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冲动控制障碍和基于努力的决策在帕金森病患者中患有下丘脑核深脑刺激的患者

Deborah Amstutz^1,2, Katrin Petermann², Mario Sousa^1,2

¹Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.

Movement disorders clinical practice

|January 3, 2025

概括

帕金森病患者的冲动控制障碍 (ICD) 与获得奖励的更大努力有关. 脑下核深度大脑刺激 (STN-DBS) 可以加速决策,但不会改变寻求奖励的行为.

科学领域:

神经科学是一个神经科学.
神经学神经学
精神病学是一个精神病学.

背景情况:

冲动控制障碍 (ICD) 是帕金森病 (PD) 中多巴胺类疗法的常见副作用.
脑下核深度大脑刺激 (STN-DBS) 对ICD的影响仍在争论中,一些研究报告改善,而另一些则恶化.
需要客观的决策措施来澄清ICD和STN-DBS之间的关系.

研究的目的:

研究ICD对帕金森病患者进行STN-DBS的基于努力的决策的影响.
客观地评估STN-DBS如何影响具有或没有ICD的PD患者的决策过程.

主要方法:

对STN-DBS前后的PD患者 (n=10) 和对STN-DBS长期治疗的单独组 (n=33) 进行的基于努力的决策任务.
在决策任务的同时,进行了神经精神和认知评估.
混合线性模型分析了ICD和STN-DBS对任务性能的影响,控制了运动症状,认知和药物等共变量.

主要成果:

患有ICD的患者表现出更高的意愿,愿意为获得奖励而付出更大的努力.
在基于努力的任务中,STN-DBS并没有显著调节接受率.
ICD,认知处理速度和STN-DBS是更快决策时间的重要预测因素.
在STN-DBS后4个月,ICD症状呈现改善的趋势,但无动于衷.

结论:

慢性STN-DBS和ICD都加速了基于努力的决策中的判断.
具体而言,ICD增强了为潜在的回报而付出努力的动机.
精心定位STN-DBS和多巴胺激素药物对于管理PD的动机行为和神经精神症状至关重要.

关键词:

帕金森病是帕金森病的一种.深度大脑刺激刺激大脑基于努力的决策方式.冲动控制障碍冲动控制障碍冲动控制障碍神经精神病症状神经精神病症状

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