ObjectiveCognitive impairment is a common nonmotor symptom of Parkinson’s disease (PD) and is associated with high mortality, caregiver distress, and nursing home placement. The risk factors for cognitive decline in PD patients include advanced age, longer disease duration, rapid eye movement sleep behavior disorder, hallucinations, excessive daytime sleepiness, and nontremor symptoms including bradykinesia, rigidity, postural instability, and gait disturbance. We conducted a cross-sectional study to determine which types of sleep disturbances are related to cognitive function in PD patients.MethodsA total of 71 PD patients (29 males, mean age 66.46 ± 8.87 years) were recruited. All patients underwent the Mini- Mental State Examination (MMSE) and the Korean Version of the Montreal Cognitive Assessments (MoCA-K) to assess global cognitive function. Sleep disorders were evaluated with the Stanford Sleepiness Scale, Epworth Sleepiness Scale, Insomnia Severity Index (ISI), Pittsburg Sleep Quality Index, and Parkinson’s Disease Sleep Scale in Korea (PDSS).ResultsThe ISI was correlated with the MMSE, and total PDSS scores were correlated with the MMSE and the MoCA-K. In each item of the PDSS, nocturnal restlessness, vivid dreams, hallucinations, and nocturnal motor symptoms were positively correlated with the MMSE, and nocturnal restlessness and vivid dreams were significantly related to the MoCA-K. Vivid dreams and nocturnal restlessness are considered the most powerful correlation factors with global cognitive function, because they commonly had significant correlation to cognition assessed with both the MMSE and the MoCA-K.ConclusionsWe found a correlation between global cognitive function and sleep disturbances, including vivid dreams and nocturnal restlessness, in PD patients.

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A number of previous studies revealed the importance of the frontoparietal network for attention and preparatory top‐down control. Here, we investigated the theta (7–9 Hz) coherence of the right frontoparietal networks to explore the differences in connectivity changes for the right frontoparietal regions during spatial attention (i.e., attention to a specific location rather than a specific feature) and nonspatial attention (i.e., attention to a specific feature rather than a specific location) tasks. The theta coherence in both tasks was primarily maintained at a preparatory state, decreases after stimulus onset, and recovers to the level of the preparatory state after the response time. However, the theta coherence of the frontoparietal network during spatial attention was immediately maintained after cue‐onset, whereas for the case of nonspatial attention, it was immediately decreased after cue‐onset. In addition, the connectivity of the right frontoparietal network, including the middle frontal gyrus and superior parietal lobe, were significantly higher for spatial attention rather than for nonspatial attention, suggesting that the dorsal parts of right frontoparietal network are more engaged in spatial‐specific attention from the preparatory state. These findings also suggest that these two attention systems involve the use of different regional connectivity patterns, not only in the cognitive state, but in the preparatory state as well.

Intracranial embolization usually arises from the heart, a vertebrobasilar artery, a carotid artery, or the aorta, but rarely from the distal subclavian artery upstream of an embolus. We report on a patient who experienced left shoulder and forearm pain with weak blood pressure and pulse followed by concurrent onset of left hemiplegia. This case is a rare example of multiple cerebral embolic infarctions, which developed as a complication of distal subclavian artery thrombosis possibly associated with protein S deficiency.

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