***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: This article reports the severity and profile of neuropsychological impairment on a prevalent cohort of patients with a clinical diagnosis of either multiple system atrophy ( n=372 ) or progressive supranuclear palsy ( n=311 ) from the Neuroprotection and Natural History in Parkinson Plus Syndromes cohort . The  Dementia Rating Scale and Frontal Assessment Battery were used to assess global cognition and executive dysfunction .  For the Dementia Rating Scale impairment was observed in approximately 57 % of the progressive supranuclear palsy group and 20 % of the multiple system atrophy group . In the former , impairment in a single cognitive domain was observed in 40 % , with the same number showing impairment in multiple domains , while in the latter the figures were 28.6 and 13.5 % , respectively . On the Frontal Assessment Battery , impairment was observed in 62.0 % of patients with progressive supranuclear palsy and 31.8 % of those with multiple system atrophy . Although the progressive supranuclear palsy group performed worse overall , the cognitive profiles of the two groups on the Dementia Rating Scale subscales were identical , with the main impairment of the Initiation and Perseveration subscale . The impaired patients in the two groups were largely indistinguishable , qualitatively and quantitatively . Impairment was associated with greater age and clinical disability in both groups and was evident even in the early stages ( 22 % in multiple system atrophy and 50 % in progressive supranuclear palsy ) . Where a pathological diagnosis was available , the original clinical diagnosis was confirmed in the majority of cases , including those with significant cognitive impairment . The rate of impairment in those with a confirmed pathological diagnosis was comparable to that of the sample as a whole . These results demonstrate , in the largest prospect ively recruited cohort of patients with progressive supranuclear palsy and multiple system atrophy studied to date , the existence of a cognitive profile similar to that previously reported in idiopathic Parkinson 's disease . The results indicate a high level of cognitive impairment associated with progressive supranuclear palsy , but also point to comparable dysfunction in a substantial proportion of the patients with multiple system atrophy . Significant cognitive impairment appears consistent with a diagnosis of multiple system atrophy , even early in the disease , with important implication s for diagnosis , research and management Abstract Bilateral deep brain stimulation is an effective treatment for most motor signs of Parkinson 's disease ( PD ) , but the effects on cognitive functions are less clear . We therefore examined the effects of bilateral deep brain stimulation on central information processing , using the event-related auditory P300 potential as an electrophysiological index of mental chronometry . Eight PD patients with bilateral stimulators within the subthalamic nuclei ( STN ) and eight age-matched controls participated . Patients were examined after overnight withdrawal of antiparkinson medication  , both “ on ” and “ off ” stimulation ( in r and om sequence ) . The P300 and reaction times were recorded using an auditory oddball paradigm  . P300 latencies were prolonged in PD patients off stimulation ( 440 ± 45 ms ) compared to controls ( 397 ± 16 ms ; P < 0.05 ) . STN stimulation significantly reduced clinical disease severity ( as indexed by the Unified Parkinson 's Disease Rating Scale ) and markedly improved reaction times , but did not improve the prolonged P300 latencies in PD patients ( 429 ± 36 ms ) . These results confirm that P300 latencies are prolonged in PD . Significantly , bilateral STN stimulation did not improve this electrophysiological measure of cognitive impairment , even though motor disability was markedly reduced . This suggests that some dopa-responsive features are resistant to STN stimulation , possibly due to involvement of dopaminergic deficits outside the nigrostriatal pathway , which are not influenced by outflow from the STN In this study , individuals with Parkinson ’s disease were tested as a model for basal ganglia dysfunction to infer how these structures contribute to the processing of emotional speech tone ( emotional prosody ) .  