Brain, Vol. 119, No. 6, 2121-2132, 1996
© 1996 Guarantors of Brain
research-article |
Acute effects of levodopa on neuropsychological performance in stable and fluctuating Parkinson's disease patients at different levodopa plasma levels
1Department of Neurology, Pharmacological Research Area, Sant Pau Hospital, Autonomous University of Barcelona 2Clinical Pharmacology Unit, Pharmacological Research Area, Sant Pau Hospital, Autonomous University of Barcelona 3Service of Neurology, Virgen de la Victoria University Hospital Malaga, Spain
Correspondence to:
Correspondence to: Jaime Kulisevsky, MD, Department of Neurology, Sant Pau Hospital, Sant Antoni M. Claret 167, 08025 Barcelona, Spain
The contribution of dopaminergic systems to cognitive defects in Parkinson's disease and the cognitive effects of levodopa remain controversial. The levodopa plasma levels and the neuropsychological performance of 10 parkinsonian patients with a stable motor response to the drug, and 10 matched parkinsonian patients with a ‘wearing-off’ phenomenon were studied 12 h after levodopa was withdrawn (time zero), and at 1 h and 4 h after an oral dose of levodopa (i.e. at ‘+1H’ and ‘+4H’), to investigate whether discrete cognitive domains are more sensitive to levodopa in parkinsonian patients with the wearing-off phenomenon. Considering the 20 patients as a whole, levodopa significantly diminished the response time in verbal and visuospatial memory tests, the extradimensional matching test and the Wisconsin card sorting test (WCST), without significantly improving or worsening the patient's accuracy. A significant group-by-time effect was only evident in the WCST; while in stable patients levodopa produced no changes, wearing-off patients significantly reduced the number of categories achieved and had more perseverative errors at +1H, recovering at +4H. These results confirm previous findings of selective adverse effects of levodopa on highly demanding executive tasks in Parkinson's disease and additionally suggest that some previous discrepancies between studies may be accounted for by lack of differentiation between stable and wearing-off conditions. ‘Frontal’ disturbances on neuropsychological tests with levodopa may become evident only after massive degeneration of the dopamine systems has occurred.
levodopa; Parkinson's disease; cognition; executive functions; motor fluctuations
Received March 8, 1996. Revised July 10, 1996. Accepted August 6, 1996.
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