Self-perceived stigma in Parkinson's Disease in an online sample: Comparison with in-person sample, role of anxiety, and relative utility of four measures of stigma perception.

OBJECTIVE: Persons with Parkinson's disease (PwPD) experience motor and non-motor symptoms that may elicit stigmatization. We investigated whether online assessment would replicate in-person findings of younger age and depression as predictors of stigma perception. We further assessed the predictive value of anxiety, and compared predictors across four stigma measures. METHODS: The online study (n = 347), like the earlier in-person study (n = 362), used the Parkinson's Disease Questionnaire stigma subscale (PDQ-39stigma). It also assessed anxiety and added the Stigma Scale for Chronic Illness (SSCI), Stigmatization Scale, and Mental Health Consumers' Experience of Stigma Scale. We correlated stigma perception scores with demographic/clinical characteristics and conducted hierarchical regression and mediation analyses. RESULTS: Online and in-person predictors of stigma perception with the PDQ-39stigma included younger age (men) and depression (men, women). Depression mediated the relation between stigma perception and motor experiences of daily living (EDLs). In the online sample, when anxiety was added, it predicted stigma perception (PDQ-39stigma, SSCI) and mediated the relation between stigma and both motor and non-motor EDLs (PDQ-39stigma). For all four stigma-perception scales, younger age predicted scores. Multiple additional predictors of PDQ-39stigma and SSCI scores suggest their utility relative to the other two scales. Conclusions: Younger age and depression predicted self-perceived stigma in online and in-person samples, indicating the cross-modal utility of the measure, PDQ-39stigma. In the online sample, anxiety also predicted stigma perception per the PDQ-39stigma and SSCI. We recommend both measures and note that treating depression and anxiety may be important especially in younger PwPD to reduce self-perceived stigma.

Discordance between Reports of Internalized Symptoms in Persons with Parkinson's Disease and Informants: Results from an Online Survey.

BACKGROUND: Self-report of motor and non-motor symptoms is integral to understanding daily challenges of persons with Parkinson's disease (PwPD). Care partners are often asked to serve as informants regarding symptom severity, raising the question of concordance with PwPD self-reports, especially regarding internalized (not outwardly visible) symptoms. OBJECTIVES: Concordance between PwPD and informant ratings of motor and non-motor symptoms was evaluated across multiple domains. METHODS: In 60 PwPD-informant pairs, we compared ratings on 11 online self-report measures comprising 33 total scores, 2/3 of which represented purely internalized symptoms. For discordant scores, multiple regression analyses were used to examine demographic/clinical predictors. RESULTS: Though concordant on 85% of measures, PwPD endorsed more non-motor symptoms, bodily discomfort, stigma, and motor symptoms than informants. For PwPD, younger age, greater disease severity, and female gender predicted discordance. CONCLUSIONS: Discordance between PwPD and informants on measures assessing symptoms that cannot be outwardly observed may require targeted education.

Associations of category fluency clustering performance with in vivo brain pathology in autosomal dominant Alzheimer's disease.

OBJECTIVES: Alzheimer's disease (AD) is known to impact semantic access, which is frequently evaluated using the Category Fluency (Animals) test. Recent studies have suggested that in addition to overall category fluency scores (total number of words produced over time), poor clustering could signal AD-related cognitive difficulties. In this study, we examined the association between category fluency clustering performance (i.e., stating words sequentially that are all contained within a subcategory, such as domestic animals) and brain pathology in individuals with autosomal dominant Alzheimer's disease (ADAD). METHODS: A total of 29 non-demented carriers of the Presenilin1 E280A ADAD mutation and 32 noncarrier family members completed the category fluency test (Animals) and the Mini-Mental State Examination (MMSE). The participants also underwent positron emission tomography (PET) scans to evaluate in vivo amyloid-beta in the neocortex and tau in medial temporal lobe regions. Differences between carriers and noncarriers on cognitive tests were assessed with Mann-Whitney tests; associations between cognitive test performance and brain pathology were assessed with Spearman correlations. RESULTS: Animal fluency scores did not differ between carriers and noncarriers. Carriers, however, showed a stronger association between animal fluency clustering and in vivo AD brain pathology (neocortical amyloid and entorhinal tau) relative to noncarriers. CONCLUSION: This study indicates that using category fluency clustering, but not total score, is related to AD pathophysiology in the preclinical and early stages of the disease.

