Alexithymia, depression, and cognition in patients with Parkinson’s disease

Abstract

Background

Basal ganglia are connected to dorsal prefrontal and orbitofrontal structures, which have an important role in emotional experience. Alexithymia is defined as the inability to recognize and verbalize emotions. There is little known about alexithymia and cognitive dysfunction and its relationship with depression. In this study, we examined the relation of alexithymia with cognition and depression in non-demented patients with Parkinson's disease (PD).

Materials and methods

Fort-two consecutive non-demented patients PD and 40 healthy controls were enrolled in the study. The Turkish version of the Montreal Cognitive Assessment scale (MOCA-TR), 20-item Toronto Alexithymia Scale (TAS-20) (F1, F2, F3 subgroups), and Beck Depression Inventory (BDI-I) were used to evaluate cognitive functions, alexithymia, and depression, respectively, in both groups.

Results

The total TAS-20 score was 55.71 ± 19 in the PD group and 46.33 ± 8.21 in the control group. There was a statistically significant difference in the total TAS-20 scores between the groups (p < 0.001). In subgroups of alexithymia, all mean scores of F1, F2, and F3 were higher in the PD group (p = 0.019, p < 0.001, and p = 0.005, respectively). In the MOCA-TR test, the mean scores in visuospatial and delayed recall of patients with PD were statistically lower than in the control group (p = 0.044 and p = 0.04, respectively). The MOCA-TR and BDI total scores were significantly correlated with TAS-20 total scores. In subgroup analysis, we only found an association between the visuospatial domain of MOCA-TR and the F3 subgroup of TAS-20 (r = − 0.22, p = 0.03). There was no relation between alexithymia and disease duration or total levodopa dose (p < 0.05).

Conclusion

Alexithymia is not a rare symptom in PD. It should be accepted as an independent non-motor symptom, and patients should be interrogated accordingly.

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References

  1. 1.

    Zgaljardic DJ et al (2003) A review of the cognitive and behavioralsequelae of Parkinson’s disease: relationship to frontostriatal circuitry. Cognitive BehavNeurol 16(4):193–210

    Google Scholar 

  2. 2.

    Costa A et al (2006) Alexithymia in Parkinson’s disease is related to severity of depressive symptoms. Eur J Neurol 13(8):836–841

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  3. 3.

    Bogdanova Y, Diaz-Santos M, Cronin-Golomb A (2010) Neurocognitive correlates of alexithymia in asymptomatic individuals with HIV. Neuropsychologia 48(5):1295–1304

    PubMed  Article  PubMed Central  Google Scholar 

  4. 4.

    Poletti M, De Rosa A, Bonuccelli U (2012) Affective symptoms and cognitive functions in Parkinson’s disease. J NeurolSci 317(1–2):97–102

    Google Scholar 

  5. 5.

    Assogna F et al (2013) Depressive symptoms in Parkinson’s disease and in non-neurological medical illnesses. Neuropsychiatr Dis Treat 9:389–396

    PubMed  PubMed Central  Google Scholar 

  6. 6.

    Bogdanova Y, Cronin-Golomb A (2013) Alexithymia and apathy in Parkinson’s disease: neurocognitive correlates. BehavNeurol 27(4):535–545

    Google Scholar 

  7. 7.

    Duncan GW et al (2014) Health-related quality of life in early Parkinson’s disease: the impact of nonmotor symptoms. MovDisord 29(2):195–202

    Google Scholar 

  8. 8.

    Assogna F et al (2016) Alexithymia in Parkinson’s disease: a systematic review of the literature. Parkinsonism RelatDisord 28:1–11

    Article  Google Scholar 

  9. 9.

    Costa A, Caltagirone C (2016) Alexithymia in Parkinson’s disease: a point of view on current evidence. Neurodegener Dis Manag 6(3):215–222

    PubMed  Article  PubMed Central  Google Scholar 

  10. 10.

    Weintraub D, Mamikonyan E (2019) The neuropsychiatry of Parkinson disease: a perfect storm. Am J Geriatr Psychiatry 27(9):998–1018

    PubMed  PubMed Central  Article  Google Scholar 

  11. 11.

    Costa A et al (2007) Neuropsychological correlates of alexithymia in Parkinson’s disease. J IntNeuropsycholSoc 13(6):980–992

    Google Scholar 

  12. 12.

