Contextual cues remediate problem solving: deficits in Parkinson's disease.

This study examined the contribution of executive functions to arrangement problem-solving performance in Parkinson's disease (PD), with a particular focus on self-directed cognitive flexibility. PD patients and healthy age-matched adults completed a battery of neuropsychological measures of executive function and a series of anagram puzzles, some of which were modified to include graphemic cues designed to prime potential solutions. PD patients were less successful than healthy controls (HC) at resolving the anagram puzzles, but when a cue accompanied the anagram stimulus, PD patients performed normally. Anagram performance was associated with measures of verbal fluency and inhibition; no association emerged with working memory or set shifting ability. These data suggest that subjects with PD may have difficulty sufficiently inhibiting their automatic response to the experimental stimulus in order to generate the novel arrangements required to produce a successful response. Such deficits might be remediated through the use of environmental cues designed to support strategy generation.