Equal Prevalence of Depression in Men and Women with Parkinson's Disease Revealed by Online Assessment.

OBJECTIVE: Identifying persons needing mental health services is hampered by stigma-related underreporting of symptoms, especially by men. Men with Parkinson's disease (PD) consistently report lower rates of depression than women in in-person studies. We predicted that online anonymity would elicit more gender-based parity in depression endorsement. METHOD: We administered the Beck Depression Inventory-II (BDI-II) online to 344 participants with PD (52% women). Depression was defined as BDI-II score >13 and/or use of antidepressant medications. RESULTS: Overall depression prevalence was consistent with in-person studies, but with no significant difference between men and women. CONCLUSIONS: Online methods may circumvent barriers to depression identification in men with PD.

Side of motor symptom onset predicts sustained attention deficits and motor improvements after attention training in Parkinson's disease.

OBJECTIVE: Parkinson's disease (PD) side of motor symptom onset has been associated with distinct cognitive deficits; individuals with left-side onset (LPD) show more visuospatial impairments, whereas those with right-side onset (RPD) show more verbal impairments. Non-spatial attention is a critical cognitive ability associated with motor functioning that is right hemisphere lateralized but has not been characterized with regard to PD side of onset. We compared individuals with LPD and RPD on non-spatial attention tasks and examined differential responses to a 4-week sustained attention training program. METHOD: Participants included 9 with LPD and 12 with RPD, who performed both brief and extended go/no-go continuous performance tasks and an attentional blink task. Participants also engaged in an at-home sustained attention training program, Tonic and Phasic Alertness Training (TAPAT), 5 days/week for 4 weeks. We assessed cognitive and motor symptoms before and after training, and after a 4-week no-contact period. RESULTS: At baseline, participants with LPD exhibited worse performance than those with RPD on the extended continuous performance task, indicating specific deficits in sustaining attention. Poorer attention was associated with worse clinical motor scores. Notably, side of onset had a significant effect on clinical motor changes after sustained attention training, with only LPD participants improving after training, and 4/9 showing clinically meaningful improvements. CONCLUSIONS: Compared to RPD, participants with LPD had poorer sustained attention pre-training and were more likely to improve on clinical motor functioning after sustained attention training. These findings support mechanistic differences between LPD and RPD and suggest potential differential treatment approaches.

Changes in Apathy, Depression, and Anxiety in Parkinson's Disease from before to during the COVID-19 Era.

Apathy, depression, and anxiety are common non-motor symptoms of Parkinson's disease (PD). Tracking the changes in such symptoms over time would be valuable not only to determine their natural course during the disease, but also to establish the effects of unusual historical events interacting with the natural course. Having collected data on apathy (Apathy Scale), depression (Beck Depression Inventory-II), and anxiety (Parkinson's Anxiety Scale) in a large sample of persons with PD (PwPD) before the beginning of the COVID-19 era, we followed up with these individuals to investigate the changes in their prevalence of apathy, depression, and anxiety across two timepoints (T1 and T2). Of the original 347 participants, 111 responded and provided complete data at T2. The data collection at T1, before COVID-19, occurred between 2017-2018. The data collection at T2 occurred in 2021 and included the same measures, with the addition of the Coronavirus Impact Scale to assess the effects of the pandemic on the individual participants. Over this period, there was a significant increase in apathy, but not in depression or anxiety. Anxiety and depression, but not apathy, were correlated with the impact of COVID-19.

Telehealth Transdiagnostic Cognitive Behavioral Therapy for Depression in Parkinson's Disease: A Pilot Randomized Controlled Trial.

