Differential susceptibility to motor impulsivity among functional subtypes of Parkinson's disease
Identifieur interne : 002146 ( Main/Corpus ); précédent : 002145; suivant : 002147Differential susceptibility to motor impulsivity among functional subtypes of Parkinson's disease
Auteurs : Scott A. Wylie ; Wery Van Den Wildenberg ; K Richard Ridderinkhof ; Daniel O. Claassen ; George F. Wooten ; Carol A. ManningSource :
- Journal of Neurology, Neurosurgery & Psychiatry [ 0022-3050 ] ; 2012-12.
Abstract
Background and objectives Parkinson's disease patients with predominant postural instability and gait difficulties (PIGD) may experience unique cognitive difficulties compared to patients with tremor predominant (TD) symptoms. PIGD patients are also at high risk for falling, and some of the worst fallers seem to react impulsively to their environment. We tested the hypothesis that PIGD patients show poorer control over motor impulses compared to TD patients. Methods 34 PD participants were divided into predominant PIGD (n=17) or TD (n=17) functional subtypes based on their presenting symptoms in their optimally treated motor state. All participants performed a speeded reaction task that quantified motor impulsivity and the proficiency of inhibiting prepotent motor impulses. Results The groups showed similar reaction times, but compared to TD patients, PIGD patients made significantly more impulsive motor errors. Notably, when the initial impulsive erroneous response was avoided, PIGD and TD groups were similar in their ability to suppress the incorrect motor impulse from further interfering with the selection of a correct action. Conclusions PD patients with PIGD predominant symptoms show greater susceptibility to acting on prepotent motor impulses compared to TD patients. This finding may have direct implications for fall risk and also points to dissociable neurocognitive pathologies in TD and PIGD subtypes. Clinically, the use of specific cognitive instruments to assess the expression and inhibition of motor impulses may help identify PD patients who have difficulty ‘thinking before they leap’ and are at high risk of falling.
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DOI: 10.1136/jnnp-2012-303056
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<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title>Differential susceptibility to motor impulsivity among functional subtypes of Parkinson's disease</title><author><name sortKey="Wylie, Scott A" sort="Wylie, Scott A" uniqKey="Wylie S" first="Scott A" last="Wylie">Scott A. Wylie</name><affiliation><mods:affiliation>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: scott.a.wylie@vanderbilt.edu</mods:affiliation></affiliation></author><author><name sortKey="Van Den Wildenberg, Wery" sort="Van Den Wildenberg, Wery" uniqKey="Van Den Wildenberg W" first="Wery" last="Van Den Wildenberg">Wery Van Den Wildenberg</name><affiliation><mods:affiliation>Amsterdam Center for the Study of Adaptive Control in Brain and Behaviour (Acacia), Psychology Department, University of Amsterdam, Amsterdam, The Netherlands</mods:affiliation></affiliation></author><author><name sortKey="Ridderinkhof, K Richard" sort="Ridderinkhof, K Richard" uniqKey="Ridderinkhof K" first="K Richard" last="Ridderinkhof">K Richard Ridderinkhof</name><affiliation><mods:affiliation>Amsterdam Center for the Study of Adaptive Control in Brain and Behaviour (Acacia), Psychology Department, University of Amsterdam, Amsterdam, The Netherlands</mods:affiliation></affiliation></author><author><name sortKey="Claassen, Daniel O" sort="Claassen, Daniel O" uniqKey="Claassen D" first="Daniel O" last="Claassen">Daniel O. Claassen</name><affiliation><mods:affiliation>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA</mods:affiliation></affiliation></author><author><name sortKey="Wooten, George F" sort="Wooten, George F" uniqKey="Wooten G" first="George F" last="Wooten">George F. Wooten</name><affiliation><mods:affiliation>Neurology Department, University of Virginia Health Systems, Charlottesville, Virginia, USA</mods:affiliation></affiliation></author><author><name sortKey="Manning, Carol A" sort="Manning, Carol A" uniqKey="Manning C" first="Carol A" last="Manning">Carol A. Manning</name><affiliation><mods:affiliation>Neurology Department, University of Virginia Health Systems, Charlottesville, Virginia, USA</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:DD3F4BC3CEDE929959391FD4A7C0CADCE748ED60</idno><date