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早期帕金森病空间认知缺陷的多巴胺能基础

Dopaminergic Basis of Spatial Deficits in Early Parkinson's Disease.

作者信息

Hanna-Pladdy B, Pahwa R, Lyons K E

机构信息

Center for Advanced Imaging Research (CAIR), Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.

Parkinson's Disease and Movement Disorder Center, Department of Neurology, University of Kansas Medical Center, Kansas City, KS 66160, USA.

出版信息

Cereb Cortex Commun. 2021 Jun 24;2(3):tgab042. doi: 10.1093/texcom/tgab042. eCollection 2021.

Abstract

Dopaminergic mechanisms regulating cognitive and motor control were evaluated comparing visuoperceptual and perceptuomotor functions in Parkinson's disease (PD). The performance of PD patients (n = 40) was contrasted with healthy controls (n = 42) across two separate visits ( and dopaminergic medications) on computerized tasks of perception and aiming to a target at variable stimulus lengths (4, 8, 12 cm). Novel visuoperceptual tasks of length equivalence and width interval estimations without motor demands were compared with tasks estimating spatial deviation in movement termination. The findings support the presence of spatial deficits in early PD, more pronounced with increased discrimination difficulty, and with shorter stimulus lengths of 4 cm for both visuoperceptual and perceptumotor functions. Dopaminergic medication had an adverse impact on visuoperceptual accuracy in particular for length equivalence estimations, in contrast with dopaminergic modulation of perceptuomotor functions that reduced angular displacements toward the target. The differential outcomes for spatial accuracy in perception versus movement termination in PD are consistent with involvement of the direct pathway and models of progressive loss of dopamine through corticostriatal loops. Future research should develop validated and sensitive standardized tests of perception and explore dopaminergic selective deficits in PD to optimize medication titration for motor and cognitive symptoms of the disease.

摘要

通过比较帕金森病(PD)患者的视觉感知和感知运动功能,评估了调节认知和运动控制的多巴胺能机制。在两次单独的就诊中(一次在停用多巴胺能药物时,另一次在服用多巴胺能药物时),将40例PD患者的表现与42例健康对照者在计算机化的感知任务以及针对不同刺激长度(4、8、12厘米)的目标瞄准任务中的表现进行了对比。将无运动需求的长度等效性和宽度间隔估计的新型视觉感知任务与估计运动终止时空间偏差的任务进行了比较。研究结果支持早期PD存在空间缺陷,随着辨别难度增加以及视觉感知和感知运动功能的刺激长度缩短至4厘米时更为明显。多巴胺能药物对视觉感知准确性有不利影响,特别是对于长度等效性估计,与之形成对比的是,多巴胺能对感知运动功能的调节减少了朝向目标的角位移。PD患者在感知与运动终止时空间准确性的不同结果与直接通路的参与以及通过皮质纹状体环路多巴胺逐渐丧失的模型一致。未来的研究应开发经过验证且敏感的标准化感知测试,并探索PD中的多巴胺能选择性缺陷,以优化针对该疾病运动和认知症状的药物滴定。

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