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Theta oscillations and minor hallucinations in Parkinson’s disease reveal decrease in frontal lobe functions and later cognitive decline

Nature Mental Health volume 1, pages 477–488 (2023)Cite this article

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Abstract

Cognitive decline and hallucinations are common and debilitating non-motor symptoms, usually occurring during later phases of Parkinson’s disease (PD). Minor hallucinations (MH) appear early in the disease course and have been suggested to predict cognitive impairment and decline in PD, however, this has not been well-established by clinical research. Here, we investigated whether, in the absence of dementia, patients with PD and MH (without differences in frontal–subcortical and posterior cognitive functions) show altered brain oscillations and whether such MH-related electrophysiological changes are associated with cognitive impairments that increase over time. Combining model-driven electroencephalography analysis with neuropsychiatric and neuropsychological examinations in 75 patients with PD, we reveal enhanced frontal theta oscillations in patients with PD suffering from MH and link these oscillatory changes with lower cognitive frontal–subcortical functions. Neuropsychological follow-up examinations five years later revealed a stronger decline in frontal–subcortical functions in patients with MH, anticipated by stronger frontal theta alterations measured during the first assessment, defining an MH- and theta-oscillation-based early marker of a cognitive decline in PD.

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Fig. 1: Flowchart of the study.
Fig. 2: Prevalence of MH in PD.
Fig. 3: Association between frontal–subcortical cognitive functions and frontal theta power and center frequency in PD-MH.
Fig. 4: Longitudinal progression of the frontal–subcortical cognitive functions.
Fig. 5: Frontal theta power during the first assessment anticipates cognitive decline occurring over 5 years.

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Data availability

Data are available here: https://gitlab.epfl.ch/fbernasc/pd_mh_eeg_cognition.git.

Code availability

Codes for the analyses are available here: https://gitlab.epfl.ch/fbernasc/pd_mh_eeg_cognition.git.

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Acknowledgements

We thank all patients for their participation to the study. We thank Prof. Andrea Serino and Prof. Gilles Allali for their comments on earlier version of the manuscript. This research was supported by two donors advised by CARIGEST SA (Fondazione Teofilo Rossi di Montelera e di Premuda and a second one wishing to remain anonymous) to O.B.; National Center of Competence in Research (NCCR) ‘Synapsy—The Synaptic Bases of Mental Diseases’ grant number 51NF40-185897 to O.B.; Parkinson Suisse to O.B.; Bertarelli Foundation to O.B.; CIBERNED (Carlos III Institute) and FIS grant PI18/01717 to J.K.; Instituto de Salud Carlos III (ISCIII), Spain, to J.K.; PERIS, expedient number SLT008/18/00088 Generalitat de Catalunya to J. Pagonabarraga.

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Authors and Affiliations

  1. Laboratory of Cognitive Neuroscience, Neuro-X Institute and Brain Mind Institute, Swiss Federal Institute of Technology, Geneva, Switzerland

    Fosco Bernasconi & Olaf Blanke

  2. Movement Disorders Unit, Neurology Department, Sant Pau Hospital, Barcelona, Spain

    Javier Pagonabarraga, Helena Bejr-Kasem, Saul Martinez-Horta, Juan Marín-Lahoz, Andrea Horta-Barba & Jaime Kulisevsky

  3. Universitat Autònoma de Barcelona, Barcelona, Spain

    Javier Pagonabarraga, Helena Bejr-Kasem, Saul Martinez-Horta, Juan Marín-Lahoz, Andrea Horta-Barba & Jaime Kulisevsky

  4. Centro de Investigación en Red-Enfermedades Neurodegenerativas, Madrid, Spain

    Javier Pagonabarraga, Saul Martinez-Horta, Juan Marín-Lahoz, Andrea Horta-Barba & Jaime Kulisevsky

  5. Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain

    Javier Pagonabarraga, Saul Martinez-Horta, Juan Marín-Lahoz, Andrea Horta-Barba & Jaime Kulisevsky

  6. Neurology Department, Hospital Universitari de Vic, Barcelona, Spain

    Helena Bejr-Kasem

  7. Department of Clinical Neurosciences, Geneva University Hospital, Geneva, Switzerland

    Olaf Blanke

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  1. Fosco Bernasconi
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F.B. conceptualized idea, analyzed the data and wrote paper, J.P., H.B-K, S.M-H collected data and wrote paper, J.K, O.B wrote paper. J.M. and A.H-B. collected data. All authors approved the definitive version of the manuscript.

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Correspondence to Fosco Bernasconi or Olaf Blanke.

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Nature Mental Health thanks Abhishek Lenka, Leonidas Stefanis and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Supplementary methods, results, Figs. 1–7 and Tables 1–8.

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Bernasconi, F., Pagonabarraga, J., Bejr-Kasem, H. et al. Theta oscillations and minor hallucinations in Parkinson’s disease reveal decrease in frontal lobe functions and later cognitive decline. Nat. Mental Health 1, 477–488 (2023). https://doi.org/10.1038/s44220-023-00080-6

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