多巴胺能药物对早期帕金森病患者模糊决策功能的影响

Effects of dopaminergic medication on decision-making under ambiguity in patients with early Par-kinson＆#39;s disease

目的：探讨多巴胺能药物对早期帕金森病（ Parkinson’ disease，PD）患者模糊风险决策能力的影响。方法采用爱荷华博弈任务（ Iowa gambling task，IGT）对24例早期未用药原发性PD患者（ Hoehn-Yabr分级≤Ⅱ级）、24例早期规律口服多巴胺能药物的原发性PD患者以及24例年龄、性别及受教育程度匹配的正常对照，进行模糊风险决策能力的测试。结果与正常组相比，未用药PD组不仅存在数字广度及词汇流畅性障碍，还存在决策功能障碍。三组在博弈任务中总净剩值差异有统计学意义（F＝6．024， P＝0．004），未用药 PD组的总净剩值[（－4．50±22．19）分]低于用药 PD 组[（8．83±23．24）分]及正常对照组[（15．92±15．77）分]（P＜0．05）。未用药PD组与用药PD组在5个block中的净剩值两两比较显示，从block1至block5两组净剩值间的差异逐渐增加，并且在block5的净剩值差异有统计学意义（P＜0．05）。用药PD组在5个block的净剩值及总净剩值与正常组相比，差异无统计学意义（均P＞0．05）。随着博弈任务卡片选择次数的增多，用药PD组有利选择次数逐渐增加；而未用药PD组有利选择次数未见明显增加趋势，倾向风险选项。研究还表明，未用药PD组的总净剩值与MoCA得分有相关性（ r＝0．614， P＝0．001）。结论早期原发性PD患者在风险概率不明确条件下存在决策能力受损，偏爱选择风险大的选项。当规律的外源性的补充多巴胺能药物3到12个月，帕金森病患者的模糊风险决策能力得到明显改善。

Objective To investigate the effects of dopaminergic medication on decision-making un-der ambiguity in patients with early Parkinson＇s disease（ PD） . Methods Using Iowa Gambling Task （ IGT） for 24 early non-medication idiopathic PD patients（ Hoehn and Yahr Scale≤Ⅱlevel） ,24 early idiopathic PD patients with regular dopaminergic medication and also for 24 healthy controls（ HC） whose age,gender,and education match to PD patients to test their ability of decision-making under ambiguity. Results The results showed non-medication PD group showed impairments on digtal span and verbal fluency and decision-making task. There was significant difference in IGT task scores among the three groups（F=6.024, P=0.004） . The total net scores of advantageous choices in IGT were significantly lower in non-medication PD group（ （-4.50 ±22.19） scores） than medication PD group（（8.83±23.24）scores） and healthy group（（15.92±15.77） scores） . The difference of net scores in block1 to block5 between non-medication PD group and medication PD group was gradually increased,and the difference of net scores in block5 was significant（P〈0.05） . There was no significant difference in total net scores and net scores in block1 to block5 between medication PD group and healthy group（P〉0.05） . As the game processing,medication PD group gradually shifted their se-lections toward the advantageous choices. But non-medication group did not exhibit this shift pattern and the performance was much poorer. Meanwhile, the study also indicated the total net scores of advantageous choices for non-medication PD group was positive correlation to the MoCA scores （ r=0.614, P=0.001）. Conclusion The present study has shown that non-medication PD group has impairment in decision-making under ambiguity risk condition and prefer to choose risky options. when exogenous complement dopaminergic medication,the risk decision-making ability of medication PD group has been improved.