when="2012" year="2012">2012</date><idno type="doi">10.1136/jnnp-2012-303056</idno><idno type="url">https://api.istex.fr/document/DD3F4BC3CEDE929959391FD4A7C0CADCE748ED60/fulltext/pdf</idno><idno type="wicri:Area/Main/Corpus">002146</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a">Differential susceptibility to motor impulsivity among functional subtypes of Parkinson's disease</title><author><name sortKey="Wylie, Scott A" sort="Wylie, Scott A" uniqKey="Wylie S" first="Scott A" last="Wylie">Scott A. Wylie</name><affiliation><mods:affiliation>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: scott.a.wylie@vanderbilt.edu</mods:affiliation></affiliation></author><author><name sortKey="Van Den Wildenberg, Wery" sort="Van Den Wildenberg, Wery" uniqKey="Van Den Wildenberg W" first="Wery" last="Van Den Wildenberg">Wery Van Den Wildenberg</name><affiliation><mods:affiliation>Amsterdam Center for the Study of Adaptive Control in Brain and Behaviour (Acacia), Psychology Department, University of Amsterdam, Amsterdam, The Netherlands</mods:affiliation></affiliation></author><author><name sortKey="Ridderinkhof, K Richard" sort="Ridderinkhof, K Richard" uniqKey="Ridderinkhof K" first="K Richard" last="Ridderinkhof">K Richard Ridderinkhof</name><affiliation><mods:affiliation>Amsterdam Center for the Study of Adaptive Control in Brain and Behaviour (Acacia), Psychology Department, University of Amsterdam, Amsterdam, The Netherlands</mods:affiliation></affiliation></author><author><name sortKey="Claassen, Daniel O" sort="Claassen, Daniel O" uniqKey="Claassen D" first="Daniel O" last="Claassen">Daniel O. Claassen</name><affiliation><mods:affiliation>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA</mods:affiliation></affiliation></author><author><name sortKey="Wooten, George F" sort="Wooten, George F" uniqKey="Wooten G" first="George F" last="Wooten">George F. Wooten</name><affiliation><mods:affiliation>Neurology Department, University of Virginia Health Systems, Charlottesville, Virginia, USA</mods:affiliation></affiliation></author><author><name sortKey="Manning, Carol A" sort="Manning, Carol A" uniqKey="Manning C" first="Carol A" last="Manning">Carol A. Manning</name><affiliation><mods:affiliation>Neurology Department, University of Virginia Health Systems, Charlottesville, Virginia, USA</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Journal of Neurology, Neurosurgery & Psychiatry</title><title level="j" type="abbrev">J Neurol Neurosurg Psychiatry</title><idno type="ISSN">0022-3050</idno><idno type="eISSN">1468-330X</idno><imprint><publisher>BMJ Publishing Group Ltd</publisher><date type="published" when="2012-12">2012-12</date><biblScope unit="volume">83</biblScope><biblScope unit="issue">12</biblScope><biblScope unit="page" from="1149">1149</biblScope></imprint><idno type="ISSN">0022-3050</idno></series><idno type="istex">DD3F4BC3CEDE929959391FD4A7C0CADCE748ED60</idno><idno type="DOI">10.1136/jnnp-2012-303056</idno><idno type="href">jnnp-83-1149.pdf</idno><idno type="ArticleID">jnnp-2012-303056</idno><idno type="PMID">22917670</idno><idno type="local">jnnp;83/12/1149</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0022-3050</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">Background and objectives Parkinson's disease patients with predominant postural instability and gait difficulties (PIGD) may experience unique cognitive difficulties compared to patients with tremor predominant (TD) symptoms. PIGD patients are also at high risk for falling, and some of the worst fallers seem to react impulsively to their environment. We tested the hypothesis that PIGD patients show poorer control over motor impulses compared to TD patients. Methods 34 PD participants were divided into predominant PIGD (n=17) or TD (n=17) functional subtypes based on their presenting symptoms in their optimally treated motor state. All participants performed a speeded reaction task that quantified motor impulsivity and the proficiency of inhibiting prepotent motor impulses. Results The groups showed similar reaction times, but compared to TD patients, PIGD patients made significantly more impulsive motor errors. Notably, when the initial impulsive erroneous response was avoided, PIGD and TD groups were similar in their ability to suppress the incorrect motor impulse from further interfering with the selection of a correct action. Conclusions PD patients with PIGD predominant symptoms show greater susceptibility to acting on prepotent motor impulses compared to TD patients. This finding may have direct implications for fall risk and also points to dissociable neurocognitive pathologies in TD and PIGD subtypes. Clinically, the use of specific cognitive instruments to assess the expression and inhibition of motor impulses may help identify PD patients who have difficulty ‘thinking before they leap’ and are at high risk of falling.