The Effects of a Socially Evaluated Cold Press Stressor on Inhibitory Gating in Persons With Parkinson’s Disease

The Effects of a Socially Evaluated Cold Press Stressor on Inhibitory Gating in Persons With Parkinson’s Disease | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article The Effects of a Socially Evaluated Cold Press Stressor on Inhibitory Gating in Persons With Parkinson’s Disease Andrew Zaman, Crystal Jewell, Patricia Izbicki, Elizabeth Stegemöller This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4965100/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Impaired inhibitory gating is a sensory processing symptom of Parkinson’s disease (PD) associated with common motor symptoms, such as bradykinesia and motor inhibition. Acute stress impairs inhibitory gating in healthy adults; however, it is unclear how stress impacts inhibitory gating in people with PD. Using a Socially Evaluated Cold Pressor (SECP) to induce acute stress, inhibitory gating was assessed through electroencephalography (EEG) in fifteen individuals diagnosed with PD in the mild to moderate range of symptom severity by measuring the p50 ratio (S1/S2) during an auditory paired click paradigm, relative to age- and gender-matched healthy older adults (HOAs). Results confirmed decreased inhibitory gating in both persons with PD and HOAs following the induction of an acute stressor. Persons with PD experienced greater, though insignificant, S1 and S2 amplitudes than HOAs with a medium-to-large effect size in the condition by group interaction ( ηp² = 0.104). These findings provide evidence to suggest that PD may also affect early auditory processing, possibly through over-compensation of the reticular activating system. However, interpretations are limited to eight individuals with PD and fifteen HOAs. Future research should examine the relationship between stress and sensory functioning on motor symptoms and cognition in persons with PD to unlock potential clinical targets for therapeutics. Biological sciences/Neuroscience/Cognitive neuroscience Biological sciences/Neuroscience/Sensory processing Biological sciences/Physiology Biological sciences/Physiology/Ageing Biological sciences/Neuroscience Biological sciences/Neuroscience/Diseases of the nervous system/Parkinsons disease Parkinson’s disease Stress Inhibitory Gating p50 paired click Figures Figure 1 Figure 2 Introduction Motor impairments such as tremor, bradykinesia, rigidity are hallmark symptoms of Parkinson’s disease (PD). However, in addition to motor symptoms, persons with PD also have a number of secondary non-motor symptoms, including sensory processing impairments (Boecker et al., 1999 , Gulberti, et al., 2015; Kaji, 2001 ; Patel, Jankovic, & Hallett, 2014 ; Teo et al., 1997 ). One sensory processing impairment seen in persons with PD is reduced inhibitory gating (Gulberti, et al., 2015; Lukhanina, et al., 2009 ; Lukhanina, Berezetskaya, & Karaban, 2011 ; Teo et al., 1997 ), which has been associated with motor symptoms such as bradykinesia (Lukhanina, et al., 2011 ). Inhibitory gating is a natural pre-attentional sensory process that filters out repetitive information (Buotros & Belger, 1999; Gjini, Arfken, & Boutros, 2010 ). Acute stress has been shown to negatively impact inhibitory gating in heathy adults (Ermutlu, Karamürsel, Ugur, Senturk, & Gokhan, 2005 ; Johnson & Adler, 1993 ; White & Yee, 1997 ). However, it is unknown how stress impacts inhibitory gating in persons with PD. While there is no consensus about the brain regions involved in inhibitory gating, most studies find that the prefrontal, somatosensory, supplementary motor, anterior cingulate, parietal, and thalamic areas are involved (Boutros, Gjini, Eickhoff, Urbach, & Pflieger, 2013 ; Garcia-Rill, et al., 2008; Grunwald, et al., 2003; Korzyukov et al., 2007 ; Tregellas et al., 2007 ; Williams, Nuechterlein, Subotnik, & Yee, 2011 ). Although the basal ganglia has not been directly implicated in inhibitory gating, evidence suggests it is also involved. For example, the basal ganglia modulates sensory information (Juri, Rodriquez-Oroz, & Obeso, 2011) and is functionally connected to prefrontal and parietal regions via subcortical loops (McHaffie, Stanford, Stein, Coizet, & Redgrave, 2005 ). Furthermore, impaired gating is seen in disorders of the basal ganglia such as PD, Huntington’s disease, and focal dystonia (Gulberti, et al., 2015; Teo et al., 1997 ; Lim, Bradshaw, Nicholls, & Altenmueller, 2005 ; Uc, Skinner, Rodnitzsky, & Garcia-Rill, 2003). Additionally, involvement of the basal ganglia is also demonstrated by studies where subthalamic nucleus deep brain stimulation, and ablative pallidal surgery restore normal inhibitory gating in persons with PD (Gulberti, et al., 2015; Mohamed, Lacono, & Yamada, 1996 , Teo, Rasco, Skinner, & Garcia-Rill, 1998 ). Overall, this evidence suggests the basal ganglia and sensorimotor loop are involved in inhibitory gating, and that inhibitory gating is associated with the proper functioning of sensory and motor processes. Inhibitory gating is modulated by key neurotransmitters such as norepinephrine. For example, inhibitory gating has an inverted-U shaped relationship with norepinephrine, where both agonists and antagonists have been shown to disrupt normal gating (Adler, et al., 1991; Stevens, Meltzer, & Rose, 1993 ). Additionally, acute stressors impair inhibitory gating, proposedly by increasing the release of norepinephrine (Ermutlu et al., 2005 ; Johnson & Adler, 1993 ). Persons with PD suffer cellular loss in the locus coeruleus, a region that produces and projects norepinephrine (Vermeiren & De Deyn, 2017 ), and thus impaired gating in persons with PD might be mediated by low levels of norepinephrine. However, it remains unknown how acute stress will impact inhibitory gating in persons with PD. Thus, the main purpose of this study is to examine how an acute stressor [Socially Evaluated Cold Pressor (SECP)] impacts inhibitory gating (p50 ratio) in persons with PD. Given the aforementioned gaps in knowledge, we hypothesize that the SECP task will impair inhibitory gating in both persons with PD and healthy older adults (HOAs). Methods Participants Fifteen participants diagnosed with idiopathic PD (mean age 67.8 ± 4.7 years; 5 males and 10 females), and fifteen age- and gender-matched HOAs (mean age 68.7 ± 5.0 years) completed this study (Table 1 ). Participants with PD were recruited via the Iowa State University Alternative Medicine and Music for PD Lab Database, which consists of a list of individuals diagnosed with PD who have indicated interest in research opportunities. HOAs were recruited via word of mouth. The primary inclusion criterion for this group was being between the ages of 50 and 80 (the average age range of a person with PD) (Wirdefeldt et al., 2011 ). Participants with PD needed to have been diagnosed with PD by a neurologist. Participants were excluded if they demonstrated any cognitive impairment (Mini-Mental Status Exam < 25). Participants were further excluded if they had: 1) severe hearing loss; 2) any metallic objects in the head (outside the mouth); 3) any implanted objects such as a pacemaker; 4) brain surgery; 5) been diagnosed with a mental disorder besides anxiety or depression; 6) any musculoskeletal disorders; 7) any other brain-related conditions; 8) were pregnant or taking birth control; 9) used tobacco, illicit drugs, or excessive amounts of alcohol; 10) had either a systolic blood pressure (SBP) above 140 mmHg or a diastolic blood pressure above 90 mmHg during the initial screening. One HOA was excluded during the initial blood pressure screening to avoid any potential cardiac events during the SECP. All participants provided written informed consent. All procedures were approved by the Iowa State University Institutional Review Board (approval #: 15–499) and were performed in accordance with relevant guidelines and regulations. Procedure Participants were scheduled for two lab visits within a one-week timespan. During the initial visit, participants were screened for cognitive impairment with the Mini-Mental Status Exam (MMSE) and high blood pressure using an automated Omron blood pressure cuff. Of note no participants scored less than 28 (out of 30) on the MMSE, however the ability of the MMSE to distinguish individuals with mild cognitive impairment (MCI) is poor and some participants might have been in the early stages of cognitive decline. Participants then provided demographic information and completed a battery of questionnaires that have been found to be reliable and valid measures for persons with PD including the Geriatric Depression Scale (GDS) (Ertan, Ertan, Kızıltan, & Uygucgil, 2005 ), and the State and Trait Anxiety Inventory (STAI) (Yang, et al., 2019). The Perceived Stress Scale (PSS) was also collected. While this scale has not been tested for its psychometric properties in persons with PD, it has been shown to be reliable and valid in older adults (Lee, 2012 ; Jiang, et al., 2017). Participants with PD also completed the Movement Disorders Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS). Table 1 shows the means and standard deviations of demographic and questionnaire data. Participants were reminded to adhere to dietary and medical restrictions prior to their second lab visit which included limiting their caffeine intake to one cup (8 oz.) of a caffeinated beverage finished at least 3 hours prior to the start of the second visit and refraining from alcoholic beverages during the 24 hours prior to the start of the second visit. If they were non-compliant with any of these restrictions, participants were asked to reschedule. All participants were also asked to eat 1–2 hours before the second visit. Participants with PD were asked to take their Parkinson’s medication 1 hour prior to the beginning of the second visit. The second visit was scheduled to align with their normal medication times. The second visit starting times were scheduled between 12PM and 3PM. During the second visit, adherence to the dietary and medical restrictions and recommendations were reviewed to ensure compliance. Electroencephalogram (EEG) was then fitted on the participant (see methods below). Next, a salivary cortisol sample was collected and then the participants completed either the stress intervention (SECP) or the control intervention (warm water hand bath). The order was counter balanced. After completing either the stress task or the control task, blood pressure was obtained with an automated Omron blood pressure cuff. Then, they verbally reported how stressful they thought the task was on a Likert scale from 1 to 10, with respective response anchors of “not stressful at all”, and the “most stressful thing I can imagine”. Cortisol, blood pressure, and perceived stress were measured to assess the effectiveness of the stress and control interventions. Participants then completed 80 trials of the paired click paradigm to examine inhibitory gating. Inhibitory gating is typically evaluated using a paired click paradigm where pairs of simple auditory stimuli elicit the EEG p50 auditory components (Lijffijt et al., 2009 ). During the paired-click paradigm, the first click is referred to as the S1 and is followed shortly thereafter by the second click or S2. The most common inhibitory gating measure is the S2/S1 ratio of the p50 component (p50 ratio) (Boutros & Belger, 1999 ; Guterman, Josiassen, & Bashore, 1992 ; Jones et al., 2016 ). The normal gating response is indicated by a low S2/S1 ratio, with a large amplitude response to S1 and a reduced amplitude response to S2. Twenty-five