Ep. 185: Cognition and movement: A dynamic duo

00:00:00: Welcome to EANcast, your weekly source for education, research and updates from the European Academy of Neurology.

00:00:15: Hello and welcome to the EANcast weekly neurology.

00:00:18: My name is Yildiz Degen-Mangy and I'm an associate editor of the e-learning platform of the European Academy of Neurology EAN Campus.

00:00:25: My guest today is Dr.

00:00:27: Marie Drutenberg, she works in the Institute of Psychology at Leiden University, the Netherlands.

00:00:33: Her main research areas are neurocognitive functioning and healthy aging, and also in neurological and neuropsychological disorders using both behavioral and neuroimaging approaches.

00:00:44: And her topic for today is cognition and movement, a dynamic deal.

00:00:49: Welcome, Dr.

00:00:49: Marie, and thank you for joining us today.

00:00:52: Thank you.

00:00:53: I'm happy to be here.

00:00:54: It's very nice to have you here today.

00:00:57: So, since you are working on cognition in healthy population and with the patients with neurological disorders both,

00:01:05: I would like to

00:01:06: start with healthy aging.

00:01:07: What are the pillars or signs of aging in healthy population in terms of cognition and movement?

00:01:13: Can you give us some clues to start with?

00:01:16: Absolutely.

00:01:17: Well, of course, it's a different experience for every individual.

00:01:21: But I think what we can see in general, if we look at the group level, Let me start with cognition is that a lot of people experience that they need a little bit more time to gather their thoughts or to process what other people have shared.

00:01:36: So they will experience some declines in information processing speed.

00:01:40: Another thing that I think that I think a lot of people associate with them with aging and that is definitely also factual is that memory tends to decline a little bit.

00:01:51: Depending on the magnitude of decline, it's either part of normal aging or if it gets more Yeah, more severe, we can progress into a mild cognitive impairment or dementia, but in healthy aging, forgetting some of the things you just said or were planning to buy on your grocery trip is also just part of the aging health elite.

00:02:11: Very nice start indeed.

00:02:13: So let's

00:02:14: move on to neurological, particularly neurodegenerative disorders, right?

00:02:19: Which

00:02:19: domains of cognition are commonly impaired?

00:02:22: I mean,

00:02:22: which

00:02:22: type of functional impairments are observed in your genetic disorders?

00:02:27: The functional impairments can actually be quite broad.

00:02:31: So there is indeed problems in the cognitive domain, in movement, but also in psychosocial functioning, for example.

00:02:40: Lovely.

00:02:41: Then from the disease perspective... Do these functional impairments really help clinicians to specifically classify the type of neurodegenerative disorders?

00:02:52: And can you give us some clues about the importance of the interpretation of these data in establishing a diagnosis sort of for specific neurodegenerative disorders?

00:03:03: Yeah, I think that the classification of these disorders as we are doing it now is based very much on the phenotypical manifestations that represent the most clinical features.

00:03:14: So if we think about Parkinson's, for example, or Huntington's, these are typically regarded as movement disorders.

00:03:21: And then conversely, we have Alzheimer's disease and other dementias, which are regarded as cognitive disorders.

00:03:28: What I think is a is potentially a problem with this classification.

00:03:33: It doesn't really take into account the fact that cognition and movement are actually strongly linked.

00:03:39: So I wonder if it's really possible at all to separate between really pure motor conditions or pure cognitive conditions, because perhaps there's actually a lot more interplay than we are currently accounting for in the classifications as they are being used.

00:03:58: Indeed, I also echo that I also believe that it's not easy to separate, purely separate cognition and movement from each other.

00:04:06: You're absolutely right.

00:04:07: So we have a very nice title of your talk.

00:04:11: Having said that movement and cognition, which I also believe is a dynamic duo indeed, can you elaborate on the link between cognition and movement, but by this time giving us examples from daily life to better understand the big picture?

00:04:27: Absolutely.

00:04:28: When we think about successful movement performance, for example, it does not just require the direct physical control of the muscles by the mescal skeletal system to generate movement, balance, and stability, but it also involves these cognitive control processes that allow us to start but also maintain a goal directed behavior even in the face of uncertain or changing environments.

