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

描述(申请人提供)：帕金森氏病(PD)的语言障碍a)比先前怀疑的更常见，b)诊断和治疗不足，c)存在时增加残疾和照顾者负担-但尚未对PD的语言问题进行适当控制的前瞻性研究。我们建议对帕金森病患者的语言变化进行这样一项纵向研究，并评估这些变化对受影响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社会语境中的语言使用，最近的报告(McNamara&Durso，2003)证明了中期PD患者在语用语言处理的某些方面存在显著缺陷。我们将检验这一假设，即语用语言/沟通技能即使在早期帕金森病患者中也会受到损害，并与与帕金森氏症相关的认知、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名新诊断的帕金森病患者的语言功能以及认知、情感和社会功能。在为期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)。混合效应回归模型将应用于数据，以得出PD患者语言轨迹的关键指标的定量估计，以及这些轨迹与疾病严重程度、用药制度、认知、情感和社会功能变化的关系。本项目的数据将使我们清楚地了解帕金森病的语用缺陷的性质及其认知和神经心理学的相关性；2)阐明新纹状体/前额叶神经系统在调节语用功能中的作用；3)阐明语用社会交际缺陷与帕金森病认知和社会缺陷的程度；以及4)建立关于基本语用功能的神经、认知和情感相关性的基准数据，这些数据可能被用来开发更有效的临床治疗社交沟通障碍的方法。

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.