minutes after completing the paired click paradigm, a salivary cortisol sample was collected from each participant. Following this, participants rested or read a magazine/book for half an hour. After the rest period, participants completed the same series of steps and tasks again with the uncompleted intervention (i.e., warm water bath or SECP). See Fig. 1 for the order of first and second visit procedures. Stress and Control Tasks The stress intervention was a SECP task where the participants placed their hand up to the wrist in an ice water bath (2–4° C) for 90 seconds. Participants were also made aware that this task was being video recorded and that their facial expressions were to be judged by trained experimenters at a later time. During the control condition, participants placed their hand in warm water (36–38°C) for 90 seconds. During the control condition participants were reminded that they were not being videotaped and the camera was moved out of sight. EEG Data Acquisition and Analysis The subjects were sitting comfortably in a semi-reclined armchair in a quiet well lit room. Participants were instructed to keep their movement to a minimum and their eyes open and focused on a piece of tape stuck to a desk 5 feet in front of them. Participants were also instructed to refrain from falling asleep. To collect the potentials, a 64 electrode EEG cap was fitted according to the international 10–20 system (Biosemi, Amsterdam, Netherlands). Eye movements were monitored with electrodes placed above and below the right eye for filtering purposes. A single common reference electrode was placed over the mastoid process ipsilateral to the participants most affected side (HOAs were matched) and the ground electrode was placed on the forehead just above the nose and between the eyebrows. The electrode of interest was Cz, which is located in the midline at the ‘vertex’ or top of the head. Impedances were checked to make sure they are below 5k ohms prior to beginning the data collection. Signals were recorded at 2kHz and amplified. During the task, auditory clicks were presented through speakers at 80dB hearing level. The auditory stimuli were pairs of identical auditory clicks (1000-Hz tone) with a duration of 20ms and an interval of 500ms between clicks. 80 trials were presented with a 7 second interval between trials. The time for each recording epoch was 300ms before the first pair of clicks until 1s following the second click. The auditory tones were collected simultaneously by the EEG data collection system to ensure synchronization. Overall, these are the recommended methods for collecting the p50 response (Dalecki, Croft, & Johnstone, 2011 ). EEG data were processed using standard methods from the Krigolson Laboratory ( https://www.krigolsonlab.com/data-analysis.html ). Signals were re-referenced offline using a bipolar montage (Cz-Iz) and filtered using a 0.5-45Hz 4th order dual-pass Butterworth band-pass and a 60Hz notch filter. Next, data was divided into smaller epochs (-200ms to 300ms) around each auditory tone. Finally, a trial was discarded if the voltage on any channel exceeded 10 µV/ms gradient and an absolute voltage difference > 100 µV. The P50 ratio (S2/S1) was the measure of habituation (Dalecki et al., 2011 ). S1 (peak-to-peak method) was the difference in amplitudes in the positive deflection between 35–65ms and the most negative deflection between 15–45 ms of the first stimulus. S2 was the difference of those amplitudes for the second stimulus. In addition, latency measures were also calculated for S2 and S1where the latency value reflected the timing difference between the maximum positive deflection and the auditory stimulus. Due to technical difficulties, EEG was not collected for 4 of the participants with PD. A clear p50 component was interpretable in both the S1 and S2 in both conditions (SECP and control) for 19 participants (8 PD and 11 HOAs). These were entered for statistical analysis. Cortisol Analysis On the day of collection, salivary cortisol samples were stored in -20°C freezer within 30 minutes. Cortisol was analyzed with the Salimetrics® Cortisol Enzyme Immunoassy Kit (RRID AB_2801306). The kit uses a competitive immunoassay in which cortisol competes with cortisol conjugated to horseradish peroxidase for the antibody binding sites. To determine the cortisol reactivity, the area under the curve was calculated using the baseline and the 25 min post intervention samples for each condition. Statistical Analysis An independent samples t -test was used to examine any group differences on demographic and questionnaire outcome measures. A 2 condition (stress, control) x 2 group (PD, HOA) repeated measures ANOVA was completed for measures of stress (perceived stress, blood pressure, and cortisol) to confirm that the SECP initiated an increase in stress for participants. To test the hypothesis that the SECP task will impair inhibitory gating (higher p50 ratios) in both persons with PD and HOAs, a 2 condition (stress, control) x 2 group (PD, HOA) repeated measures ANOVA was used to determine differences on inhibitory gating (p50 ratio) and measures of early auditory processing (amplitude and latency of S1 and S2). For all repeated measures ANOVAs, partial eta squared ( η p 2 ) effect sizes were calculated. Significance was set at α = 0.05. For all post hoc analyses, a Bonferroni correction was used to interpret statistical significance. Results Table 2 shows the means and standard deviations for all stress related measures (perceived stress, blood pressure, and cortisol). Table 3 shows the means and standard deviations for all auditory processing measures. Participants Participants with PD had higher trait anxiety than the HOAs ( t (28) = 3.086, p = 0.005, Mean Difference ( MD ) = + 9.2, d = 1.126). No other demographic variables were significantly different (Table 1 ). Perceived Stress There was a main effect of condition ( F (1,28) = 147.393, p < 0.001, η p 2 = 0.840). The participants found that the SECP was more stressful than the control condition ( MD = + 5.2, d = 2.256). There was no main effect of group ( F (1,28) = 0.267, p = 0.609, η p 2 = 0.009), or an interaction effects for group x condition ( F (1,28) = 0.006, p = 0.938, η p 2 = 0.000). Blood Pressure There was a main effect of condition for both systolic ( F (1,28) = 8.003, p = 0.009, η p 2 = 0.222) and diastolic blood pressure ( F (1,28) = 5.543, p = 0.026, η p 2 = 0.165). The participants had higher systolic blood pressure after the SECP compared to the control condition ( MD = + 6.4 mmHg, d = 0.518). Participants also had higher diastolic blood pressure after the SECP compared to the control condition ( MD = + 2.8 mmHg, d = 0.430). There was no main effect of group for systolic blood pressure ( F (1,28) = 2.138, p = 0.155, η p 2 = 0.071) or diastolic blood pressure ( F (1,28) = 0.360, p = 0.553, η p 2 = 0.013). There were no interaction effects of group x condition for systolic blood pressure ( F (1,28) = 0.889, p = 0.354; η p 2 = 0.031) or diastolic blood pressure ( F (1,28) = 0.767, p = 0.388; η p 2 = 0.027)). Cortisol There was a main effect of condition for cortisol ( F (1,28) = 6.780, p = 0.015 η p 2 = 0.195). Participants had a higher cortisol area under the curve (AUC) values during the SECP compared to the control condition ( MD = + 13.4 ng/dl/hr, d = 0.479). There was no main effect of group ( F (1,28) = 0.187, p = 0.699, η p 2 = 0.007) and no interaction effects for group x condition ( F (1,28) = 0.596, p = 0.447, η p 2 = 0.021). Inhibitory Gating Figure 2 A shows the results for inhibitory gating (see Fig. 2 B for EEG waveform from one person with PD in both conditions). Results revealed a main effect of condition ( F (1,17) = 12.813, p = 0.002, η p 2 = 0.430). In general, there was less inhibitory gating following the SECP compared to the control condition (MD = + 0.20, d = 0.760). No main effect of group ( F (1,17) = 0.736, p = 0.403, η p 2 = 0.042) or interaction effects for condition x group ( F (1,17) = 1.971, p = 0.178, η p 2 = 0.104) were found. Early Auditory Components Figure 2 C and 2 D show the results for S1 amplitude and S2 amplitude. No main effects of condition were found [S1 amplitude ( F (1,17) = 0.261, p = 0.616, η p 2 = 0.015 ); S2 amplitude ( F (1,17) = 1.527, p = 0.233, η p 2 = 0.082))]. However, there was a group trend for S1 amplitude ( F (1,17) = 3.560, p = 0.076, η p 2 = 0.173), and S2 amplitude ( F (1,17) = 4.109, p = 0.059, η p 2 = 0.195). Persons with PD had a greater S1 amplitude ( MD = + 4.1 µV, d = 0.672) and S2 amplitude ( MD = + 3.0 µV, d = 0.675) than HOAs. No condition x group interactions were found [S1 amplitude ( F (1,17) = 0.206, p = 0.656, η p 2 = 0.012 ); S2 amplitude ( F (1,17) = 0.376, p = 0.548, η p 2 = 0.022)]. Discussion This present study aimed to test the effects of SECP on inhibitory gating in persons with PD. The results revealed that the SECP was successful in increasing stress related measures (perceived stress, blood pressure, and cortisol) and decreasing inhibitory gating in both HOAs and persons with PD. While not significant, the SECP decreased inhibitory gating to a greater degree in persons with PD ( MD = + 0.293) compared to HOAs ( MD = + 0.127), with the condition by group interaction showing a medium to large effect size ( η p 2 = 0.104). Similar to previous research (Teo et al., 1997 ), the results also showed that persons with PD had larger (albeit not significantly different), S1 and S2 amplitudes, suggesting that PD may also affect early auditory processing. During the control condition, persons with PD and HOAs had similar inhibitory gating ratios, and stress decreased inhibitory gating in both groups. While not statistically significant, there was a medium to large condition by group interaction effect size ( η p 2 = 0.104), where the stress condition resulted in a decrease in inhibitory gating in persons with PD that was more than double what was observed in the HOAs. This suggests that in persons with PD, stress may impair inhibitory gating to a greater degree. The negative impact stress has on inhibitory gating in persons with PD has several clinical implications including deleterious effects on motor, cognitive, and sensory functioning. Inhibitory gating is associated with PD motor symptoms such as motor inhibition as well as bradykinesia (Cheng, et al., 2016; Liu, Xiao, Shi, & Zhao, 2011 ; Lukhanina et al., 2011 ; Yadon, et al., 2009 ). Two likely mechanisms associated with this motor impairment due to reduced inhibitory gating include 1) increased sensory overload, which may impair cognitive functioning by competing for limited cognitive resources (Croft, Lee, Bertolot, & Gruzelier, 2001 ; Desimone & Duncan, 1995 ; Yadon, et al., 2009 ); and 2) disrupting sensory processes that might contribute to motor impairments (Chudler & Dong, 1995 ; Conte, Khan, Defazio, Rothwell, & Berardelli, 2013 ; Konczak et al., 2009 ; Müller, et al., 2013; Nieuwboer & Giladi, 2013 ). Thus, stress has the potential to negatively impact PD motor symptoms via its negative impact on cognitive and sensory functions. One important consideration in interpreting the results of this study is the stage of PD progression. As previously stated, persons with PD and HOAs had similar inhibitory gating ratios during the control condition. This was not completely unexpected as our sample of persons with PD were in the mild to moderate stages of disease severity (Hoehn and Yahr (H&Y) = 2.3). While, previous research demonstrated that compared to HOAs persons with PD have greater impairment in inhibitory gating (Teo et al., 1997 ), those