Nondemented individuals with and without Parkinson ’s disease ( n = 21/group ) completed neuropsychological tests and tasks that required them to process the meaning of emotional prosody in various ways ( discrimination , identification , emotional feature rating ) . Individuals with basal ganglia disease exhibited abnormally reduced sensitivity to the emotional significance of prosody in a range of context s , a deficit that could not be attributed to changes in mood , emotional-symbolic processing , or estimated frontal lobe cognitive re source limitations in most conditions . On the basis of these and broader findings in the literature , it is argued that the basal ganglia provide a critical mechanism for reinforcing the behavioral significance of prosodic patterns and other temporal representations derived from cue sequences ( Lieberman , 2000 ) , facilitating cortical elaboration of these events We previously reported that the P1 or P50 midlatency evoked potential underwent decreased habituation or disinhibition in patients with Parkinson 's Disease . This sleep state-dependent response appears to be generated by cholinergic elements of the reticular activating system . We attempted to determine if the decreased habituation or disinhibition of the P1 potential would be altered by bilateral pallidotomy .  Twenty-three patients who met inclusion criteria for surgery underwent pre- and post-operative evaluation using a Modified United Parkinson 's Disease Rating Scale ( UPDRS ) and P1 potential recordings .  Decreased habituation of the P1 potential was determined using a paired stimulus paradigm in which click stimuli were presented at 250 , 500 and 1000 msec interstimulus intervals ( ISI ) . Pre-operatively , patients showed disinhibition of the P1 potential at the 250 msec ISI ( 60 37 % vs. 21 20 % ) and 500 msec ISI ( 78 47 % vs. 43 31 % ) compared to age-matched control subjects . Post-operatively , the same patients showed a significant improvement in habituation of the P1 potential at the same ISIs ( 250 msec 37 21 % ; 500 msec 43 32 % ) . UPDRS scores for these patients pre-operatively were 59 18 and 24 11 post-operatively , result ing in a significant reduction in symptom severity . We conclude that bilateral pallidotomy result ed in a significant improvement in symptom ratings and reduced the disinhibition of the P1 midlatency evoked response To assess cortical and subcortical contributions to phonemic processing , patients with left frontal , temporal-parietal , or cerebellar lesions as well as those with Parkinson 's disease were tested on  phonemic identification and production tasks . In Experiment 1 , patients and controls were asked to identify syllables on both a voicing and place of articulation continuum . Subcortical patients were relatively unimpaired at this task whereas cortical patients were less accurate at identifying the endpoints of both continua and exhibited little evidence of categorical perception . For Experiment 2 , controls and patients were asked to produce syllables . Subcortical patients were able to produce contrastive voice onset times ( VOTs ) for voicing cognates although VOT of the voiceless phoneme was more variable for cerebellar patients . Cortical patients showed greater overlap in the production of both VOT and formant transition intervals . These results are discussed in terms of the type of computations hypothesized to originate from each neural area Auditory event-related potentials were recorded using the oddball paradigm in 26 patients with Parkinson 's disease , all treated with L-Dopa .  The latency of the P3 wave was significantly greater than in an age-matched controls , and was also correlated with the disease duration , but not with scores on two scales measuring cognitive deficit . One year later , when treatment with a dopaminergic agonist , bromocriptine 20 - 30 mg/day , had been added to the therapeutic regimen , N2 and P3 latencies had increased , whereas several clinical parameters had improved . Thus a longer P3 latency does not seem to be linked to a global cognitive deficit . The use of neuropsychological tests exploring more limited tasks should show the prospect i ve utility of event-related potentials in Parkinson 's disease Auditory event related potentials ( ERPs ) and visual evoked potentials ( VEPs ) were recorded from eight patients with Parkinson 's disease , before and after a single dose of apomorphine .  To assess the treatment effects , the patients ' motor state , Benton visual retention test ( BVRT ) , and digit span tests were also examined . After apomorphine , although motor performance improved , the ERP latencies were delayed and the N2-P3 ERP amplitude was significantly diminished by comparison with pretreatment values . These data suggest that apomorphine induces , besides its motor effects in patients with Parkinson 's disease , a slowing down of cognitive processing . Preferential stimulation of dopamine autoreceptors in mesocortical and mesolimbic systems may represent a neural mechanism for these effects . Also , the posttreatment BVRT rotation errors significantly increased , suggesting an apomorphine induced impairment of visuospatial perception Abstract . Rationale : Cholecystokinin ( CCK ) is a neuropeptide which is colocalized with dopamine ( DA ) in neurons of the mesolimbic-frontocortical and nigrostriatal DA system . In animals CCK enhances DA activity in these systems . Objectives : The present study examined the effects of a single intranasal administration of CCK-8 on auditory brain potential ( AEP ) signs of cognitive processing and on motor performance in patients with Parkinson 's disease ( PD ) , known to originate from degeneration of DA neurons primarily in the nigrostriatal DA system . Methods : Thirteen PD patients were examined after medication withdrawal , on two occasions after administration of placebo and 25 µg CCK-8 , and compared with healthy controls matched for age and sex .  