mothers (OR = 2.89) and fathers (OR = 1.96) and an origin from non-Western countries (OR = 2.56 and OR = 1.85, respectively) were also related to positive emotions. CONCLUSIONS: For most children, losing the first primary tooth is associated with positive emotions. Dental visits and parental factors influence these emotions. Parents and dentists should be aware of their impact on children's emotional development.