Bradyphrenia and Tachyphrenia in Idiopathic Parkinsonism Appear, in Part, Iatrogenic: An Observational Study with Systematic Review Background
-
Published:2023-10-12
Issue:20
Volume:12
Page:6499
-
ISSN:2077-0383
-
Container-title:Journal of Clinical Medicine
-
language:en
-
Short-container-title:JCM
Author:
Wang Wenjing12, Baker Kieran3ORCID, Umamahesan Chianna14, Gilmour Steven3, Charlett André45, Taylor David14, Young Allan H.12ORCID, Dobbs R. John146, Dobbs Sylvia M.146
Affiliation:
1. South London and Maudsley NHS Foundation Trust, London SE5 8AB, UK 2. Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK 3. Department of Mathematics, King’s College London, London WC2R 2LS, UK 4. Institute of Pharmaceutical Science, King’s College London, London SE1 9NH, UK 5. Statistics, Modelling and Economics, UK Health Security Agency, London NW9 5EQ, UK 6. Department of Gastroenterology, King’s College Hospital, London SE5 9RS, UK
Abstract
We question whether bradyphrenia, slowing of cognitive processing not explained by depression or a global cognitive assessment, is a nosological entity in idiopathic parkinsonism (IP). The time taken to break contact of an index finger with a touch-sensitive plate was measured, with and without a warning in the alerting signal as to which side the imperative would indicate, in 77 people diagnosed with IP and in 124 people without an IP diagnosis. The ability to utilise a warning, measured by the difference between loge-transformed reaction times (unwarned minus warned), was termed ‘cognitive efficiency’. It was approximately normally distributed. A questionnaire on self- and partner perception of proband’s bradyphrenia was applied. A multivariable model showed that those prescribed levodopa were less cognitively efficient (mean −5.2 (CI −9.5, −1.0)% per 300 mg/day, p = 0.02), but those prescribed the anti-muscarinic trihexyphenidyl were more efficient (14.7 (0.2, 31.3)% per 4 mg/day, p < 0.05) and those prescribed monoamine oxidase-B inhibitor (MAOBI) tended to be more efficient (8.3 (0.0, 17.4)%, p = 0.07). The variance in efficiency was greater within IP (F-test, p = 0.01 adjusted for any demographic covariates: coefficient of variation, with and without IP, 0.68 and 0.46, respectively), but not so after adjustment for anti-parkinsonian medication (p = 0.13: coefficient of variation 0.62). The within-participant follow-up time, a median of 4.8 (interquartile range 3.1, 5.5) years (101 participants), did not influence efficiency, irrespective of IP status. Perception of bradyphrenia did not usefully predict efficiency. We conclude that both bradyphrenia and ‘tachyphrenia’ in IP appear to have iatrogenic components, of clinically important size, related to the dose of antiparkinsonian medication. Levodopa is the most commonly prescribed first-line medication: co-prescribing a MAOBI may circumvent its associated bradyphrenia. The previously reported greater efficiency associated with (low-dose) anti-muscarinic was confirmed.
Funder
Nomis Foundation, Zurich, Switzerland Cecil Pilkington Charitable Trust, London, UK Psychiatry Research Trust, London, UK sychiatry Research Trust Engineering and Physical Sciences Research Council National Institute for Health and Care Research Maudsley Biomedical Research Centre King’s College London
Reference35 articles.
1. Etudes sur les complications et les sequelles mentales de l’encéphalite épidémique;Naville;Encéphale,1922 2. Hypothesis: The bradyphrenia of parkinsonism is a nosological entity;Dobbs;Acta Neurol. Scand.,1993 3. Assessment of the bradyphrenia of parkinsonism: A novel use of delayed auditory feedback;Dobbs;Acta Neurol. Scand.,1993 4. Koerts, J., Van Beilen, M., Tucha, O., Leenders, K.L., and Brouwer, W.H. (2011). Executive Functioning in Daily Life in Parkinson’s Disease: Initiative; Planning and Multi-Task Performance. PLoS ONE, 6. 5. Zhang, C., Reeves, S., David, A.S., Costello, H., and Rogers, J. (2023). Neuropsychiatric features of Parkinson’s disease in the era prior to the use of dopaminergic therapies. Cogn. Neuropsychiatry, 1–10.
|
|