早期帕金森病的模糊决策功能障碍

目的探讨早期帕金森病(Parkinson’s disease,PD)患者在概率不明确条件下的模糊决策能力是否受损,并分析该功能损害与其他认知功能的关系以及是否与基底节区病变有关。方法研究对象为年龄、性别匹配的早期PD患者(Hoehn-Yahr分级≤Ⅱ级)、右侧基底节梗死(right basal ganglia infarction,BGI)患者和正常对照各20名。采用蒙特利尔认知评估量表、Stroop字色测试等工具对进行背景认知功能测试,采用爱荷华博弈实验(Iowa Gambling Task,IGT)对各组进行模糊决策评测,分析IGT测试成绩与背景认知之间的相关性。结果3组Stroop测试成绩的差异有统计学意义(F=33.27,P<0.05),PD组(21.35±4.28)差于BGI组(13.30±3.21)和对照组(13.60±2.98)(P<0.05)。3组在IGT测试成绩差异亦有统计学意义(F=5.38,P<0.05),PD组总有利备择得分(48.95±7.01)低于BGI组(52.95±2.72)和正常对照组(53.15±2.43)(P<0.05)。BGI组的Stroop测试和模糊决策IGT测试成绩与对照组比较,差异均无统计学意义(P>0.05)。早期PD患者IGT测试成绩与Stroop测试成绩呈负相关(r=-0.65,P<0.05)。结论早期PD患者存在模糊决策障碍和执行功能障碍,两者间存在相关性。单纯基底节区脑梗死对模糊决策和执行功能无显著影响。PD患者模糊决策障碍可能源于基底节以外脑区损害。

Decision-making under ambiguity in patients with early Parkinson's disease

Objective To investigate the ability of decision making under ambiguity condition in patients with early Parkinson’s disease(PD) and explore the relationship of this deficiency with other cognitive function and damage to the basal ganglia.Method Twenty patients with early PD,20 patients with infarction in the right basal ganglia(BGI) and 20 age-and gender-matched healthy controls were included in the present study.The ability of decision-making under ambiguity was analyzed using Iowa Gambling Task(IGT).The general background cognitive functions in all subjects were assessed using Montreal Cognitive Assessment(MoCA),Digital Span(DS) and Stroop test.The correlation of IGT scores with the general background cognitive functions was analyzed.Results There was significant difference in Stroop test scores among the three groups(F = 33.27,P < 0.05).PD group(21.35 ± 4.28) performed significantly worse on Stroop task than the BGI group(13.30 ± 3.21) and healthy control group(13.60 ± 2.98)(P < 0.05).There was significant difference in IGT task scores among the three group(F = 5.38,P < 0.05).The total number of advantageous choice in IGT were significantly lower in PD group(48.95 ± 7.01) than the BGI group(52.95 ± 2.72) and healthy control group(53.15 ± 2.43)(P < 0.05).There is no significant difference in either Stroop test or IGT test between the BGI group and healthy control group(P > 0.05).The frequency of choosing the advantage options in IGT was correlated with Stroop test in PD group(r =-0.65,P < 0.05).Conclusions Our study shows that early PD patients have significant impairments in the ability of decision-making ? under ambiguity as well as executive function and decision-making?ability impairment is correlated with the decreased executive function.Isolated ischemic damage to the basal ganglia has no remarkable influence on decision-making ability under ambiguity and executive function.The malfunction of decision-making? under ambiguity in early PD may be associated with the damage in the brain regions other than basal ganglia.