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Set-shifting and spatial orientation in patients with Parkinson's disease.

Individuals with Parkinson's disease were compared to normal control subjects on a series of widely used neuropsychological measures. The two groups were matched for gender, handedness, age, education, and occupation. The neuropsychological tests were chosen to measure two specific functions: (a) spatial orientation (i.e., measures of personal orientation, extrapersonal orientation, right/left orientation, and mental rotation), and (b) the ability to shift mental set (e.g., generating responses from alternating categories). The tests chosen to measure spatial orientation had no set-shifting component, and the tests chosen to measure set-shifting had no spatial orientation component. Multivariate statistical analyses revealed a significant difference between the subjects with Parkinson's disease and the control subjects on the measures of set-shifting ability. In contrast, no significant difference between the groups was observed on the measures of spatial orientation. These results are discussed in terms of the current speculation in the literature regarding the relationship between set-shifting deficits and a disruption of dopaminergic fibers to the prefrontal cortex in Parkinson's disease.