Gülşen Çağrı, Koçer Bilge, Çomoğlu Selim Selçuk, Gündüz Arzu Güçlü
Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Gazi University, Emek, 6. Street, No: 2, Çankaya, 06490, Ankara, Turkey.
Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Osmangazi University, Eskişehir, Turkey.
Neurol Sci. 2023 May;44(5):1633-1641. doi: 10.1007/s10072-022-06589-5. Epub 2023 Jan 4.
Dual-task manual dexterity is required to perform activities of daily living and is affected by cognitive functions. This study aimed to investigate the effects of two main treatment options, subthalamic nucleus deep brain stimulation (STN-DBS) and dopaminergic treatment (DT), on dual-task manual dexterity and cognitive functions of people with Parkinson's disease (PwPD).
Twenty-one PwPD were assessed in four different conditions as medication "on-off" and STN-DBS "on-off" in random order. Motor symptoms were measured with the Movement Disorder Society-Unified Parkinson Disease Rating Scale, motor section (MDS-UPDRS-III). Single and dual-task manual dexterity was assessed with the Nine-Hole Peg Test (NHPT) and cognitive functions were assessed with the Stroop Test (ST) and the Trail Making Test (TMT).
Both DT and STN-DBS enhanced MDS-UPDRS-III, and the combination of DT and STN-DBS provided further improvement. Only STN-DBS enhanced dominant hand single-task NHPT scores. Non-dominant single-task NHPT scores and dual-task NHPT scores improved with both treatments alone; however, STN-DBS resulted in more improvement than DT. Dual-task interference, ST, and TMT scores improved with both treatments alone; however, combining DT and STN-DBS did not provide more improvement.
DT, STN-DBS, and combining both treatments have different effects on motor symptoms, single and dual-task manual dexterity, dual-task interference, and cognitive functions. These results indicate that DT and STN-DBS may affect motor and cognitive functions via different mechanisms. Effects of DT and STN-DBS on manual dexterity may depend on the degree of cognitive involvement in manual dexterity tasks.
日常生活活动需要双任务操作灵巧性，且其受认知功能影响。本研究旨在调查两种主要治疗方案，即丘脑底核深部脑刺激（STN-DBS）和多巴胺能治疗（DT），对帕金森病患者（PwPD）双任务操作灵巧性和认知功能的影响。
21例帕金森病患者按随机顺序在四种不同状态下接受评估，即药物“开-关”和STN-DBS“开-关”状态。运动症状采用运动障碍协会统一帕金森病评定量表运动部分（MDS-UPDRS-III）进行测量。单任务和双任务操作灵巧性通过九孔插板测试（NHPT）进行评估，认知功能通过斯特鲁普测试（ST）和连线测验（TMT）进行评估。
DT和STN-DBS均能改善MDS-UPDRS-III，DT与STN-DBS联合使用效果更佳。仅STN-DBS能提高优势手单任务NHPT评分。非优势手单任务NHPT评分和双任务NHPT评分在两种治疗单独使用时均有所改善；然而，STN-DBS的改善程度大于DT。双任务干扰、ST和TMT评分在两种治疗单独使用时均有所改善；然而，DT与STN-DBS联合使用并未带来更多改善。
DT、STN-DBS以及两种治疗联合使用对运动症状、单任务和双任务操作灵巧性、双任务干扰以及认知功能有不同影响。这些结果表明，DT和STN-DBS可能通过不同机制影响运动和认知功能。DT和STN-DBS对操作灵巧性的影响可能取决于操作灵巧性任务中认知参与的程度。
