• Amara Gul The Islamia University of Bahawalpur
  • Javed Yousaf The Islamia University of Bahawalpur


Background: In recent years, alexithymia has gained attention of medical researchers as a prognostic factor for serious health problems. The present study aimed to assess alexithymia as a determinant of cognitive decline in patients with Parkinson’s disease. Methods: Patients diagnosed with Parkinson’s disease (n=60) at Bahawal Victoria Hospital, Civil Hospital Bahawalpur and Nishter Hospital Multan during May 2016 until June 2017 participated in the study. Healthy individuals (n=60) took part in the study from local community as controls. Participants completed Bermond–Vorst Alexithymia Questionnaire and Montreal Cognitive Assessment.  It was a cross sectional study design. Purposive sampling technique was used and data was analysed through multivariate analysis of variance and bivariate correlation. Results: Patients with Parkinson’s disease (177.96±8.93) showed higher attitudes of alexithymia as compared with healthy individuals (37.46±8.01), F (1,118)= 8216.52, p<0.001, ηp2=.98. In contrast with healthy controls (28.60±0.58), patients with Parkinson’s disease (2.25±.95) were cognitively impaired F (1,118)=36424.38, p<0.001,ηp2=.99. Alexithymia was a significant predictor of cognitive performance (R2=0.99, F (2, 119) = 5698.95, p<0.001). Conclusion: Alexithymia is a significant marker of cognitive decline in patients with Parkinson’s disease.Keywords: Parkinson’s disease; Cognition; Emotion; Alexithymia


Kojima M. Alexithymia as a prognostic risk factor for health problems: a brief review of epidemiological studies. Biopsychosoc Med 2012;6(1):21.

Brown RJ, Bouska JF, Frow A, Kirkby A, Baker GA, Kemp S, et al. Emotional deregulation, alexithymia, and attachment in psychogenic nonepileptic seizures. Epilepsy Behav 2013;29(1):178-83.

Ricciardi L, Demartini B, Fotopoulou A, Edwards MJ. Alexithymia in neurological diseases: A review. J Neuropsychiatry Clin Neurosci 2015;27(3):179–87.

Assogna F, Cravello L, Orfei MD, Cellupica N, Caltagirone C, Spalletta G. Alexithymia in Parkinson’s disease: A systematic review of the literature. Parkinsonism Relat Disord 2016;28:1–11.

Riedel O, Klotsche J, Spottke A, Deuschl G, Forst H, Henn F, et al. Cognitive impairment in 873 patients with idiopathic Parkinson's disease. Results from the German Study on Epidemiology of Parkinson's Disease with Dementia (GEPAD). J Neurol 2008;255(2):255–64.

Mansoor H, DAWN. ‘Over 100 people daily fall prey to Parkinson’s in Pakistan. Published 05 April, 2017. [Internet]. [cited 2017 Sep 14]. Available from:

Larsen JK, Brand N, Bermond B, Hijman R. Cognitive and emotional characteristics of alexithymia: a review of neurobiological studies. J Psychosom Res 2003;54(6):533–41.

Cooney JW, Stacy M. Neuropsychiatric issues in Parkinson’s disease. Curr Neurol Neurosci Rep 2016;16(5):49.

Alvarado-Bolanos A, Cervantes-Arriaga A, Rodrigues-Violante M, LIorens-Arenas R, Calderon-Fajardo H, Milan-Cepeda R, et al. Impact of neuropsychiatric symptoms on the quality of life of subjects with Parkinson’s disease. J Parkinsons Dis 2015;5(3):541–8.

Butterfield LC, Cimino CR, Oelke LE, Hauser RA, Sanchez-Ramos J. The independent influence of apathy and depression on cognitive functioning in Parkinson’s disease. Neuropsychology 2010;24(6):721–30.

Dujardin K, Sockeel P, Deliaux M, Destee A, Defebvre L. Apathy may herald cognitive decline and dementia in Parkinson’s disease. Mov Disord 2009;24(16):2391–7.

Miyake A, Friedman NP, Emerson MJ, Witzki AH, Howerter A, Wagner TD. The unity and diversity of executive functions and their contributions to complex "Frontal Lobe" tasks: a latent variable analysis. Cogn Psychol 2000;41(1):49–100.

Eslinger PJ, Damasio AR. Severe disturbance of higher cognition after bilateral frontal lobe ablation: patient EVR. Neurology 1985;35(12):1731–41.

Duncan J, Owen AM. Common regions of the human frontal lobe recruited by diverse cognitive demands. Trends Neurosci 2000;23(10):475–83.

Wingbermühle E, Theunissen H, Verhoeven WMA, Kessels RP, Egger JI. The neurocognition of alexithymia: evidence from neuropsychological and neuroimaging studies. Acta Neuropsychiatr 2012;24(2):67–80.

DSM American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Publishing; 2013.

Mahieux F, Michelet D, Manifacier MJ, Boller F, Fermanian J, Guillard A. Mini-Mental Parkinson: first validation study of a new bedside test constructed for Parkinson’s disease. Behav Neurol 1995;8(1):15–22.

Sheehan DV, Lecrubier Y, Harnett-Sheehan K, Amorim P, Janavs J, Weiller E, et al. The Mini International Neuropsychiatric Interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998;59(Suppl 20):22–33.

Vorst HCM, Bermond B. Validity and reliability of the Bermond-Vorst alexithymia questionnaire. Personal Individ Differ 2001;30(3):413–34.

Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 2005;53(4):695–99.

Muller J, Buhner M, Ellgring H. The assessment of alexithymia: psychometric properties and validity of the Bermond-Vorst alexithymia questionnaire. Personal Individ Differ 2004;37(2):373–91.

Hoops S, Nazem S, Siderowf AD, Duda JE, Xie SX, Stern MB, et al. Validity of the MoCA and MMSE in the detection of MCI and dementia in Parkinson disease. Neurology 2009;73(21):1738–45.

Weintraub D, Simuni T, Caspell-Garcia C, Coffey C, Lasch S, Siderowf A, et al. Cognitive performance and neuropsychiatric symptoms in early, untreated Parkinson's disease. Mov Disord 2015;30(7):919–27.

Alzahrani H, Venneri A. Cognitive and neuroanatomical correlates of neuropsychiatric symptoms in Parkinson's disease: A systematic review. J Neurol Sci 2015;356(1-2):32–44.

Sturm VE, Levenson RW. Alexithymia in Neurodegenerative Disease. Neurocase 2011;17(3):242–50.

Caycedo AM, Miller B, Kramer J, Rascovsky K. Early features in frontotemporal dementia. Curr Alzheimer Res 2009;6(4):337–40.

Moriguchi Y, Ohnishi T, Decety J, Hirakata M, Maeda M, Matsuda H, et al. The human mirror neuron system in a population with deficient self-awareness: an fMRI study in alexithymia. Hum Brain Mapp 2009;30(7):2063–76.