The Cognitive Neuropsychiatry of Parkinson's Disease by Patrick McNamara

By Patrick McNamara

Patients with Parkinson's sickness (PD) endure so much visibly with such motor deficits as tremor and pressure and not more evidently with a variety of nonmotor signs, together with autonomic disorder, temper problems, and cognitive impairment. The neuropsychiatric disturbances of PD will be as disabling as its motor issues; yet they've got only in the near past began to be studied intensively by way of clinicians and scientists. during this e-book, Patrick McNamara examines the foremost neuropsychiatric syndromes of PD intimately and provides a cognitive thought that bills for either their neurology and their phenomenology. McNamara deals an updated assessment of present wisdom of such neuropsychiatric manifestations of PD as cognitive deficits, character alterations, speech and language signs, sleep problems, apathy, psychosis, and dementia. He argues that the cognitive, temper, and character indicators of PD stem from the weakening or suppression of the agentic facets of the self. McNamara's research may possibly bring about greater therapy for Parkinson's sufferers. yet its overarching objective is to reach at a greater realizing of the human brain and its breakdown styles in sufferers with PD. The human mind-brain is an complicated and complicated constitution patched jointly to supply what we name the self. once we realize the disruption of the self constitution that happens with a few of the neuropsychiatric issues linked to PD, McNamara argues, we get a glimpse into the internal workings of the main amazing constitution of the self: the agentic self, the self that acts.

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We turn now to a review of the properties of the agentic self. Properties of the Agentic Self To the extent that the agentic self reflects on itself, it is important to point out (along with Synofzik, Vosgerau, & Newen, 2008) that the sense of agency can be decomposed into a prereflective, largely automatically induced feeling of agency that occurs in tandem with voluntary motor acts and an inferentially derived judgment of agency that occurs when we sometimes reflect on our actions. Thus, our thinking about ourselves as agents is constrained by these automatic and effortful processes that underlie our experiences of agency.

Even patients with sporadic PD who have typical clinical and pathologic features with no family history are often found to have LRRK2 mutations. Many of these genes impact, in one way or another, the metabolic processing of protein manufacture and degradation. 4 Genes linked to PD Locus Gene/Protein Inheritance Pattern Clinical Phenotype PARK1 SNCA/α-synuclein Autosomal dominant PARK2 PARK2/parkin Autosomal recessive PARK3 PARK5 PARK6 Unknown UCH-L1 PINK1 Autosomal dominant Autosomal dominant Autosomal recessive PARK7 PARK7/DJ-1 Autosomal recessive PARK8 LRRK2/dardarin Autosomal dominant PARK10 PARK11 FTDP-17 Unknown Unknown MAPT/tau Genetic susceptibility Genetic susceptibility Autosomal dominant SCA2 SCA3 Nurr1 Synphilin-1 Mitochondria ATXN2/ataxin-2 ATXN2/ataxin-3 NR4A2/NURR1 SNCAIP/synphilin-1 NADH complex 1 Autosomal dominant Autosomal dominant Likely autosomal dominant Likely autosomal dominant Mitochondrial inheritance (maternal line) Mid-age onset (45–60 years with typical PD ± dementia) Juvenile (<20 years) onset with atypical features Typical PD Mid-age onset with typical PD Early onset (20–45 years) PD with slow progression Early onset PD with slow progression Mid-age onset with typical PD ± dementia and amyotrophy Typical PD Typical PD Parkinson’s associated with frontotemporal dementia Typical PD Typical PD Typical PD Typical PD Typical PD Source: Modified from Butler and McNamara (2011, in press).

Adaptation is not possible unless the aim is to match a target. With a target, you can then reduce the distance between you and the target. The TD mechanism is basically a reward-prediction error signal that carries information about timing and intensity of an expected or future reward (Houk, Adams, & Barto, 1995; Montague, Dayan, & Sejnowski, 1996; Schultz, 1998; Schultz, Dayan, & Montague, 1997). It uses the computed difference between the expected and the actual outcome to improve future outcomes.

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