Pagonabarraga Javier, García-Sánchez Carmen, Llebaria Gisela, Pascual-Sedano Berta, Gironell Alexandre, Kulisevsky Jaime
Movement Disorders Unit, Neurology Department, Sant Pau Hospital, Autonomous University of Barcelona, Barcelona, Spain.
Mov Disord. 2007 Jul 30;22(10):1430-1435. doi: 10.1002/mds.21457.
Impulse control disorders (ICD) related to reward-processing dysfunction have been reported in Parkinson's disease (PD). The relationship between clinical markers of limbic dysfunction with demographic variables and cognitive status of PD is incompletely known. Our objective was to further characterize the relationship between limbic and cognitive dysfunction in a representative sample of nondemented PD patients without antecedents of ICD, as assessed by a risk-taking test of decision-making and a comprehensive neuropsychological battery. Prospective, controlled study of 35 nondemented PD patients and 31 matched controls who received the Iowa gambling task (IGT), the Mattis Dementia Rating Scale (MDRS) and verbal fluencies for global cognitive function, the Stroop and digit span tests for executive function, and the Rey Auditory Verbal Learning Test for memory. Compared to controls, PD patients performed significantly worse on the IGT. No clear relationship with demographic variables including dopaminergic treatment and motor response to levodopa (stable or fluctuating) emerged. Performance on the IGT was not related to executive function. In contrast, an inverse relationship was found between the IGT and memory and global cognitive performance, with patients with the better MDRS and memory scores performing significantly worse on the IGT. Our results confirm subclinical dysfunction of the limbic system in nondemented PD patients. Although impaired decision-making appears unrelated to executive dysfunction, patients with the better cognitive status appears more prone to assume risky behaviors.
帕金森病（PD）中已报道了与奖赏处理功能障碍相关的冲动控制障碍（ICD）。边缘系统功能障碍的临床标志物与PD患者的人口统计学变量和认知状态之间的关系尚不完全清楚。我们的目的是通过一项决策冒险测试和一套全面的神经心理测验，进一步描述一组无ICD病史的非痴呆PD患者代表性样本中边缘系统功能障碍与认知功能障碍之间的关系。对35名非痴呆PD患者和31名匹配对照进行前瞻性对照研究，他们接受了爱荷华赌博任务（IGT）、马蒂斯痴呆评定量表（MDRS）和用于整体认知功能的语言流畅性测试、用于执行功能的斯特鲁普测试和数字广度测试，以及用于记忆的雷伊听觉词语学习测试。与对照组相比，PD患者在IGT上的表现明显更差。未发现与包括多巴胺能治疗和对左旋多巴的运动反应（稳定或波动）在内的人口统计学变量有明确关系。IGT的表现与执行功能无关。相反，发现IGT与记忆和整体认知表现之间呈负相关，MDRS和记忆分数较好的患者在IGT上的表现明显更差。我们的结果证实了非痴呆PD患者边缘系统存在亚临床功能障碍。尽管决策受损似乎与执行功能障碍无关，但认知状态较好的患者似乎更容易采取冒险行为。
