PDF(Pubmed)
Abstract：
We question whether bradyphrenia, slowing of cognitive processing not explained by depression or a global cognitive assessment, is a nosological entity in idiopathic parkinsonism (IP). The time taken to break contact of an index finger with a touch-sensitive plate was measured, with and without a warning in the alerting signal as to which side the imperative would indicate, in 77 people diagnosed with IP and in 124 people without an IP diagnosis. The ability to utilise a warning, measured by the difference between loge-transformed reaction times (unwarned minus warned), was termed \'cognitive efficiency\'. It was approximately normally distributed. A questionnaire on self- and partner perception of proband\'s bradyphrenia was applied. A multivariable model showed that those prescribed levodopa were less cognitively efficient (mean -5.2 (CI -9.5, -1.0)% per 300 mg/day, p = 0.02), but those prescribed the anti-muscarinic trihexyphenidyl were more efficient (14.7 (0.2, 31.3)% per 4 mg/day, p < 0.05) and those prescribed monoamine oxidase-B inhibitor (MAOBI) tended to be more efficient (8.3 (0.0, 17.4)%, p = 0.07). The variance in efficiency was greater within IP (F-test, p = 0.01 adjusted for any demographic covariates: coefficient of variation, with and without IP, 0.68 and 0.46, respectively), but not so after adjustment for anti-parkinsonian medication (p = 0.13: coefficient of variation 0.62). The within-participant follow-up time, a median of 4.8 (interquartile range 3.1, 5.5) years (101 participants), did not influence efficiency, irrespective of IP status. Perception of bradyphrenia did not usefully predict efficiency. We conclude that both bradyphrenia and \'tachyphrenia\' in IP appear to have iatrogenic components, of clinically important size, related to the dose of antiparkinsonian medication. Levodopa is the most commonly prescribed first-line medication: co-prescribing a MAOBI may circumvent its associated bradyphrenia. The previously reported greater efficiency associated with (low-dose) anti-muscarinic was confirmed.
摘要：
我们质疑缓血症，不能通过抑郁或全球认知评估来解释认知过程的减慢，是特发性帕金森病（IP）的病态实体。测量食指与触敏板中断接触所需的时间，在警告信号中有和没有警告的情况下，该命令将指示哪一侧，77名被诊断为IP的人和124名没有IP诊断的人。利用警告的能力，通过loge转换的反应时间之间的差异（未警告减去警告）来衡量，被称为“认知效率”。它大致呈正态分布。应用了一份关于先证者精神徐缓的自我和伴侣感知的问卷。多变量模型显示，那些处方左旋多巴的认知效率较低（平均-5.2（CI-9.5，-1.0）％每300毫克/天，p=0.02),但那些规定的抗毒蕈碱己基苯基更有效（14.7（0.2，31.3）％每4毫克/天，p<0.05）和那些规定的单胺氧化酶-B抑制剂（MAOBI）趋于更有效（8.3（0.0，17.4）％，p=0.07)。IP内的效率差异更大(F检验，p=0.01，对任何人口统计学协变量进行调整：变异系数，有和没有IP，分别为0.68和0.46)，但在调整抗帕金森病药物后并非如此（p=0.13：变异系数0.62）。参与者内部随访时间，中位数为4.8年（四分位数范围3.1，5.5年）（101名参与者），不影响效率，无论IP状态如何。对迟钝症的感知并不能有效地预测效率。我们得出的结论是，在IP中，迟钝症和“速尿症”似乎都具有医源性成分，临床上重要的尺寸，与抗帕金森病药物的剂量有关。左旋多巴是最常用的一线药物：共同处方MAOBI可能会规避其相关的痛快。证实了先前报道的与(低剂量)抗毒蕈碱相关的更高的效率。