differences were driven by individuals with PD who were in the later stages of the disease (H&Y = 4 & 5). It may be the stage of the PD modulates how stress impacts inhibitory gating due to greater degeneration in various parts of the brain (e.g. locus coeruleus, prefrontal cortex, basal ganglia, etc.). For example, individuals in the later stages of PD are likely to have impaired inhibitory gating in non-stressful conditions, while their inhibitory gating under stress might be differentially impacted. Consistent with other studies that observed larger auditory event-related potentials in persons with PD (Gulberti et al., 2015 ; Tanaka et al., 2000 ; Teo et al. 1997 ), there was a trend ( p < 0.1) for p50 amplitudes to be greater in persons with PD. This may suggest an over-activation of the ascending cholinergic reticular activating system within persons with PD (Skinner, Miyazato, & Garcia-Rill, 2002 ; Teo, et al., 1997). This over-activation is thought to be a compensatory mechanism to attenuate cognitive and motor deficits due to nigrostriatal dopamine loss (Bohnen et al., 2015 ; Kucinski, de Jong, & Sarter, 2017 ). Thus, the auditory p50 amplitude may be a useful biomarker to examine the interaction between dopaminergic and cholinergic systems in persons with PD. However, it is important to note that the effect of the stress on p50 amplitudes was not statistically significant, suggesting that the SECP had a greater impact on the gating of S2, and less of an impact the auditory event-related potentials mediated by the ascending reticular activating system. Limitations While our sample size was large enough to support our initial hypothesis that the SECP reduced inhibitory gating in both HOAs and persons with PD, we were likely underpowered to find a group by condition interaction. However, the effect sizes suggested that stress reduces inhibitory gating in individuals with PD to a greater degree. Another limitation is that our participants with PD had greater trait anxiety levels than our HOAs (as measured by the STAI2), while unknown this could potentially impact their inhibitory gating responses to an acute stressor. Finally, the potential mechanisms, mediating neurotransmitters, and motor symptoms discussed as having been associated with inhibitory gating were not assessed and future studies are needed to clarify how stress might impact these in persons with PD. Conclusion The acute SECP stressor decreased inhibitory gating in persons with PD and HOAs, and the decrease appeared to be larger in persons with PD. Moreover, a statistical trend ( p < 0.1) for persons with PD to have larger S1 and S2 amplitudes was revealed, possibly suggesting an over-activation /compensation by the reticular activating system. Understanding the impact of stress and inhibitory gating in persons with PD has the potential to unlock important mechanisms and neuropharmacological targets for treatment. In the future, work will be expanded to assess the relationship between stress and inhibitory gating on motor symptoms as well as cognition in persons with PD. Declarations Competing Interests: None. Data Availability Data is available upon request from the corresponding author. Funding Source: None Author Contribution Lab: Alternative Medicine and Music for Parkinson’s Disease Lab, Department of Kinesiology, Iowa State UniversityAZ: Conception and design of the work, acquisition, analysis, and interpretation of data, drafting of manuscriptCJ: Drafting of manuscriptPI: Critical revision of workELS: Conception and design of the work, interpretation of data, critical revision of work Data Availability Data Availability: Data is available upon request from the corresponding author. References Adler, L. E. et al. Yohimbine causes a transient impairment in P50 auditory sensory gating. Soc. Neurosci. Abstr (Vol . 17 , 1454 (1991). Adler, L. E. et al. Varied effects of atypical neuroleptics on P50 auditory gating in schizophrenia patients. Am. J. Psychiatry . 161 (10), 1822–1828 (2004). Boecker, H. et al. 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K., Bradshaw, J. L., Nicholls, M. E. & Altenmueller, E. Enhanced P1-N1 auditory evoked potential in patients with musicians' cramp. Ann. N. Y. Acad. Sci. 1060 (1), 349–359 (2005). Liu, T., Xiao, T., Shi, J. & Zhao, L. Sensory gating, inhibition control and child intelligence: an event-related potentials study. Neuroscience . 189 , 250–257 (2011). Lukhanina, E. P., Kapustina, M. T., Berezetskaya, N. M. & Karaban, I. N. Reduction of the postexcitatory cortical inhibition upon paired-click auditory stimulation in patients with Parkinson’s disease. Clin. Neurophysiol. 120 (10), 1852–1858 (2009). Lukhanina, E., Berezetskaya, N. & Karaban, I. Paired-pulse inhibition in the auditory cortex in Parkinson's disease and its dependence on clinical characteristics of the patients. Parkinson’s Disease , 2011 . (2011). McHaffie, J. G., Stanford, T. R., Stein, B. E., Coizet, V. & Redgrave, P. Subcortical loops through the basal ganglia. Trends Neurosci. 28 (8), 401–407 (2005). Mohamed, A. S., lacono, R. P. & Yamada, S. Normalization of middle latency auditory P1 potential following posterior ansa-pallidotomy in idiopathic Parkinson's disease. Neurol. Res. 18 (6), 516–520 (1996). Müller, M. L. et al. Thalamic cholinergic innervation and postural sensory integration function in Parkinson’s disease. Brain . 136 (11), 3282–3289 (2013). Nieuwboer, A. & Giladi, N. Characterizing freezing of gait in Parkinson's disease: models of an episodic phenomenon. Mov. Disord. 28 (11), 1509–1519 (2013). Obeso, I., Wilkinson, L. & Jahanshahi, M. Levodopa medication does not influence motor inhibition or conflict resolution in a conditional stop-signal task in Parkinson’s disease. Exp. Brain Res. 213 (4), 435 (2011). Palmer, G. J., Ziegler, M. G. & Lake, C. R. Response of norepinephrine and blood pressure to stress increases with age. J. Gerontol. 33 (4), 482–487 (1978). Patel, N., Jankovic, J. & Hallett, M. Sensory aspects of movement disorders. Lancet Neurol. 13 (1), 100–112 (2014). Ruppert, D. Trimming and Winsorization Encyclopedia of Statistical Sciences. (2004). Skinner, R. D., Miyazato, H. & Garcia-Rill, E. The sleep state-dependent P50 auditory evoked potential in neuropsychiatric diseases. In International Congress Series (Vol. 1232, 813–825). Elsevier. (2002), April. Stevens, K. E., Meltzer, J. & Rose, G. M. Disruption of sensory gating by the α2 selective noradrenergic antagonist yohimbine. Biol. Psychiatry . 33 (2), 130–132 (1993). Tanaka, H. et al. Event-related potential and EEG measures in Parkinson’s disease without and with dementia. Dement. Geriatr. Cogn. Disord. 11 (1), 39–45 (2000). Teo, C. et al. Decreased habituation of midlatency auditory evoked responses in Parkinson's disease. Mov. disorders: official J. Mov. Disorder Soc. 12 (5), 655–664 (1997). Teo, C., Rasco, L., Skinner, R. D. & Garcia-Rill, E. Disinhibition of the sleep state-dependent P1 potential in Parkinson’s disease-improvement after pallidotomy. Sleep. Res. Online . 1 (1), 62–70 (1998). Tregellas, J. R. et al. Increased hemodynamic response in the hippocampus, thalamus and prefrontal cortex during abnormal sensory gating in schizophrenia. Schizophr. Res. 92 (1–3), 262–272 (2007). Uc, E. Y., Skinner, R. D., Rodnitzky, R. L. & Garcia-Rill, E. The midlatency auditory evoked potential P50 is abnormal in Huntington's disease. J. Neurol. Sci. 212 (1–2), 1–5 (2003). Vermeiren, Y. & De Deyn, P. P. Targeting the norepinephrinergic system in Parkinson's disease and related disorders: the locus coeruleus story. Neurochem. Int. 102 , 22–32 (2017). White, P. M. & Yee, C. M. Effects of attentional and stressor manipulations on the P50 gating response. Psychophysiology . 34 (6), 703–711 (1997). Williams, T. J., Nuechterlein, K. H., Subotnik, K. L. & Yee, C. M. Distinct neural generators of sensory gating in schizophrenia. Psychophysiology . 48 (4), 470–478 (2011). Wirdefeldt, K., Adami, H. O., Cole, P., Trichopoulos, D. & Mandel, J. Epidemiology and etiology of Parkinson’s disease: a review of the evidence. Eur. J. Epidemiol. 26 , 1–58 (2011). Yadon, C. A., Bugg, J. M., Kisley, M. A. & Davalos, D. B. P50 sensory gating is related to performance on select tasks of cognitive inhibition. Cogn. Affect. Behav. Neurosci. 9 (4), 448–458 (2009). Yang, H. J. et al. Measuring anxiety in patients with early-stage Parkinson's disease: Rasch analysis of the State-Trait Anxiety Inventory. Front. Neurol. 10 , 49 (2019). Additional & Information. Tables Table 1 Demographic and Questionnaire Information Means and standard deviations for all demographic measures, and cognitive questionnaires. For between subjects comparisons ** p < 0.01. HOA; healthy older adult; PD: Parkinson’s disease; Movement Disorder Society - Unified Parkinson’s Disease Rating Scale: MDS - UPDRS; H&Y: Hoehn and Yahr; MMSE: Mini-Mental Status Exam; MOCA: Montreal Cognitive Assessment; GDS: Geriatric Depression Scale; PSS: Perceived Stress Scale; STAI1: State and Trait Anxiety Inventory (State); STAI2: State and Trait Anxiety Inventory (Trait). PD HOA Age (Years) 67.8 ± 4.7 68.7 ± 5.0 Gender (% Male) 33.3 ± 50.0 33.3 ± 50.0 MDS - UPDRS 66.9 ± 5.8 N/A H&Y 2.3 ± 0.1 N/A Years Diagnosed 9.9 ± 1.7 N/A MMSE 29.3 ± 0.7 29.7 ± 0.6 GDS 6.5 ± 4.5 3.8 ± 3.7 PSS 13.5 ± 5.6 9.2 ± 6.6 STAI1 33.3 ± 8.5 28 ± 10.9 STAI2** 38.3 ± 8.7 29.1 ± 7.6 Table 2 Stress Measures Means and standard deviations for all measures of stress for both groups and both conditions. For a main effect of condition * p < 0.05, ** p < 0.01, *** p < 0.001. DBP: Diastolic blood pressure; HOA: healthy older adult; PD: persons with Parkinson’s disease; SBP: Systolic blood pressure. Table 2 PD Control HOA Control PD SECP HOA SECP Perceived Stress*** 1.20 ± 0.56 1.00 ± 0.00 6.40 ± 2.53 6.13 ± 2.27 SBP (mmHg)** 121.3 ± 13.0 130.5 ± 16.2 129.7 ± 15.4 134.7 ± 13.8 DBP (mmHg)* 75.6 ± 9.3 74.9 ± 8.0 79.5 ± 8.7 76.7 ± 8.3 Cortisol (ng/dl/hr)* 66.7 ± 26.4 58.8 ± 23.2 76.1 ± 27.0 76.3 ± 34.2 Table 3 p50 Measures Means and standard deviations for all p50 measures for both groups and both conditions. For a main effect of condition, ** p < 0.01. HOA: healthy older adult; PD: Parkinson’s disease; S1: stimulus 1; S2: stimulus 2. Table 3 PD Control HOA Control PD SECP HOA SECP p50 Ratio** 0.61 ± 0.28 0.60 ± 0.12 0.90 ± 0.47 0.72 ± 0.16 S1Amplitude (µV) 10.42 ± 5.73 6.04 ± 2.86 9.82 ± 7.56 6.01 ± 3.00 S2 Amplitude (µV) 6.31 ± 4.27 3.71 ± 2.16 7.59 ± 5.50 4.14 ± 2.00 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4965100","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":361921134,"identity":"aae7410f-5eb4-4e63-be6f-4775356f92e3","order_by":0,"name":"Andrew Zaman","email":"","orcid":"","institution":"Iowa State University","correspondingAuthor":false,"prefix":"","firstName":"Andrew","middleName":"","lastName":"Zaman","suffix":""},{"id":361921137,"identity":"dec3e006-928f-4b1e-a3bb-8b9c4d52e4b5","order_by":1,"name":"Crystal Jewell","email":"","orcid":"","institution":"Iowa State University","correspondingAuthor":false,"prefix":"","firstName":"Crystal","middleName":"","lastName":"Jewell","suffix":""},{"id":361921140,"identity":"597daf1c-bbae-431a-9e0b-459639c746a1","order_by":2,"name":"Patricia Izbicki","email":"","orcid":"","institution":"Iowa State University","correspondingAuthor":false,"prefix":"","firstName":"Patricia","middleName":"","lastName":"Izbicki","suffix":""},{"id":361921144,"identity":"127f6917-a8f5-4314-8118-cf4c11aede5a","order_by":3,"name":"Elizabeth