帕金森病中的动机障碍与基于认知努力的决策
Motivational disturbances and cognitive effort-based decision-making in Parkinson's disease.
作者信息
Scott Bonnie M, Eisinger Robert S, Mara Roshan, Rana Amtul-Noor, Bhatia Anika, Thompson Sable, Okun Michael S, Gunduz Aysegul, Bowers Dawn
机构信息
Department of Neurology, The University of Texas at Austin Dell Medical School, Austin, TX, USA; Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA.
Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA.
出版信息
Parkinsonism Relat Disord. 2025 May;134:107355. doi: 10.1016/j.parkreldis.2025.107355. Epub 2025 Mar 18.
BACKGROUND
Motivational disturbances, such as apathy and impulse control disorders (ICDs), frequently co-occur in patients with Parkinson's disease (PD). The assessment of these motivational disturbances has proven to be challenging due the absence of validated objective behavioral measures for evaluating motivation in older adults. This scenario may contribute to underdiagnosis. The present study aimed to investigate the clinical utility of a modified version of an existing effort-based decision-making task which required cognitive (e.g., working memory) instead of physical (e.g., finger tapping) effort.
METHODS
Ninety-five non-demented individuals (45-85 years of age) with idiopathic PD completed a cognitive screening measure, self-report questionnaires, and a cognitive adaptation of the Effort Expenditure for Rewards Task (COG-EEfRT), which is a multi-trial game where a participant can choose whether to expend greater effort for larger rewards which vary in magnitude and probability. Patients were classified as having clinically significant symptoms of apathy and/or an ICD based on recommended cut-off scores on the Apathy Scale (AS) and Questionnaire for Impulse Control Disorders in Parkinson's Disease - Rating Scale (QUIP-RS). The methodological cutoffs defined two groups: Apathy (36.8 %), and ICD (48.4 %).
RESULTS
The level of effort expended by patients significantly predicted apathy and ICD status with high accuracy (88.2 % and 82.4 %, respectively), above and beyond age, levodopa equivalent dose and self-report measures of motivation. Additionally, we found that greater symptoms of apathy and ICD (i.e., negative urgency) were significantly correlated with patients choosing to expend greater effort. This result varied based on reward probability and outcome.
CONCLUSION
We offer preliminary evidence suggesting the clinical utility of the COG-EEfRT for identifying and quantifying motivational disturbances in PD. Additionally, anticipatory anhedonia and impulsive traits may be important predictors of cognitive effort-based decision-making. Compared to tasks requiring physical effort, the COG-EEfRT may be a more suitable tool for PD and perhaps for people with motor impairment.
背景
动机障碍，如冷漠和冲动控制障碍（ICD），在帕金森病（PD）患者中经常同时出现。由于缺乏用于评估老年人动机的经过验证的客观行为测量方法，对这些动机障碍的评估已被证明具有挑战性。这种情况可能导致诊断不足。本研究旨在调查现有基于努力的决策任务的修改版本的临床效用，该任务需要认知（如工作记忆）而非身体（如手指敲击）努力。
方法
95名年龄在45 - 85岁之间的非痴呆型特发性PD患者完成了一项认知筛查测量、自我报告问卷以及奖励任务的努力支出认知适应性测试（COG - EEfRT），这是一个多轮游戏，参与者可以选择是否为更大的奖励付出更多努力，这些奖励在大小和概率上有所不同。根据冷漠量表（AS）和帕金森病冲动控制障碍问卷 - 评定量表（QUIP - RS）上推荐的临界值，将患者分类为具有临床上显著的冷漠和/或ICD症状。方法学临界值定义了两组：冷漠组（36.8%）和ICD组（48.4%）。
结果
患者付出的努力水平能够以较高的准确率显著预测冷漠和ICD状态（分别为88.2%和82.4%），超越了年龄、左旋多巴等效剂量和动机的自我报告测量。此外，我们发现更严重的冷漠和ICD症状（即消极紧迫性）与患者选择付出更多努力显著相关。这一结果因奖励概率和结果而异。
结论
我们提供了初步证据，表明COG - EEfRT在识别和量化PD患者的动机障碍方面具有临床效用。此外，预期性快感缺失和冲动特质可能是基于认知努力的决策的重要预测因素。与需要身体努力的任务相比，COG - EEfRT可能是更适合PD患者以及可能适合运动障碍患者的工具。
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