帕金森病患者风险决策能力研究

Decision-making under risk condition in patients with Parkinson＇ s disease

目的探讨帕金森病（Parkinson’disease，PD）患者在风险概率明确条件下的决策能力是否改变，进一步研究基底节与决策的关系。方法采用风险概率明确的骰子博弈测试（Game of Dice Test，GDT）对25例PD患者（PD组）和25名健康被试者（HC组）进行风险决策能力研究。结果与HC组（5．72±3．69）相比，PD组（10．88±5．58）更倾向于选择风险选项（t=3．86，P〈0．01）。PD组（-3748．00±3923．87）的最后总资产通常是负值，而HC组（684．00±1764．62）都有盈利，两者的差异有统计学意义（t=-5．15，P〈0．01）。PD组选择最多的是风险最大的选项即1个数字，而HC组选择最多的是3个数字的联合（1个数字：PD组：6．48±5．81；HC组：1．00±1．44：t=4．58，P〈0．01；3个数字：PD组：2．64±2．14；HC组：7．04±2．54；t=-6．62，P〈0．01），差异有统计学意义。此外，选择风险选项的次数与负反馈利用率（r=-0．59，P=0．003）和Stroop结果（r=0．55，P=0．004）的相关性显著。结论研究表明PD患者在风险概率明确条件下存在明显的决策能力改变，并与执行功能和负反馈利用率相关。

Objective To investigate the ability of decision making under risk condition in patients with Parkinson＇ s disease （ PD ）, and to explore the neural relationship between basal ganglia and the decision-making ability. Method Twenty-five PD patients and 25 healthy controls （HC） were investigated by Game of Dice Test （GDT） with explicit probability. Results PD patients performed poorly in the entire task, selecting more risky options （ PD ： 10. 88 ± 5.58 ; HC ： 5.72 ± 3.69 ; t = 3.86, P 〈 0. 01 ）, compared with heahhy controls. In general, the final asset of PD group was negative while the result of HC group was always profitable and the difference was significant （ PD ： - 3748.00 ± 3923.87 ; HC ：684. 00 ± 1764. 62 ; t = -5.15,P 〈 0. 01 ）. The most frequent choice made by PD patients was one number, which is the most risky one. Accordingly, the most frequent choice made by HC group was three numbers （one number： PD： 6. 48±5.81;HC：1.00±1.44;t =4.58,P〈0.01; three numbers： PD：2.64 ±2.14;HC：7.04 ±2.54; t = -6.62,P 〈 0. 01 ）. The frequency of choosing the risky options was correlated with the rate of using negative feedbaek（r = -0. 59 ,P =0. 003） , and the result of Stroop test（r =0. 55 ,P =0. 004）. Conclusion Present study has shown that PD patients have significant impairments in decision-making under risk condition, and the impairments are correlated with executive function and negative feedback.