The third goal is to perform collaborative research studies into the early events underlying dementia in people with intellectual disabilities with many different research groups in the USA and Europe, with the specific purpose of developing new therapeutic targets for people with DS and dementia, which may translate to those with AD and other dementias in the general population. This project is unique in that it is the only funded biobank consortium in the United States focused on people with intellectual disabilities. Few studies have focused on this medically under-investigated group. About the Researcher All investigators involved in this project have significant experience in the Down syndrome and Alzheimer fields.
March 31, Keywords: Butterfield ABSTRACT Depression and apathy are two of the mo st common psychiatric symptoms in Parkinsons disease PD with prevalence estimates at higher rates than in medical populations with similar levels of disabilit y.
Several studies have provided evidence to suggest that apathy and depression are i Neuropathology of downs syndrome essay clinical phenomena that may differentially affect cognition.
Recent rese arch suggests that apathy may account for cognitive deficits over and above that of depression, especially in the domain of executive functioning. However, few studies ha ve examined the independent influence of depression and apathy on cognitive abilities in patients diagnosed with PD using sensitive measures of specific cognitive domains.
The purpose of this study was to examine the independent influences of symptoms of depression and apathy on memo ry and executive functioning in patients diagnosed with PD using severity scales specifically designed to provide greater discrimination between sympto ms.
Depression severity was assessed using items that do not overlap with apathy symptoms or with somatic symptoms of PD itself. Apathy was PAGE 7 vi measured using a scale previously shown to have little overlap with depressive symptoms. Results revealed that apathy, but not depr ession, was significantly associated with executive functioning.
In contrast, immediate memory was significantly associated with both apathy and depression. However, apathy accounted for added variance in memory scores when controlling for depression with marginal significance. When controlling for age, although less clear, th ese patterns remained.
Differentiation of apathy and depressi on and understanding their independent effects on cognitive functioning have several implications both for clinical intervention and for scientific investigation. Secondly, it has been associated with increased mortality as it may interfere with medication compliance.
If appropriately identified, prel iminary research suggests that symptoms of apathy may be medically treated independently of depres sive symptoms. Distinguishing apathy and depression has robust implications for the ad vancement of psychological science, patient care, and for enhancing quality of life in patients and caregivers.
PAGE 8 1 1. Introduction Parkinsons Disease PDa chronic and degenerative neurological disorder, affects approximately one million people over the age of fifty in the United States alone.
Apathy, a sy mptom related to motivational and selfinitiation impairment, is also elevated in PD and other disorder s involving the basal ganglia, with an average estimated prevalence of Again, this is higher th an found in the general population, where the prevalence of clinically elevat ed apathy is estimated at 6.
Psychiatric symptoms may negativ ely impact several patient variables, including daily functioning, cognitive f unctioning, and quality of life and may additionally impact caregiver burden and distress Shra g, Jahanshahi, and Quinn, ; Chen, ; Keranen et al.
Several studies suggest that apathy and depression are independent clinical phenomena that negatively affect memo ry, language, and executive functioning Starkstein et al. Recent research suggests that apathy may account for cognitive deficits over and above that of depression.
Few studies have investig ated the independent influence of depression and apathy on cognitive abilities in patients diagnosed with PD. Further, the few studies that have examin ed these relationships have used simple screening measures of global cognitive ability that are insensitive to specific cognitive domains.
The present study will attempt to enhan ce our understanding of the independent influences of depression and apathy on memo ry and executive functioning in patients diagnosed with PD using sensitive and more specific cognitive measures.
Hierarchical regression will allow for examination of the influence of depression on cognitive performance while controlling for the independe nt influence of apat hy, and vice versa.
Before providing a detailed account of the me thodological plan for the present study, an introduction to PD and a review of the lite rature that has examined the relationships between depression, apathy, and cognition in this population is provided.
Most cases of PD present after th e age of 50, with a mean age of onset at 55 to 60 years Mackin, ; St ern, Few cases, if any, appear after the age of 80 Mackin, These include toxi c exposures environmental, occupational, or drug inducedoxidative stre ss, and genetics. Most cases of PD are considered idiopathic or of unknown cause.
PD is a chronic, progressive neurodegenerative disorder marked by slow degeneration of dopaminergic neurons primarily in the substantia nigra.
The depletion of dopamine interferes largely with the nigrostriatal pathway of the basal ganglia, a system largely implicated in the production of move ment and coordinated muscle control Gibb, Although dopamine and the nigrostriatal pathway are primarily affected, th ere is evidence of disr uption to other brain regions e.
Decreased dopamine in the mesolimbic pathway, a system related to rewa rd sensitivity, may cont ribute to psychiatric symptoms of depression and apathy Lieberman, ; Fibiger, Tremors often occur in th e hands, fingers, forearms, foot, mouth, or chin, and take place when the limbs are at rest.
When the patient voluntarily initiates movement, however, the tremor subsides.
Rigidity refers to muscle stiffness that occurs, also called cogwheeling, which can result in muscle pain or discomfort during movement. PAGE 11 4 Bradykinesia refers to the slowness of voluntary movement, such as standing up, walking, and sitting down, that occurs because of delayed transmission signals from the brain to the muscles.
Parkinsons gait, char acterized by a shortened stride, and shuffling steps, is a common feature. Other primary motor symptoms include postural instability, or poor balance, and other coordination impa irment.
In later stages of the disease, akinesia lack of voluntary movementfe stination more severe and abnormal gait patternhypophonia voice weaknessdysarth ria speech impairmentchewing and swallowing difficulties, as well as drooling can occur Mackin, Symptom progression varies by individual but typically progresses over a period of 10 to 20 years Langston, Progression ca n be divided into th ree states:Darwin Skeptics A Select List of Science Academics, Scientists, and Scholars Who are Skeptical of Darwinism Ralph F.
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The term “mnestic block syndrome” emphasizes that the memory loss may be reversible and that just the conscious access to them may be blocked. shaped over the life time by the ups and downs of brain development (myelination, pruning neuropathology, and cognitive deficits.
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