Département de Kinésiologie, Université de Montréal, Montréal, Québec, Canada.
Brain Cogn. 2013 Mar;81(2):271-82. doi: 10.1016/j.bandc.2012.12.001. Epub 2013 Jan 8.
The capacity to learn new visuomotor associations is fundamental to adaptive motor behavior. Evidence suggests visuomotor learning deficits in Parkinson's disease (PD). However, the exact nature of these deficits and the ability of dopamine medication to improve them are under-explored. Previous studies suggested that learning driven by large and small movement errors engaged distinct neural mechanisms. Here, we investigated whether PD patients have a generalized impairment in visuomotor learning or selective deficits in learning from large explicit errors which engages cognitive strategies or small imperceptible movement errors involving primarily implicit learning processes. Visuomotor learning skills of non-medicated and medicated patients were assessed in two reaching tasks in which the size of visuospatial errors experienced during learning was manipulated using a novel three-dimensional virtual reality environment. In the explicit perturbation task, the visuomotor perturbation was applied suddenly resulting in large consciously detected initial spatial errors, whereas in the implicit perturbation task, the perturbation was gradually introduced in small undetectable steps such that subjects never experienced large movement errors. A major finding of this study was that PD patients in non-medicated and medicated conditions displayed slower learning rates and smaller adaptation magnitudes than healthy subjects in the explicit perturbation task, but performance similar to healthy controls in the implicit perturbation task. Also, non-medicated patients showed an average reduced deadaptation relative to healthy controls when exposed to the large errors produced by the sudden removal of the perturbation in both the explicit and implicit perturbation tasks. Although dopaminergic medication consistently improved motor signs, it produced a variable impact on learning the explicit perturbation and deadaptation and unexpectedly worsened performance in some patients. Considered together, these results indicate that PD selectively impairs the ability to learn from large consciously detected visuospatial errors. This finding suggests that basal ganglia-related circuits are important neural structures for adaptation to sudden perturbations requiring awareness and high-cost action selection. Dopaminergic treatment may selectively compromise the ability to learn from large explicit movement errors for reasons that remain to be elucidated.
学习新的视动关联的能力是适应性运动行为的基础。有证据表明帕金森病 (PD) 存在视动学习缺陷。然而,这些缺陷的确切性质以及多巴胺药物改善它们的能力尚未得到充分探索。先前的研究表明,由大运动误差和小运动误差驱动的学习涉及不同的神经机制。在这里,我们研究了 PD 患者是否存在视动学习的普遍障碍,或者是否存在从小的、明显的错误中选择性地学习的缺陷,这种学习涉及认知策略,或者从主要涉及内隐学习过程的小的、不可察觉的运动错误中学习。使用新型的三维虚拟现实环境,通过操纵学习过程中经历的视空间误差的大小,在两个伸展任务中评估未用药和用药患者的视动学习技能。在显性扰动任务中,视动扰动突然施加,导致大的、有意识检测到的初始空间误差;而在隐性扰动任务中,扰动逐渐以小的、不可察觉的步骤引入,使得受试者从未经历过大的运动误差。本研究的一个主要发现是,与健康受试者相比,未用药和用药条件下的 PD 患者在显性扰动任务中的学习率较慢,适应幅度较小,但在隐性扰动任务中的表现与健康对照组相似。此外,当暴露于显性和隐性扰动任务中突然移除扰动产生的大误差时,与健康对照组相比,未用药患者的平均重新适应能力降低。尽管多巴胺能药物治疗始终改善运动体征,但它对视动显性扰动的学习和重新适应产生了可变的影响,并且在某些患者中出乎意料地恶化了表现。综合考虑,这些结果表明 PD 选择性地损害了从大的、有意识检测到的视空间误差中学习的能力。这一发现表明,基底节相关回路是适应需要意识和高成本动作选择的突发性扰动的重要神经结构。多巴胺能治疗可能会选择性地损害从大的显性运动误差中学习的能力,原因尚待阐明。