认知双任务对早期帕金森病患者姿势稳定性及手灵活性的影响

The effect of dual-task interference on postural sway and hand flexibility in early Parkinson＇s disease

目的 研究认知双任务对早期帕金森病（Parkinson＇s disease,PD）患者姿势稳定性及手灵活性的影响.方法 选择23例早期PD患者为PD组,Hohn-Yahr（H-Y）分期为1～1.5期.23例性别和年龄匹配的健康受试者为对照组,其均无PD病史.摆动参数的测量由可佩戴惯性加速计来完成.主要计算来自加速计信号的两个姿势摆动参数：（1）均方根加速度（root mean square acceleration,RMS）;（2）急动度（jerkiness of sway,JERK）.手灵活性的测量由普渡钉板完成,比较两组间对应钉子数.结果 在常规状态下,PD组与对照组各摆动参数之间比较均差异无统计学意义（P＞0.05）.在执行认知双任务状态下,两组RMS值[睁眼双任务：PD组（0.156±0.112） m/s2,对照组（0.086±0.026） m/s2;闭眼双任务：PD组（0.204±0.162） mr/s2,对照组（0.095±0.023） m/s2]差异有统计学意义（P＜0.01）.在执行认知双任务状态下,总JERK值,前后（AP）方向和左右（ML）方向JERK值,PD患者均高于对照组（P＜0.05）.PD组患者在30 s内放入的钉子数[（17.33±4.87）个]较对照组[（20.77±4.13）个]少,差异有统计学意义（P＜0.05）.结论 早期PD患者手的灵活性明显下降.早期PD患者在站立的同时执行一个需求认知任务将会威胁到其平衡的稳定性.

Objective To observe the effect of dual-task interference on postural sway and hand flexibility of patients with early Parkinson＆#39;s disease （PD）.Methods Twenty-tree patients with early PD and twcnty-three healthy,sex-and age-matched control subjects were examined.Postural sway was measured with an accelerometer at the centre of mass at the lower spine.Two parameters of postural sway were computed from the acceleration signals including root mean square acceleration （RMS） and jerkiness of sway （JERK）.Purdue pegboard test,single-task tests and dual-task test were performed respectively to record the numbers of nails inserted with left hand,right hand and both hands within 30 seconds.Results In the usual conditions,no significant differences of postural sway parameters were found between the control group and PD group in eye open and eye closed condition.In dualtask condition,PD patients showed an increase of RMS values （eye open conditions：PD group （0.156±0.112） m/s2,control group （0.086±0.026） m/s2;eye closed conditions：PD group （0.204±0.162）m/s2,control group （0.095±0.023）m/s2） of sway acceleration,compared with control subjects （P〈0.01）.These differences reached significance during cognitive task performance in eye open and eye closed with dual task.PD patients showed larger JERK values with increasing difficulty of the sway task which also reached significance during cognitive task performance（P〈0.05）.The number of pegs inserted within 30 s in patients with PD （17.33±4.87）was significantly lower than that in controls （20.77±4.13） （P〈0.05）.Conclusion The hand flexibility of patients with early PD obviously decrease.The balance of patients with early PD may deteriorate when their attention is diverted or reduced because of attempting to perform cognitive tasks.