Wearing-off in Parkinson’s disease: neuropsychological differences between on and off periods

Abstract

Fabiane Caillava-Santos,1,2 Regina Margis,2 Carlos Roberto de Mello Rieder2–4 1Psychology Department, Universidade da Região da Campanha, Bagé, RS, Brazil; 2Curso de Pós-Graduação em Medicina, Ciências Médicas da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; 3Movement Disorders Center, Division of Neurology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil; 4Movement Disorder Clinic, Division of Neurology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, BrazilBackground: Levodopa-associated motor fluctuations are common complications observed in Parkinson’s disease (PD) patients. Although nonmotor fluctuations are a significant cause of morbidity, they frequently are not properly identified. Few studies have characterized the nonmotor emotional fluctuations and their relation to motor fluctuations.Aims: The objective of the present study is to analyze the occurrence of fluctuations in anxiety and depression symptoms, as well as in cognitive function (memory, language, executive function, and attention), and their relation to motor fluctuations in PD patients presenting wearing-off phenomenon.Methods: Twenty-four patients were assessed during the wearing on-off periods. The State-Trait Anxiety Inventory (STAI-State) and Beck Depression Inventory (BDI) were used to assess anxiety and depression, respectively, and the Wisconsin Card Sorting Test (WCST), Stroop Test, Rey Auditory Verbal Learning Test (RAVLT), Weschler Memory Scale - digits (WMS) and Controlled Oral Word Association (COWA) for assessing executive functions, verbal memory, attention and work memory and verbal fluency, respectively.Results: Patients presented higher depression and anxiety scores in the wearing-off period (P<0.05). Differences were also found in the semantic verbal fluency (P=0.017) and executive function (P=0.008) tests performance.Conclusions: Nonmotor symptoms such as anxiety and depression, verbal fluency, and executive function performance are influenced by motor fluctuations.Keywords: Parkinson’s disease, wearing-off, neuropsychological assessment, depression, anxiety