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People with Parkinson’s disease (PD) and their care partners frequently report cognitive decline as one of their greatest concerns. Mild cognitive impairment affects approximately 20–50% of people with PD, and longitudinal studies reveal dementia in up to 80% of PD. Through the Parkinson’s Disease Foundation Community Choice Research Award Program, the PD community identified maintaining cognitive function as one of their major unmet needs. In response, a working group of experts across multiple disciplines was organized to evaluate the unmet needs, current challenges, and future opportunities related to cognitive impairment in PD. Specific conference goals included defining the current state in the field and gaps regarding cognitive issues in PD from patient, care partner, and healthcare professional viewpoints; discussing non-pharmacological interventions to help maintain cognitive function; forming recommendations for what people with PD can do at all disease stages to maintain cognitive health; and proposing ideas for how healthcare professionals can approach cognitive changes in PD. This paper summarizes the discussions of the conference, first by addressing what is currently known about cognitive dysfunction in PD and discussing several non-pharmacological interventions that are often suggested to people with PD. Second, based on the conference discussions, we provide considerations for people with PD for maintaining cognitive health and for healthcare professionals and care partners when working with people with PD experiencing cognitive impairment. Furthermore, we highlight key issues and knowledge gaps that need to be addressed in order to advance research in cognition in PD and improve clinical care.

The period from June 28 to July 2, 2015 marked the inaugural Gordon Research Conference (GRC) on Parkinson’s Disease held at Colby Sawyer College in New London, NH, USA. There were 184 attendees from 19 countries, indicating a clear interest and need for this type of meeting in the field of Parkinson’s disease. The meeting, chaired by David Sulzer and co-chaired by Andrew Singleton, invited 33 speakers to cover eight topics on Parkinson’s disease. Fifty posters were presented, and of these, eight innovative posters were invited to give short talks at the end of each session. Discussion Leaders at the beginning of each session ensured that there was cohesion to the themes being discussed, providing a running dialog throughout the meeting. The general consensus was that the first GRC on Parkinson’s Disease filled an important need within the research community, and that there is great excitement and interest for the 2017 GRC on Parkinson’s Disease.

This dissertation examines the perceptual salience of several acoustic cues in zebra finch song. Birdsong has long served as an animal model of speech development. Both are learned during a sensitive period, and require auditory feedback for learning and maintenance. Zebra finch song is commonly studied due to its stereotyped nature. Song syllables are complex, containing multiple cues that are modulated over millisecond time scales. Using psychoacoustic methods, male zebra finches were tested on discrimination of changes to their own and conspecific songs. Females and budgerigars were also tested, since they have auditory experience with song, but do not sing. Three types of synthetic songs were created to determine which acoustic cues in song were most salient to birds. Same-seed noise songs were made of syllable envelopes filled with the same piece of random Gaussian noise. This removed spectral structure but kept song envelope cues intact. Random noise songs were made of each syllable envelope filled with a unique piece of noise. This provided more complex fine structure to the same song envelope. Lastly, Schroeder songs were made of Schroeder harmonic waveforms with the same duration as song syllables. In Schroeder waveforms, spectrum and envelope are constant, but phase changes occur across frequencies. Two types of song changes were tested: single interval duration doublings and single syllable reversals. All birds were much more sensitive to syllable changes than to interval changes. For natural song, there was a duration effect on performance for male zebra finches only. Performance on syllable reversals shorter than 100 milliseconds was positively correlated with syllable duration. In Schroeder song, where only fine temporal structure changes with reversal, all three groups showed a duration effect. Thus, females and budgerigars may focus less on fine structure in natural song than males. In the absence of song spectral structure, birds relied on syllable envelope cues for reversal discrimination. Thus, removal of a single cue from song did not greatly affect reversal discrimination. However, birds performed best when all cues were present. This is reminiscent of human speech, in which multiple redundant cues are used for speech recognition.

Anxiety is a severe problem for at least one-third of people living with Parkinson’s disease (PD). Anxiety appears to have a greater adverse impact on quality of life than motor impairment. Despite its high prevalence and impact on daily life, anxiety is often undiagnosed and untreated. To better address anxiety in PD, future research must improve knowledge about the mechanism of anxiety in PD and address the lack of empirical evidence from clinical trials. In response to these challenges, the Parkinson’s Foundation sponsored an expert meeting on anxiety on June 13th and 14th 2018. This paper summarizes the findings from that meeting informed by a review of the existing literature and discussions among patients, caregivers, and an international, clinician-scientist, expert panel working group. The goal is to provide recommendations to improve our understanding and treatment of anxiety in PD.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.