Background: Cognitive behavioral therapy (CBT) is an effective treatment for depression in persons with Parkinson's disease (PwPD), but there are significant barriers preventing PwPD from receiving care in person. Telehealth CBT circumvents many of these barriers. Objectives: We conducted a pilot randomized controlled trial evaluating the efficacy, feasibility, and acceptability of telehealth transdiagnostic CBT intervention for depression in PwPD. Methods: Twelve PwPD with Major Depressive Disorder were enrolled, half randomly assigned to the treatment-immediate condition (TI) and half to the waitlist control condition (WLC). TI and WLC participants received 12 CBT sessions and assessments before treatment, immediately after treatment, and at the 6-week follow-up. Results: The intervention was efficacious for treating depression in PwPD, with secondary benefits to anxiety, apathy, learning, memory, and quality of life. Improvements were largely maintained at follow-up. The intervention was highly feasible and acceptable. Conclusions: Telehealth transdiagnostic CBT was an effective intervention for PwPD with depression.

Perceived stigma and quality of life in Parkinson's disease with additional health conditions.

Background: Parkinson's disease (PD) is associated with perceived stigma and affects quality of life (QoL). Additional health conditions may influence these consequences of PD. Aims: This study assessed the impact of health conditions on perceived stigma and QoL in persons with PD. We hypothesised that individuals with more health conditions would report more stigma and poorer QoL. We also examined the contributions of demographic and clinical characteristics to the correlations between health conditions and perceived stigma/QoL. Methods: We identified 196 eligible participants from the Boston University Online Survey Study of Parkinson's Disease and examined their health history, performance on multiple stigma measures, and scores on the 39-item Parkinson's Disease Questionnaire assessing QoL. Results: At least one health condition was reported by 79% of the sample, with a median of 2 and a range of 0-7 health conditions. More perceived stigma and poorer QoL were associated with thyroid disease, depression, anxiety, and the total number of health conditions. These correlations were related to younger age, less education, and earlier disease onset. Other health conditions (high blood pressure, back/leg surgery, headache, cancer/tumours, and heart disease) were not significantly correlated with stigma or QoL. Conclusions: Having more health conditions, or thyroid disease, depression, or anxiety, was associated with more perceived stigma and poorer QoL, with younger age, less education, and earlier disease onset affecting the associations. It is important to consider the burden of health conditions and how they affect persons with PD with specific clinical characteristics.

Smartphone-Based Neuropsychological Assessment in Parkinson's Disease: Feasibility, Validity, and Contextually Driven Variability in Cognition.

OBJECTIVES: The prevalence of neurodegenerative disorders demands methods of accessible assessment that reliably captures cognition in daily life contexts. We investigated the feasibility of smartphone cognitive assessment in people with Parkinson's disease (PD), who may have cognitive impairment in addition to motor-related problems that limit attending in-person clinics. We examined how daily-life factors predicted smartphone cognitive performance and examined the convergent validity of smartphone assessment with traditional neuropsychological tests. METHODS: Twenty-seven nondemented individuals with mild-moderate PD attended one in-lab session and responded to smartphone notifications over 10 days. The smartphone app queried participants 5x/day about their location, mood, alertness, exercise, and medication state and administered mobile games of working memory and executive function. RESULTS: Response rate to prompts was high, demonstrating feasibility of the approach. Between-subject reliability was high on both cognitive games. Within-subject variability was higher for working memory than executive function. Strong convergent validity was seen between traditional tests and smartphone working memory but not executive function, reflecting the latter's ceiling effects. Participants performed better on mobile working memory tasks when at home and after recent exercise. Less self-reported daytime sleepiness and lower PD symptom burden predicted a stronger association between later time of day and higher smartphone test performance. CONCLUSIONS: These findings support feasibility and validity of repeat smartphone assessments of cognition and provide preliminary evidence of the effects of context on cognitive variability in PD. Further development of this accessible assessment method could increase sensitivity and specificity regarding daily cognitive dysfunction for PD and other clinical populations.

Telehealth cognitive behavioral therapy for depression in Parkinson's disease: A case study.

