【論文摘要】Cognitive Functions Associated With Context-Dependent Behavior in People With Parkinson's Disease

【論文摘要】巴金森氏症患者環境依賴性行為與認知功能之相關性研究

陳雪婷(Suet-Ting Chan) ； 李旻昊(Min-Hao Li) ； 李亞芸(Ya-Yun Lee)

《物理治療》 43卷4期 (2018/12) Pp. 326-326

https://doi.org/10.6215/FJPT.201812.P20

摘要

Background and Purpose: Context-dependent behavior is a phenomenon that individuals demonstrate better motor performance in the context that a task was originally learned, while the task performance may worsen if performed in a novel context. Previous works from our laboratory have shown that individuals with Parkinson’s disease (PD) were more context-dependent than age-matched non-disabled adults. Moreover, our unpublished data revealed that PD with freezing of gait (FoG) appeared to be more context-dependent than those without FoG. Increased context-dependency in people with PD would impede the ability to generalize what has been learned in one context to another. Thus, a different intervention strategy may be needed to enhance the training benefits. Although context-dependent behavior may influence clinician's intervention approach, it is difficult to quickly identify this phenomenon within a short clinical visit. Hence, it would be important and helpful if we can identify the individuals who demonstrate context-dependent behavior with easily accessed measures. This study aimed to determine the clinical measures associated with the context-dependent behavior in people with PD. The participants were subdivided into those who had FoG and those without FoG in order to determine whether the associations may differ in these patient populations. Methods: This study recruited 32 individuals with PD, including 16 PD participants with FoG (PD + FoG) and 16 PD participants without FoG (PD − FoG). A specially designed finger sequence task was used to determine context-dependent behavior. Participants were required to practice 3 numerical finger sequences; each sequence was associated with unique incidental contexts. One day after practice, participants were tested under 2 conditions: the sequence-context associations were changed or remained the same as practice. The performance differences between the 2 testing conditions would suggest the amount of context-dependency. The participants were also tested with clinical measures that could be easily evaluated in the clinics, including the Timed Up and Go (TUG) test, 10 m walk test (10MWT), Montreal Cognitive Assessment (MoCA), Trail Making Test (TMT), Stroop test, and the Unified Parkinson's Disease Rating Scale (UPDRS). To evaluate the relationships between context-dependency and the clinical measures, Pearson's correlation coefficient was used, and the significance level was set at 0.05. Results: In the PD − FoG group, a positively correlation was found between context dependency and TMT (r = 0.584, p = 0.02), while a negatively correlation were found between context dependency and MoCA (r = -0.535, p = 0.04). No significant correlations were found between context-dependent behavior and other clinical measures. Additionally, no significant correlations were observed in the PD + FoG group. Conclusion: In PD − FoG, poorer MoCA or TMT scores were associated with greater context-dependency; while no associations were observed between context-dependent behavior and clinical outcome measures in participants with PD + FoG. Clinical Relevance: Clinicians could use MoCA or TMT to identify potential PD individuals without FoG who may demonstrate context-dependent behavior.