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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

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1 2 3 1 1 2 3 47 22 I II III 106 1 Tel: 02-23627076 E-mail: huams@ntu.edu.tw resting tremor muscular rigidity bradykinesia

postural disturbance

Calne, 2001

Mortimer, Pirozzolo, Hansch, & Webster, 1982

Original Articles

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Zetusky, Jankovic, & Pirozzolo, 1985

Alexander DeLong Strick 1986

Lichter & Cummings, 2001

Cooper, Sagar, Jordan, Harvey, & Sullivan, 1991; Dubois & Pillon, 1997; Levin & Katzen, 1995; Levin, Maria, & Weiner, 1989; Stern, Mayeux, Hermann, & Rosen, 1988

duration; Levin, Llabre, Ansley, Weiner, & Sanchez-Ramos, 1990

Hoehn Yahr 1967 Hoehn and Yahr stage

Van Spaendonck, Berger, Horstink, Buytenhuijs, & Cools, 1996

frontal-striatal circuit; Dubois & Pillon, 1997

Cummings & Huber, 1992

Levin, Llabre, Reisman, Weiner, Sanchez-Ramos, & Singer, 1991

Brown & Marsden, 1986

Pai & Chan, 2001 Cognitive Ability Screening Instrument, CASI

( 1994

2001 Hsieh & Lee, 1999)

1 2 3 4 159 confusional state Clinical Dementia Rating; Morris, 1993

47 Symptoms Check List-90-Revised, SCL-90-R; 1983 22 64.00 6.84 10.45 4.60 27.00 1.57 MMSE; Folstein, Folstein, & McHugh, 1975 95.91 12.71

Unified Parkinson's Disease Rating Scale, UPDRS; Fahn & Elton, 1987

UPDRS

Mentation, Behavior and Mood Activities of Daily Living

Motor Examination Complications of Therapy

Modified Hoehn and Yahr Stage Schwab and England Schwab and England's Activities of Daily Living Scale; Schwab & England, 1961

gait postural stability

speech UPDRS

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Herishanu-Naaman, 1998; Van Spaendonck et al., 1996

N =

5 N = 10 N = 32

Dubois & Pillon, 1997

Temporal Orientation, TO; Benton, Sivan, Hamsher, Varney, & Spreen,

1994 Orientation to

Personal Information and Place, OPIP; Hamsher,

1983 1986

2002

2002 Benton Visual

Retention Test, BVRT; Benton, 1974

Judgment of Line Orientation, JLO; Benton et al., 1994 Facial Recognition Test, FRT; Benton et al., 1994

Three-Dimensional Block Construction Test; Benton et al., 1994

Modified Wisconsin Card Sorting Test; Nelson, 1976

Semantic Association of Verbal Fluency Test; Hua, Chang, & Chen, 1997

A Trail Making Test A; Reitan & Wolfson,

1993 Line Cancellation

Test, Hamsher, 1979

1. ANOVA

2.

Scheffe's method 3. Polyserial correlation coeffi cient, r

p < .01

r = .367; r = - .439

[F(1, 66) = 2.36, p = .129; F(1, 66) =

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2.12, p = .150) A A r = .613 A [F(1, 66) = 1.62, p = .207] I II III

-Kruskal-Wallis one-way analysis of variance by ranks

WAIS-R

A

A

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[ F ( 3 , 6 4 ) = 1.90, p = .139] [F(3, 64) = 1.44, p = .240] [F(3, 64) = 2.94, p = . 0 4 0 ] [F(3, 64) = 4.89, p = .004] A [F(3, 64) = 1.76, p = .163] ( )

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UPDRS r = -.341, p = .019 r = -.312, p = .033 r = -.293, p = .045 r = -.337, p = .020 r = -.316, p = .030 r = -.350, p = .016 r = -.331, p = .023 N = 5 N = 10 N = 32 Tsai, Lu, Hua, Lo, & Lo, 1994

I I

Brown & Marsden, 1988

Canavan, Passingham, Marsden, Quinn, Wyke, & Polkey, 1989

Lees & Smith, 1983

Brown 1988

Canavan 1989

multiple system atrophy Lees Smith (1983)

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II I I I L e e s Smith 1983 L e v i n Katzen 1995 Van Spaendonck 1996 Va k i l & Herishanu-Naaman, 1998; Van Spaendonck et al., 1996 III N e l s o n 1 9 7 6 NSC92-2413-H-002-008 1994 1986 2002 2002 2001 1983

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Parallel organization of functionally segregated cir-cuits linking basal ganglia and cortex. Annual Review

of Neuroscience, 9, 357-381.

Benton, A. L. (1974). Revised Visual Retention Test (4th

ed.). New York: The Psychological Corporation. Benton, A. L., Sivan, A. B., Hamsher, K. d., Varney, N.

R., & Spreen, O. (1994). Contributions to

neuropsy-chological assessment: A clinical manual (2nded.).

New York: Oxford University Press.

Brown, R. G., & Marsden, C. D. (1986). Visuospatial function in Parkinson's disease. Brain, 109, 987-1002.

Brown, R. G., & Marsden, C. D. (1988). An investiga-tion of the phenomenon of "set" in Parkinson's dis-ease. Movement Disorders, 3, 152-161.

Calne, D. B. (2001). Parkinson's disease is not one dis-ease. Parkinsonism & Related Disorders, 7, 3-7. Canavan, A. G., Passingham, R. E., Marsden, C. D.,

Quinn, N., Wyke, M., & Polkey, C. E. (1989). The performance on learning tasks of patients in the early stages of Parkinson's disease. Neuropsychologia, 27, 141-156.

