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. 2023 Feb 24;18(2):e0279722.
doi: 10.1371/journal.pone.0279722. eCollection 2023.

Exploring impaired self-awareness of motor symptoms in Parkinson's disease: Resting-state fMRI correlates and the connection to mindfulness

Timo Marcel Buchwitz  1 , Marina Christine Ruppert-Junck  1   2 , Andrea Greuel  1 , Franziska Maier  3 , Franziska Thieken  1 , Viktoria Jakobs  1 , Carsten Eggers  1   2   4
Affiliations

Exploring impaired self-awareness of motor symptoms in Parkinson's disease: Resting-state fMRI correlates and the connection to mindfulness

Timo Marcel Buchwitz et al. PLoS One. .

Abstract

Objective: To further explore the phenomenon of impaired self-awareness of motor symptoms in patients with Parkinson's Disease by using an evaluated measurement approach applied in previous studies, while also examining its connection with dispositional mindfulness and possible correlates of functional connectivity.

Background: Recently, the phenomenon of impaired self-awareness has been studied more intensively by applying different measurement and imaging methods. Existing literature also points towards a possible connection with mindfulness, which has not been examined in a cross-sectional study. There is no data available concerning correlates of functional connectivity.

Methods: Non-demented patients with idiopathic Parkinson's Disease without severe depression were tested for impaired self-awareness for motor symptoms following a psychometrically evaluated approach. Mindfulness was measured by applying the German version of the Five Facet Mindfulness Questionnaire. A subset of eligible patients underwent functional MRI scanning. Spearman correlation analyses were performed to examine clinical data. Whole-brain voxelwise regressions between seed-based connectivity and behavioral measures were calculated to identify functional connectivity correlates of impaired self-awareness scores.

Results: A total of 41 patients with Parkinson's Disease were included. 15 patients successfully underwent resting-state fMRI scanning. Up to 88% of patients showed signs of impaired self-awareness. Awareness for hypokinetic movements correlated with total mindfulness values and three facets, while awareness for dyskinetic movements did not. Three significant clusters between scores of impaired self-awareness in general and for dyskinetic movements were identified linking behavioral measures with the functional connectivity of the inferior frontal gyrus, the right insular cortex, the supplementary motor area, and the precentral gyrus among others. Impaired self-awareness for hypokinetic movements did not have any neural correlate.

Conclusions: Clinical data is comparable with results from previous studies applying the same structured approach to measure impaired self-awareness in Parkinson's Disease. Functional connectivity analyses were conducted for the first time to evaluate neural correlates thereof. This data does not support a connection between impaired self-awareness of motor symptoms and dispositional mindfulness.

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Conflict of interest statement

In the last 12 months C. Eggers has received speaker’s or consulting honoraria from Abbvie Inc., Stada Pharma Inc., EverPharma Inc. and Philyra Inc. T.M. Buchwitz has received consulting honoraria from Philyra Inc. All other authors had no conflicts of interest. All funders had no role in study design, data collection, decision to publish, or preparation of the manuscript. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Spearman correlations between ISAm and demographic, disease-related and neuropsychological data.
Abbreviations: BDI-II, Beck Depression Inventory; ECFT-MI, Extended Complex Figure Test–Motor Independent Version; LEDD, levodopa equivalent daily dose; MoCA, Montreal Cognitive Assessment; TMT, Trail Making Test; VLMT, Verbal learning and memory test; WAIS-IV, Wechsler Adult Intelligence Scale–Fourth Edition; vfl, verbal fluency; (+), higher scores indicate higher impairment or worse performance; *p < .05; (*) p ≥ .05 after correction for age and education years.
Fig 2
Fig 2. Overview of quality assurance measures for the resting-state fMRI subsample.
Abbreviations: MaxGSchange, maximum change of the global BOLD signal; MeanGSchange, mean change of the global BOLD signal; MaxMotion, maximum amount of motion; MeanMotion, average amount of motion; Q, quartile; IQR, interquartile range, S, subject.
Fig 3
Fig 3. Associations between ISAm-total, ISAm-LID and resting-state fMRI functional connectivity.
A) Positive association between ISAm-total scores and functional connectivity between the left IFG seed and the insular cortex. B) Negative association between ISAm-LID scores and functional connectivity between the left IFG seed and the supplementary motor area. C) Negative association between ISAm-LID scores and functional connectivity in between the right IFG seed and the precentral gyrus. All results were corrected for multiple comparisons using family-wise error (FWE) correction at cluster level. Abbreviations: ACC, anterior cingulate cortex; IFG, inferior frontal gyrus.
Fig 4
Fig 4. Spearman correlations between ISAm and FFMQ-D scores.
Abbreviations: FFMQ-D, Five Facet Mindfulness Questionnaire–German version; *p < .05.
See this image and copyright information in PMC

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