Hall J M, Shine J M, Walton C C, Gilat M, Kamsma Y P T, Naismith S L, Lewis S J G
Parkinson's Disease Research Clinic, Brain and Mind Research Institute, University of Sydney, NSW, Australia; Centre for Human Movement Sciences, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.
Parkinson's Disease Research Clinic, Brain and Mind Research Institute, University of Sydney, NSW, Australia.
Parkinsonism Relat Disord. 2014 Jun;20(6):604-7. doi: 10.1016/j.parkreldis.2014.02.028. Epub 2014 Mar 12.
Previous studies have associated freezing of gait in Parkinson's disease with the presence of specific phenotypic features such as mood disturbances, REM sleep behavior disorder and selective cognitive impairments. However, it is not clear whether these features are present in the earlier stages of disease or simply represent a more general pattern of progression. To investigate this issue, the current study evaluated motor, cognitive, affective and autonomic features as well as REM sleep behavior disorder in Parkinson's disease patients in the early stages of the condition.
Thirty-eight freezers and fifty-three non-freezers with disease duration of less than five years and a Hoehn and Yahr stage of less than three were included in this study. The groups were matched on a number of key disease features including age, disease duration, motor severity and dopamine dose equivalence. Furthermore, patients were assessed on measures of motor, cognitive, affective and autonomic features, as well as REM sleep behavior disorder.
Compared to non-freezers, patients with freezing of gait had significantly more non-tremor symptoms and a selective impairment on executive functions, such as set-shifting ability and working memory. Freezers and non-freezers did not differ on measures of tremor, autonomic function, REM sleep behavior disorder, mood or more general cognition.
These results suggest the pathophysiological mechanisms underlying freezing of gait in the early clinical stages of Parkinson's disease are likely to be related to specific changes in the frontostriatal pathways rather than being due to brainstem or more diffuse neuropathology.
先前的研究已将帕金森病中的冻结步态与特定的表型特征联系起来，如情绪障碍、快速眼动睡眠行为障碍和选择性认知障碍。然而，尚不清楚这些特征是在疾病的早期阶段就已存在，还是仅仅代表了一种更普遍的进展模式。为了研究这个问题，本研究评估了帕金森病早期患者的运动、认知、情感和自主神经特征以及快速眼动睡眠行为障碍。
本研究纳入了38名有冻结步态的患者和53名无冻结步态的患者，疾病持续时间均小于5年，Hoehn和Yahr分期均小于3期。两组在一些关键疾病特征上进行了匹配，包括年龄、疾病持续时间、运动严重程度和多巴胺等效剂量。此外，对患者的运动、认知、情感和自主神经特征以及快速眼动睡眠行为障碍进行了评估。
与无冻结步态的患者相比，有冻结步态的患者有更多的非震颤症状，并且在执行功能方面存在选择性损害，如转换能力和工作记忆。有冻结步态的患者和无冻结步态的患者在震颤、自主神经功能、快速眼动睡眠行为障碍、情绪或更一般的认知方面没有差异。
这些结果表明，帕金森病临床早期冻结步态的病理生理机制可能与额纹状体通路的特定变化有关，而不是由于脑干或更广泛的神经病理学原因。
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