00:04:54: An example that I tend to use is if you're carrying something and you accidentally drop it.

00:04:59: Most people immediately try to catch it, right?

00:05:02: If it's your mobile phone, for example.

00:05:04: But if you're carrying a really hot cup of coffee.

00:05:06: you might be able to overrule that initial response to catch it because you know it's going to be really hot and you're going to burn yourself and then not catch it.

00:05:14: So there is this, it's not just a movement, it's also your cognition and your experience with hot beverages in this case that will guide your behavior.

00:05:26: Very nice examples indeed.

00:05:28: Mewing to these bases, are there any?

00:05:31: Evidence that suggests that individuals with mood disorders often experience cognitive problems.

00:05:37: You all already said that it's not easy to separate one from each other.

00:05:42: Correct.

00:05:44: For Parkinson's disease and Huntington's disease, so let's start from sort of a more motor perspective, if you will.

00:05:50: There's definitely evidence that people living with these disorders are also experiencing cognitive problems.

00:05:57: In my work, we've also looked into this in a bit more detail, for example, for Parkinson's, where we studied motor sequence learning in people with Parkinson's who were either on or off their dopaminergic medication.

00:06:12: And we wanted to test different components of sequence learning, because on the one hand, there's this cognitive component of learning the order of the movements, being able to initiate the movements.

00:06:24: And on the other hand, there's the actual execution.

00:06:26: of the movements.

00:06:28: And these two processes, the cognitive versus the more motor processes, actually rely on different neural systems.

00:06:35: And our hypothesis was that one would actually benefit from medication, which would be the motor system.

00:06:40: And one would actually have a disadvantage of having developer energy medication, which would be the cognitive system.

00:06:48: And we designed a task in which we were able to separate those two processes, then examine the effect of dopaminergic medication, and indeed found that the motor components or the motor aspects of the task were improved by medication, but the cognitive processes were actually impaired by medication.

00:07:10: So this shows us that there's this distinction between the two types of processes involved in movement sequence learning.

00:07:19: So we definitely see cognitive problems in due course of the disease, speaking of Parkinson's disease as well, right?

00:07:25: Yeah.

00:07:26: Then I was thinking, the vice versa, how come on a moment disorder symptoms or moment related symptoms in patients with this time cognitive disorders?

00:07:36: Can you talk about evidence-based data?

00:07:39: Yeah, that's a fantastic question.

00:07:41: Alzheimer's disease, for example, is typically regarded as a cognitive disorder, but there are several studies, including work for myself and Dr.

00:07:50: Vincent Koppelmans from the University of Utah, that this clinical condition is actually also associated with problems in the motor domain.

00:07:58: And there's even indications from studies by other researchers that those motor problems can be present before the onset of those more characteristic cognitive problems.

00:08:10: I do have to say that the motor symptoms that people with Alzheimer's disease can show are relatively subtle.

00:08:17: So they can include slower walking speed or poor balance, poor manual dexterity, some increased cognitive motor, dual tasking costs.

00:08:29: So it doesn't necessarily have to be... very obvious things in everyday life that you may experience in a patient with this type of neurological disorder.

00:08:42: But studies definitely show these sort of more subtle impairments.

00:08:46: Yeah.

00:08:48: So there's definitely a strong link in association between the cognitive problems and movement disorders related symptoms, right?

00:08:57: Correct.

00:08:59: Indeed.

00:08:59: So let's deepen a little bit into the for the physiological aspects in terms of the connections of movement and cognition.

00:09:08: Are there any models or frameworks that would help us to capture the associations between cognitive symptoms and movement better?

00:09:16: Well, I think in my view, it would really help if we perhaps move away a little bit from the classical sort of motor versus cognitive distinction of neurodegenerative disorders and switch to a more... comprehensive, multi-dimensional approach that can encompass different aspects of the conditions.

00:09:38: And I think we could focus on various dimensions of symptomatology, like cognitive impairment, motor, perhaps other physical disturbances, but also psychological or behavioral symptoms that people are experiencing.

00:09:52: Well, that's a very nice point.

