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Why Are Some Parkinson Disease Patients Unaware of Their Dyskinesias?

Jenkinson, Paul M. PhD*; Edelstyn, Nicola M. J. PhD; Stephens, Richard PhD; Ellis, Simon J. MD

Cognitive and Behavioral Neurology: June 2009 - Volume 22 - Issue 2 - p 117-121
doi: 10.1097/WNN.0b013e3181a722b0
Original Studies

Objective To test the hypothesis that anosognosia for dyskinesias in Parkinson disease (PD) results from a failure to detect discrepancies between intended and actual movement.

Background PD patients often complain of drug-induced dyskinesias (involuntary movements) less than their carers. This remarkable unawareness is an example of anosognosia (ie, unawareness of deficits associated with an illness). A better understanding of anosognosia for dyskinesias in PD is important to understand the impact of the illness and side effects of treatment.

Methods The ability to detect a discrepancy between intended movement and visual feedback about actual movement was investigated in 6 PD patients with anosognosia for dyskinesias, 11 nonanosognosic PD controls with dyskinesias, and 22 healthy volunteers, using a mirror to reverse the expected visual consequences of an executed movement.

Results Nonanosognosic PD patients and healthy volunteers rated mirror-reversed movement as significantly stranger than normal movement (P=0.024 and <0.001, respectively), whereas PD patients with anosognosia for dyskinesias did not (P=0.375).

Conclusions The findings support our proposal, in that PD patients with anosognosia for dyskinesias do not report mirror-reversed movement (in which intentions and visual feedback conflict) as feeling distinct from normal movement.

*Psychology and Mental Health, Staffordshire University

School of Psychology and Research Institute for Life Course Studies, University of Keele

Department of Neurology, University Hospital of North Staffordshire, UK

Reprints: Paul M. Jenkinson, PhD, Psychology and Mental Health, Staffordshire University, ST4 2DE, UK (e-mail: p.m.jenkinson@

Received for publication October 22, 2008; accepted March 8, 2009

This study was completed by the first author as part of the requirements for a PhD at the University of Keele. It was supported by the School of Psychology and The Neurosciences Trust.

© 2009 Lippincott Williams & Wilkins, Inc.