    Poletti M et al (2011) alexithymia may modulate decision making in patients with de novo Parkinson’s disease. FunctNeurol 26(3):127–131

    Google Scholar 

  13. 13.

    Assogna F et al (2012) Alexithymia is a non-motor symptom of Parkinson disease. Am J Geriatr Psychiatry 20(2):133–141

    PubMed  Article  PubMed Central  Google Scholar 

  14. 14.

    Lin CY et al (2016) Degraded impairment of emotion recognition in Parkinson’s disease extends from negative to positive emotions. BehavNeurol 2016:9287092

    Google Scholar 

  15. 15.

    Borsci G et al (2009) Alexithymia in healthy women: a brain morphology study. J Affect Disord 114(1–3):208–215

    PubMed  Article  PubMed Central  Google Scholar 

  16. 16.

    Goerlich-Dobre KS et al (2015) Neuroanatomical profiles of alexithymia dimensions and subtypes. Hum Brain Mapp 36(10):3805–3818

    PubMed  PubMed Central  Article  Google Scholar 

  17. 17.

    Xu P et al (2018) Structure of the alexithymic brain: a parametric coordinate-based meta-analysis. NeurosciBiobehav Rev 87:50–55

    Google Scholar 

  18. 18.

    Bermond B, Vorst HC, Moormann PP (2006) Cognitive neuropsychology of alexithymia: implications for personality typology. Cogn Neuropsychiatry 11(3):332–360

    PubMed  Article  PubMed Central  Google Scholar 

  19. 19.

    Haber SN (2014) The place of dopamine in the cortico-basal ganglia circuit. Neuroscience 282:248–257

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  20. 20.

    Trojano L, Papagno C (2018) Cognitive and behavioral disorders in Parkinson’s disease: an update. II: behavioral disorders. NeurolSci 39(1):53–61

    Google Scholar 

  21. 21.

    Costa A et al (2010) prevalence and characteristics of alexithymia in Parkinson’s disease. Psychosomatics 51(1):22–28

    PubMed  Article  PubMed Central  Google Scholar 

  22. 22.

    Poletti M et al (2011) alexithymia is associated with depression in de novo Parkinson’s disease. PsychotherPsychosom 80(4):251–253

    Google Scholar 

  23. 23.

    Castelli L et al (2014) alexithymia in patients with Parkinson’s disease treated with DBS of the subthalamic nucleus: a case-control study. Front Psychol 5:1168

    PubMed  PubMed Central  Article  Google Scholar 

  24. 24.

    Tomlinson CL et al (2010) Systematic review of levodopa dose equivalency reporting in Parkinson’s disease. MovDisord 25(15):2649–2653

    Google Scholar 

  25. 25.

    Ozdilek B, Kenangil G (2014) Validation of the Turkish Version of the Montreal Cognitive Assessment Scale (MoCA-TR) in patients with Parkinson’s disease. ClinNeuropsychol 28(2):333–343

    Google Scholar 

  26. 26.

    Güleç H et al (2009) reliability and factorial validity of the Turkish version of the 20-item Toronto alexithymia scale (TAS-20). KlinikPsikofarmakolojiBulteni 19(3):214

    Google Scholar 

  27. 27.

    Bagby RM, Parker JD, Taylor GJ (1994) The twenty-item Toronto Alexithymia Scale-I. Item selection and cross-validation of the factor structure. J Psychosom Res 38(1):23–32

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  28. 28.

    ŞN H (1988) Validation of the BDI with a group of Turkish psychiatric outpatients. Turk J Psychol 6(22):118

    Google Scholar 

  29. 29.

    Goerlich-Dobre KS et al (2014) Alexithymia-an independent risk factor for impulsive-compulsive disorders in Parkinson’s disease. MovDisord 29(2):214–220

    Google Scholar 

  30. 30.

    Enrici I et al (2015) Emotion processing in Parkinson’s disease: a three-level study on recognition, representation, and regulation. PLoS ONE 10(6):e0131470

    PubMed  PubMed Central  Article  CAS  Google Scholar 

  31. 31.

    Bailey PE, Henry JD (2007) Alexithymia, somatization and negative affect in a community sample. Psychiatry Res 150(1):13–20

    PubMed  Article  PubMed Central  Google Scholar 

  32. 32.