</div></front></TEI><istex><corpusName>bmj</corpusName><author><json:item><name>Scott A Wylie</name><affiliations><json:string>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA</json:string><json:string>E-mail: scott.a.wylie@vanderbilt.edu</json:string></affiliations></json:item><json:item><name>Wery van den Wildenberg</name><affiliations><json:string>Amsterdam Center for the Study of Adaptive Control in Brain and Behaviour (Acacia), Psychology Department, University of Amsterdam, Amsterdam, The Netherlands</json:string></affiliations></json:item><json:item><name>K Richard Ridderinkhof</name><affiliations><json:string>Amsterdam Center for the Study of Adaptive Control in Brain and Behaviour (Acacia), Psychology Department, University of Amsterdam, Amsterdam, The Netherlands</json:string></affiliations></json:item><json:item><name>Daniel O Claassen</name><affiliations><json:string>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA</json:string></affiliations></json:item><json:item><name>George F Wooten</name><affiliations><json:string>Neurology Department, University of Virginia Health Systems, Charlottesville, Virginia, USA</json:string></affiliations></json:item><json:item><name>Carol A Manning</name><affiliations><json:string>Neurology Department, University of Virginia Health Systems, Charlottesville, Virginia, USA</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Movement disorders</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Parkinson's disease</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>motor control</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>executive function</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>tremor</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>gait disorders</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>cognitive neuropsychology</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>cognition</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Lewy body</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Huntington's</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>limbic system</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>multisystem atrophy</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Alzheimer's disease</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>cognitive neuropsychology</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Huntington's</value></json:item></subject><language><json:string>eng</json:string></language><abstract>Background and objectives Parkinson's disease patients with predominant postural instability and gait difficulties (PIGD) may experience unique cognitive difficulties compared to patients with tremor predominant (TD) symptoms. PIGD patients are also at high risk for falling, and some of the worst fallers seem to react impulsively to their environment. We tested the hypothesis that PIGD patients show poorer control over motor impulses compared to TD patients. Methods 34 PD participants were divided into predominant PIGD (n=17) or TD (n=17) functional subtypes based on their presenting symptoms in their optimally treated motor state. All participants performed a speeded reaction task that quantified motor impulsivity and the proficiency of inhibiting prepotent motor impulses. Results The groups showed similar reaction times, but compared to TD patients, PIGD patients made significantly more impulsive motor errors. Notably, when the initial impulsive erroneous response was avoided, PIGD and TD groups were similar in their ability to suppress the incorrect motor impulse from further interfering with the selection of a correct action. Conclusions PD patients with PIGD predominant symptoms show greater susceptibility to acting on prepotent motor impulses compared to TD patients. This finding may have direct implications for fall risk and also points to dissociable neurocognitive pathologies in TD and PIGD subtypes. Clinically, the use of specific cognitive instruments to assess the expression and inhibition of motor impulses may help identify PD patients who have difficulty ‘thinking before they leap’ and are at high risk of falling.