FRONTAL-LOBE DYSFUNCTION IN PARKINSONS-DISEASE - THE CORTICAL FOCUS OF NEOSTRIATAL OUTFLOW
FRONTAL-LOBE DYSFUNCTION IN PARKINSONS-DISEASE - THE CORTICAL FOCUS OF NEOSTRIATAL OUTFLOW
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DOI：
10.1093/brain/109.5.845
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发表时间：
1986-10-01
期刊：
影响因子：
14.5
通讯作者：
LANG, AE
中科院分区：
文献类型：
--
作者：
TAYLOR, AE;SAINTCYR, JA;LANG, AE
总结本研究调查的假设，作为帕金森氏病的后果，扰乱尾状核流出将导致赤字的认知功能依赖于前额叶皮层的完整性，皮质焦点caudatofugal信号。由于帕金森氏病还涉及纹状体外中脑细胞的病变，这些细胞减少了对该皮质区域的多巴胺的外源性供应，因此这些功能处于双重风险中。从100名连续的帕金森病患者中抽取40名非痴呆患者，并根据年龄、教育程度、智商和性别与40名正常对照组进行匹配。对所有患者进行神经系统疾病指标的定量评估。对患者和正常组进行神经心理学评估，包括一般智力、心理技能、记忆、视觉空间和执行功能测试。在帕金森病患者组中没有观察到整体认知能力下降。此外，记忆力和视觉空间能力一般完好无损。出现了一小簇赤字，解释为反映损伤的能力，自发产生有效的策略时，依赖于自我导向的特定任务的规划。此外，一些被认为对额叶功能敏感的测试区分了症状强烈偏侧于身体右侧和左侧的患者。后来研究了与疾病严重程度和患者属性（包括智商和年龄）相关的战略规划缺陷，这两者都与特定任务的表现有关。结果进行了比较，与以前的调查帕金森病患者和讨论的角度，动物和人类的研究，涉及大脑皮层和基底神经节的损害。由于前额叶皮层被认为在自我导向的行为规划中起着至关重要的作用，流出模型在预测尾状核功能障碍的后果中的有效性得到了支持。
SUMMARYThis study investigates the hypothesis that, as a consequence of Parkinson's disease, disturbed caudate outflow will lead to deficits in cognitive functions dependent upon the integrity of the prefrontal cortex, the cortical focus of caudatofugal signals. Since Parkinson's disease also involves lesions in extrastriatal midbrain cells which reduce the extrinsic supply of dopamine to this cortical region, such functions are at double risk. Forty nondemented parkinsonian patients were drawn from a pool of 100 consecutive patients and matched with 40 normal control subjects according to age, education, IQ, and sex. All patients were quantitatively rated on neurological indices of disease Neuropsychological assessment of the patient and normal groups included tests of general intelligence, psychomotor skills, memory, visuospatial and executive functions. No global cognitive decline was observed in the parkinsonian group. Moreover, memory and visuospatial abilities were generally intact. A small cluster of deficits emerged, interpreted as reflecting impairment in the ability to spontaneously generate efficient strategies when relying on self-directed task-specific planning. In addition, several tests thought to be sensitive to frontal lobe function distinguished patients with symptoms strongly lateralized to the right versus left side of the body. Deficits in strategic planning were later investigated in relation to severity of disease and to patient attributes including IQ and age, both of which were relevant to performance on specific tasks. Results were compared with previous investigations in parkinsonian patients and discussed from the perspective of both animal and human studies involving damage to the cerebral cortex and basal ganglia. As the prefrontal cortex is thought to play a crucial role in self-directed behavioural planning, the validity of an outflow model in predicting the consequences of caudate nucleus dysfunction was supported.