Altered transposition asymmetry in serial ordering in early Parkinson's disease

Introduction: The ability to arrange thoughts and actions in an appropriate serial order is impaired in Parkinson's disease (PD). However, it is unclear how serial order is represented and manipulated and how the representation or manipulation is altered in the early stages of PD. We aimed to analyze the pattern of performance errors in serial ordering versus serial recall in nondemented PD patients with mild clinical symptoms and healthy adults to identify the underlying principles of serial ordering. Methods: PD patients (N = 57) and healthy controls (N = 40) completed the adaptive digit ordering and digit span forward tests. We focused on items recalled in incorrect positions (transposition) and analyzed the tendency to recall transposed items too early (anticipation) versus too late (postponement). We also analyzed the tendency to recall the item displaced by the error (fill-in) versus the item following the error in the target output order (infill) after anticipation errors. Results: PD patients not only made more transposition errors but also showed distinct error patterns. The patients made more anticipations but not postponements, and more fill-ins but not in fills than healthy controls in the ordering test (transposition asymmetry). Individual patients' percentage of anticipations was negatively correlated with their daily exposure to D2/3 receptor agonists. Patients’ error pattern in the forward test was normal. Conclusion: The increase in anticipations in PD suggests an increase in the forward-specific variability in the representation of serial order. Their increase in fill-ins suggests a deficit in the chaining mechanism involved in the manipulation of serial order.