Why are some Parkinson’s disease patients unaware of their dyskinesias?

Jenkinson, P., Edelstyn, N.M.J., Stephen, R. and Ellis, S.J. (2009) Why are some Parkinson’s disease patients unaware of their dyskinesias? Cognitive and Behavioral Neurology, 22 (2). pp. 117-121. ISSN 1543-3633
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Objective : To test the hypothesis that anosognosia-for-dyskinesias in Parkinson’s disease (PD) results from a failure to detect discrepancies between intended and actual movement. Background : PD patients often complain of drug-induced dyskinesias (involuntary movements) less than their carers. This remarkable unawareness is an example of anosognosia (i.e., unawareness of deficits associated with an illness). A better understanding of anosognosia-for-dyskinesias in PD is important to understanding the impact of the illness and side effects of treatment. Method : The ability to detect a discrepancy between intended movement and visual feedback about actual ovement was investigated in 6 PD patients with anosognosia-for-dyskinesias, 11 non-anosognosic PD controls with dyskinesias, and 22 healthy volunteers (HVs), using a mirror to reverse the expected visual consequences of an executed movement. Results : Non-anosognosic PD patients and HVs rated mirror-reversed movement as significantly stranger than normal movement (p=.024 and <.001 respectively), whereas PD patients with anosognosia-for-dyskinesias did not (p=.375). Conclusion: The findings support our proposal, in that PD patients with anosognosia-fordyskinesias do not report mirror-reversed movement (in which intentions and visual feedback conflict) as feeling distinct from normal movement.


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