多巴胺能药物对早期帕金森病患者决策认知功能的影响

The effects of dopaminergic medication on cognitive function of decision-making in patients with early stage Parkinson’s disease

目的研究多巴胺能药物对早期帕金森病(PD)患者在明确概率条件下风险决策认知功能的影响。方法采用骰子博弈试验(GDT)进行明确概率风险决策能力的评估。共纳入40例规律口服多巴胺能药物的原发性PD患者(服药组)、40例撤药后的原发性PD患者(撤药组)以及匹配的40名正常对照组。结果在GDT中,服药组风险选项次数明显大于撤药组和HC组(均P<0.05)。服药组安全选项次数明显小于撤药组和HC组(均P<0.05)。PD患者负反馈利用率与风险选项的次数呈负相关(r=-0.57,P=0.000),与H-Y分级呈负相关(r=-0.23,P=0.046)。结论在风险概率明确情境下,多巴胺能药物会增加早期PD患者对高风险和高回报选项的偏爱,使负反馈的利用率降低。短期撤药后风险决策能力能够改善。

Objective To estimate the effects of dopaminergic medication on cognitive function of decisionmaking in explicit risky situation in early stage Parkinson's disease ( PD) patients.Methods The Game of Dice Test ( GDT) was used to test the ability of decision-making in explicit risky situation.Forty idiopathic PD patients with regular oral administration of dopaminergic medication ( ON group),40 idiopathic PD patients after withdrawal of dopaminergic medication ( OFF group),and 40 healthy controls matched to PD patients were included.Results In GDT,the frequency of risky options in ON group was significantly greater than OFF group and HC group( all P < 0. 05).The frequency of safe options in ON group was significantly less than OFF group and HC group( all P < 0. 05).The negative feedback utilization rate of PD patients was negatively correlated with the frequency of risky options ( r =- 0. 57,P = 0. 000),and was negatively correlated with the H-Y grade ( r =- 0. 23,P = 0. 046). Conclusions In explicit risky situation,dopaminergic medication increases the preference for high-risk and highreward options in early PD patients while reduces the utilization rate of negative feedback.The ability of decisionmaking under risk can be improved after short-term medication withdrawal.