Department of Neurology and Psychiatry, Sapienza University of Rome, Italy.
Parkinsonism Relat Disord. 2013 Nov;19(11):1004-8. doi: 10.1016/j.parkreldis.2013.07.002. Epub 2013 Jul 23.
To study the factors and possible mechanisms associated with decreased self-awareness of levodopa-induced dyskinesias (LIDs) in patients with Parkinson's disease (PD).
We enrolled 30 PD patients with LIDs. Patients were video-recorded in an "on" phase while experiencing LIDs. LIDs were objectively rated by means of the Unified Dyskinesias Rating Scale (UDyRS) by two movement disorders specialists while examining the patients. Patients were asked to rate the body site and the severity of their LIDs according to the 5-point UDyRS. Patients then rated their own LIDs while watching the video recording of themselves. Lastly, the patients rated the LIDs of other reference PD patients on a video recording. The same reference video recordings were shown to 15 healthy individuals matched for age, gender and education.
Seven of the 30 PD patients investigated were subjectively unaware of the presence of their LIDs. The majority of patients, however, recognized their LIDs when watching video recording of themselves. Patients displayed a specific poor self-awareness of trunk LIDs, in both the subjective evaluation and in the video recording-based subjective evaluation. By contrast PD patients correctly recognized LIDs in video recordings of reference PD patients. Poor self-awareness correlated with predominance of motor symptoms on the left body side.
Poor self-awareness of LIDs is present in a proportion of PD patients as a form of anosognosia. The poor self-awareness of LIDs in the trunk is likely to be due to a complex interplay involving both anosognosic mechanisms and deficits in proprioceptive axial kinesthesia.
研究帕金森病（PD）患者左旋多巴诱导的运动障碍（LIDs）自我意识降低的相关因素和可能机制。
我们纳入了 30 名 LIDs 患者。在“开期”时，让患者观看自己的视频记录，同时两名运动障碍专家根据统一运动障碍评分量表（UDyRS）对 LIDs 进行客观评估。患者根据 UDyRS 的 5 分制对自己的 LIDs 进行身体部位和严重程度的评分。然后，患者在观看自己的视频记录时对自己的 LIDs 进行评分。最后，患者对其他参考 PD 患者的视频记录中的 LIDs 进行评分。将相同的参考视频记录展示给 15 名年龄、性别和教育程度匹配的健康个体。
在所调查的 30 名 PD 患者中，有 7 名患者主观上没有意识到自己的 LIDs。然而，大多数患者在观看自己的视频记录时都能识别出自己的 LIDs。患者在主观评估和基于视频记录的主观评估中都表现出对躯干 LIDs 的特定的自我意识差。相比之下，PD 患者能够正确识别参考 PD 患者视频记录中的 LIDs。自我意识差与左侧身体运动症状占主导有关。
作为一种认知障碍的形式，一部分 PD 患者存在 LIDs 自我意识差。躯干 LIDs 的自我意识差可能是由于涉及认知障碍机制和本体感觉轴向运动觉缺陷的复杂相互作用所致。