</abstract><qualityIndicators><score>8.339</score><pdfVersion>1.4</pdfVersion><pdfPageSize>595.276 x 793.701 pts</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>15</keywordCount><abstractCharCount>1655</abstractCharCount><pdfWordCount>4947</pdfWordCount><pdfCharCount>33821</pdfCharCount><pdfPageCount>6</pdfPageCount><abstractWordCount>241</abstractWordCount></qualityIndicators><title>Differential susceptibility to motor impulsivity among functional subtypes of Parkinson's disease</title><pmid><json:string>22917670</json:string></pmid><genre><json:string>research-article</json:string></genre><host><volume>83</volume><pages><first>1149</first></pages><issn><json:string>0022-3050</json:string></issn><issue>12</issue><genre></genre><language><json:string>unknown</json:string></language><eissn><json:string>1468-330X</json:string></eissn><title>Journal of Neurology, Neurosurgery & 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Ltd</publisher><availability><p>BMJ</p></availability><date>2012-08-23</date></publicationStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a">Differential susceptibility to motor impulsivity among functional subtypes of Parkinson's disease</title><author corresp="yes"><persName><forename type="first">Scott A</forename><surname>Wylie</surname></persName><email>scott.a.wylie@vanderbilt.edu</email><affiliation>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA</affiliation></author><author><persName><forename type="first">Wery</forename><surname>van den Wildenberg</surname></persName><affiliation>Amsterdam Center for the Study of Adaptive Control in Brain and Behaviour (Acacia), Psychology Department, University of Amsterdam, Amsterdam, The Netherlands</affiliation></author><author><persName><forename type="first">K Richard</forename><surname>Ridderinkhof</surname></persName><affiliation>Amsterdam Center for the Study of Adaptive Control in Brain and Behaviour (Acacia), Psychology Department, University of Amsterdam, Amsterdam, The Netherlands</affiliation></author><author><persName><forename type="first">Daniel O</forename><surname>Claassen</surname></persName><affiliation>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA</affiliation></author><author><persName><forename type="first">George F</forename><surname>Wooten</surname></persName><affiliation>Neurology Department, University of Virginia Health Systems, Charlottesville, Virginia, USA</affiliation></author><author><persName><forename type="first">Carol A</forename><surname>Manning</surname></persName><affiliation>Neurology Department, University of Virginia Health Systems, Charlottesville, Virginia, USA</affiliation></author></analytic><monogr><title level="j">Journal of Neurology, Neurosurgery & Psychiatry</title><title level="j" type="abbrev">J Neurol Neurosurg Psychiatry</title><idno type="pISSN">0022-3050</idno><idno type="eISSN">1468-330X</idno><imprint><publisher>BMJ Publishing Group Ltd</publisher><date type="published" when="2012-12"></date><biblScope unit="volume">83</biblScope><biblScope unit="issue">12</biblScope><biblScope unit="page" from="1149">1149</biblScope></imprint></monogr><idno type="istex">DD3F4BC3CEDE929959391FD4A7C0CADCE748ED60</idno><idno type="DOI">10.1136/jnnp-2012-303056</idno><idno type="href">jnnp-83-1149.pdf</idno><idno type="ArticleID">jnnp-2012-303056</idno><idno type="PMID">22917670</idno><idno type="local">jnnp;83/12/1149</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2012-08-23</date></creation><langUsage><language ident="en">en</language></langUsage><abstract><p>Background and objectives Parkinson's disease patients with predominant postural instability and gait difficulties (PIGD) may experience unique cognitive difficulties compared to patients with tremor predominant (TD) symptoms. PIGD patients are also at high risk for falling, and some of the worst fallers seem to react impulsively to their environment. We tested the hypothesis that PIGD patients show poorer control over motor impulses compared to TD patients. Methods 34 PD participants were divided into predominant PIGD (n=17) or TD (n=17) functional subtypes based on their presenting symptoms in their optimally treated motor state. All participants performed a speeded reaction task that quantified motor impulsivity and the proficiency of inhibiting prepotent motor impulses. Results The