Stegemöller","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0klEQVRIiWNgGAWjYNCCCgk4k7GBsHJmID4D1MIGUU2kFsY2BhK08POfP/jw6zwLefn5zc8ffGCwkd1wgIAWyRnJzMay2yQMNxxjM2ycwZBmTFCLwQ1mNmnJbRKMG9gYDJt5GA4nEtRif/4w+2/JORL289vYPzb/YfhPWIsBQzIb48cGicSGYzyGzQwMBwhrkbiRbCzNcEwiecOxnMKZPQbJxjMJaeHvP/jw44+aOtv5zcc3fPhRYSfbR0gLCDDzILmTOMD4g0iFo2AUjIJRMEIBAJGZQzkH66vqAAAAAElFTkSuQmCC","orcid":"","institution":"Iowa State University","correspondingAuthor":true,"prefix":"","firstName":"Elizabeth","middleName":"","lastName":"Stegemöller","suffix":""}],"badges":[],"createdAt":"2024-08-23 14:59:59","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4965100/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4965100/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":65945695,"identity":"b3599567-e944-4756-a45a-8bd50528b7af","added_by":"auto","created_at":"2024-10-04 17:37:05","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":25886,"visible":true,"origin":"","legend":"\u003cp\u003eFirst and Second Visit Procedure\u003c/p\u003e","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4965100/v1/a291c626755c707c38c22617.png"},{"id":65945694,"identity":"e919b9c0-8229-4918-881b-cc87d0611dab","added_by":"auto","created_at":"2024-10-04 17:37:05","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":27310,"visible":true,"origin":"","legend":"\u003cp\u003eThe Effects of Stress and Inhibitory Gating and the p50 Response\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eA)\u003c/strong\u003ep50 ratio for both groups and both conditions. \u003cstrong\u003eB)\u003c/strong\u003e Example EEG waveform from one person with PD in both conditions. \u003cstrong\u003eC)\u003c/strong\u003e S1 Amplitude for both groups and both conditions. \u003cstrong\u003eD)\u003c/strong\u003e S2 Amplitude for both groups and both conditions. Standard error bars shown. In Figure 1A long horizontal bars show a main effect of condition, ** \u003cem\u003ep\u003c/em\u003e\u0026lt;0.01\u003c/p\u003e","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4965100/v1/0f4da99cabb8bb2a082acb32.png"},{"id":74058591,"identity":"01f39979-deab-42e2-8b5e-9e8daf0849b6","added_by":"auto","created_at":"2025-01-17 10:54:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":943310,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4965100/v1/842912ee-0737-41ca-bdac-c597648ba4be.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eThe Effects of a Socially Evaluated Cold Press Stressor on Inhibitory Gating in Persons With Parkinson’s Disease\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMotor impairments such as tremor, bradykinesia, rigidity are hallmark symptoms of Parkinson\u0026rsquo;s disease (PD). However, in addition to motor symptoms, persons with PD also have a number of secondary non-motor symptoms, including sensory processing impairments (Boecker et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e1999\u003c/span\u003e, Gulberti, et al., 2015; Kaji, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2001\u003c/span\u003e; Patel, Jankovic, \u0026amp; Hallett, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Teo et al., \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e1997\u003c/span\u003e). One sensory processing impairment seen in persons with PD is reduced inhibitory gating (Gulberti, et al., 2015; Lukhanina, et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Lukhanina, Berezetskaya, \u0026amp; Karaban, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Teo et al., \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e1997\u003c/span\u003e), which has been associated with motor symptoms such as bradykinesia (Lukhanina, et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). Inhibitory gating is a natural pre-attentional sensory process that filters out repetitive information (Buotros \u0026amp; Belger, 1999; Gjini, Arfken, \u0026amp; Boutros, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). Acute stress has been shown to negatively impact inhibitory gating in heathy adults (Ermutlu, Karam\u0026uuml;rsel, Ugur, Senturk, \u0026amp; Gokhan, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2005\u003c/span\u003e; Johnson \u0026amp; Adler, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e1993\u003c/span\u003e; White \u0026amp; Yee, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e1997\u003c/span\u003e). However, it is unknown how stress impacts inhibitory gating in persons with PD.\u003c/p\u003e \u003cp\u003eWhile there is no consensus about the brain regions involved in inhibitory gating, most studies find that the prefrontal, somatosensory, supplementary motor, anterior cingulate, parietal, and thalamic areas are involved (Boutros, Gjini, Eickhoff, Urbach, \u0026amp; Pflieger, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Garcia-Rill, et al., 2008; Grunwald, et al., 2003; Korzyukov et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2007\u003c/span\u003e; Tregellas et al., \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2007\u003c/span\u003e; Williams, Nuechterlein, Subotnik, \u0026amp; Yee, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). Although the basal ganglia has not been directly implicated in inhibitory gating, evidence suggests it is also involved. For example, the basal ganglia modulates sensory information (Juri, Rodriquez-Oroz, \u0026amp; Obeso, 2011) and is functionally connected to prefrontal and parietal regions via subcortical loops (McHaffie, Stanford, Stein, Coizet, \u0026amp; Redgrave, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2005\u003c/span\u003e). Furthermore, impaired gating is seen in disorders of the basal ganglia such as PD, Huntington\u0026rsquo;s disease, and focal dystonia (Gulberti, et al., 2015; Teo et al., \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e1997\u003c/span\u003e; Lim, Bradshaw, Nicholls, \u0026amp; Altenmueller, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2005\u003c/span\u003e; Uc, Skinner, Rodnitzsky, \u0026amp; Garcia-Rill, 2003). Additionally, involvement of the basal ganglia is also demonstrated by studies where subthalamic nucleus deep brain stimulation, and ablative pallidal surgery restore normal inhibitory gating in persons with PD (Gulberti, et al., 2015; Mohamed, Lacono, \u0026amp; Yamada, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e1996\u003c/span\u003e, Teo, Rasco, Skinner, \u0026amp; Garcia-Rill, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e1998\u003c/span\u003e). Overall, this evidence suggests the basal ganglia and sensorimotor loop are involved in inhibitory gating, and that inhibitory gating is associated with the proper functioning of sensory and motor processes.\u003c/p\u003e \u003cp\u003eInhibitory gating is modulated by key neurotransmitters such as norepinephrine. For example, inhibitory gating has an inverted-U shaped relationship with norepinephrine, where both agonists and antagonists have been shown to disrupt normal gating (Adler, et al., 1991; Stevens, Meltzer, \u0026amp; Rose, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e1993\u003c/span\u003e). Additionally, acute stressors impair inhibitory gating, proposedly by increasing the release of norepinephrine (Ermutlu et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2005\u003c/span\u003e; Johnson \u0026amp; Adler, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e1993\u003c/span\u003e). Persons with PD suffer cellular loss in the locus coeruleus, a region that produces and projects norepinephrine (Vermeiren \u0026amp; De Deyn, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), and thus impaired gating in persons with PD might be mediated by low levels of norepinephrine. However, it remains unknown how acute stress will impact inhibitory gating in persons with PD. Thus, the main purpose of this study is to examine how an acute stressor [Socially Evaluated Cold Pressor (SECP)] impacts inhibitory gating (p50 ratio) in persons with PD. Given the aforementioned gaps in knowledge, we hypothesize that the SECP task will impair inhibitory gating in both persons with PD and healthy older adults (HOAs).\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eFifteen participants diagnosed with idiopathic PD (mean age 67.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.7 years; 5 males and 10 females), and fifteen age- and gender-matched HOAs (mean age 68.7\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0 years) completed this study (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Participants with PD were recruited via the Iowa State University Alternative Medicine and Music for PD Lab Database, which consists of a list of individuals diagnosed with PD who have indicated interest in research opportunities. HOAs were recruited via word of mouth. The primary inclusion criterion for this group was being between the ages of 50 and 80 (the average age range of a person with PD) (Wirdefeldt et al., \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). Participants with PD needed to have been diagnosed with PD by a neurologist. Participants were excluded if they demonstrated any cognitive impairment (Mini-Mental Status Exam\u0026thinsp;\u0026lt;\u0026thinsp;25). Participants were further excluded if they had: 1) severe hearing loss; 2) any metallic objects in the head (outside the mouth); 3) any implanted objects such as a pacemaker; 4) brain surgery; 5) been diagnosed with a mental disorder besides anxiety or depression; 6) any musculoskeletal disorders; 7) any other brain-related conditions; 8) were pregnant or taking birth control; 9) used tobacco, illicit drugs, or excessive amounts of alcohol; 10) had either a systolic blood pressure (SBP) above 140 mmHg or a diastolic blood pressure above 90 mmHg during the initial screening. One HOA was excluded during the initial blood pressure screening to avoid any potential cardiac events during the SECP. All participants provided written informed consent. All procedures were approved by the Iowa State University Institutional Review Board (approval #: 15\u0026ndash;499) and were performed in accordance with relevant guidelines and regulations.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eProcedure\u003c/h2\u003e \u003cp\u003eParticipants were scheduled for two lab visits within a one-week timespan. During the initial visit, participants were screened for cognitive impairment with the Mini-Mental Status Exam (MMSE) and high blood pressure using an automated Omron blood pressure cuff. Of note no participants scored less than 28 (out of 30) on the MMSE, however the ability of the MMSE to distinguish individuals with mild cognitive impairment (MCI) is poor and some participants might have been in the early stages of cognitive decline. Participants then provided demographic information and completed a battery of questionnaires that have been found to be reliable and valid measures for persons with PD including the Geriatric Depression Scale (GDS) (Ertan, Ertan, Kızıltan, \u0026amp; Uygucgil, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2005\u003c/span\u003e), and the State and Trait Anxiety Inventory (STAI) (Yang, et al., 2019). The Perceived Stress Scale (PSS) was also collected. While this scale has not been tested for its psychometric properties in persons with PD, it has been shown to be reliable and valid in older adults (Lee, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Jiang, et al., 2017). Participants with PD also completed the Movement Disorders Society-Unified Parkinson\u0026rsquo;s Disease Rating Scale (MDS-UPDRS). Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the means and standard deviations of demographic and questionnaire data.