Poor dopaminergic response of impaired dexterity in Parkinson's disease: Bradykinesia or limb kinetic apraxia?
Poor dopaminergic response of impaired dexterity in Parkinson's disease: Bradykinesia or limb kinetic apraxia?
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DOI：
10.1002/mds.22199
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发表时间：
2008-09-15
影响因子：
8.6
通讯作者：
Bohlhalter, Stephan
中科院分区：
文献类型：
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作者：
Gebhardt, Andreas;Vanbellingen, Tim;Bohlhalter, Stephan
帕金森病 (PD) 患者即使只有轻微的运动迟缓，也经常表现出手灵活性受损，这表明他们可能患有肢体运动性失用症 (LKA)，即精细运动技能的丧失，而不能用基本运动缺陷来解释。为了探索这种分离，我们研究了 PD 中敏捷性和运动迟缓的多巴胺能反应差异。 12 名 PD 患者（4 名女性，年龄 64.4 +/- 8.3，平均值 + SD）和 12 名匹配的健康对照者 (64.8 +/- 8.9) 分别在 ON 与 OFF 以及第一次与第二次试验中进行了两次测试。应用硬币旋转（CR）任务来评估灵活性，并应用手指敲击（FT）任务来评估运动迟缓。通过视频录制来跟踪表演，并通过测量三个 10 秒时段内 CR 和 FT 的频率进行分析。统计分析采用混合因子设计，以组（PD 与对照组）作为受试者间因素，以药物（ON 状态与 OFF 状态或第一次试验与第二次试验）、任务（FT 与 CR）和惯用手（主导与非主导）作为受试者内因素。在 PD 患者中，无论是否涉及手部，多巴胺能治疗仅轻度改善 CR 表现，而 FT 评分则大幅增加（达到对照水平），这由因素组、药物和任务的显着三重相互作用所证明（F-1.12 = 7.9，P = 0.01；eta(2) = 0.26）。此外，在 OFF 和 ON 组中，CR 评分均显着低于正常对照组，表明 PD 的灵活性显着受损（P < 0.001）。总之，手灵巧度受损对多巴胺能治疗的反应显着减弱，表明 PD 灵巧性缺陷与 LKA 而不是运动迟缓有关。 (C) 2008 年运动障碍协会。
Patients with Parkinson's disease (PD) often show impaired manual dexterity even when being only minimally bradykinetic, suggesting that they may have limb kinetic apraxia (LKA), that is, a loss of fine motor skill not explained by elemental motor deficits. To explore this dissociation, we investigated the differential dopaminergic responsiveness of dexterity and bradykinesia in PD. Twelve patients with PD (4 women, age 64.4 +/- 8.3, mean + SD) and 12 matched healthy controls (64.8 +/- 8.9) were tested twice in ON vs. OFF and 1st vs. 2nd trial, respectively. A coin rotation (CR) task was applied to assess dexterity and a finger tapping (FT) task to assess bradykinesia. Performance was followed by video recording and analyzed by measuring the frequency of CR and FT during three 10-second periods. Statistical analysis was done by a mixed factorial design with group (PD vs. controls) as between-subject factor and medication (ON- vs. OFF-state or 1st vs. 2nd trial), task (FT vs. CR), and handedness (dominant vs. nondominant) as within-subject factors. In patients with PD, regardless of hand involved, dopaminergic treatment only mildly improved CR performance, in contrast to the strong increase in FT scores (up to the level of controls), as demonstrated by the significant triple interaction of the factors group, medication, and task (F-1.12 = 7.9, P = 0.01; eta(2) = 0.26). Furthermore, CR scores were considerably lower, both in OFF and ON, than in normal controls, pointing to a substantial impairment of dexterity in PD (P < 0.001). In conclusion, impaired manual dexterity showing significantly diminished response to dopaminergic treatment suggests that dextrous deficits in PD are related to LKA rather than bradykinesia. (C) 2008 Movement Disorder Society.