Attenuated neural response to gamble outcomes in drug-naive patients with Parkinson's disease.
Attenuated neural response to gamble outcomes in drug-naive patients with Parkinson's disease.
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帕金森病初治患者对赌博结果的神经反应减弱。
DOI：
10.1093/brain/awt027
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
H. Siebner
中科院分区：
文献类型：
--
作者：
J. van der Vegt;Oliver J. Hulme;S. Zittel;Kristoffer Hougaard Madsen;M. Weiss;C. Buhmann;B. Bloem;A. Münchau;H. Siebner
帕金森病是由黑质多巴胺能神经元退化引起的，表现为一系列运动、认知和情感缺陷。帕金森病也会影响奖励处理，但随着退化从背侧纹状体发展到腹侧纹状体，与疾病相关的强化学习缺陷的出现速度比运动症状要慢。帕金森病的奖赏处理功能障碍很难研究，因为大多数患者都接受过多巴胺能药物治疗，这些药物会使腹侧纹状体的奖赏反应敏感，通常会导致冲动控制障碍。为了避免这种治疗混乱，我们分析了一组新诊断的帕金森病患者的奖励处理的神经基础，这些患者从未接受过多巴胺能药物治疗。 13 名未曾接受药物治疗的帕金森病患者和 12 名年龄匹配的健康对照受试者在执行一项简单的二选一赌博任务时接受了全脑功能磁共振成像，从而导致随机且参数可变的金钱收益和损失。在帕金森病患者中，对奖励结果的神经反应（由血氧水平依赖性信号反映）在一大群中脑边缘和中皮质区域中减弱，包括腹侧壳核、腹侧被盖区、丘脑和海马。尽管这些区域在健康个体中表现出对奖励结果的线性反应，但在未接受药物治疗的帕金森病患者中，这种反应显着降低或检测不到。结果表明，中皮质-边缘多巴胺能系统的核心区域，包括腹侧被盖区、腹侧纹状体和内侧眶额皮质，在疾病早期阶段就已经受到显着损害，并且这些缺陷不能归因于多巴胺能治疗的污染效应。
Parkinson's disease results from the degeneration of dopaminergic neurons in the substantia nigra, manifesting as a spectrum of motor, cognitive and affective deficits. Parkinson's disease also affects reward processing, but disease-related deficits in reinforcement learning are thought to emerge at a slower pace than motor symptoms as the degeneration progresses from dorsal to ventral striatum. Dysfunctions in reward processing are difficult to study in Parkinson's disease as most patients have been treated with dopaminergic drugs, which sensitize reward responses in the ventral striatum, commonly resulting in impulse control disorders. To circumvent this treatment confound, we assayed the neural basis of reward processing in a group of newly diagnosed patients with Parkinson's disease that had never been treated with dopaminergic drugs. Thirteen drug-naive patients with Parkinson's disease and 12 healthy age-matched control subjects underwent whole-brain functional magnetic resonance imaging while they performed a simple two-choice gambling task resulting in stochastic and parametrically variable monetary gains and losses. In patients with Parkinson's disease, the neural response to reward outcome (as reflected by the blood oxygen level-dependent signal) was attenuated in a large group of mesolimbic and mesocortical regions, comprising the ventral putamen, ventral tegmental area, thalamus and hippocampus. Although these regions showed a linear response to reward outcome in healthy individuals, this response was either markedly reduced or undetectable in drug-naive patients with Parkinson's disease. The results show that the core regions of the meso-cortico-limbic dopaminergic system, including the ventral tegmental area, ventral striatum, and medial orbitofrontal cortex, are already significantly compromised in the early stages of the disease and that these deficits cannot be attributed to the contaminating effect of dopaminergic treatment.
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影响因子：
14.5
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