Attentional dysfunction and the punding spectrum in Parkinson's disease

• Published in: Parkinsonism & related disorders 2021-03, Vol.84, p.23-28
• Main Authors: Hinkle, Jared T., Perepezko, Kate, Mills, Kelly A., Pontone, Gregory M.
• Format: Article
• Language: English
• Subjects: Aged; Attention; Attention - physiology; Cognitive Dysfunction - etiology; Cognitive Dysfunction - physiopathology; Cognitive impairment; Disruptive, Impulse Control, and Conduct Disorders - etiology; Disruptive, Impulse Control, and Conduct Disorders - physiopathology; Female; Humans; Male; Middle Aged; Neuropsychological Tests; Parkinson Disease - complications; Parkinson Disease - physiopathology; Parkinson''s disease; Punding
• ISSN: 1353-8020; 1873-5126; 1873-5126
• DOI: 10.1016/j.parkreldis.2021.01.019

Punding is a complication of Parkinson's disease (PD) treatment and stimulant abuse that features excessive preoccupation with repetitive and/or aimless behaviors. We hypothesized that cognitive impairment and functional limitations influence how punding behaviors manifest in PD. We extracted data on punding, hobbyism, and cognition from the Parkinson's Progression Marker Initiative (PPMI). Punding and hobbyism were measured with the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease (QUIP) scale. We determined how cognition predicted punding and hobbyism behaviors—adjusting for levodopa dose, Hoehn & Yahr stage, disease duration, and age—using generalized estimating equation (GEE) logistic regression. Activities of daily living (ADL) and motor impairment were measured with the MDS-UPDRS scale. In GEE logistic regression models, punding was selectively associated with lower scores on the Letter Number Sequencing test (LNS), the primary attention test in PPMI (Odds ratio: 0.87 (95% CI: 0.79–0.96); p = 0.022). This was corroborated by a subscale-analysis of Montreal Cognitive Assessment (MoCA) scores, as only the attention subscale was significantly associated with punding (OR: 0.59 (0.45–0.77); p