\u003c/p\u003e \u003cp\u003eParticipants were reminded to adhere to dietary and medical restrictions prior to their second lab visit which included limiting their caffeine intake to one cup (8 oz.) of a caffeinated beverage finished at least 3 hours prior to the start of the second visit and refraining from alcoholic beverages during the 24 hours prior to the start of the second visit. If they were non-compliant with any of these restrictions, participants were asked to reschedule. All participants were also asked to eat 1\u0026ndash;2 hours before the second visit. Participants with PD were asked to take their Parkinson\u0026rsquo;s medication 1 hour prior to the beginning of the second visit. The second visit was scheduled to align with their normal medication times. The second visit starting times were scheduled between 12PM and 3PM.\u003c/p\u003e \u003cp\u003eDuring the second visit, adherence to the dietary and medical restrictions and recommendations were reviewed to ensure compliance. Electroencephalogram (EEG) was then fitted on the participant (see methods below). Next, a salivary cortisol sample was collected and then the participants completed either the stress intervention (SECP) or the control intervention (warm water hand bath). The order was counter balanced. After completing either the stress task or the control task, blood pressure was obtained with an automated Omron blood pressure cuff. Then, they verbally reported how stressful they thought the task was on a Likert scale from 1 to 10, with respective response anchors of \u0026ldquo;not stressful at all\u0026rdquo;, and the \u0026ldquo;most stressful thing I can imagine\u0026rdquo;. Cortisol, blood pressure, and perceived stress were measured to assess the effectiveness of the stress and control interventions.\u003c/p\u003e \u003cp\u003eParticipants then completed 80 trials of the paired click paradigm to examine inhibitory gating. Inhibitory gating is typically evaluated using a paired click paradigm where pairs of simple auditory stimuli elicit the EEG p50 auditory components (Lijffijt et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). During the paired-click paradigm, the first click is referred to as the S1 and is followed shortly thereafter by the second click or S2. The most common inhibitory gating measure is the S2/S1 ratio of the p50 component (p50 ratio) (Boutros \u0026amp; Belger, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e1999\u003c/span\u003e; Guterman, Josiassen, \u0026amp; Bashore, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e1992\u003c/span\u003e; Jones et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). The normal gating response is indicated by a low S2/S1 ratio, with a large amplitude response to S1 and a reduced amplitude response to S2.\u003c/p\u003e \u003cp\u003e Twenty-five minutes after completing the paired click paradigm, a salivary cortisol sample was collected from each participant. Following this, participants rested or read a magazine/book for half an hour. After the rest period, participants completed the same series of steps and tasks again with the uncompleted intervention (i.e., warm water bath or SECP). See Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e for the order of first and second visit procedures.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStress and Control Tasks\u003c/h2\u003e \u003cp\u003e The stress intervention was a SECP task where the participants placed their hand up to the wrist in an ice water bath (2\u0026ndash;4\u0026deg; C) for 90 seconds. Participants were also made aware that this task was being video recorded and that their facial expressions were to be judged by trained experimenters at a later time. During the control condition, participants placed their hand in warm water (36\u0026ndash;38\u0026deg;C) for 90 seconds. During the control condition participants were reminded that they were not being videotaped and the camera was moved out of sight.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eEEG Data Acquisition and Analysis\u003c/h2\u003e \u003cp\u003eThe subjects were sitting comfortably in a semi-reclined armchair in a quiet well lit room. Participants were instructed to keep their movement to a minimum and their eyes open and focused on a piece of tape stuck to a desk 5 feet in front of them. Participants were also instructed to refrain from falling asleep.\u003c/p\u003e \u003cp\u003eTo collect the potentials, a 64 electrode EEG cap was fitted according to the international 10\u0026ndash;20 system (Biosemi, Amsterdam, Netherlands). Eye movements were monitored with electrodes placed above and below the right eye for filtering purposes. A single common reference electrode was placed over the mastoid process ipsilateral to the participants most affected side (HOAs were matched) and the ground electrode was placed on the forehead just above the nose and between the eyebrows. The electrode of interest was Cz, which is located in the midline at the \u0026lsquo;vertex\u0026rsquo; or top of the head. Impedances were checked to make sure they are below 5k ohms prior to beginning the data collection. Signals were recorded at 2kHz and amplified. During the task, auditory clicks were presented through speakers at 80dB hearing level. The auditory stimuli were pairs of identical auditory clicks (1000-Hz tone) with a duration of 20ms and an interval of 500ms between clicks. 80 trials were presented with a 7 second interval between trials. The time for each recording epoch was 300ms before the first pair of clicks until 1s following the second click. The auditory tones were collected simultaneously by the EEG data collection system to ensure synchronization. Overall, these are the recommended methods for collecting the p50 response (Dalecki, Croft, \u0026amp; Johnstone, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2011\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEEG data were processed using standard methods from the Krigolson Laboratory (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.krigolsonlab.com/data-analysis.html\u003c/span\u003e\u003cspan address=\"https://www.krigolsonlab.com/data-analysis.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). Signals were re-referenced offline using a bipolar montage (Cz-Iz) and filtered using a 0.5-45Hz 4th order dual-pass Butterworth band-pass and \u003csup\u003ea\u003c/sup\u003e 60Hz notch filter. Next, data was divided into smaller epochs (-200ms to 300ms) around each auditory tone. Finally, a trial was discarded if the voltage on any channel exceeded 10 \u0026micro;V/ms gradient and an absolute voltage difference\u0026thinsp;\u0026gt;\u0026thinsp;100 \u0026micro;V.\u003c/p\u003e \u003cp\u003eThe P50 ratio (S2/S1) was the measure of habituation (Dalecki et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). S1 (peak-to-peak method) was the difference in amplitudes in the positive deflection between 35\u0026ndash;65ms and the most negative deflection between 15\u0026ndash;45 ms of the first stimulus. S2 was the difference of those amplitudes for the second stimulus. In addition, latency measures were also calculated for S2 and S1where the latency value reflected the timing difference between the maximum positive deflection and the auditory stimulus. Due to technical difficulties, EEG was not collected for 4 of the participants with PD. A clear p50 component was interpretable in both the S1 and S2 in both conditions (SECP and control) for 19 participants (8 PD and 11 HOAs). These were entered for statistical analysis.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eCortisol Analysis\u003c/h2\u003e \u003cp\u003eOn the day of collection, salivary cortisol samples were stored in -20\u0026deg;C freezer within 30 minutes. Cortisol was analyzed with the Salimetrics\u0026reg; Cortisol Enzyme Immunoassy Kit (RRID AB_2801306). The kit uses a competitive immunoassay in which cortisol competes with cortisol conjugated to horseradish peroxidase for the antibody binding sites. To determine the cortisol reactivity, the area under the curve was calculated using the baseline and the 25 min post intervention samples for each condition.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eAn independent samples \u003cem\u003et\u003c/em\u003e-test was used to examine any group differences on demographic and questionnaire outcome measures. A 2 condition (stress, control) x 2 group (PD, HOA) repeated measures ANOVA was completed for measures of stress (perceived stress, blood pressure, and cortisol) to confirm that the SECP initiated an increase in stress for participants. To test the hypothesis that the SECP task will impair inhibitory gating (higher p50 ratios) in both persons with PD and HOAs, a 2 condition (stress, control) x 2 group (PD, HOA) repeated measures ANOVA was used to determine differences on inhibitory gating (p50 ratio) and measures of early auditory processing (amplitude and latency of S1 and S2). For all repeated measures ANOVAs, partial eta squared (\u003cem\u003eη\u003c/em\u003e\u003csub\u003e\u003cem\u003ep\u003c/em\u003e\u003c/sub\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e) effect sizes were calculated. Significance was set at α\u0026thinsp;=\u0026thinsp;0.05. For all post hoc analyses, a Bonferroni correction was used to interpret statistical significance.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the means and standard deviations for all stress related measures (perceived stress, blood pressure, and cortisol). Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the means and standard deviations for all auditory processing measures.\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eParticipants with PD had higher trait anxiety than the HOAs (\u003cem\u003et\u003c/em\u003e\u003csub\u003e(28)\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;3.086, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.005, Mean Difference (\u003cem\u003eMD\u003c/em\u003e)\u0026thinsp;=\u0026thinsp;+\u0026thinsp;9.2, \u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.126). No other demographic variables were significantly different (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003ePerceived Stress\u003c/h2\u003e \u003cp\u003eThere was a main effect of condition (\u003cem\u003eF\u003c/em\u003e\u003csub\u003e(1,28)\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;147.393, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001, \u003cem\u003eη\u003c/em\u003e\u003csub\u003e\u003cem\u003ep\u003c/em\u003e\u003c/sub\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.840). The participants found that the SECP was more stressful than the control condition (\u003cem\u003eMD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;+\u0026thinsp;5.2, \u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.256). There was no main effect of group (\u003cem\u003eF\u003c/em\u003e\u003csub\u003e(1,28)\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;0.267, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.609, \u003cem\u003eη\u003c/em\u003e\u003csub\u003e\u003cem\u003ep\u003c/em\u003e\u003c/sub\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.009), or an interaction effects for group x condition (\u003cem\u003eF\u003c/em\u003e\u003csub\u003e(1,28)\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;0.006, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.938, \u003cem\u003eη\u003c/em\u003e\u003csub\u003e\u003cem\u003ep\u003c/em\u003e\u003c/sub\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.000).