Objective: To analyze the existence of a relationship between Dyskinesias-reduced-self-awareness (DRSA) and abilities related to cognitive and affective Theory of Mind (ToM), which may represent a novel explanation of the phenomenon. Indeed a reduction in self-awareness may be considered a critical manifestation of impaired ToM abilities, in terms of meta-representation.

Background: Levodopa-induced dyskinesias (LIDs) are one of the most common motor complications in PD. The abnormal subjective perception of motor impairment is an interesting neuropsychological phenomenon that could potentially allow a better understanding of the impact of the disease and the pharmacological side effects. The presence of DRSA in PD was previously related to metacognitive-executive functions. The ability to mentalize, to understand the mental state of others and to predict behavior based on those states (also defined as ToM) have to be taken into account as another possible intervening factor.

Methods: Forty-one cognitive preserved PD patients with LIDs were studied. Two different rating scales to measure DRSA were used: the Global Awareness of Movement Disorders (GAM) and the Dyskinesias Subtracted-Index (DS-I). In order to study whether GAM and DS-I scores could be influenced by ToM or Reading the Mind in the Eyes (RME) tasks, two multiple linear regression analyses, adjusted for a combination of neuropsychological-behavioral measures, were conducted.

Results: Specific aspects of mentalizing measured by means of RME task influenced both the GAM and DS-I self-awareness outcome (p<.0001; p=.0207, respectively). Moreover DS-I scores were also influenced by Trail Making Test-B performance (p=.0315). Conversely, global cognition, mood changes and cognitive ToM were not related with DRSA.

Conclusions: PD patients with DRSA showed an association between the affective component of ToM and executive dysfunction related to dyskinesias. Self-reflecting ability and the use of own experience of mental states, beliefs, attitudes, and experiences to understand the mental states of Others are require to a preserved awareness. Our data support the notion that DRSA is caused by a complex interplay between specific neuropsychological and motor factors, rather than resulting from a pure motor problem.

« Back to 2016 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/dyskinesias-reduced-self-awareness-and-theory-of-mind-in-parkinsons-disease-a-novel-frame-of-interpretation/