中低教育程度且無失智症之巴金森氏病患者之神經心理功能與動作症狀間關係之初探

目的：國外文獻顯示主要臨床症狀以僵硬、動作緩慢的巴金森氏病患者之認知功能較以顫抖為主者差，顯示二者應存在神經病理上的差異。現今國內缺乏檢視症狀與認知功能間關係的研究，而國外研究樣本多為高教育程度與高智商者，顯然無法對應教育程度偏低的本土老人族群。本研究以中低教育程度者作為樣本，檢視動作症狀與認知功能之間的關係。方法：47位中低教育程度且非失智之巴金森氏病患者在服藥狀態下以巴金森氏病評估量表評估其動作症狀嚴重度。22位正常人依年齡、教育程度及智能與患者配對作為控制組，兩組均接受記憶、視空間與執行功能等一系列神經心理功能評估，比較組間認知功能的差異。結果：患者症狀嚴重度與認知功能的關係並不顯著；然而，進一步分析個別症狀則發現以僵硬症狀為主者較其他動作症狀者認知功能缺損的比率有較高的趨勢。與正常人相較，侯葉等級Ⅰ的患者並無明顯認知功能改變，侯葉等級Ⅱ的患者在威斯康辛卡片分類測驗的完成類別數有顯著差異，侯葉等級Ⅲ的患者則在威斯康辛卡片分類測驗的完成類別數、近期記憶與語意聯想語文流暢測驗有顯著差異。結論：初步研究結果顯示，在認知功能與動作症狀關係上可見，僵硬涉及較多的認知功能方面的缺損，與國外研究針對高教育程度患者之結果相似。顯示無論教育程度的高低，僵硬症狀與認知功能缺損有關。然而，限於樣本數的不足，未來研究需要更大樣本來加以驗證。

關鍵字

巴金森氏病；神經心理功能；動作障礙

並列摘要

Objective: In the western literature, cognitive decline in the patients with rigidity and bradykinesia features has been noted to be more remarkable than those with a predominant motor symptom of tremor. Accordingly, it has been suggested that these patients with various predominant motor symptoms might have heterogeneous neuropathological involvements. Nevertheless, few studies have investigated these issues in Taiwan. In addition, most of our patients are low-educated and incompatible with those with high education level in western societies. Thus, our study attempted to examine the relationship between neuropsychological function and motor symptoms in low-educated patients with Parkinson's disease (PD). Method: Forty-seven nondemented PD patients with low education level received Unified Parkinson Disease Rating Scale (UPDRS) for rating their motor severity under ”on” condition. Twenty-two healthy subjects, matched for age and education level, served as normal controls. Both groups received a series of neuropsychological tests consisting of mainly memory, visuospatial and executive functions. Results: Data analysis revealed that there was no significant correlation between patients' motor severity and performance on neuropsychological tests. However, patients with a predominant symptom of rigidity showed impaired performance on the cognitive tests while there were no significant differences between patients with a remarkable symptom of tremor or bradykinesia and normal controls in cognitive performance. There were no significant differences between performance of patients with motor staging Ⅰ and that of normal controls on the neurocognitive tests. However, patients with the stagings Ⅱ and Ⅲ performed significantly poorer on the executive function and/or memory tests. Conclusion: Based on our preliminary results, we noted that only patients with a predominant motor symptom of rigidity evidenced remarkable neurocognitive deficits. This result seems to further support findings in western literature. We thus suggest that there is a remarkable relationship between the severity of rigidity and neurocognitive impairments regardless of educational levels. However, since our results were based on a small sample, further investigation on a large scale to re-examine this issue is necessary.