Marzinzik Frank, Herrmann Anja, Gogarten Jacob H, Lueschow Andreas, Weber Joachim E, Schindlbeck Katharina A, Klostermann Fabian
Charité, University Medicine Berlin, Berlin, Germany,
J Neural Transm (Vienna). 2015 Aug;122(8):1125-33. doi: 10.1007/s00702-014-1354-4. Epub 2014 Dec 31.
Parkinson's disease (PD) is characterised by motor deficits as well as cognitive alterations, particularly concerning frontal lobe control. Here, we were interested in whether executive function is abnormal already early in PD, as well as whether this dysfunction worsens as a part of the dementia in PD. The following groups engaged in tasks addressing action control: PD patients with mild and advanced motor symptoms (aPD) without dementia, PD patients with dementia (PDD), patients with Alzheimer's disease (AD) and healthy subjects (CON). Subjects either had to perform or inhibit button presses upon go and no-go cues, respectively. These cues were preceded by pre-cues, either randomly instructive of right or left hand preparation (switch condition), or repetitively instructive for one side only (non-switch condition). PDD and aPD omitted more go responses than CON. Furthermore, PDD disproportionally committed failures upon no-go cues compared to CON. In the non-switch condition, PDD performed worse than AD, whose deficits increased to the level of PDD in the switch condition. Over all PD patients, task performance correlated with disease severity. Under the switch condition, task performance was low in both PDD and AD. In the non-switch condition, this also held true for advanced PD patients (with and without dementia), but not for AD. Thus, the deficits evident in PDD appear to develop from imbalanced inhibitory-to-excitatory action control generally inherent to PD. These results specify the concept of dysexecution in PD and differentiate the cognitive profile of PDD from that of AD patients.
帕金森病（PD）的特征在于运动缺陷以及认知改变，尤其是与额叶控制有关的方面。在此，我们感兴趣的是执行功能在PD早期是否已经异常，以及这种功能障碍是否会作为PD痴呆的一部分而恶化。以下几组参与了涉及动作控制的任务：无痴呆的轻度和重度运动症状的PD患者（aPD）、患有痴呆的PD患者（PDD）、阿尔茨海默病（AD）患者和健康受试者（CON）。受试者分别必须根据“执行”和“不执行”提示执行或抑制按键操作。这些提示之前有预提示，要么随机指示右手或左手准备（切换条件），要么仅对一侧进行重复指示（非切换条件）。PDD和aPD比CON遗漏了更多的“执行”反应。此外，与CON相比，PDD在“不执行”提示时出现的失误比例更高。在非切换条件下，PDD的表现比AD差，AD的缺陷在切换条件下增加到PDD的水平。在所有PD患者中，任务表现与疾病严重程度相关。在切换条件下，PDD和AD的任务表现都很低。在非切换条件下，晚期PD患者（有或无痴呆）也是如此，但AD患者不是。因此，PDD中明显的缺陷似乎源于PD普遍存在的抑制性与兴奋性动作控制失衡。这些结果明确了PD中执行功能障碍的概念，并区分了PDD与AD患者的认知特征。