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eBlood Pressure\u003c/h2\u003e \u003cp\u003eThere was a main effect of condition for both systolic (\u003cem\u003eF\u003c/em\u003e\u003csub\u003e(1,28)\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;8.003, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.009, \u003cem\u003eη\u003c/em\u003e\u003csub\u003e\u003cem\u003ep\u003c/em\u003e\u003c/sub\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.222) and diastolic blood pressure (\u003cem\u003eF\u003c/em\u003e\u003csub\u003e(1,28)\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;5.543, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.026, \u003cem\u003eη\u003c/em\u003e\u003csub\u003e\u003cem\u003ep\u003c/em\u003e\u003c/sub\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.165). The participants had higher systolic blood pressure after the SECP compared to the control condition (\u003cem\u003eMD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;+\u0026thinsp;6.4 mmHg, \u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.518). Participants also had higher diastolic blood pressure after the SECP compared to the control condition (\u003cem\u003eMD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;+\u0026thinsp;2.8 mmHg, \u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.430). There was no main effect of group for systolic blood pressure (\u003cem\u003eF\u003c/em\u003e\u003csub\u003e(1,28)\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;2.138, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.155, \u003cem\u003eη\u003c/em\u003e\u003csub\u003e\u003cem\u003ep\u003c/em\u003e\u003c/sub\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.071) or diastolic blood pressure (\u003cem\u003eF\u003c/em\u003e\u003csub\u003e(1,28)\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;0.360, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.553, \u003cem\u003eη\u003c/em\u003e\u003csub\u003e\u003cem\u003ep\u003c/em\u003e\u003c/sub\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.013). There were no interaction effects of group x condition for systolic blood pressure (\u003cem\u003eF\u003c/em\u003e\u003csub\u003e(1,28)\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;0.889, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.354; \u003cem\u003eη\u003c/em\u003e\u003csub\u003e\u003cem\u003ep\u003c/em\u003e\u003c/sub\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.031) or diastolic blood pressure (\u003cem\u003eF\u003c/em\u003e\u003csub\u003e(1,28)\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;0.767, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.388; \u003cem\u003eη\u003c/em\u003e\u003csub\u003e\u003cem\u003ep\u003c/em\u003e\u003c/sub\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.027)).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eCortisol\u003c/h2\u003e \u003cp\u003eThere was a main effect of condition for cortisol (\u003cem\u003eF\u003c/em\u003e\u003csub\u003e(1,28)\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;6.780, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.015 \u003cem\u003eη\u003c/em\u003e\u003csub\u003e\u003cem\u003ep\u003c/em\u003e\u003c/sub\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.195). Participants had a higher cortisol area under the curve (AUC) values during the SECP compared to the control condition (\u003cem\u003eMD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;+\u0026thinsp;13.4 ng/dl/hr, \u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.479). There was no main effect of group (\u003cem\u003eF\u003c/em\u003e\u003csub\u003e(1,28)\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;0.187, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.699, \u003cem\u003eη\u003c/em\u003e\u003csub\u003e\u003cem\u003ep\u003c/em\u003e\u003c/sub\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.007) and no interaction effects for group x condition (\u003cem\u003eF\u003c/em\u003e\u003csub\u003e(1,28)\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;0.596, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.447, \u003cem\u003eη\u003c/em\u003e\u003csub\u003e\u003cem\u003ep\u003c/em\u003e\u003c/sub\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.021).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eInhibitory Gating\u003c/h2\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA shows the results for inhibitory gating (see Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eB for EEG waveform from one person with PD in both conditions). Results revealed a main effect of condition (\u003cem\u003eF\u003c/em\u003e\u003csub\u003e(1,17)\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;12.813, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002, \u003cem\u003eη\u003c/em\u003e\u003csub\u003e\u003cem\u003ep\u003c/em\u003e\u003c/sub\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.430). In general, there was less inhibitory gating following the SECP compared to the control condition (MD\u0026thinsp;=\u0026thinsp;+\u0026thinsp;0.20, \u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.760). No main effect of group (\u003cem\u003eF\u003c/em\u003e\u003csub\u003e(1,17)\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;0.736, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.403, \u003cem\u003eη\u003c/em\u003e\u003csub\u003e\u003cem\u003ep\u003c/em\u003e\u003c/sub\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.042) or interaction effects for condition x group (\u003cem\u003eF\u003c/em\u003e\u003csub\u003e(1,17)\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;1.971, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.178, \u003cem\u003eη\u003c/em\u003e\u003csub\u003e\u003cem\u003ep\u003c/em\u003e\u003c/sub\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.104) were found.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eEarly Auditory Components\u003c/h2\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eC and \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eD show the results for S1 amplitude and S2 amplitude. No main effects of condition were found [S1 amplitude (\u003cem\u003eF\u003c/em\u003e\u003csub\u003e(1,17)\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;0.261, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.616, \u003cem\u003eη\u003c/em\u003e\u003csub\u003e\u003cem\u003ep\u003c/em\u003e\u003c/sub\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.015 ); S2 amplitude (\u003cem\u003eF\u003c/em\u003e\u003csub\u003e(1,17)\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;1.527, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.233, \u003cem\u003eη\u003c/em\u003e\u003csub\u003e\u003cem\u003ep\u003c/em\u003e\u003c/sub\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.082))]. However, there was a group trend for S1 amplitude (\u003cem\u003eF\u003c/em\u003e\u003csub\u003e(1,17)\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;3.560, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.076, \u003cem\u003eη\u003c/em\u003e\u003csub\u003e\u003cem\u003ep\u003c/em\u003e\u003c/sub\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.173), and S2 amplitude (\u003cem\u003eF\u003c/em\u003e\u003csub\u003e(1,17)\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;4.109, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.059, \u003cem\u003eη\u003c/em\u003e\u003csub\u003e\u003cem\u003ep\u003c/em\u003e\u003c/sub\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.195). Persons with PD had a greater S1 amplitude (\u003cem\u003eMD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;+\u0026thinsp;4.1 \u0026micro;V, \u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.672) and S2 amplitude (\u003cem\u003eMD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;+\u0026thinsp;3.0 \u0026micro;V, \u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.675) than HOAs. No condition x group interactions were found [S1 amplitude (\u003cem\u003eF\u003c/em\u003e\u003csub\u003e(1,17)\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;0.206, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.656, \u003cem\u003eη\u003c/em\u003e\u003csub\u003e\u003cem\u003ep\u003c/em\u003e\u003c/sub\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.012 ); S2 amplitude (\u003cem\u003eF\u003c/em\u003e\u003csub\u003e(1,17)\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;0.376, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.548, \u003cem\u003eη\u003c/em\u003e\u003csub\u003e\u003cem\u003ep\u003c/em\u003e\u003c/sub\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.022)].\u003c/p\u003e \u003c/div\u003e "},{"header":"Discussion","content":" \u003cp\u003eThis present study aimed to test the effects of SECP on inhibitory gating in persons with PD. The results revealed that the SECP was successful in increasing stress related measures (perceived stress, blood pressure, and cortisol) and decreasing inhibitory gating in both HOAs and persons with PD. While not significant, the SECP decreased inhibitory gating to a greater degree in persons with PD (\u003cem\u003eMD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;+\u0026thinsp;0.293) compared to HOAs (\u003cem\u003eMD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;+\u0026thinsp;0.127), with the condition by group interaction showing a medium to large effect size (\u003cem\u003eη\u003c/em\u003e\u003csub\u003e\u003cem\u003ep\u003c/em\u003e\u003c/sub\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.104). Similar to previous research (Teo et al., \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e1997\u003c/span\u003e), the results also showed that persons with PD had larger (albeit not significantly different), S1 and S2 amplitudes, suggesting that PD may also affect early auditory processing.\u003c/p\u003e \u003cp\u003eDuring the control condition, persons with PD and HOAs had similar inhibitory gating ratios, and stress decreased inhibitory gating in both groups. While not statistically significant, there was a medium to large condition by group interaction effect size (\u003cem\u003eη\u003c/em\u003e\u003csub\u003e\u003cem\u003ep\u003c/em\u003e\u003c/sub\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.104), where the stress condition resulted in a decrease in inhibitory gating in persons with PD that was more than double what was observed in the HOAs. This suggests that in persons with PD, stress may impair inhibitory gating to a greater degree.\u003c/p\u003e \u003cp\u003eThe negative impact stress has on inhibitory gating in persons with PD has several clinical implications including deleterious effects on motor, cognitive, and sensory functioning.\u003c/p\u003e \u003cp\u003eInhibitory gating is associated with PD motor symptoms such as motor inhibition as well as bradykinesia (Cheng, et al., 2016; Liu, Xiao, Shi, \u0026amp; Zhao, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Lukhanina et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Yadon, et al., \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). Two likely mechanisms associated with this motor impairment due to reduced inhibitory gating include 1) increased sensory overload, which may impair cognitive functioning by competing for limited cognitive resources (Croft, Lee, Bertolot, \u0026amp; Gruzelier, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2001\u003c/span\u003e; Desimone \u0026amp; Duncan, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e1995\u003c/span\u003e; Yadon, et al., \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2009\u003c/span\u003e); and 2) disrupting sensory processes that might contribute to motor impairments (Chudler \u0026amp; Dong, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e1995\u003c/span\u003e; Conte, Khan, Defazio, Rothwell, \u0026amp; Berardelli, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Konczak et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; M\u0026uuml;ller, et al., 2013; Nieuwboer \u0026amp; Giladi, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Thus, stress has the potential to negatively impact PD motor symptoms via its negative impact on cognitive and sensory functions.