Ortelli Paola, Ferrazzoli Davide, Zarucchi Marianna, Maestri Roberto, Frazzitta Giuseppe
Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, Moriggia-Pelascini Hospital, Como, Italy.
Istituti Clinici Scientifici Maugeri - Istituto di Ricovero e Cura a Carattere Scientifico, Biomedical Engineering Unit of Montescano Institute, Pavia, Italy.
Front Neurosci. 2018 Dec 17;12:972. doi: 10.3389/fnins.2018.00972. eCollection 2018.
Attention is crucial to voluntary perform actions in Parkinson's disease (PD), allowing patients to bypass the impaired habitual motor control. The asymmetrical degeneration of the dopaminergic system could affect the attentional functions. To investigate the relationship between the asymmetric dopaminergic degeneration and the attentional resources in Parkinsonian patients with right-side (RPD) and left-side (LPD) motor symptoms predominance. 50 RPD, 50 LPD, and 34 healthy controls underwent visual (V), auditory (A), and multiple choices (MC) reaction time (RTs) tasks. For PD patients, these tasks were performed before and after a 4-week intensive, motor-cognitive rehabilitation treatment (MIRT). The effectiveness of treatment was evaluated assessing Unified Parkinson's disease Rating Scale (UPDRS) III and Timed-up and Go Test (TUG). RTs did not differ between PD patients and healthy controls. Before MIRT, no differences between LPD and RPD patients were observed in RTs ( = 0.20), UPDRS III ( = 0.60), and TUG ( = 0.38). No differences in dopaminergic medication were found between groups ( = 0.44 and = 0.66 before and after MIRT, respectively). After MIRT, LPD patients showed a significant reduction in MC RTs ( = 0.05), V RTs ( = 0.02), and MC-V RTs. A significant association between changes in RTs and improvements in UPDRS III and TUG was observed in LPD patients. attention does not differ among RPD patients, LPD patients and healthy controls. Only LPD patients improved their performances on attentional tasks after MIRT. We argue that the increased early susceptibility of the left nigrostriatal system to degeneration affects differently the cognitive modifiability and the neuroplastic potential. Our results could provide insight into new therapeutic approaches, highlighting the importance to design different treatments for RPD patients and LPD patients.
注意力对于帕金森病（PD）患者自主执行动作至关重要，它能使患者避开受损的习惯性运动控制。多巴胺能系统的不对称性退化可能会影响注意力功能。为了研究右侧（RPD）和左侧（LPD）运动症状为主的帕金森病患者中不对称多巴胺能退化与注意力资源之间的关系。50例RPD患者、50例LPD患者和34名健康对照者接受了视觉（V）、听觉（A）和多项选择（MC）反应时间（RTs）任务。对于PD患者，这些任务在为期4周的强化运动认知康复治疗（MIRT）前后进行。通过评估统一帕金森病评定量表（UPDRS）III和计时起立行走测试（TUG）来评价治疗效果。PD患者和健康对照者的反应时间没有差异。在MIRT之前，LPD患者和RPD患者在反应时间（P = 0.20）、UPDRS III（P = 0.60）和TUG（P = 0.38）方面没有观察到差异。各组之间多巴胺能药物治疗没有差异（MIRT前后分别为P = 0.44和P = 0.66）。MIRT后，LPD患者的MC反应时间（P = 0.05）、V反应时间（P = 0.02）和MC - V反应时间显著缩短。在LPD患者中观察到反应时间变化与UPDRS III和TUG改善之间存在显著关联。RPD患者、LPD患者和健康对照者之间的注意力没有差异。只有LPD患者在MIRT后注意力任务表现得到改善。我们认为左侧黑质纹状体系统对退化的早期易感性增加对认知可塑性和神经可塑性潜力有不同影响。我们的结果可为新的治疗方法提供见解，强调为RPD患者和LPD患者设计不同治疗方法的重要性。