Parkinson's disease (PD) is characterized as a motor disorder, but the majority of individuals with PD also suffer from nonmotor symptoms, including mental health difficulties, such as depression, anxiety, and apathy, as well as decreased cognitive function, daily function, sleep quality, and quality of life. Cognitive behavioral therapy (CBT) is an effective treatment for depression in PD, but motor disability, work schedule, transportation issues, and care partner burden may cause difficulty in attending weekly face-to-face therapy sessions. A promising avenue in the delivery of CBT is telehealth. CBT administered live via videoconference technology may circumvent many of the barriers that prevent those with PD from receiving treatment. This case study evaluates the preliminary efficacy, feasibility, and acceptability of 12-week telehealth CBT for depression in PD. CBT administered via telehealth was feasible, acceptable, and efficacious for a study participant with PD and major depressive disorder. In addition to effectively treating depression, the telehealth intervention improved quality of life and aspects of cognitive functioning, as well as symptoms of anxiety, apathy, and subjective cognitive impairment, all of which are prevalent nonmotor symptoms of PD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Initial investigation of test-retest reliability of home-to-home teleneuropsychological assessment in healthy, English-speaking adults.

Prior teleneuropsychological research has assessed the reliability between in-person and remote administration of cognitive assessments. Few, if any, studies have examined the test-retest reliability of cognitive assessments conducted in sequential clinic-to-home or home-to-home teleneuropsychological evaluations - a critical issue given the state of clinical practice during the COVID-19 pandemic. This study examined this key psychometric question for several cognitive tests administered over repeated videoconferencing visits 4-6 months apart in a sample of healthy English-speaking adults.A total of 44 participants (ages 18-75) completed baseline and follow-up cognitive testing 4-6 months apart. Testing was conducted in a home-to-home setting over HIPAA-compliant videoconferencing meetings on participants' audio-visual enabled laptop or desktop computers. The following measures were repeated at both virtual visits: the Controlled Oral Word Association Test (FAS), Category Fluency (Animals), and Digit Span Forward and Backward from the Wechsler Adult Intelligence Scale, Fourth Edition. Intraclass correlation coefficients (ICC), Pearson correlations, root mean square difference (RMSD), and concordance correlation coefficients (CCC) were calculated as test-retest reliability metrics, and practice effects were assessed using paired-samples t-tests.Some tests exhibited small practice effects, and test-retest reliability was marginal or worse for all measures except FAS, which had adequate reliability (based on ICC and r). Reliability estimates with RMSD suggested that change within +/- 1 SD on these measures may reflect typical test-retest variability.The included cognitive measures exhibited questionable reliability over repeated home-to-home videoconferencing evaluations. Future teleneuropsychology test-retest reliability research is needed with larger, more diverse samples and in clinical populations.

Towards Neuroscience of the Everyday World (NEW) using functional Near-Infrared Spectroscopy.

Functional Near-Infrared Spectroscopy (fNIRS) assesses human brain activity by noninvasively measuring changes of cerebral hemoglobin concentrations caused by modulation of neuronal activity. Recent progress in signal processing and advances in system design, such as miniaturization, wearability and system sensitivity, have strengthened fNIRS as a viable and cost-effective complement to functional Magnetic Resonance Imaging (fMRI), expanding the repertoire of experimental studies that can be performed by the neuroscience community. The availability of fNIRS and Electroencephalography (EEG) for routine, increasingly unconstrained, and mobile brain imaging is leading towards a new domain that we term "Neuroscience of the Everyday World" (NEW). In this light, we review recent advances in hardware, study design and signal processing, and discuss challenges and future directions towards achieving NEW.

Increasing Contrast Improves Object Perception in Parkinson's Disease with Visual Hallucinations.

