Saint-Cyr J A, Taylor A E, Nicholson K
Department of Psychology, Toronto Hospital, Ontario, Canada.
Adv Neurol. 1995;65:1-28.
When viewed as a whole, these basal ganglia-thalamo-cortical circuits appear to play a modulating role in a wide range of behaviors. At the cortical level, given convergence upon specified regions within the frontal lobes, the behaviors in question would be those dependent upon SMA, premotor, frontal eye fields, dorsolateral, and orbitofrontal outflow targets. Broadly speaking, processes such as the generation, maintenance, switching, and blending of motor, mental, or emotional sets would be involved. Accordingly, in basal ganglia disease, the planning and the execution of the above behavioral domains can be affected. Given the diversity and complexity of activity within the basal ganglia, the consequences of disruption depend largely upon lesion site and the associated interplay of neurochemical factors. For example, in the motor domain, damage to various striatal circuitry levels can result in either hypo- or hyperkinetic disorders of movement. Following this analogy, it might also be said that diverse lesions, depending on site, can result in problems with the development and maintenance of behavioral sets ("hypophrenic") versus problems in relinquishing preferential sets ("hyperphrenic"). These contrasting patterns are best represented in PD and OCD, respectively. In the latter case, however, the "hyperphrenic" pattern would only apply to those behaviors which are part of the obsessional rituals. This suggests that procedural system "overdrive" remains domain-specific as is the case for most operations within the procedural system. To return to the broad principle of habituation, a process first described in the context of the visual system and its connections with the tail of the caudate nucleus, it would be tempting to view PD and OCD as disorders of "under" and "over" habituation to behavioral routines. Unfortunately, the situation has proven to be more complex in view of recent neuropsychological findings (Nicholson et al., in preparation). Using a variety of problem-solving and other cognitive tasks, both PD and OCD patients were found to require more practice and/or the provision of external guidelines to facilitate habit formation. Thus, in both cases, as in other disorders of the basal ganglia, the establishment of useful heuristics by which to direct adaptive behavior suffers. OCD patients therefore appear to have at least two compartmentalized types of basal ganglia dysfunction: the ritualistic compulsions and obsessions as well as the heuristic inefficiency (i.e., poor procedural mobilization). PD patients would also suffer a similar fate as it is known that the degrees of motor versus nonmotor (i.e., procedural) deficit are poorly correlated (42).(ABSTRACT TRUNCATED AT 400 WORDS)
从整体来看，这些基底神经节 - 丘脑 - 皮质回路似乎在广泛的行为中发挥调节作用。在皮质层面，鉴于额叶内特定区域的汇聚，所讨论的行为将是那些依赖于辅助运动区、运动前区、额叶眼区、背外侧和眶额流出目标的行为。一般来说，会涉及运动、思维或情绪定势的产生、维持、转换和融合等过程。因此，在基底神经节疾病中，上述行为领域的计划和执行可能会受到影响。鉴于基底神经节内活动的多样性和复杂性，破坏的后果在很大程度上取决于病变部位以及相关神经化学因素的相互作用。例如，在运动领域，纹状体不同回路水平的损伤可导致运动过少或运动过多的运动障碍。按照这个类推，也可以说，根据部位不同，不同的病变可能导致行为定势的形成和维持出现问题（“思维迟缓”），而不是放弃优先定势出现问题（“思维亢进”）。这些相反的模式分别在帕金森病和强迫症中表现得最为明显。然而，在后一种情况下，“思维亢进”模式仅适用于那些作为强迫仪式一部分的行为。这表明程序系统“超速运转”仍然是特定领域的，就像程序系统内的大多数操作一样。回到习惯化的宽泛原则，这一过程最初是在视觉系统及其与尾状核尾部的连接背景下描述的，人们可能会倾向于将帕金森病和强迫症视为对行为常规“习惯化不足”和“习惯化过度”的疾病。不幸的是，鉴于最近的神经心理学研究结果（尼科尔森等人，正在准备中），情况已被证明更为复杂。使用各种解决问题和其他认知任务，发现帕金森病患者和强迫症患者都需要更多练习和/或提供外部指导来促进习惯形成。因此，在这两种情况下，与基底神经节的其他疾病一样，指导适应性行为的有用启发式方法的建立受到影响。因此，强迫症患者似乎至少有两种分隔的基底神经节功能障碍类型：仪式性强迫行为和强迫观念以及启发式效率低下（即程序调动不佳）。帕金森病患者也会遭遇类似的命运，因为已知运动缺陷与非运动（即程序）缺陷的程度相关性很差（42）（摘要截取自400字）