groups showed similar reaction times, but compared to TD patients, PIGD patients made significantly more impulsive motor errors. Notably, when the initial impulsive erroneous response was avoided, PIGD and TD groups were similar in their ability to suppress the incorrect motor impulse from further interfering with the selection of a correct action. Conclusions PD patients with PIGD predominant symptoms show greater susceptibility to acting on prepotent motor impulses compared to TD patients. This finding may have direct implications for fall risk and also points to dissociable neurocognitive pathologies in TD and PIGD subtypes. Clinically, the use of specific cognitive instruments to assess the expression and inhibition of motor impulses may help identify PD patients who have difficulty ‘thinking before they leap’ and are at high risk of falling.</p></abstract><textClass><keywords scheme="keyword"><list><head>Keywords</head><item><term>Parkinson's disease</term></item><item><term>motor control</term></item><item><term>executive function</term></item><item><term>tremor</term></item><item><term>gait disorders</term></item><item><term>cognitive neuropsychology</term></item><item><term>cognition</term></item><item><term>Lewy body</term></item><item><term>Huntington's</term></item><item><term>limbic system</term></item><item><term>multisystem atrophy</term></item><item><term>Alzheimer's disease</term></item><item><term>cognitive neuropsychology</term></item><item><term>Huntington's</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2012-08-23">Created</change><change when="2012-12">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/DD3F4BC3CEDE929959391FD4A7C0CADCE748ED60/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus bmj" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="no"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Archiving and Interchange DTD v2.3 20070202//EN" URI="archivearticle.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="research-article"><front><journal-meta><journal-id journal-id-type="hwp">jnnp</journal-id><journal-id journal-id-type="nlm-ta">J Neurol Neurosurg Psychiatry</journal-id><journal-id journal-id-type="publisher-id">jnnp</journal-id><journal-title>Journal of Neurology, Neurosurgery & Psychiatry</journal-title><abbrev-journal-title abbrev-type="publisher">J Neurol Neurosurg Psychiatry</abbrev-journal-title><abbrev-journal-title>J Neurol Neurosurg Psychiatry</abbrev-journal-title><issn pub-type="ppub">0022-3050</issn><issn pub-type="epub">1468-330X</issn><publisher><publisher-name>BMJ Publishing Group Ltd</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="publisher-id">jnnp-2012-303056</article-id><article-id pub-id-type="doi">10.1136/jnnp-2012-303056</article-id><article-id pub-id-type="other">jnnp;83/12/1149</article-id><article-id pub-id-type="other">jnnp;jnnp-2012-303056</article-id><article-id pub-id-type="pmid">22917670</article-id><article-id pub-id-type="other">1149</article-id><article-id pub-id-type="other">jnnp-2012-303056</article-id><article-categories><subj-group subj-group-type="heading"><subject>Movement disorders</subject></subj-group><series-title>Research paper</series-title></article-categories><title-group><article-title>Differential susceptibility to motor impulsivity among functional subtypes of Parkinson's disease</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Wylie</surname><given-names>Scott A</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>van den Wildenberg</surname><given-names>Wery</given-names></name><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Ridderinkhof</surname><given-names>K Richard</given-names></name><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Claassen</surname><given-names>Daniel O</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Wooten</surname><given-names>George F</given-names></name><xref ref-type="aff" rid="aff3">3</xref></contrib><contrib contrib-type="author"><name><surname>Manning</surname><given-names>Carol A</given-names></name><xref ref-type="aff" rid="aff3">3</xref></contrib></contrib-group><aff id="aff1"><label>1</label>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA</aff><aff id="aff2"><label>2</label>Amsterdam Center for the Study of Adaptive Control in Brain and Behaviour (Acacia), Psychology Department, University of Amsterdam, Amsterdam, The Netherlands</aff><aff id="aff3"><label>3</label>Neurology Department, University of Virginia Health