Sáez-Francàs Naia, Hernández-Vara Jorge, Corominas-Roso Margarita, Alegre José, Jacas Carlos, Casas Miguel
Servei de Psiquiatria, Hospital Universitari Vall d'Hebron, CIBERSAM, Department of Psychiatry, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.
Servei de Neurologia, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.
J Neurol Sci. 2014 Feb 15;337(1-2):167-72. doi: 10.1016/j.jns.2013.12.003. Epub 2013 Dec 7.
Fatigue is a common non-motor symptom in Parkinson's disease patients. The reasons for its perception are not completely understood. One suggested possibility might be that perceived fatigue is related with abnormal interpretation of somatic symptoms. It has been described that somatic markers misinterpretation leads to poor decision-making. We hypothesized that fatigued Parkinson's disease patients would show poorer performance than non-fatigued in a decision-making task.
To test our hypothesis, 89 Parkinson's disease patients were assessed for the presence of fatigue using the Parkinson Fatigue Scale. All patients were also administered scales evaluating psychopathology and neuropsychological tests, including the Iowa Gambling Task.
33 (37.1%) patients fulfilled the established criteria for fatigue. In the univariate analysis, fatigued patients showed higher levels of anxiety (state: p = 0.001, trait: p < 0.001), impulsivity (p = 0.051), and depression (p < 0.001) than non-fatigued patients. No statistically significant differences in other neuropsychological test results (Stroop, Trail Making Test, Tower of London) were found between fatigued and non-fatigued patients except for the Iowa Gambling Task, in which fatigued patients showed poorer performance (p = 0.001) after controlling for confounding factors.
These results suggest that fatigued Parkinson's disease patients may present abnormal decision-making process, which may reflect abnormal processing of somatic markers when faced with an activity that requires effort.
疲劳是帕金森病患者常见的非运动症状。其产生原因尚未完全明确。一种可能的原因是，感知到的疲劳与躯体症状的异常解读有关。已有研究表明，躯体标记物的错误解读会导致决策能力下降。我们推测，在决策任务中，疲劳的帕金森病患者表现会比未疲劳的患者更差。
为验证我们的推测，使用帕金森疲劳量表对89名帕金森病患者的疲劳情况进行评估。所有患者还接受了评估精神病理学的量表测试和神经心理学测试，包括爱荷华赌博任务。
33名（37.1%）患者符合既定的疲劳标准。单因素分析显示，疲劳患者的焦虑水平（状态：p = 0.001，特质：p < 0.001）、冲动性（p = 0.051）和抑郁水平（p < 0.001）均高于未疲劳患者。除爱荷华赌博任务外，疲劳患者与未疲劳患者在其他神经心理学测试结果（斯特鲁普测试、连线测验、伦敦塔测验）上未发现统计学显著差异。在爱荷华赌博任务中，控制混杂因素后，疲劳患者表现更差（p = 0.001）。
这些结果表明，疲劳的帕金森病患者可能存在异常的决策过程，这可能反映出在面对需要努力的活动时，躯体标记物的处理存在异常。
