The many facets of motor learning and their relevance for Parkinson's disease.
The many facets of motor learning and their relevance for Parkinson's disease.
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DOI：
10.1016/j.clinph.2017.03.042
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发表时间：
2017-07
期刊：
影响因子：
--
通讯作者：
Ghilardi MF
中科院分区：
文献类型：
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作者：
Marinelli L;Quartarone A;Hallett M;Frazzitta G;Ghilardi MF
运动学习的最终目标是运动技能的优化和自动化，这是一个复杂的过程，包括隐式和显式（或陈述性）成分。运动学习涉及不同的神经网络和神经递质系统，这取决于任务类型和学习阶段。在习得的第一阶段之后，一项运动技能会经历巩固（即变得抵抗干扰）和保持，在这一过程中，睡眠和长期增强似乎起着重要作用。帕金森病运动学习的研究产生了有争议的结果，可能源于使用不同的实验范式。当考虑到任务的特征、指令、背景、学习阶段和措施类型时，很明显，一般来说，只有依赖于注意力资源和认知策略的学习才会受到PD的影响，这与该疾病中额纹状体缺陷的发现一致。左旋多巴似乎不能逆转PD患者的学习缺陷，而对白球或丘脑底核进行深部脑刺激似乎是有益的。最后也是最重要的是，PD患者经常表现出对新学技能的保留能力下降，这个问题甚至在疾病的早期阶段就存在。对运动学习过程的深入剖析和理解为PD的有效医学、外科和康复治疗提供了坚实的基础。
The final goal of motor learning, a complex process that includes both implicit and explicit (or declarative) components, is the optimization and automatization of motor skills. Motor learning involves different neural networks and neurotransmitters systems depending on the type of task and on the stage of learning. After the first phase of acquisition, a motor skill goes through consolidation (i.e., becoming resistant to interference) and retention, processes in which sleep and long-term potentiation seem to play important roles. The studies of motor learning in Parkinson’s disease have yielded controversial results that likely stem from the use of different experimental paradigms. When a task’s characteristics, instructions, context, learning phase and type of measures are taken into consideration, it is apparent that, in general, only learning that relies on attentional resources and cognitive strategies is affected by PD, in agreement with the finding of a fronto-striatal deficit in this disease. Levodopa administration does not seem to reverse the learning deficits in PD, while deep brain stimulation of either globus pallidus or subthalamic nucleus appears to be beneficial. Finally and most importantly, patients with PD often show a decrease in retention of newly learned skill, a problem that is present even in the early stages of the disease. A thorough dissection and understanding of the processes involved in motor learning is warranted to provide solid bases for effective medical, surgical and rehabilitative approaches in PD.