\u003c/p\u003e \u003cp\u003eOne important consideration in interpreting the results of this study is the stage of PD progression. As previously stated, persons with PD and HOAs had similar inhibitory gating ratios during the control condition. This was not completely unexpected as our sample of persons with PD were in the mild to moderate stages of disease severity (Hoehn and Yahr (H\u0026amp;Y)\u0026thinsp;=\u0026thinsp;2.3). While, previous research demonstrated that compared to HOAs persons with PD have greater impairment in inhibitory gating (Teo et al., \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e1997\u003c/span\u003e), those differences were driven by individuals with PD who were in the later stages of the disease (H\u0026amp;Y\u0026thinsp;=\u0026thinsp;4 \u0026amp; 5). It may be the stage of the PD modulates how stress impacts inhibitory gating due to greater degeneration in various parts of the brain (e.g. locus coeruleus, prefrontal cortex, basal ganglia, etc.). For example, individuals in the later stages of PD are likely to have impaired inhibitory gating in non-stressful conditions, while their inhibitory gating under stress might be differentially impacted.\u003c/p\u003e \u003cp\u003eConsistent with other studies that observed larger auditory event-related potentials in persons with PD (Gulberti et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Tanaka et al., \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2000\u003c/span\u003e; Teo et al. \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e1997\u003c/span\u003e), there was a trend (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.1) for p50 amplitudes to be greater in persons with PD. This may suggest an over-activation of the ascending cholinergic reticular activating system within persons with PD (Skinner, Miyazato, \u0026amp; Garcia-Rill, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2002\u003c/span\u003e; Teo, et al., 1997). This over-activation is thought to be a compensatory mechanism to attenuate cognitive and motor deficits due to nigrostriatal dopamine loss (Bohnen et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Kucinski, de Jong, \u0026amp; Sarter, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Thus, the auditory p50 amplitude may be a useful biomarker to examine the interaction between dopaminergic and cholinergic systems in persons with PD. However, it is important to note that the effect of the stress on p50 amplitudes was not statistically significant, suggesting that the SECP had a greater impact on the gating of S2, and less of an impact the auditory event-related potentials mediated by the ascending reticular activating system.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eWhile our sample size was large enough to support our initial hypothesis that the SECP reduced inhibitory gating in both HOAs and persons with PD, we were likely underpowered to find a group by condition interaction. However, the effect sizes suggested that stress reduces inhibitory gating in individuals with PD to a greater degree. Another limitation is that our participants with PD had greater trait anxiety levels than our HOAs (as measured by the STAI2), while unknown this could potentially impact their inhibitory gating responses to an acute stressor. Finally, the potential mechanisms, mediating neurotransmitters, and motor symptoms discussed as having been associated with inhibitory gating were not assessed and future studies are needed to clarify how stress might impact these in persons with PD.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe acute SECP stressor decreased inhibitory gating in persons with PD and HOAs, and the decrease appeared to be larger in persons with PD. Moreover, a statistical trend (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.1) for persons with PD to have larger S1 and S2 amplitudes was revealed, possibly suggesting an over-activation /compensation by the reticular activating system. Understanding the impact of stress and inhibitory gating in persons with PD has the potential to unlock important mechanisms and neuropharmacological targets for treatment. In the future, work will be expanded to assess the relationship between stress and inhibitory gating on motor symptoms as well as cognition in persons with PD.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eCompeting Interests:\u003c/h2\u003e \u003cp\u003eNone.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eData Availability\u003c/h2\u003e \u003cp\u003eData is available upon request from the corresponding author.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding Source:\u003c/h2\u003e \u003cp\u003eNone\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eLab: Alternative Medicine and Music for Parkinson\u0026rsquo;s Disease Lab, Department of Kinesiology, Iowa State UniversityAZ: Conception and design of the work, acquisition, analysis, and interpretation of data, drafting of manuscriptCJ: Drafting of manuscriptPI: Critical revision of workELS: Conception and design of the work, interpretation of data, critical revision of work\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData Availability: Data is available upon request from the corresponding author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAdler, L. 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P50, N100, and P200 sensory gating: relationships with behavioral inhibition, attention, and working memory. \u003cem\u003ePsychophysiology\u003c/em\u003e. \u003cb\u003e46\u003c/b\u003e (5), 1059\u0026ndash;1068 (2009).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLim, V. K., Bradshaw, J. L., Nicholls, M. E. \u0026amp; Altenmueller, E. Enhanced P1-N1 auditory evoked potential in patients with musicians' cramp. \u003cem\u003eAnn. N. Y. Acad. Sci.\u003c/em\u003e \u003cb\u003e1060\u003c/b\u003e (1), 349\u0026ndash;359 (2005).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu, T., Xiao, T., Shi, J. \u0026amp; Zhao, L. Sensory gating, inhibition control and child intelligence: an event-related potentials study. \u003cem\u003eNeuroscience\u003c/em\u003e. \u003cb\u003e189\u003c/b\u003e, 250\u0026ndash;257 (2011).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLukhanina, E. P., Kapustina, M. T., Berezetskaya, N. M. \u0026amp; Karaban, I. N. Reduction of the postexcitatory cortical inhibition upon paired-click auditory stimulation in patients with Parkinson\u0026rsquo;s disease. \u003cem\u003eClin. Neurophysiol.\u003c/em\u003e \u003cb\u003e120\u003c/b\u003e (10), 1852\u0026ndash;1858 (2009).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLukhanina, E., Berezetskaya, N. \u0026amp; Karaban, I. Paired-pulse inhibition in the auditory cortex in Parkinson's disease and its dependence on clinical characteristics of the patients. \u003cem\u003eParkinson\u0026rsquo;s Disease\u003c/em\u003e, \u003cem\u003e2011\u003c/em\u003e. (2011).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcHaffie, J. G., Stanford, T. R., Stein, B. E., Coizet, V. \u0026amp; Redgrave, P. Subcortical loops through the basal ganglia. \u003cem\u003eTrends Neurosci.\u003c/em\u003e \u003cb\u003e28\u003c/b\u003e (8), 401\u0026ndash;407 (2005).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMohamed, A. S., lacono, R. P. \u0026amp; Yamada, S. Normalization of middle latency auditory P1 potential following posterior ansa-pallidotomy in idiopathic Parkinson's disease. \u003cem\u003eNeurol. Res.\u003c/em\u003e \u003cb\u003e18\u003c/b\u003e (6), 516\u0026ndash;520 (1996).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eM\u0026uuml;ller, M. L. et al. Thalamic cholinergic innervation and postural sensory integration function in Parkinson\u0026rsquo;s disease. \u003cem\u003eBrain\u003c/em\u003e. \u003cb\u003e136\u003c/b\u003e (11), 3282\u0026ndash;3289 (2013).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNieuwboer, A. \u0026amp; Giladi, N. Characterizing freezing of gait in Parkinson's disease: models of an episodic phenomenon. \u003cem\u003eMov. Disord.\u003c/em\u003e \u003cb\u003e28\u003c/b\u003e (11), 1509\u0026ndash;1519 (2013).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eObeso, I., Wilkinson, L. \u0026amp; Jahanshahi, M. Levodopa medication does not influence motor inhibition or conflict resolution in a conditional stop-signal task in Parkinson\u0026rsquo;s disease. \u003cem\u003eExp. Brain Res.\u003c/em\u003e \u003cb\u003e213\u003c/b\u003e (4), 435 (2011).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePalmer, G. J., Ziegler, M. G. \u0026amp; Lake, C. R. Response of norepinephrine and blood pressure to stress increases with age. \u003cem\u003eJ. Gerontol.\u003c/em\u003e \u003cb\u003e33\u003c/b\u003e (4), 482\u0026ndash;487 (1978).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePatel, N., Jankovic, J. \u0026amp; Hallett, M. Sensory aspects of movement disorders. \u003cem\u003eLancet Neurol.\u003c/em\u003e \u003cb\u003e13\u003c/b\u003e (1), 100\u0026ndash;112 (2014).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRuppert, D. Trimming and Winsorization Encyclopedia of Statistical Sciences. (2004).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSkinner, R. D., Miyazato, H. \u0026amp; Garcia-Rill, E. The sleep state-dependent P50 auditory evoked potential in neuropsychiatric diseases. In International Congress Series (Vol. 1232, 813\u0026ndash;825). Elsevier. (2002), April.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStevens, K. E., Meltzer, J. \u0026amp; Rose, G. M. Disruption of sensory gating by the α2 selective noradrenergic antagonist yohimbine. \u003cem\u003eBiol. Psychiatry\u003c/em\u003e. \u003cb\u003e33\u003c/b\u003e (2), 130\u0026ndash;132 (1993).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTanaka, H. et al. Event-related potential and EEG measures in Parkinson\u0026rsquo;s disease without and with dementia. \u003cem\u003eDement. Geriatr. Cogn. Disord.\u003c/em\u003e \u003cb\u003e11\u003c/b\u003e (1), 39\u0026ndash;45 (2000).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTeo, C. et al. Decreased habituation of midlatency auditory evoked responses in Parkinson's disease. \u003cem\u003eMov. disorders: official J. Mov. Disorder Soc.\u003c/em\u003e \u003cb\u003e12\u003c/b\u003e (5), 655\u0026ndash;664 (1997).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTeo, C., Rasco, L., Skinner, R. D. \u0026amp; Garcia-Rill, E. Disinhibition of the sleep state-dependent P1 potential in Parkinson\u0026rsquo;s disease-improvement after pallidotomy. \u003cem\u003eSleep. Res. Online\u003c/em\u003e. \u003cb\u003e1\u003c/b\u003e (1), 62\u0026ndash;70 (1998).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTregellas, J. R. et al. Increased hemodynamic response in the hippocampus, thalamus and prefrontal cortex during abnormal sensory gating in schizophrenia. \u003cem\u003eSchizophr. Res.\u003c/em\u003e \u003cb\u003e92\u003c/b\u003e (1\u0026ndash;3), 262\u0026ndash;272 (2007).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUc, E. Y., Skinner, R. D., Rodnitzky, R. L. \u0026amp; Garcia-Rill, E. The midlatency auditory evoked potential P50 is abnormal in Huntington's disease. \u003cem\u003eJ. Neurol. Sci.\u003c/em\u003e \u003cb\u003e212\u003c/b\u003e (1\u0026ndash;2), 1\u0026ndash;5 (2003).