Gaprielian Pauline, Scott Stephen H, Levy Ron
Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada.
Department of Biomedical and Molecular Sciences, Queen's University, Kingston K7L 3N6, Ontario, Canada.
Parkinsons Dis. 2022 Mar 28;2022:8132923. doi: 10.1155/2022/8132923. eCollection 2022.
In addition to motor symptoms such as difficulty in movement initiation and bradykinesia, patients with Parkinson's disease (PD) display nonmotor executive cognitive dysfunction with deficits in inhibitory control. Preoperative psychological assessments are used to screen for impulsivity that may be worsened by deep brain stimulation (DBS) of the subthalamic nucleus (STN). However, it is unclear whether anti-Parkinson's therapy, such as dopamine replacement therapy (DRT) or DBS, which has beneficial effects on motor function, adversely affects inhibitory control or its domains. The detrimental effects of STN-DBS are more apparent when tasks test the inhibition of habitual prepotent responses or involve complex cognitive loads. Our goal was to use a reverse visually guided reaching (RVGR) task, a hand-based version of the antisaccade task, to simultaneously measure motor performance and response inhibition in subjects with PD. We recruited 55 healthy control subjects, 26 PD subjects receiving treatment with DRTs, and 7 PD subjects receiving treatment with STN-DBS and DRTs. In the RVGR task, a cursor moved opposite to the subject's hand movement. This was compared to visually guided reaching (VGR) where the cursor moved in the same direction as the subject's hand movement. Reaction time, mean speed, and direction errors (in RVGR) were assessed. Reaction times were longer, and mean speeds were slower during RVGR compared to VGR in all three groups but worse in untreated subjects with PD. Treatment with DRTs, DBS, or DBS + DRT improved the reaction time and speed on the RVGR task to a greater extent than VGR. Additionally, DBS or DBS + DRT demonstrated an increase in direction errors, which was correlated with decreased reaction time. These results show that the RVGR task quantifies the benefit of STN-DBS on bradykinesia and the concomitant reduction of proactive inhibitory control. The RVGR task has the potential to be used to rapidly screen for preoperative deficits in inhibitory control and to titrate STN-DBS, to maximize the therapeutic benefits on movement, and minimize impaired inhibitory control.
除了运动症状，如运动启动困难和运动迟缓外，帕金森病（PD）患者还表现出非运动执行认知功能障碍，抑制控制存在缺陷。术前心理评估用于筛查可能因丘脑底核（STN）深部脑刺激（DBS）而加重的冲动性。然而，尚不清楚对运动功能有有益作用的抗帕金森病治疗，如多巴胺替代疗法（DRT）或DBS，是否会对抑制控制或其领域产生不利影响。当任务测试对习惯性优势反应的抑制或涉及复杂认知负荷时，STN-DBS的有害影响更为明显。我们的目标是使用反向视觉引导伸手（RVGR）任务，即基于手部的反扫视任务版本，同时测量PD患者的运动表现和反应抑制。我们招募了55名健康对照受试者、26名接受DRT治疗的PD受试者以及7名接受STN-DBS和DRT联合治疗的PD受试者。在RVGR任务中，光标与受试者的手部运动方向相反移动。将其与视觉引导伸手（VGR）任务进行比较，在VGR任务中，光标与受试者的手部运动方向相同。评估反应时间、平均速度和方向误差（在RVGR任务中）。在所有三组中，与VGR相比，RVGR任务中的反应时间更长，平均速度更慢，但未治疗的PD受试者情况更差。DRT、DBS或DBS+DRT治疗在RVGR任务上比VGR任务更大程度地改善了反应时间和速度。此外，DBS或DBS+DRT显示方向误差增加，这与反应时间缩短相关。这些结果表明，RVGR任务量化了STN-DBS对运动迟缓的益处以及同时减少的主动抑制控制。RVGR任务有潜力用于快速筛查术前抑制控制缺陷，并调整STN-DBS，以最大限度地提高对运动的治疗益处，并最小化抑制控制受损。
