Self-unawareness of levodopa induced dyskinesias in patients with Parkinson's disease
Self-unawareness of levodopa induced dyskinesias in patients with Parkinson's disease
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DOI：
10.1016/j.bandc.2014.06.014
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发表时间：
2014-10-01
影响因子：
2.5
通讯作者：
Lopiano, Leonardo
中科院分区：
文献类型：
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作者：
Amanzio, Martina;Palermo, Sara;Lopiano, Leonardo
该研究分析了48例帕金森病（PD）患者的运动障碍-自我意识降低。由于与执行功能障碍的关联是一个有争议的问题，我们假设它在运动障碍的自我无意识中起着重要作用，我们使用神经认知方法分析了多巴胺能治疗对内侧-前额叶-腹侧-纹状体回路的作用。特别注意元认知能力相关的动作监测，代表一种新的解释的现象。PD患者进行了评估，使用不同的评级量表，我们设计来衡量运动意识障碍。为了确定在认知-临床水平上测量的每个变量是否有助于预测运动障碍意识量表的分数，我们使用后者作为二元因变量进行了多元logistic回归模型。我们使用威斯康星州卡片分类测验-元认知测验-版本来评估前额叶-腹侧-纹状体回路的执行功能。数据显示，使用运动障碍评定量表的自我意识降低与整体监测（p = 0.04）、监测分辨率（p = 0.04）和控制敏感性（p = 0.04）相关。患者未能感知自己的表现，区分正确和不正确的种类，对自己的选择充满信心，因此决定在task.We没有发现任何关联与执行功能使用运动迟缓评定量表。我们的研究结果表明，当监测注意力表现的比较机制在前额叶纹状体水平受到损害时，患者失去了识别未实现有意识意识的运动障碍的能力。(C)2014年爱思唯尔公司All rights reserved.
The study analyzes the presence of dyskinesias-reduced-self-awareness in forty-eight patients suffering from Parkinson's disease (PD). As the association with executive dysfunction is a matter of debate and we hypothesize it plays an important role in dyskinesias self-unawareness, we analyzed the role of dopaminergic treatment on the medial-prefrontal-ventral-striatal circuitry using a neurocognitive approach. Special attention was given to metacognitive abilities related to action-monitoring that represent a novel explanation of the phenomenon.PD patients were assessed using different rating scales that we devised to measure movement awareness disorders. In order to ascertain whether each variable measured at a cognitive-clinical level contributes to predicting the scores of the movement-disorder-awareness-scales, we conducted multiple logistic regression models using the latter as binary dependent variables. We used the Wisconsin Card Sorting Test-metacognitive-version to assess the executive functions of the prefrontal-ventral-striatal circuitry.Data showed that a reduction of self-awareness using the Dyskinesia rating scale was associated with global monitoring (p = .04), monitoring resolution (p = .04) and control sensitivity (p =.04). Patients failed to perceive their performance, distinguish between correct and incorrect sorts, be confident in their choice and consequently decide to gamble during the task.We did not find any association with executive functions using the hypo-bradykinesia rating scale. Our findings indicate that when the comparator mechanism for monitoring attentive performance is compromised at a prefrontal striatal level, patients lose the ability to recognize their motor disturbances that do not achieve conscious awareness. (C) 2014 Elsevier Inc. All rights reserved.