Systems, Charlottesville, Virginia, USA</aff><author-notes><corresp><label>Correspondence to</label> Dr Scott A Wylie, 1161 21st Avenue South, A-0118 Medical Center North, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37232, USA; <email>scott.a.wylie@vanderbilt.edu</email></corresp></author-notes><pub-date pub-type="ppub"><month>12</month><year>2012</year></pub-date><pub-date pub-type="epub"><day>23</day><month>8</month><year>2012</year></pub-date><volume>83</volume><volume-id pub-id-type="other">83</volume-id><volume-id pub-id-type="other">83</volume-id><issue>12</issue><issue-id pub-id-type="other">jnnp;83/12</issue-id><issue-id pub-id-type="other">12</issue-id><issue-id pub-id-type="other">83/12</issue-id><fpage>1149</fpage><history><date date-type="received"><day>23</day><month>4</month><year>2012</year></date><date date-type="rev-recd"><day>19</day><month>7</month><year>2012</year></date><date date-type="accepted"><day>1</day><month>8</month><year>2012</year></date></history><permissions><copyright-statement>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</copyright-statement><copyright-year>2012</copyright-year></permissions><self-uri content-type="pdf" xlink:role="full-text" xlink:href="jnnp-83-1149.pdf"></self-uri><abstract><sec><title>Background and objectives</title><p>Parkinson's disease patients with predominant postural instability and gait difficulties (PIGD) may experience unique cognitive difficulties compared to patients with tremor predominant (TD) symptoms. PIGD patients are also at high risk for falling, and some of the worst fallers seem to react impulsively to their environment. We tested the hypothesis that PIGD patients show poorer control over motor impulses compared to TD patients.</p></sec><sec><title>Methods</title><p>34 PD participants were divided into predominant PIGD (n=17) or TD (n=17) functional subtypes based on their presenting symptoms in their optimally treated motor state. All participants performed a speeded reaction task that quantified motor impulsivity and the proficiency of inhibiting prepotent motor impulses.</p></sec><sec><title>Results</title><p>The groups showed similar reaction times, but compared to TD patients, PIGD patients made significantly more impulsive motor errors. Notably, when the initial impulsive erroneous response was avoided, PIGD and TD groups were similar in their ability to suppress the incorrect motor impulse from further interfering with the selection of a correct action.</p></sec><sec><title>Conclusions</title><p>PD patients with PIGD predominant symptoms show greater susceptibility to acting on prepotent motor impulses compared to TD patients. This finding may have direct implications for fall risk and also points to dissociable neurocognitive pathologies in TD and PIGD subtypes. Clinically, the use of specific cognitive instruments to assess the expression and inhibition of motor impulses may help identify PD patients who have difficulty ‘thinking before they leap’ and are at high risk of falling.</p></sec></abstract><kwd-group><kwd>Parkinson's disease</kwd><kwd>motor control</kwd><kwd>executive function</kwd><kwd>tremor</kwd><kwd>gait disorders</kwd><kwd>cognitive neuropsychology</kwd><kwd>cognition</kwd><kwd>Lewy body</kwd><kwd>Huntington's</kwd><kwd>limbic system</kwd><kwd>multisystem atrophy</kwd><kwd>Alzheimer's disease</kwd><kwd>cognitive neuropsychology</kwd><kwd>Huntington's</kwd></kwd-group></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><partName>Research paper</partName><title>Differential susceptibility to motor impulsivity among functional subtypes of Parkinson's disease</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><partName>Research paper</partName><title>Differential susceptibility to motor impulsivity among functional subtypes of Parkinson's disease</title></titleInfo><name type="personal" displayLabel="corresp"><namePart type="given">Scott A</namePart><namePart type="family">Wylie</namePart><affiliation>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA</affiliation><affiliation>E-mail: scott.a.wylie@vanderbilt.edu</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Wery</namePart><namePart type="family">van den Wildenberg</namePart><affiliation>Amsterdam Center for the Study of Adaptive Control in Brain and Behaviour (Acacia), Psychology Department, University of Amsterdam, Amsterdam, The Netherlands</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">K Richard</namePart><namePart