Pragmatic language skills in patients with Parkinson's Disease (PD)

描述（由申请人提供）：帕金森氏病（PD）中的语言障碍a)比以前怀疑的更频繁，b)诊断和治疗不足，c)出现时增加了残疾和照顾者的负担，但尚未进行适当控制的PD语言问题前瞻性研究。我们建议对PD患者的语言变化进行这样的纵向研究，并评估这些变化对患者日常功能的影响。我们将重点关注“语用”语言过程，因为这些过程涉及到语言在社会环境中的使用，最近的报告（McNamara & Durso, 2003）记录了中期PD患者在语用语言加工的某些方面存在显著缺陷。我们将检验这一假设，即实用语言/沟通技能在早期PD中受损，并且与PD相关的认知、情感（如抑郁）和社交功能障碍显著相关。我们提出了一项纵向研究设计，评估54名新诊断的PD患者的语言功能以及认知、情感和社会功能。在5年的研究过程中，患者将接受三次评估（大约每1.5年一次）。将对数据应用混合效应回归模型，定量估计PD患者语言轨迹的关键指标，以及这些轨迹与疾病严重程度、给药方案、认知、情感和社会功能变化的关系。这个项目的数据将1)让我们清楚地了解帕金森症的语用缺陷的本质及其认知和神经心理学相关因素；2)阐明新纹状体/前额叶神经系统在语用功能中介中的作用；3)明确语用社会交际缺陷与PD的认知和社会缺陷的关系程度；4)建立基本语用功能的神经、认知和情感相关的基准数据，这些数据有可能用于开发更有效的临床治疗社交障碍的方法。

DESCRIPTION (provided by applicant): Language disorders in Parkinson's disease (PD) are a) more frequent than previously suspected, b) under- diagnosed and under-treated and c) increase disability and caregiver burden when present - yet no properly controlled, prospective studies of language problems in PD have yet been conducted. We propose to conduct just such a longitudinal study of language changes in PD and to assess the impact of these changes on daily functioning in affected patients. We will focus on "pragmatic" language processes as these concern the use of language in social context and recent reports (McNamara & Durso, 2003) document significant deficits in selected aspects of pragmatic language processing in mid-stage PD patients. We will test the hypothesis that pragmatic language/communication skills are impaired even in early PD and are significantly related to cognitive, affective (e.g., depression) and social dysfunction associated with PD. We propose a longitudinal research design assessing language functions as well as cognitive, affective and social functions in a group of 54 newly diagnosed PD patients. Patients will be assessed three times over the course of the 5-year study (approximately every 1.5 years). Mixed effects regression modeling will be applied to the data to derive quantitative estimates of key indicators of language trajectories of PD patients and the relations of these trajectories to changes in disease severity, medication dosing regimes, cognitive, affective and social functions. Data from this project will 1) give us a clear picture of the nature of the pragmatic deficit in PD as well as its cognitive and neuropsychological correlates; 2) clarify the role neo-striatal/prefrontal neural systems in mediation of pragmatic functions; 3) clarify the extent to which pragmatic social communication deficits are related to the cognitive and social deficits of PD; and 4) establish benchmark data on neural, cognitive and affective correlates of fundamental pragmatic functions which could potentially be used to develop more effective clinical treatments for disorders of social communication.