Attention/Working Memory and Executive Function in Parkinson's Disease: Review, Critique, and Recommendations

Roberta Biundo^{1

2}, Ondrej Bezdicek³, Davide Maria Cammisuli⁴, Brenna Cholerton⁵, John C Dalrymple-Alford^{6

7

8}, Nicola Edelstyn⁹, Eleonora Fiorenzato¹⁰, Erin Holker¹¹, Saul Martinez-Horta^{12

13}, Alice Martini¹⁴, Gabriella Santangelo¹⁵, Barbara Segura^{16

17

18}, Chiara Siri¹⁹, Alexander Tröster²⁰, Tiago A Mestre²¹, Álvaro Sánchez Ferro^{13

22}, Michelle Hyczy de Siqueira Tosin²³, Matej Skorvanek^{24

25}, Daniel Weintraub²⁶, Gert J Geurtsen²⁷; members of the MDS Clinical Outcome Assessment Scientific Evaluation Committee

Affiliations

¹ Department of General Psychology, University of Padua, Padua, Italy.
² IRCCS, San Camillo Hospital, Venice, Italy.
³ Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University, Prague, Czech Republic.
⁴ Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy.
⁵ Department of Pathology, Stanford University School of Medicine, Stanford, California, USA.
⁶ Te Kura Mahi ā-Hirikapo School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand.
⁷ New Zealand Brain Research Institute, Christchurch, New Zealand.
⁸ Department of Medicine, University of Otago, Dunedin, New Zealand.
⁹ Department of Psychology, Bath Spa University, Bath, UK.
¹⁰ Neurodegenerative Disease Unit, Department of Neuroscience, University of Padua, Padua, Italy.
¹¹ Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
¹² Movement Disorders Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Research Institute Sant Pau, Barcelona, Spain.
¹³ Centro de Investigagión Biomédica en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.
¹⁴ Addiction and Mental Health Department, Azienda Sanitaria Friuli Occidentale, Pordenone, Italy.
¹⁵ Department of Psychology, University of Campania, "Luigi Vanvitelli", Caserta, Italy.
¹⁶ Medical Psychology Unit, Department of Medicine, Institute of Neurosciences, University of Barcelona, Barcelona, Spain.
¹⁷ Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
¹⁸ Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, Barcelona, Spain.
¹⁹ Parkinson's Disease and Movement Disorders Neurorehabilitation Unit, Moriggia Pelascini Hospital, Como, Italy.
²⁰ Department of Clinical Neuropsychology and Center for Neuromodulation, Barrow Neurological Institute, Phoenix, Arizona, USA.
²¹ Parkinson's Disease and Movement Disorders Center, Division of Neurology, Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa Brain and Mind Institute, Ottawa, Ontario, Canada.
²² Movement Disorders Unit, Neurology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.
²³ Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA.
²⁴ Department of Neurology, Safarik University, Kosice, Slovakia.
²⁵ Department of Neurology, University Hospital of Louis Pasteur, Kosice, Slovakia.
²⁶ Department of Psychiatry, University of Pennsylvania School of Medicine; Parkinson's Disease Research, Education and Clinical Center (PADRECC), Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA.
²⁷ Department of Medical Psychology, Amsterdam UMC Location, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands.

PMID: 40678921
PMCID: PMC12485586
DOI: 10.1002/mds.30293

Review

Attention/Working Memory and Executive Function in Parkinson's Disease: Review, Critique, and Recommendations

Roberta Biundo et al. Mov Disord. 2025 Sep.

. 2025 Sep;40(9):1791-1804.

doi: 10.1002/mds.30293. Epub 2025 Jul 18.

