TY - JOUR
T1 - Attentional dysfunction and the punding spectrum in Parkinson's disease
AU - Hinkle, Jared T.
AU - Perepezko, Kate
AU - Mills, Kelly A.
AU - Pontone, Gregory M.
N1 - Funding Information:
PPMI investigators also conducted the Movement Disorder Society (MDS)-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS). We extracted the total MDS-UPDRS part III score and Hoehn & Yahr score as measures of motor impairment. Levodopa equivalent daily dose (LEDD) was calculated as per convention and a separate LEDD tabulation from only dopamine receptor agonists was also calculated [12].PPMI – a public-private partnership – is funded by the Michael J. Fox Foundation for Parkinson's Research and funding partners, including Abbvie, Allergan, Amathus Therapeutics, Avid Radiopharmaceuticals, Biogen, Biolegend, Bristol-Myers Squibb, Celgene, Denali, GE Healthcare, Genentech, GlaxoSmithKline, Janssen Neuroscience, Lilly, Lundbeck, Merck, Meso Scale Discovery, Pfizer, Piramal, Prevail Therapeutics, Roche, Sanofi Genzyme, Servier, Takeda, Teva, UCB, Verily, and Voyager Therapeutics. Golub Capital is a philanthropic funding partner.J.H.: Receives tuition and stipend support through the Medical Scientist Training Program at the Johns Hopkins School of Medicine (NIH/NIGMS 5 T32 GM007309).K.M.: Dr. Mills receives salary support through the NIH NCATS (KL2TR001077, PI Daniel Ford). He has received funding from Northwestern University.G.P.: Dr. Pontone receives funding through the NIH NIA as part of a K23 award (AG044441-01A1). He is also co-sponsored by Acadia Pharmaceuticals, Inc., for writing a book on psychosis in Parkinson's that was co-written by the National Parkinson's Foundation.
Funding Information:
G.P.: Dr. Pontone receives funding through the NIH NIA as part of a K23 award ( AG044441-01A1 ). He is also co-sponsored by Acadia Pharmaceuticals, Inc. , for writing a book on psychosis in Parkinson's that was co-written by the National Parkinson's Foundation.
Funding Information:
K.M.: Dr. Mills receives salary support through the NIH NCATS ( KL2TR001077 , PI Daniel Ford). He has received funding from Northwestern University .
Publisher Copyright:
© 2021 Elsevier Ltd
PY - 2021/3
Y1 - 2021/3
N2 - Background: Punding is a complication of Parkinson's disease (PD) treatment and stimulant abuse that features excessive preoccupation with repetitive and/or aimless behaviors. We hypothesized that cognitive impairment and functional limitations influence how punding behaviors manifest in PD. Methods: We extracted data on punding, hobbyism, and cognition from the Parkinson's Progression Marker Initiative (PPMI). Punding and hobbyism were measured with the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease (QUIP) scale. We determined how cognition predicted punding and hobbyism behaviors—adjusting for levodopa dose, Hoehn & Yahr stage, disease duration, and age—using generalized estimating equation (GEE) logistic regression. Activities of daily living (ADL) and motor impairment were measured with the MDS-UPDRS scale. Results: In GEE logistic regression models, punding was selectively associated with lower scores on the Letter Number Sequencing test (LNS), the primary attention test in PPMI (Odds ratio: 0.87 (95% CI: 0.79–0.96); p = 0.022). This was corroborated by a subscale-analysis of Montreal Cognitive Assessment (MoCA) scores, as only the attention subscale was significantly associated with punding (OR: 0.59 (0.45–0.77); p < 0.001). Baseline impairment in LNS (Hazard ratio: 2.52 (1.22–5.20); p = 0.012) and MoCA attention (HR: 2.68 (1.32–5.42); p = 0.006) predicted earlier punding in Cox regression. In turn, ADL dysfunction predicted punding (OR: 1.55 (1.20–2.00); p < 0.001), but not hobbyism. Conclusion: Attentional dysfunction is a domain-specific cognitive biomarker of punding risk in PD. Further, attentional capacity and functional impairment may determine the complexity of perseverative behaviors on the continuum from rudimentary punding to semi-purposeful hobbyism.
AB - Background: Punding is a complication of Parkinson's disease (PD) treatment and stimulant abuse that features excessive preoccupation with repetitive and/or aimless behaviors. We hypothesized that cognitive impairment and functional limitations influence how punding behaviors manifest in PD. Methods: We extracted data on punding, hobbyism, and cognition from the Parkinson's Progression Marker Initiative (PPMI). Punding and hobbyism were measured with the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease (QUIP) scale. We determined how cognition predicted punding and hobbyism behaviors—adjusting for levodopa dose, Hoehn & Yahr stage, disease duration, and age—using generalized estimating equation (GEE) logistic regression. Activities of daily living (ADL) and motor impairment were measured with the MDS-UPDRS scale. Results: In GEE logistic regression models, punding was selectively associated with lower scores on the Letter Number Sequencing test (LNS), the primary attention test in PPMI (Odds ratio: 0.87 (95% CI: 0.79–0.96); p = 0.022). This was corroborated by a subscale-analysis of Montreal Cognitive Assessment (MoCA) scores, as only the attention subscale was significantly associated with punding (OR: 0.59 (0.45–0.77); p < 0.001). Baseline impairment in LNS (Hazard ratio: 2.52 (1.22–5.20); p = 0.012) and MoCA attention (HR: 2.68 (1.32–5.42); p = 0.006) predicted earlier punding in Cox regression. In turn, ADL dysfunction predicted punding (OR: 1.55 (1.20–2.00); p < 0.001), but not hobbyism. Conclusion: Attentional dysfunction is a domain-specific cognitive biomarker of punding risk in PD. Further, attentional capacity and functional impairment may determine the complexity of perseverative behaviors on the continuum from rudimentary punding to semi-purposeful hobbyism.
KW - Attention
KW - Cognitive impairment
KW - Parkinson''s disease
KW - Punding
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U2 - 10.1016/j.parkreldis.2021.01.019
DO - 10.1016/j.parkreldis.2021.01.019
M3 - Article
C2 - 33545553
AN - SCOPUS:85100378217
SN - 1353-8020
VL - 84
SP - 23
EP - 28
JO - Parkinsonism and Related Disorders
JF - Parkinsonism and Related Disorders
ER -