Cooper, J. A., Sagar, H. J., Jordan, N., Harvey, N. S., & Sullivan, E. V. (1991). Cognitive impairment in early, untreated Parkinson's disease and its relationship to motor disability. Brain, 114, 2095-2122.

Cummings, J. L., & Huber, S. J. (1992). Visuospatial abnormalities in Parkinson's disease. In S. J. Huber & J. L. Cummings (Eds.), Parkinson's disease:

Neurobehavioral aspects. New York: Oxford

University Press.

Dubois, B., & Pillon, B. (1997). Cognitive deficits in Parkinson's disease. Journal of Neurology, 244, 2-8. Fahn, S., & Elton, R. (1987). Unified Parkinson's

dis-ease rating scale. In S. Fahn, M. Goldstein, D. Marsden, & D. Calne (Eds.), Recent developments in

Parkinson's disease (pp. 153-163). New Jersey:

Mac-Millan.

Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician.

Journal of Psychiatric Research, 12, 189-198.

Hamsher, K. d. (1979). Line Cancellation Test. Milwaukee: University of Wisconsin medical school, Department of Neurology.

Hamsher, K. d. (1983). Orientation to Personal

Information and Place. Milwaukee: University of

Wisconsin medical school, Department of Neurology. Henry, J. D., & Crawford, J. R. (2004). Verbal fluency

deficits in Parkinson's disease: A meta-analysis.

Journal of the International Neuropsychological Society, 10, 608-622.

Hoehn, M. M., & Yahr, M. D. (1967). Parkinsonism: Onset, progression and mortality. Neurology, 17, 427-442.

Hsieh, S., & Lee, C. Y. (1999). Source memory in Parkinson's disease. Perceptual and Motor Skills, 89, 355-367.

Hua, M. S., Chang, S. H., & Chen, S. T. (1997). Factor structure and age effects with an aphasia test battery in normal Taiwanese adults. Neuropsychology, 11, 156-162.

Lees, A. J., & Smith, E. (1983). Cognitive deficits in the early stages of Parkinson's disease. Brain, 106, 257-270.

Levin, B. E., & Katzen, H. L. (1995). Early cognitive changes and nondementing behavioral abnormalities in Parkinson's disease. Advances in Neurology, 65, 85-95.

Levin, B. E., Llabre, M. M., Ansley, J., Weiner, W. J., & Sanchez-Ramos, J. (1990). Do parkinsonians exhibit visuospatial deficits? Advances in Neurology, 53, 311-315.

Levin, B. E., Llabre, M. M., Reisman, S., Weiner, W. J., Sanchez-Ramos, J., Singer, C., et al. (1991). Visuospatial impairment in Parkinson's disease.

Neurology, 41, 365-369.

Levin, B. E., Maria, M. L., & Weiner, W. J. (1989). Cognitive impairments associated with early Parkinson's disease. Neurology, 39, 557-561.

Lichter, D. G., & Cummings, J. L. (2001).

Frontal-sub-cortical circuits in psychiatric and neurological dis-orders. New York: Guilford Press.

Morris, J. C. (1993). The Clinical Dementia Rating (CDR): Current version and scoring rules. Neurology,

43, 2412-2414.

Mortimer, J. A., Pirozzolo, F. J., Hansch, E. C., & Webster, D. D. (1982). Relationship of motor symp-toms to intellectual deficits in Parkinson disease.

Neurology, 32, 133-137.

Nelson, H. E. (1976). A modified card sorting test sensi-tive to frontal lobe defects. Cortex, 12, 313-324.

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tive decline in Parkinson's disease: A study of 102 patients. Acta Neurologica Scandinavica, 103, 243-247.

Reitan, R. M., & Wolfson, D. (1993). The

Halstead-Reitan neuropsychological test battery: Theory and clinical interpretation (2nded.). S. Tucson, Ariz.:

Neuropsychology Press.

Schwab, R. S., & England, A. C., Jr. (1961). Parkinson's disease: Rehabilitation aspects. Rehabilitation

litera-ture, 22, 326-336.

Stern, Y., Mayeux, R., Hermann, A., & Rosen, J. (1988). Prism adaptation in Parkinson's disease. Journal of

Neurology, Neurosurgery, and Psychiatry, 51,

1584-1587.

Tsai, C. H., Lu, C. S., Hua, M. S., Lo, W. L., & Lo, S. K. (1994). Cognitive dysfunction in early onset parkin-sonism. Acta Neurologica Scandinavica, 89, 9-14.

and procedural learning in Parkinson's disease patients having tremor or bradykinesia as the predom-inant symptom. Cortex, 34, 611-620.

Van Spaendonck, K. P., Berger, H. J., Horstink, M. W., Buytenhuijs, E. L., & Cools, A. R. (1996). Executive functions and disease characteristics in Parkinson's disease. Neuropsychologia, 34, 617-626.

Zetusky, W. J., Jankovic, J., & Pirozzolo, F. J. (1985). The heterogeneity of Parkinson's disease: Clinical and prognostic implications. Neurology, 35, 522-526.

2004 11 10 2005 04 07 2005 04 11

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The Relationship between Neuropsychological Functions and Motor Symptoms in

Low-educated Nondemented Patients with Parkinson's Disease: A Preliminary Study

Cheng-Chang Yang

1

, Mau-Sun Hua

2

, Yih-Ru Wu

3

, and Lung Yu

1

1Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University 2Department of Psychology, National Taiwan University

3Department of Neurology, Chang Gung Memorial Hospital

Abstract

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 neu-ropsychological tests consisting of mainly memory, visuospatial and executive functions.

Results: Data analysis revealed that there was no significant correlation between patients' motor severity and

per-formance 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 sig-nificantly 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.

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