AEPs were recorded while subjects performed an attention task ( oddball paradigm ) . Results : In the placebo condition , AEPs in the PD patients did not show marked alteration but were rather comparable to those in the controls . In healthy controls , CCK-8  enhanced the P3 complex ( P<0.05 ) and shortened latencies of the N2 and P3 components of the AEP evoked by task relevant target stimuli ( P<0.05 ) . Contrary to expectations , in PD patients these AEP components were distinctly delayed after CCK–8 ( P<0.05 ) . Motor performance was not changed by CCK-8 in PD patients or in controls . Conclusion : Data indicate a deleterious rather than beneficial effect of CCK on cognitive processing in PD patients that might result from a prevailing effect of the neuropeptide on transmitter systems ( e.g. GABAergic ) other than the DA system Nondemented Parkinson ’s disease ( PD ) patients showed increased amplitude of event-related potential component P3 . We recorded 18-channel spontaneous eyes-closed resting EEG and auditory oddball event-related potentials in 29 PD patients and 11 age-matched controls . Combining Mini-Mental State Examination score and oddball P3 counting performance , 15 patients were intellectually normal , 7 moderately , and 7 severely demented .  P3 and N1 amplitude and latency , mean amplitude of 1,024 ms post-stimulus ( separate after rare and after frequent stimuli ) , and resting EEG total power for 40 s were computed , and linearly regressed for age , sex , and L-dopa dosage . In nondemented PD patients , increased P3 amplitude was confirmed , but N1 amplitude and mean amplitude after rare and frequent stimuli were also increased as well as – most important – resting EEG total power . With increasing dementia , amplitude and power decreased , and P3 latency increased . Task dem and s can not explain increased P3 amplitude , since similarly increased EEG total power was found during no-task resting . Prospect i ve studies must determine whether P3 amplitude and EEG power in nondemented PD patients can serve as predictors of dementia Recent evidence suggests that the frontal lobe plays an important role in an orienting response to novel events , and that frontal lobe dysfunction is linked to attentional and cognitive deficits in Parkinson 's disease ( PD ) . We tested the hypothesis that the neural network involved in novelty detection may be impaired in PD patients by study ing event-related brain potentials to target and novel stimuli and their correlation to performance in neuropsychological tests in non-demented PD patients . The PD patients showed prolonged P3 latency to novel stimuli compared with age-matched controls , whereas their P3 latency to target stimuli was not different from that in controls . The PD patients also manifested amplitude reduction and less habituation of the P3 to novel stimuli over frontal scalp sites compared with controls . The prolonged latency and frontal reduction of novelty P3 correlated with a poor performance in the Wisconsin Card Sorting Test . These results suggest that the orienting response of PD patients to novel events is impaired and that recording novelty P3 might provide a neurophysiological and quantitative measure of attentional and cognitive deficits linked to the frontal lobe in non-demented PD patients In the present study , we compared the performance of normal subjects in three age groups and of medicated Parkinson 's disease patients on auditory selective attention processes . Two tone sequences were dichotically presented . Subjects responded to deviant tones in the attended location .  Event-related potentials ( ERPs ) were recorded from nine scalp electrodes . The old group showed significant decline in hit rate , increase in N1 amplitude , and reduction in P3a , P3b , target negativity , and mismatch negativity amplitude . The amplitude and duration of late Nd increased with age , reflecting modulation of both attended and unattended st and ard ERPs 
    Output:
    
The collected data revealed distinct impairments in a range of central auditory processes in PD , including altered deviance detection of basic auditory features , auditory brainstem processing , auditory gating and selective auditory attention .
In contrast to PD , literature on central auditory processing in MSA and PSP was relatively scarce , but provided some evidence for impaired central auditory processing in MSA and PSP .