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.
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).
Alexithymia is not a rare symptom in PD. It should be accepted as an independent non-motor symptom, and patients should be interrogated accordingly.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
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
Costa A et al (2006) Alexithymia in Parkinson’s disease is related to severity of depressive symptoms. Eur J Neurol 13(8):836–841
Bogdanova Y, Diaz-Santos M, Cronin-Golomb A (2010) Neurocognitive correlates of alexithymia in asymptomatic individuals with HIV. Neuropsychologia 48(5):1295–1304
Poletti M, De Rosa A, Bonuccelli U (2012) Affective symptoms and cognitive functions in Parkinson’s disease. J NeurolSci 317(1–2):97–102
Assogna F et al (2013) Depressive symptoms in Parkinson’s disease and in non-neurological medical illnesses. Neuropsychiatr Dis Treat 9:389–396
Bogdanova Y, Cronin-Golomb A (2013) Alexithymia and apathy in Parkinson’s disease: neurocognitive correlates. BehavNeurol 27(4):535–545
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
Assogna F et al (2016) Alexithymia in Parkinson’s disease: a systematic review of the literature. Parkinsonism RelatDisord 28:1–11
Costa A, Caltagirone C (2016) Alexithymia in Parkinson’s disease: a point of view on current evidence. Neurodegener Dis Manag 6(3):215–222
Weintraub D, Mamikonyan E (2019) The neuropsychiatry of Parkinson disease: a perfect storm. Am J Geriatr Psychiatry 27(9):998–1018
Costa A et al (2007) Neuropsychological correlates of alexithymia in Parkinson’s disease. J IntNeuropsycholSoc 13(6):980–992
Poletti M et al (2011) alexithymia may modulate decision making in patients with de novo Parkinson’s disease. FunctNeurol 26(3):127–131
Assogna F et al (2012) Alexithymia is a non-motor symptom of Parkinson disease. Am J Geriatr Psychiatry 20(2):133–141
Lin CY et al (2016) Degraded impairment of emotion recognition in Parkinson’s disease extends from negative to positive emotions. BehavNeurol 2016:9287092
Borsci G et al (2009) Alexithymia in healthy women: a brain morphology study. J Affect Disord 114(1–3):208–215
Goerlich-Dobre KS et al (2015) Neuroanatomical profiles of alexithymia dimensions and subtypes. Hum Brain Mapp 36(10):3805–3818
Xu P et al (2018) Structure of the alexithymic brain: a parametric coordinate-based meta-analysis. NeurosciBiobehav Rev 87:50–55
Bermond B, Vorst HC, Moormann PP (2006) Cognitive neuropsychology of alexithymia: implications for personality typology. Cogn Neuropsychiatry 11(3):332–360
Haber SN (2014) The place of dopamine in the cortico-basal ganglia circuit. Neuroscience 282:248–257
Trojano L, Papagno C (2018) Cognitive and behavioral disorders in Parkinson’s disease: an update. II: behavioral disorders. NeurolSci 39(1):53–61
Costa A et al (2010) prevalence and characteristics of alexithymia in Parkinson’s disease. Psychosomatics 51(1):22–28
Poletti M et al (2011) alexithymia is associated with depression in de novo Parkinson’s disease. PsychotherPsychosom 80(4):251–253
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
Tomlinson CL et al (2010) Systematic review of levodopa dose equivalency reporting in Parkinson’s disease. MovDisord 25(15):2649–2653
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
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
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
ŞN H (1988) Validation of the BDI with a group of Turkish psychiatric outpatients. Turk J Psychol 6(22):118
Goerlich-Dobre KS et al (2014) Alexithymia-an independent risk factor for impulsive-compulsive disorders in Parkinson’s disease. MovDisord 29(2):214–220
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
Bailey PE, Henry JD (2007) Alexithymia, somatization and negative affect in a community sample. Psychiatry Res 150(1):13–20
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
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
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
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
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
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
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
Leweke F, Leichsenring F, Kruse J, Hermes S (2012) Is alexithymia associated with specific mental disorders? Psychopathology 45(1):22–28
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
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
Grabe HJ et al (2014) alexithymia and brain gray matter volumes in a general population sample. Hum Brain Mapp 35(12):5932–5945
Spalletta G et al (2001) Alexithymic features in stroke: effects of laterality and gender. Psychosom Med 63(6):944–950
Hogeveen J et al (2016) Acquired alexithymia following damage to the anterior insula. Neuropsychologia 82:142–148
Paradiso S et al (2008) Aging and alexithymia: association with reduced right rostral cingulate volume. Am J Geriatr Psychiatry 16(9):760–769
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
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
Dafsari HS et al (2019) Beneficial effects of bilateral subthalamic stimulation on alexithymia in Parkinson’s disease. Eur J Neurol 26(2):222-e17
There was no external source of funding.
Conflict of interest
All authors declare that they have no conflicts of interest.
The study received ethics approval by the Institutional Review Board of Erenkoy Mental Health and Neurological Disorders Training and Research Hospital.
All participants provided informed consent prior to their participation.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
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
- Parkinson disease