BACKGROUND: Deficits in basic vision are associated with visual hallucinations in Parkinson's disease. Of particular interest is contrast sensitivity loss in this disorder and its effect on object identification. OBJECTIVES: Evaluate whether increased contrast improves object perception in persons with Parkinson's disease and visual hallucinations, without dementia. METHODS: We assessed 26 individuals with mild to moderate idiopathic Parkinson's disease, half of whom reported one or more episodes of hallucinations/unusual perceptual experiences in the past month, with a letter-identification task that determined the contrast level required to achieve 80% accuracy. Contrast sensitivity was further assessed with a chart that presented stimuli at multiple spatial frequencies. The groups were closely matched for demographic and clinical characteristics except for experience of hallucinations. RESULTS: Relative to participants without visual hallucinations, those with hallucinations had poorer spatial frequency contrast sensitivity and required significantly greater contrast to correctly identify the letters on the identification task. Specifically, participants with hallucinations required a mean contrast of 52.8%, whereas participants without hallucinations required 35.0%. When given sufficient contrast, the groups with and without hallucinations were equally accurate in letter identification. CONCLUSIONS: Compared to those without hallucinations, individuals with Parkinson's disease and hallucinations without dementia showed poorer contrast sensitivity. Once contrast was individually enhanced, the groups were equally accurate at object identification. These findings suggest the potential of visual perception tests to predict, and perception-based interventions to reduce, hallucinations in Parkinson's disease.

Retinal Imaging Findings in Carriers With PSEN1-Associated Early-Onset Familial Alzheimer Disease Before Onset of Cognitive Symptoms.

Importance: Individuals with autosomal dominant mutations for Alzheimer disease are valuable in determining biomarkers present prior to the onset of cognitive decline, improving the ability to diagnose Alzheimer disease as early as possible. Optical coherence tomography (OCT) has surfaced as a potential noninvasive technique capable of analyzing central nervous system tissues for biomarkers of Alzheimer disease. Objective: To evaluate whether OCT can detect early retinal alterations in carriers of the presenilin 1 (PSEN1 [OMIM 104311]) E280A mutation who are cognitively unimpaired. Design, Setting, and Participants: A cross-sectional imaging study conducted from July 13, 2015, to September 16, 2020, included 10 carriers of the PSEN1 E280A mutation who were cognitively unimpaired and 10 healthy noncarrier family members, all leveraged from a homogenous Colombian kindred. Statistical analysis was conducted from September 9, 2017, to September 16, 2020. Main Outcomes and Measures: Mixed-effects multiple linear regression was performed to compare the thickness values of the whole retina and individual retinal layers on OCT scans between mutation carriers and noncarriers. Simple linear-effects and mixed-effects multiple linear regression models were used to assess whether age was an effect modifier for PSEN1 mutation of amyloid ß levels and retinal thickness, respectively. Fundus photographs were used to compare the number of arterial and venous branch points, arterial and venous tortuosity, and fractal dimension. Results: This study included 10 carriers of the PSEN1 E280A mutation who were cognitively unimpaired (7 women [70%]; mean [SD] age, 36.3 [8.1] years) and 10 healthy noncarrier family members (7 women [70%]; mean [SD] age, 36.4 [8.2] years). Compared with noncarrier controls, PSEN1 mutation carriers who were cognitively unimpaired had a generalized decrease in thickness of the whole retina as well as individual layers detected on OCT scans, with the inner nuclear layer (outer superior quadrant, ß = -3.06; P = .007; outer inferior quadrant, ß = -2.60; P = .02), outer plexiform layer (outer superior quadrant, ß = -3.44; P = .03), and outer nuclear layer (central quadrant, ß = -8.61; P = .03; inner nasal quadrant, ß = -8.39; P = .04; inner temporal quadrant, ß = -9.39; P = .02) showing the greatest amount of statistically significant thinning. Age was a significant effect modifier for the association between PSEN1 mutation and amyloid ß levels in cortical regions (ß = 0.03; P = .001) but not for the association between PSEN1 mutation and retinal thickness. No statistical difference was detected in any of the vascular parameters studied. Conclusions and Relevance: These findings suggest that OCT can detect functional and morphologic changes in the retina of carriers of familial Alzheimer disease who are cognitively unimpaired several years before clinical onset, suggesting that OCT findings and retinal vascular parameters may be biomarkers prior to the onset of cognitive decline.

Cognitive-Behavioral Therapy for Anxiety in Parkinson's Disease.