00:09:55: Do you think the psychological... basis of the people have, for example, comorbidities, just maybe a triggering factor for the, you know, development of cognitive problems in patients.

00:10:09: So maybe.

00:10:10: Yeah, I'm not necessarily aware of it being a trigger, but it's definitely a comorbidity.

00:10:16: And it's something that also a lot of people mention is actually a burden on their daily life.

00:10:21: So it's something that I believe we can can and should not ignore.

00:10:26: Definitely right.

00:10:27: Then coming to your last but not least, from a patient care-centered perspective, how do you think a more integrated approach to understand movement and cognition in basics as well as clinical aspects would impact the diagnosis and treatment of the patients with cognitive and movement disorders from the patient-centered?

00:10:53: That's a great question.

00:10:54: I am fully convinced that recognizing that neurodegenerative disorders are not just purely motoric in nature or not just purely cognitive in nature.

00:11:02: It will actually benefit in the patients, but also their family members, perhaps even society in general.

00:11:08: Because I believe very strongly that enriching the understanding of this type of symptoms that people with various disorders can be experiencing, symptoms that otherwise may even go a noticed or not attributed to the disorders that can really help them to feel more understood but also for others to better Be able to put into context why perhaps their loved one is not paying attention to them or is sometimes forgetting something.

00:11:37: It's not because they're not interested.

00:11:39: It's because they need a little bit more time to process or perhaps because it wasn't really consolidated into their memory appropriately.

00:11:48: It's not something they are doing on purpose.

00:11:51: I think it may actually also help in reducing stigma that sometimes exists around these conditions, which in turn is something that can really help the patients themselves to, you know, if we reduce the stigma for them to feel better and hopefully have more quality of life.

00:12:09: It really opens another perspective, which is a real burden as well as the motor and non-motor symptoms of these moment disorders and cognitive problems and non-motor symptoms.

00:12:20: Stigma is really very important, affecting the persons.

00:12:24: Yeah, absolutely.

00:12:25: In Parkinson's disease, we actually quite often hear people say that, you know, those motor symptoms, they're part of the disorder, they're sometimes a bit annoying, but what actually bothers them is their cognition or things in there.

00:12:39: How they describe it is like their personality almost changing, and then also what other people think of them.

00:12:46: That's what they find very difficult.

00:12:48: And the caregivers, right?

00:12:50: The family members also reported, I believe, Marie, because, you know, the cognitive problems in Parkinson's disease is a little bit different from the ones in Alzheimer's disease, which, you know... shows itself presents with more behavioral problems.

00:13:06: So this may be a very stigmatizing issue for the patients and their caregivers or family members as well.

00:13:13: Well, fantastic.

00:13:15: I love this talk of yours.

00:13:16: It was very fruitful.

00:13:18: I enjoyed myself a lot.

00:13:20: So would you like to give any take-home messages for our audience, for the young people listening to us as well, in terms of cognitive issues, immune disorders and their relationships?

00:13:31: Absolutely.

00:13:33: I'm not saying that we should directly change all the clinical practices as we are currently doing it, but I think it would be fantastic if people could at least share with the patients that they're seeing.

00:13:45: you know that this disorder that you're currently being diagnosed with or have been diagnosed a while ago is mainly known for let's say problems in the motor domain but it's also possible for you to experience problems in other domains like ignition or psychosocial functioning etc.

00:14:01: Just to make them aware that this can be something that is part of the disease.

00:14:04: it's not necessarily to scare them but just to make them more informed and that if they ever have any concerns or question about it that they should feel free to bring it up.

00:14:14: during one of the consultations because perhaps it's actually something that we do know is part of what they are currently living with and we can help them get better.

00:14:23: Great take on message indeed.

00:14:25: So raising the awareness is one of the pillars, major keys to cope with the disease and the symptoms or the burden, right?

00:14:33: Absolutely.

00:14:34: Well, personally, I'd like to thank you a lot for this delightful talk.

00:14:38: It was a pleasure to have you today and thank you for joining us today.

00:14:43: I'd like to say goodbye to all of our audience.

00:14:54: This has been EANcast Weekly Neurology.

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