Jahanshahi M, Brown R G, Marsden C D
Department of Clinical Neurology, National Hospital for Neurology and Neurosurgery, London, United Kingdom.
J Neurol Neurosurg Psychiatry. 1993 Nov;56(11):1169-77. doi: 10.1136/jnnp.56.11.1169.
The aim of the study was to compare the quantitative and qualitative similarities and differences in the performance of patients with Parkinson's disease, Huntington's disease and cerebellar disease on a number of reaction time tasks. Simple reaction time (SRT), uncued and fully cued four choice (CRT) tasks were performed by eight patients with Parkinson's disease after withdrawal of dopaminergic medication for an average of 14.4 hours; by seven non-demented patients with Huntington's disease and by eight patients with cerebellar disease. An S1 (warning signal/precue)-S2 (imperative stimulus) paradigm was used in all tasks, with the S1-S2 interval randomly varying between 0, 200, 800, 1600 and 3200 ms across trials. The patients with Huntington's disease had a significantly longer SRT than those with Parkinson's disease. None of the other group differences in uncued and unwarned SRT and CRT was significant. For the patients with Parkinson's disease and those with cerebellar disease, unwarned SRT was faster than uncued and unwarned CRT. For the patients with Huntington's disease, this CRT/SRT difference was not significant. A warning signal before the imperative stimulus resulted in a reduction of reaction time in all three groups. Advance information provided by S1 about the response that would be required by S2 was used by patients in all three groups, evident from reaction times in the fully cued CRT task being faster than those in the uncued CRT condition. Patients with cerebellar disease had slower movement times in the SRT and CRT conditions compared with the patients with Parkinson's disease and Huntington's disease, whose times did not differ. In one SRT condition, when the absence of a warning signal was predictable, patients with cerebellar disease, and to a lesser extent those with Huntington's disease, were able to maintain a general motor readiness before the imperative stimulus. This was not the case for the patients with Parkinson's disease who seemed more dependent on the presence of a warning signal to reduce their reaction time. With a few exceptions, the pattern of results of the three groups were qualitatively similar. It may be concluded that similar reaction time deficits are found in Parkinson's disease, in patients with other disorders of the basal ganglia (Huntington's disease), as well as those with a disease sparing the basal ganglia (cerebellar disease). The non-specific slowness observed at the behavioural level may, however, have diverse central mechanisms.
本研究的目的是比较帕金森病、亨廷顿病和小脑疾病患者在一系列反应时间任务中的定量和定性异同。八名帕金森病患者在停用多巴胺能药物平均14.4小时后,进行了简单反应时间(SRT)、无提示和完全提示四选一(CRT)任务;七名非痴呆型亨廷顿病患者和八名小脑疾病患者也参与了这些任务。所有任务均采用S1(警告信号/预提示)-S2(指令刺激)范式,在各次试验中,S1 - S2间隔在0、200、800、1600和3200毫秒之间随机变化。亨廷顿病患者的SRT明显长于帕金森病患者。在无提示和无警告的SRT及CRT方面,其他组间差异均无统计学意义。对于帕金森病患者和小脑疾病患者,无警告的SRT比无提示和无警告的CRT更快。对于亨廷顿病患者,这种CRT/SRT差异不显著。指令刺激前的警告信号使三组患者的反应时间均缩短。所有三组患者都利用了S1提供的关于S2所需反应的提前信息,这从完全提示的CRT任务中的反应时间比无提示的CRT任务中更快可以看出。与帕金森病患者和亨廷顿病患者相比,小脑疾病患者在SRT和CRT条件下的动作时间更慢,而后两者的动作时间无差异。在一种SRT条件下,当无警告信号可预测时,小脑疾病患者以及程度较轻的亨廷顿病患者能够在指令刺激前保持一般的运动准备状态。帕金森病患者并非如此,他们似乎更依赖警告信号的存在来缩短反应时间。除了少数例外,三组的结果模式在定性上相似。可以得出结论,在帕金森病、其他基底神经节疾病(亨廷顿病)患者以及未累及基底神经节的疾病(小脑疾病)患者中,发现了相似的反应时间缺陷。然而,在行为水平观察到的非特异性迟缓可能具有多种中枢机制。