帕金森病患者的决策认知障碍

目的 探讨帕金森病(PD)患者的社会决策认知能力.方法 将20例首发PD患者以及与其人口学资料相匹配的健康对照组(HC)作为研究对象,采用爱荷华博弈任务(Iowa Gambling Task)进行社会决策行为能力的测试.采用Hoehn-Yahr分级量表对PD患者的严重程度进行评定.结果 与HC组相比,PD组不仅存在词汇流畅性以及数字广度障碍,而且存在决策认知障碍.在博弈任务中,PD组的总不利选择次数明显高于HC组(分别为51.6±5.8,46.8±8.2),差异有统计学意义[t_(38)=2.12,P=0.04].采用2(组)×5(阶段)的方差分析比较两组不同阶段的总有利选择,结果 发现,2组间的主效应显著[F_(1,38)=6.16,P=0.01];不同阶段的主效应亦显著[F_(4,152)=2.43,P=0.04].随着博弈任务卡片选择次数的增多,HC组有利选择次数逐渐增加;而帕金森病患者却不具有此种稳定的决策行为模式.同时研究还表明,PD患者的总不利选择次数与患者的疾病严重程度呈正相关(r=0.52;P＜0.05).结论 PD患者存在决策认知功能障碍,而这种社会决策障碍可能与前额叶眶面功能异常有关.

The deficit of decision-making in Parkinson's disease

Objective To investigate the characteristics of decision-making impairment in Pakinson's disease (PD) patients.Methods A total of 20 individuals with idiopathic PD were compared with matched health controls on the Iowa Gambling Task,A series of battery including the assessment working memory,visual spatial ability and verbal fluency was also administered.The severity of disease was assessed based on the Hohen and Yahr scale.Results The results showed that PD group impaired on verbal fluency,working memory and decision-making task.In Iowa gambling task,the PD group selected more disadvantageous cards than health controls (51.6±5.8,46.8±8.2 respectively),the difference between two groups is significant (t(38)=2.12,P=0.04).A 2(group)×5 (block) ANOVA (analysis of variance) on the scores of advantageous from the gambling task revealed a significant main effect of group (F(1,38)=6.16,P=0.01).The ANOVA also revealed a significant main effect of block (F(4,152)=2.43,P=0.04).The results showed that health controls gradually shifted their selections toward the good decks as the game progresses,but the PD group did not exhibit this stable advantageous shift in decision-making.Meanwhile,the study indicated the total number of disadvantageous cards for PD was positive con,elation to the degrees of severity to clinical symptom.Conclusion The present study suggests that the decision-making impairment might be in early PD.The deficit of decision-making for PD might be attributed to the dysfunction of the orbito-frontal cortex.