type="family">Ridderinkhof</namePart><affiliation>Amsterdam Center for the Study of Adaptive Control in Brain and Behaviour (Acacia), Psychology Department, University of Amsterdam, Amsterdam, The Netherlands</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Daniel O</namePart><namePart type="family">Claassen</namePart><affiliation>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">George F</namePart><namePart type="family">Wooten</namePart><affiliation>Neurology Department, University of Virginia Health Systems, Charlottesville, Virginia, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Carol A</namePart><namePart type="family">Manning</namePart><affiliation>Neurology Department, University of Virginia Health Systems, Charlottesville, Virginia, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article"></genre><originInfo><publisher>BMJ Publishing Group Ltd</publisher><dateIssued encoding="w3cdtf">2012-12</dateIssued><dateCreated encoding="w3cdtf">2012-08-23</dateCreated><copyrightDate encoding="w3cdtf">2012</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract>Background and objectives Parkinson's disease patients with predominant postural instability and gait difficulties (PIGD) may experience unique cognitive difficulties compared to patients with tremor predominant (TD) symptoms. PIGD patients are also at high risk for falling, and some of the worst fallers seem to react impulsively to their environment. We tested the hypothesis that PIGD patients show poorer control over motor impulses compared to TD patients. Methods 34 PD participants were divided into predominant PIGD (n=17) or TD (n=17) functional subtypes based on their presenting symptoms in their optimally treated motor state. All participants performed a speeded reaction task that quantified motor impulsivity and the proficiency of inhibiting prepotent motor impulses. Results The groups showed similar reaction times, but compared to TD patients, PIGD patients made significantly more impulsive motor errors. Notably, when the initial impulsive erroneous response was avoided, PIGD and TD groups were similar in their ability to suppress the incorrect motor impulse from further interfering with the selection of a correct action. Conclusions PD patients with PIGD predominant symptoms show greater susceptibility to acting on prepotent motor impulses compared to TD patients. This finding may have direct implications for fall risk and also points to dissociable neurocognitive pathologies in TD and PIGD subtypes. Clinically, the use of specific cognitive instruments to assess the expression and inhibition of motor impulses may help identify PD patients who have difficulty ‘thinking before they leap’ and are at high risk of falling.</abstract><subject><genre>Keywords</genre><topic>Parkinson's disease</topic><topic>motor control</topic><topic>executive function</topic><topic>tremor</topic><topic>gait disorders</topic><topic>cognitive neuropsychology</topic><topic>cognition</topic><topic>Lewy body</topic><topic>Huntington's</topic><topic>limbic system</topic><topic>multisystem atrophy</topic><topic>Alzheimer's disease</topic><topic>cognitive neuropsychology</topic><topic>Huntington's</topic></subject><relatedItem type="host"><titleInfo><title>Journal of Neurology, Neurosurgery & Psychiatry</title></titleInfo><titleInfo type="abbreviated"><title>J Neurol Neurosurg Psychiatry</title></titleInfo><genre type="Journal">journal</genre><identifier type="ISSN">0022-3050</identifier><identifier type="eISSN">1468-330X</identifier><identifier type="PublisherID">jnnp</identifier><identifier type="PublisherID-hwp">jnnp</identifier><identifier type="PublisherID-nlm-ta">J Neurol Neurosurg Psychiatry</identifier><part><date>2012</date><detail type="volume"><caption>vol.</caption><number>83</number></detail><detail type="issue"><caption>no.</caption><number>12</number></detail><extent unit="pages"><start>1149</start></extent></part></relatedItem><identifier type="istex">DD3F4BC3CEDE929959391FD4A7C0CADCE748ED60</identifier><identifier type="DOI">10.1136/jnnp-2012-303056</identifier><identifier type="href">jnnp-83-1149.pdf</identifier><identifier type="ArticleID">jnnp-2012-303056</identifier><identifier type="PMID">22917670</identifier><identifier type="local">jnnp;83/12/1149</identifier><accessCondition type="use and reproduction" contentType="copyright">Published by the BMJ Publishing Group Limited. 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