    Karvonen JT, Veijola J, Kokkonen P, Läksy K, Miettunen J, Joukamaa M (2005) Somatization and alexithymia in young adult Finnish population. Gen Hosp Psychiatry 27(4):244–249

    PubMed  Article  PubMed Central  Google Scholar 

  33. 33.

    Honkalampi K, Hintikka J, Tanskanen A, Lehtonen J, Viinamaki H (2000) Depression is strongly associated with alexithymia in the general population. J Psychosom Res 48(1):99–104

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  34. 34.

    Maaranen P, Tanskanen A, Honkalampi K, Haatainen K, Hintikka J, Viinamaki H (2005) Factors associated with pathological dissociation in the general population. Aust N Z J Psychiatry 39(5):387–394

    PubMed  Article  PubMed Central  Google Scholar 

  35. 35.

    Sayar K, Kose S, Grabe HJ, Topbas M (2005) Alexithymia and dissociative tendencies in an adolescent sample from Eastern Turkey. Psychiatry ClinNeurosci 59(2):127–134

    Google Scholar 

  36. 36.

    Honkalampi K, Hintikka J, Laukkanen E, Lehtonen J, Viinamaki H (2001) Alexithymia and depression: a prospective study of patients with major depressive disorder. Psychosomatics 42(3):229–234

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  37. 37.

    Honkalampi K, Saarinen P, Hintikka J, Virtanen V, Viinamaki H (1999) Factors associated with alexithymia in patients suffering from depression. PsychotherPsychosom 68(5):270–275

    CAS  Google Scholar 

  38. 38.

    Saarijarvi S, Salminen JK, Toikka TB (2001) Alexithymia and depression: a 1-year follow-up study in outpatients with major depression. J Psychosom Res 51(6):729–733

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  39. 39.

    Leweke F, Leichsenring F, Kruse J, Hermes S (2012) Is alexithymia associated with specific mental disorders? Psychopathology 45(1):22–28

    PubMed  Article  PubMed Central  Google Scholar 

  40. 40.

    Li S et al (2015) The association between alexithymia as assessed by the 20-item Toronto Alexithymia Scale and depression: a meta-analysis. Psychiatry Res 227(1):1–9

    PubMed  Article  PubMed Central  Google Scholar 

  41. 41.

    Hintikka J et al (2001) Are alexithymia and depression distinct or overlapping constructs?: a study in a general population. Compr Psychiatry 42(3):234–239

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  42. 42.

    Grabe HJ et al (2014) alexithymia and brain gray matter volumes in a general population sample. Hum Brain Mapp 35(12):5932–5945

    PubMed  PubMed Central  Article  Google Scholar 

  43. 43.

    Spalletta G et al (2001) Alexithymic features in stroke: effects of laterality and gender. Psychosom Med 63(6):944–950

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  44. 44.

    Hogeveen J et al (2016) Acquired alexithymia following damage to the anterior insula. Neuropsychologia 82:142–148

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  45. 45.

    Paradiso S et al (2008) Aging and alexithymia: association with reduced right rostral cingulate volume. Am J Geriatr Psychiatry 16(9):760–769

    PubMed  PubMed Central  Article  Google Scholar 

  46. 46.

    Bankier B, Aigner M, Bach M (2001) Alexithymia in DSM-IV disorder: comparative evaluation of somatoform disorder, panic disorder, obsessive-compulsive disorder, and depression. Psychosomatics 42(3):235–240

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  47. 47.

    Hoops S et al (2009) Validity of the MoCA and MMSE in the detection of MCI and dementia in Parkinson disease. Neurology 73(21):1738–1745

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  48. 48.

    Dafsari HS et al (2019) Beneficial effects of bilateral subthalamic stimulation on alexithymia in Parkinson’s disease. Eur J Neurol 26(2):222-e17

    CAS  PubMed  Article  PubMed Central  Google Scholar 

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Correspondence to Gulay Kenangil.

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Kenangil, G., Demir, M., Tur, E. et al. Alexithymia, depression, and cognition in patients with Parkinson’s disease. Acta Neurol Belg (2021). https://doi.org/10.1007/s13760-020-01581-2

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Keywords

  • Alexithymia
  • Cognition
  • Parkinson disease