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVermeiren, Y. \u0026amp; De Deyn, P. P. Targeting the norepinephrinergic system in Parkinson's disease and related disorders: the locus coeruleus story. \u003cem\u003eNeurochem. Int.\u003c/em\u003e \u003cb\u003e102\u003c/b\u003e, 22\u0026ndash;32 (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWhite, P. M. \u0026amp; Yee, C. M. Effects of attentional and stressor manipulations on the P50 gating response. \u003cem\u003ePsychophysiology\u003c/em\u003e. \u003cb\u003e34\u003c/b\u003e (6), 703\u0026ndash;711 (1997).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilliams, T. J., Nuechterlein, K. H., Subotnik, K. L. \u0026amp; Yee, C. M. Distinct neural generators of sensory gating in schizophrenia. \u003cem\u003ePsychophysiology\u003c/em\u003e. \u003cb\u003e48\u003c/b\u003e (4), 470\u0026ndash;478 (2011).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWirdefeldt, K., Adami, H. O., Cole, P., Trichopoulos, D. \u0026amp; Mandel, J. Epidemiology and etiology of Parkinson\u0026rsquo;s disease: a review of the evidence. \u003cem\u003eEur. J. Epidemiol.\u003c/em\u003e \u003cb\u003e26\u003c/b\u003e, 1\u0026ndash;58 (2011).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYadon, C. A., Bugg, J. M., Kisley, M. A. \u0026amp; Davalos, D. B. P50 sensory gating is related to performance on select tasks of cognitive inhibition. \u003cem\u003eCogn. Affect. Behav. Neurosci.\u003c/em\u003e \u003cb\u003e9\u003c/b\u003e (4), 448\u0026ndash;458 (2009).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang, H. J. et al. Measuring anxiety in patients with early-stage Parkinson's disease: Rasch analysis of the State-Trait Anxiety Inventory. \u003cem\u003eFront. Neurol.\u003c/em\u003e \u003cb\u003e10\u003c/b\u003e, 49 (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdditional \u0026amp; Information.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic and Questionnaire Information Means and standard deviations for all demographic measures, and cognitive questionnaires. For between subjects comparisons **\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01. HOA; healthy older adult; PD: Parkinson\u0026rsquo;s disease; Movement Disorder Society - Unified Parkinson\u0026rsquo;s Disease Rating Scale: MDS - UPDRS; H\u0026amp;Y: Hoehn and Yahr; MMSE: Mini-Mental Status Exam; MOCA: Montreal Cognitive Assessment; GDS: Geriatric Depression Scale; PSS: Perceived Stress Scale; STAI1: State and Trait Anxiety Inventory (State); STAI2: State and Trait Anxiety Inventory (Trait).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHOA\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (Years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e67.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68.7\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender (% Male)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e33.3\u0026thinsp;\u0026plusmn;\u0026thinsp;50.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.3\u0026thinsp;\u0026plusmn;\u0026thinsp;50.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMDS - UPDRS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e66.9\u0026thinsp;\u0026plusmn;\u0026thinsp;5.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eH\u0026amp;Y\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eYears Diagnosed\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e9.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMMSE\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e29.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGDS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e6.5\u0026thinsp;\u0026plusmn;\u0026thinsp;4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePSS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e13.5\u0026thinsp;\u0026plusmn;\u0026thinsp;5.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.2\u0026thinsp;\u0026plusmn;\u0026thinsp;6.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSTAI1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e33.3\u0026thinsp;\u0026plusmn;\u0026thinsp;8.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28\u0026thinsp;\u0026plusmn;\u0026thinsp;10.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSTAI2**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e38.3\u0026thinsp;\u0026plusmn;\u0026thinsp;8.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.1\u0026thinsp;\u0026plusmn;\u0026thinsp;7.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStress Measures Means and standard deviations for all measures of stress for both groups and both conditions. For a main effect of condition *\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, **\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01, ***\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001. DBP: Diastolic blood pressure; HOA: healthy older adult; PD: persons with Parkinson\u0026rsquo;s disease; SBP: Systolic blood pressure.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePD Control\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eHOA Control\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003ePD SECP\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eHOA SECP\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePerceived Stress***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.20\u0026thinsp;\u0026plusmn;\u0026thinsp;0.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e6.40\u0026thinsp;\u0026plusmn;\u0026thinsp;2.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e6.13\u0026thinsp;\u0026plusmn;\u0026thinsp;2.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSBP (mmHg)**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e121.3\u0026thinsp;\u0026plusmn;\u0026thinsp;13.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e130.5\u0026thinsp;\u0026plusmn;\u0026thinsp;16.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e129.7\u0026thinsp;\u0026plusmn;\u0026thinsp;15.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e134.7\u0026thinsp;\u0026plusmn;\u0026thinsp;13.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDBP (mmHg)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e75.6\u0026thinsp;\u0026plusmn;\u0026thinsp;9.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e74.9\u0026thinsp;\u0026plusmn;\u0026thinsp;8.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e79.5\u0026thinsp;\u0026plusmn;\u0026thinsp;8.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e76.7\u0026thinsp;\u0026plusmn;\u0026thinsp;8.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCortisol (ng/dl/hr)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e66.7\u0026thinsp;\u0026plusmn;\u0026thinsp;26.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e58.8\u0026thinsp;\u0026plusmn;\u0026thinsp;23.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e76.1\u0026thinsp;\u0026plusmn;\u0026thinsp;27.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e76.3\u0026thinsp;\u0026plusmn;\u0026thinsp;34.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ep50 Measures Means and standard deviations for all p50 measures for both groups and both conditions. For a main effect of condition, **\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01. HOA: healthy older adult; PD: Parkinson\u0026rsquo;s disease; S1: stimulus 1; S2: stimulus 2.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePD Control\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eHOA Control\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003ePD SECP\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eHOA SECP\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ep50 Ratio**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.61\u0026thinsp;\u0026plusmn;\u0026thinsp;0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.90\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e0.72\u0026thinsp;\u0026plusmn;\u0026thinsp;0.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS1Amplitude (\u0026micro;V)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e10.42\u0026thinsp;\u0026plusmn;\u0026thinsp;5.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e6.04\u0026thinsp;\u0026plusmn;\u0026thinsp;2.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e9.82\u0026thinsp;\u0026plusmn;\u0026thinsp;7.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e6.01\u0026thinsp;\u0026plusmn;\u0026thinsp;3.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS2 Amplitude (\u0026micro;V)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e6.31\u0026thinsp;\u0026plusmn;\u0026thinsp;4.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.71\u0026thinsp;\u0026plusmn;\u0026thinsp;2.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e7.59\u0026thinsp;\u0026plusmn;\u0026thinsp;5.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e4.14\u0026thinsp;\u0026plusmn;\u0026thinsp;2.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Parkinson’s disease, Stress, Inhibitory Gating, p50, paired click","lastPublishedDoi":"10.21203/rs.3.rs-4965100/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4965100/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eImpaired inhibitory gating is a sensory processing symptom of Parkinson\u0026rsquo;s disease (PD) associated with common motor symptoms, such as bradykinesia and motor inhibition. Acute stress impairs inhibitory gating in healthy adults; however, it is unclear how stress impacts inhibitory gating in people with PD. Using a Socially Evaluated Cold Pressor (SECP) to induce acute stress, inhibitory gating was assessed through electroencephalography (EEG) in fifteen individuals diagnosed with PD in the mild to moderate range of symptom severity by measuring the p50 ratio (S1/S2) during an auditory paired click paradigm, relative to age- and gender-matched healthy older adults (HOAs). Results confirmed decreased inhibitory gating in both persons with PD and HOAs following the induction of an acute stressor. Persons with PD experienced greater, though insignificant, S1 and S2 amplitudes than HOAs with a medium-to-large effect size in the condition by group interaction (\u003cem\u003eηp\u0026sup2; =\u003c/em\u003e 0.104). These findings provide evidence to suggest that PD may also affect early auditory processing, possibly through over-compensation of the reticular activating system. However, interpretations are limited to eight individuals with PD and fifteen HOAs. Future research should examine the relationship between stress and sensory functioning on motor symptoms and cognition in persons with PD to unlock potential clinical targets for therapeutics.\u003c/p\u003e","manuscriptTitle":"The Effects of a Socially Evaluated Cold Press Stressor on Inhibitory Gating in Persons With Parkinson’s Disease","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-04 17:37:00","doi":"10.21203/rs.3.rs-4965100/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"684faf67-d7c4-49e5-8909-2e831fa3d58d","owner":[],"postedDate":"October 4th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":38559384,"name":"Biological sciences/Neuroscience/Cognitive neuroscience"},{"id":38559385,"name":"Biological sciences/Neuroscience/Sensory processing"},{"id":38559386,"name":"Biological sciences/Physiology"},{"id":38559387,"name":"Biological sciences/Physiology/Ageing"},{"id":38559388,"name":"Biological sciences/Neuroscience"},{"id":38559389,"name":"Biological sciences/Neuroscience/Diseases of the nervous system/Parkinsons disease"}],"tags":[],"updatedAt":"2025-01-17T10:53:25+00:00","versionOfRecord":[],"versionCreatedAt":"2024-10-04 17:37:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4965100","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4965100","identity":"rs-4965100","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}