Parkinson's disease (PD) is characterized by motor symptoms, but nonmotor symptoms also significantly impair daily functioning and reduce quality of life. Anxiety is prevalent and debilitating in PD, but remains understudied and undertreated. Much affective research in PD focuses on depression rather than anxiety, and as such, there are no evidence-based treatments for anxiety in this population. Cognitive-behavioral therapy (CBT) has shown promise for treating depression in PD and may be efficacious for anxiety. This exploratory study implemented a multiple-baseline single-case experimental design to evaluate the utility and feasibility of CBT for individuals with PD who also met criteria for a DSM-5 anxiety disorder (n = 9). Participants were randomized to a 2-, 4-, or 6-week baseline phase, followed by 12 CBT sessions, and two post treatment assessments (immediately post treatment and 6-week follow-up). Multiple outcome measures of anxiety and depression were administered weekly during baseline and intervention. Weekly CBT sessions were conducted in-person (n = 5) or via secure videoconferencing (n = 4). At post treatment, seven of the nine participants showed significant reductions in anxiety and/or depression, with changes functionally related to treatment and most improvements maintained at 6-week follow-up. Effects of CBT on secondary outcomes varied across participants, with preliminary evidence for reduction in fear of falling. Adherence and retention were high, as were treatment satisfaction and acceptability. The findings of this pilot study provide preliminary evidence for the utility of CBT as a feasible treatment for anxiety and comorbid depressive symptoms in PD and highlight the potential of telehealth interventions for mood in this population.

Temporal Associations between Sleep and Daytime Functioning in Parkinson's Disease: A Smartphone-Based Ecological Momentary Assessment.

OBJECTIVES/BACKGROUND: Disruptions to mood, cognition, and other daytime functioning are common and debilitating symptoms of Parkinson's disease (PD), and there is evidence that sleep problems contribute to these symptoms. However, previous studies are limited by reliance on self-reported sleep and cross-sectional designs. With the aim of assessing sleep as a possible treatment target for improving daytime functioning in PD, we used smartphone-based ecological momentary assessment (EMA) and actigraphy to investigate temporal associations between sleep (objective and subjective) and daytime functioning. PARTICIPANTS/METHODS: Twenty participants with mild-moderate PD wore actigraphs and completed sleep diaries for 14-15 days. They reported daytime functioning (anxiety, positive affect, cognitive function, fatigue, and social function) twice daily via smartphone-administered questionnaires. Multilevel modeling examined whether sleep quantity/quality predicted next-day functioning, and whether current mood (anxiety, positive affect) predicted later sleep. RESULTS: Average completion rates for sleep diaries and daytime questionnaires were 94% and 91%, respectively. Subjective sleep quality predicted next-day anxiety (B = -.75, SE = .25, p= .003), but objective sleep did not predict any daytime functioning variables (p's>.112). Positive affect predicted later subjective sleep quality (B = 0.03, SE = .01, p = .003) but not objective sleep quantity/quality (p's>.107). CONCLUSIONS: We demonstrated the feasibility of using EMA in PD. On a daily timescale, subjective sleep quality was bidirectionally associated with mood, whereas objective sleep was not associated with any daytime functioning. This discrepancy suggests that perception of sleep is important for mood in PD, which could provide targets for non-pharmacological interventions.

Spatial judgment in Parkinson's disease: Contributions of attentional and executive dysfunction.

Spatial judgment is impaired in Parkinson's disease (PD), with previous research suggesting that disruptions in attention and executive function are likely contributors. If judgment of center places demands on frontal systems, performance on tests of attention/executive function may correlate with extent of bias in PD, and attentional disturbance may predict inconsistency in spatial judgment. The relation of spatial judgment to attention/executive function may differ for those with left-side versus right-side motor onset (LPD, RPD), reflecting effects of attentional lateralization. We assessed 42 RPD, 37 LPD, and 67 healthy control participants with a Landmark task (LM) in which a cursor moved horizontally from the right (right-LM) or left (left-LM). The task was to judge the center of the line. Participants also performed neuropsychological tests of attention and executive function. LM group differences were found on left-LM only, with both PD subgroups biased leftward of the control group (RPD p < .05; LPD p < .01; no RPD-LPD difference). For left-LM trials, extent of bias significantly correlated with performance on the cognitive tasks for PD but not for the control group. PD showed greater variability in perceived center than the control group; this variability correlated with performance on the cognitive tasks. The correlations between performance on the test of spatial judgment and the tests of attention/executive function suggest that frontal-based attentional dysfunction affects dynamic spatial judgment, both in extent of spatial bias and in consistency of response as indexed by intertrial variability. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Predictors of self-perceived stigma in Parkinson's disease.

