- 學位論文
帕金森氏症合併視幻覺的額葉功能與事件相關電位之研究
A study of frontal lobe function and event-related potential in Parkinson’s disease with visual hallucinations
摘要
背景與目的: 視幻覺為帕金森氏症患者常見之併發症，而且被認為可以協助預測帕金森氏症疾病進程中失智現象的產生。諸多文獻已證實，事件相關電位可用來偵測早期認知缺損或失智症患者的認知功能評估。因此，我們藉視覺事件相關電位及額葉功能評估，來探討無失智但有視幻覺的帕金森氏症患者其認知功能與事件相關電位之變化及相關性。 方法: 招募自一家大學醫院的57位無失智症狀的受試者(22位女性，35位男性，年齡分布46至81歲，平均年齡67.56歲)，其中有視幻覺帕金森氏症患者14位，無視幻覺的帕金森氏症患者25位，正常受試者18位。所有受試者均接受視覺事件相關電位檢查及額葉功能測驗，視覺相關電位是採用兩種不同的固定刺激間隔(1600ms與5000ms)之odd-ball paradigm刺激模式；而額葉功能測驗包含注意力、視覺空間、語言流暢度、記憶、高級執行功能與動作計劃等。 結果: 額葉功能測驗顯示，視幻覺帕金森氏症患者較無視幻覺的帕金森氏症患者與正常受試者在多項認知功能表現呈現顯著下降，而無視幻覺的帕金森氏症患者之認知功能也較正常受試者差。不論在哪種刺激間隔下，與正常受試者相比，視幻覺帕金森氏症患者的P300潛時呈現顯著延長，其振幅雖有下降但未達顯著差異。與無視幻覺帕金森氏症患者相比，視幻覺帕金森氏症患者仍有P300潛時延長與振幅下降的現象但無顯著差異。 結論: 依P300的異常與額葉功能的表現，均支持視幻覺帕金森氏症患者已有早期認知缺損，且視幻覺帕金森氏症患者相較於無視幻覺帕金森氏症患者更為嚴重。本研究也顯示，額葉功能測驗較視覺P300更有助於偵測視幻覺帕金森氏症患者之認知缺損，而不同的固定刺激間隔並不影響視覺事件相關電位P300的潛時與振幅。
並列摘要
Background and Purpose Visual hallucination (VH) is a common and disabling complication in Parkinson’s disease (PD) and has been considered a risk factor for developing dementia. Event-related potential (ERP) is a useful tool to detect subtle cognitive impairment. Using Frontal Test Battery (FTB) and visual ERP, we aimed to investigate the effect of VH on cognition and assess the association between P300 and cognitive decline in non-demented PD with VH. Methods We recruited 14 PD with VH patients, 25 PD without VH patients, and 18 age-matched controls from one university-based hospital. All subjects were submitted to comprehensive FTB and visual P300 measurement. A visual odd-ball paradigm with two different fixed inter-stimulus intervals (1600ms and 5000ms) elicits visual ERP. The comprehensive FBT was used to assess attention, visual-spatial function, verbal fluency, memory, higher executive function and motor programming. Results As compared with PD without VH patients and controls, the PD with VH patients had significantly cognitive decline in FTB. Regardless of different ISI, the P300 latency was significantly prolonged in PD with VH patients compared with controls, although the P300 amplitude was not significantly reduced. Meanwhile, the P300 measurement was not significantly different between PD patients with and without VH. Conclusions Our findings suggest that PD patients with VH may have abnormality of FTB and delayed P300 latency which reflect executive dysfunction. The comprehensive FTB, comparing with visual ERP, is more sensitive in detecting early cognitive decline in PD with VH patients. Modulation of inter-stimulus interval has no significant effect on the latency or latency of visual P300.