多巴胺能药物对早期帕金森病患者决策认知功能的影响
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摘要
目的研究多巴胺能药物对早期帕金森病(PD)患者在明确概率条件下风险决策认知功能的影响。方法采用骰子博弈试验(GDT)进行明确概率风险决策能力的评估。共纳入40例规律口服多巴胺能药物的原发性PD患者(服药组)、40例撤药后的原发性PD患者(撤药组)以及匹配的40名正常对照组。结果在GDT中,服药组风险选项次数明显大于撤药组和HC组(均P<0.05)。服药组安全选项次数明显小于撤药组和HC组(均P<0.05)。PD患者负反馈利用率与风险选项的次数呈负相关(r=-0.57,P=0.000),与H-Y分级呈负相关(r=-0.23,P=0.046)。结论在风险概率明确情境下,多巴胺能药物会增加早期PD患者对高风险和高回报选项的偏爱,使负反馈的利用率降低。短期撤药后风险决策能力能够改善。
Objective To estimate the effects of dopaminergic medication on cognitive function of decision-making in explicit risky situation in early stage Parkinson's disease(PD) patients. Methods The Game of Dice Test(GDT) was used to test the ability of decision-making in explicit risky situation. Forty idiopathic PD patients with regular oral administration of dopaminergic medication(ON group), 40 idiopathic PD patients after withdrawal of dopaminergic medication(OFF group), and 40 healthy controls matched to PD patients were included.Results In GDT, the frequency of risky options in ON group was significantly greater than OFF group and HC group(allP<0.05). The frequency of safe options in ON group was significantly less than OFF group and HC group(allP<0.05). The negative feedback utilization rate of PD patients was negatively correlated with the frequency of risky options(r=-0.57, P=0.000), and was negatively correlated with the H-Y grade(r=-0.23, P=0.046).Conclusions In explicit risky situation, dopaminergic medication increases the preference for high-risk and high-reward options in early PD patients while reduces the utilization rate of negative feedback. The ability of decision-making under risk can be improved after short-term medication withdrawal.
Objective To estimate the effects of dopaminergic medication on cognitive function of decision-making in explicit risky situation in early stage Parkinson's disease(PD) patients. Methods The Game of Dice Test(GDT) was used to test the ability of decision-making in explicit risky situation. Forty idiopathic PD patients with regular oral administration of dopaminergic medication(ON group), 40 idiopathic PD patients after withdrawal of dopaminergic medication(OFF group), and 40 healthy controls matched to PD patients were included.Results In GDT, the frequency of risky options in ON group was significantly greater than OFF group and HC group(allP<0.05). The frequency of safe options in ON group was significantly less than OFF group and HC group(allP<0.05). The negative feedback utilization rate of PD patients was negatively correlated with the frequency of risky options(r=-0.57, P=0.000), and was negatively correlated with the H-Y grade(r=-0.23, P=0.046).Conclusions In explicit risky situation, dopaminergic medication increases the preference for high-risk and high-reward options in early PD patients while reduces the utilization rate of negative feedback. The ability of decision-making under risk can be improved after short-term medication withdrawal.
引文
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[12] Broen MP,Narayen NE,Kuijf ML,et al.Prevalence of anxiety in Parkinson's disease:A systematic review and meta-analysis[J].Mov Disord,2016,31(8):1125-1133.
[13] Reijnders JS,Ehrt U ,Weber WE,et al.A systematic review of prevalence studies of depression in Parkinson's disease[J].Mov Disord,2010,23(2):183-189.
[14] Cools R.Dopaminergic modulation of cognitive function-implications for L-DOPA treatment in Parkinson's disease [J].Neurosci Biobehav Rev,2006,30(1):1-23.
[15] Evens R,Hoefler M,Biber K,et al.The Iowa Gambling Task in Parkinson's disease:A meta-analysis on effects of disease and medication[J].Neuropsychologia,2016,91:163-172.
[16] Voon V,Reynolds B,Brezing C,et al.Impulsive choice and response in dopamine agonist-related impulse control behaviors[J].Psychopharmacology (Berl),2010,207(4):645-659.
[17] Xi C,Zhu Y,Mu Y,et al.Theory of mind and decision-making processes are impaired in Parkinson's disease [J].Behav Brain Res,2015,279(4):226-233.
[18] Cools R.Inverted-U-shaped dopamine actions on human working memory and cognitive control [J].Biol Psychiatry,2011,69(12):e113-e125.
[2] 李凯,陈海波,汪凯,等.早中期帕金森病患者前瞻性记忆损害的特点[J].中华神经科杂志,2009,42(2):79-82.
[3] Emre M,Aarsland D,Brown R,et al.Clinical diagnostic criteria for dementia associated with Parkinson's disease[J].Mov Disord,2010,22(12):1689-1707.
[4] 马建军,孙翠萍,李学,等.早期未治疗帕金森病患者模糊和风险决策的特点[J].中华老年心脑血管病杂志,2016,18(2):116-118.
[5] Evens R ,Hoefler M ,Biber K ,et al.The Iowa gambling task in Parkinson's disease:A meta-analysis on effects of disease and medication[J].Neuropsychologia,2016,91:163-172.
[6] 方娟,马慧娟,胡盼盼,等.多巴胺能药物对早期帕金森病患者模糊决策功能的影响[J].中华行为医学与脑科学杂志,2016,25(12):1091-1095.
[7] 马慧娟,严孙宏,陈先文,等.帕金森病患者风险决策能力研究[J].中华神经科杂志,2011,44(12):810-813.
[8] Brand M,Fujiwara E,Borsutzky S,et al.Decision-making deficits of korsakoff patients in a new gambling task with explicit rules:associations with executive functions[J].Neuropsychology,2005,19(3):267-277.
[9] Rangel A,Camerer C,Montague PR.A framework for studying the neurobiology of value-based decision making[J].Nat Rev Neurosci,2008,9(7):545-556.
[10] Poletti M,Cavedini P,Bonuccelli U.Iowa gambling task in Parkinson's disease [J].J Clin Exp Neuropsychol,2011,33(4):395-409.
[11] Hoops S ,Nazem S ,Siderowf AD ,et al.Validity of the MoCA and MMSE in the detection of MCI and dementia in Parkinson disease[J].Neurology,2009,73(21):1738-1745.
[12] Broen MP,Narayen NE,Kuijf ML,et al.Prevalence of anxiety in Parkinson's disease:A systematic review and meta-analysis[J].Mov Disord,2016,31(8):1125-1133.
[13] Reijnders JS,Ehrt U ,Weber WE,et al.A systematic review of prevalence studies of depression in Parkinson's disease[J].Mov Disord,2010,23(2):183-189.
[14] Cools R.Dopaminergic modulation of cognitive function-implications for L-DOPA treatment in Parkinson's disease [J].Neurosci Biobehav Rev,2006,30(1):1-23.
[15] Evens R,Hoefler M,Biber K,et al.The Iowa Gambling Task in Parkinson's disease:A meta-analysis on effects of disease and medication[J].Neuropsychologia,2016,91:163-172.
[16] Voon V,Reynolds B,Brezing C,et al.Impulsive choice and response in dopamine agonist-related impulse control behaviors[J].Psychopharmacology (Berl),2010,207(4):645-659.
[17] Xi C,Zhu Y,Mu Y,et al.Theory of mind and decision-making processes are impaired in Parkinson's disease [J].Behav Brain Res,2015,279(4):226-233.
[18] Cools R.Inverted-U-shaped dopamine actions on human working memory and cognitive control [J].Biol Psychiatry,2011,69(12):e113-e125.