Powell J H, al-Adawi S, Morgan J, Greenwood R J
Department of Psychology, Goldsmiths College, New Cross, London SE14 6NW, UK.
J Neurol Neurosurg Psychiatry. 1996 Apr;60(4):416-21. doi: 10.1136/jnnp.60.4.416.
To test the hypothesis that treatment with bromocriptine would ameliorate deficits in clinical motivation, responsiveness to reward, and frontal cognitive function after brain injury.
An open trial in six men and five women who had had either traumatic brain injury or subarachnoid haemorrhage between two months and five years previously. After repeated baseline assessments, bromocriptine was given in gradually increasing doses. Assessments were repeated at increasing doses, during maintenance, and after withdrawal. Novel structured instruments for quantifying motivation were developed; measures of anxiety and depression, and cognitive tests sensitive to motivation or frontal lobe involvement were also given.
Bromocriptine treatment was followed by improved scores on all measures other than mood. Improvement was maintained after bromocriptine withdrawal in eight of the patients.
Poor motivation in patients with brain injury may result from dysfunction in the mesolimbic/mesocortical dopaminergic circuitry, giving rise to associated deficiencies in reward responsiveness and frontal cognitive function.
检验如下假设，即使用溴隐亭治疗可改善脑损伤后临床动机、奖赏反应性及额叶认知功能方面的缺陷。
对6名男性和5名女性进行一项开放性试验，这些受试者在之前的两个月至五年间曾发生过创伤性脑损伤或蛛网膜下腔出血。在进行多次基线评估后，逐渐增加溴隐亭的给药剂量。在剂量增加期间、维持治疗期间及停药后均重复进行评估。开发了用于量化动机的新型结构化工具；还进行了焦虑和抑郁测量以及对动机或额叶受累敏感的认知测试。
除情绪外，溴隐亭治疗后所有测量指标的分数均有所改善。8名患者在停用溴隐亭后仍保持改善状态。
脑损伤患者动机不足可能是由于中脑边缘/中脑皮质多巴胺能神经回路功能障碍所致，进而导致奖赏反应性和额叶认知功能出现相关缺陷。