OBJECTIVE: The burden of PD extends beyond physical limitations and includes significant psychosocial adjustments as individuals undergo changes to their self-perception and how others perceive them. There is limited quantitative evidence of the factors that contribute to self-perceived stigma, which we addressed in the present study. METHODS: In 362 individuals with PD (157 women, 205 men), self-perceived stigma was measured by the four-item stigma subscale of the Parkinson's Disease Questionnaire (PDQ-39). Hierarchical linear modeling was used to assess predictors of stigma including demographics (age, gender) and disease characteristics: duration, stage (Hoehn & Yahr Scale), motor severity (Unified Parkinson's Disease Rating Scale, UPDRS, Part 3), activities of daily living (UPDRS Part 2), and depression (Geriatric Depression Scale). Predictor variables were chosen based on their significant correlations with the stigma subscale. Further analyses were conducted for men and women separately. RESULTS: For the total sample, the full model accounted for 14% of the variance in stigma perception (p < .001). Younger age and higher depression scores were the only significant predictors (both p < .001). This pattern was also seen for the men in the sample. For the women, only depression was a significant predictor. Depression mediated the relation between stigma and activities of daily living. CONCLUSIONS: Younger age (men) and depression (men and women) were the primary predictors of self-perceived stigma in PD. Disease characteristics (motor and ADL) did not contribute to stigma perception. Depression is a potential treatment target for self-perceived stigma in PD.

American Geriatrics Society and National Institute on Aging Bench-to-Bedside Conference: Sensory Impairment and Cognitive Decline in Older Adults.

This article summarizes the presentations and recommendations of the tenth annual American Geriatrics Society and National Institute on Aging Bench-to-Bedside research conference, "Sensory Impairment and Cognitive Decline," on October 2-3, 2017, in Bethesda, Maryland. The risk of impairment in hearing, vision, and other senses increases with age, and almost 15% of individuals aged 70 and older have dementia. As the number of older adults increases, sensory and cognitive impairments will affect a growing proportion of the population. To limit its scope, this conference focused on sensory impairments affecting vision and hearing. Comorbid vision, hearing, and cognitive impairments in older adults are more common than would be expected by chance alone, suggesting that some common mechanisms might affect these neurological systems. This workshop explored the mechanisms and consequences of comorbid vision, hearing, and cognitive impairment in older adults; effects of sensory loss on the aging brain; and bench-to-bedside innovations and research opportunities. Presenters and participants identified many research gaps and questions; the top priorities fell into 3 themes: mechanisms, measurement, and interventions. The workshop delineated specific research questions that provide opportunities to improve outcomes in this growing population. J Am Geriatr Soc 66:2052-2058, 2018.

Eye movement control during visual pursuit in Parkinson's disease.

BACKGROUND: Prior studies of oculomotor function in Parkinson's disease (PD) have either focused on saccades without considering smooth pursuit, or tested smooth pursuit while excluding saccades. The present study investigated the control of saccadic eye movements during pursuit tasksand assessed the quality of binocular coordinationas potential sensitive markers of PD. METHODS: Observers fixated on a central cross while a target moved toward it. Once the target reached the fixation cross, observers began to pursue the moving target. To further investigate binocular coordination, the moving target was presented on both eyes (binocular condition), or on one eye only (dichoptic condition). RESULTS: The PD group made more saccades than age-matched normal control adults (NC) both during fixation and pursuit. The difference between left and right gaze positions increased over time during the pursuit period for PD but not for NC. The findings were not related to age, as NC and young-adult control group (YC) performed similarly on most of the eye movement measures, and were not correlated with classical measures of PD severity (e.g., Unified Parkinson's Disease Rating Scale (UPDRS) score). DISCUSSION: Our results suggest that PD may be associated with impairment not only in saccade inhibition, but also in binocular coordination during pursuit, and these aspects of dysfunction may be useful in PD diagnosis or tracking of disease course.