Authors

Affiliations

¹ Department of General Psychology, University of Padua, Padua, Italy.
² IRCCS, San Camillo Hospital, Venice, Italy.
³ Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University, Prague, Czech Republic.
⁴ Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy.
⁵ Department of Pathology, Stanford University School of Medicine, Stanford, California, USA.
⁶ Te Kura Mahi ā-Hirikapo School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand.
⁷ New Zealand Brain Research Institute, Christchurch, New Zealand.
⁸ Department of Medicine, University of Otago, Dunedin, New Zealand.
⁹ Department of Psychology, Bath Spa University, Bath, UK.
¹⁰ Neurodegenerative Disease Unit, Department of Neuroscience, University of Padua, Padua, Italy.
¹¹ Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
¹² Movement Disorders Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Research Institute Sant Pau, Barcelona, Spain.
¹³ Centro de Investigagión Biomédica en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.
¹⁴ Addiction and Mental Health Department, Azienda Sanitaria Friuli Occidentale, Pordenone, Italy.
¹⁵ Department of Psychology, University of Campania, "Luigi Vanvitelli", Caserta, Italy.
¹⁶ Medical Psychology Unit, Department of Medicine, Institute of Neurosciences, University of Barcelona, Barcelona, Spain.
¹⁷ Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
¹⁸ Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, Barcelona, Spain.
¹⁹ Parkinson's Disease and Movement Disorders Neurorehabilitation Unit, Moriggia Pelascini Hospital, Como, Italy.
²⁰ Department of Clinical Neuropsychology and Center for Neuromodulation, Barrow Neurological Institute, Phoenix, Arizona, USA.
²¹ Parkinson's Disease and Movement Disorders Center, Division of Neurology, Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa Brain and Mind Institute, Ottawa, Ontario, Canada.
²² Movement Disorders Unit, Neurology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.
²³ Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA.
²⁴ Department of Neurology, Safarik University, Kosice, Slovakia.
²⁵ Department of Neurology, University Hospital of Louis Pasteur, Kosice, Slovakia.
²⁶ Department of Psychiatry, University of Pennsylvania School of Medicine; Parkinson's Disease Research, Education and Clinical Center (PADRECC), Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA.
²⁷ Department of Medical Psychology, Amsterdam UMC Location, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands.

PMID: 40678921
PMCID: PMC12485586
DOI: 10.1002/mds.30293

Abstract

Background: Cognitive impairment in Parkinson's disease (PD) is a well-established non-motor complication that significantly affects the quality of life and well-being of both patients and care partners. To optimally detect mild cognitive impairment or dementia, extensive neuropsychological assessment is essential. A wide range of cognitive tests and clinical outcome assessments have been used in clinical settings, often without regard to their clinimetric quality.

Methods: We performed a literature review of tests assessing attention/working memory and executive domains in PD (tests on other domains are included in an accompanying review). The selected tests were evaluated for their clinimetric properties and categorized by a panel of experts as "recommended," "recommended with caveats," "suggested," or "listed" according to the International Parkinson and Movement Disorder Society Clinical Outcome Assessment Scientific Evaluation Committee guidelines.

Results: A total of 30 tests were reviewed. Eight tests were "recommended," including four tests assessing attention/working memory abilities (WAIS-IV Digit Span, Coding and Symbol Search subtests, and Trail Making Test) and four tests assessing executive abilities (WAIS-IV Similarities, Wisconsin Card Sorting Test, Fluency Tests, and Stroop Color-Word Test). These tests demonstrated good to excellent levels of reliability and validity, have normative datasets, and are sensitive to change. Eight other tests were "recommended with caveats", eleven were "suggested," and three were "listed."

Conclusions: The recommended tests for attention/working memory and executive functioning in PD can guide PD cognitive assessment. Other tests were identified as potentially useful; however, caution is advised due to their clinimetric limitations. Further validation studies are required for these tests. © 2025 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Keywords: Parkinson's disease; attention‐executive functions; cognition; psychometric properties; rating test.

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References

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Attention/Working Memory and Executive Function in Parkinson's Disease: Review, Critique, and Recommendations

Affiliations

Attention/Working Memory and Executive Function in Parkinson's Disease: Review, Critique, and Recommendations

Authors

Affiliations

Abstract

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical