Abstract

Up to 23% of newly diagnosed, non-demented, Parkinson’s disease (PD) patients experience deficits in executive functioning (EF). In fact, EF deficits may occur up to 39-months prior to the onset of motor decline. Optimal EF requires working memory, attention, cognitive flexibility, and response inhibition underlying appropriate decision-making. The capacity for making strategic decisions requires inhibiting imprudent decisions and are associated with noradrenergic and dopaminergic signaling in prefrontal and orbitofrontal cortex. Catecholaminergic dysfunction and the loss of noradrenergic and dopaminergic cell bodies early in PD progression in the aforementioned cortical areas likely contribute to EF deficits resulting in non-strategic decision-making. Thus, detecting these deficits early in the disease process could help identify a significant portion of individuals with PD pathology (14–60%) before frank motor impairment. A task to evaluate EF in the domain of non-strategic decision-making might be useful to indicate the moderate loss of catecholamines that occurs early in PD pathology prior to motor decline and cognitive impairment. In this review, we focus on the potential utility of the Iowa Gambling Task (IGT) for this purpose, given significant overlap between in loss of dopaminergic and noradrenergic cells bodies in early PD and the deficits in catecholamine function associated with decreased EF. As such, given the loss of catecholamines already well-underway after PD diagnosis, we evaluate the potential utility of the IGT to identify the risk of therapeutic non-compliance and a potential companion approach to detect PD in premotor stages.

中文翻译：

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爱荷华州赌博任务在帕金森病中的效用是否有神经生物学原理？

摘要

多达 23% 的新诊断的非痴呆症帕金森病 (PD) 患者在执行功能 (EF) 方面存在缺陷。事实上，EF 缺陷可能发生在运动衰退开始前 39 个月。最佳 EF 需要工作记忆、注意力、认知灵活性和反应抑制，以做出适当的决策。制定战略决策的能力需要抑制轻率的决定，并且与前额叶和眶额叶皮层中的去甲肾上腺素能和多巴胺能信号有关。在上述皮质区域的 PD 进展早期，儿茶酚胺能功能障碍以及去甲肾上腺素能和多巴胺能细胞体的丧失可能导致 EF 缺陷，从而导致非战略决策。因此，在疾病过程的早期发现这些缺陷可以帮助在明显的运动障碍之前识别出很大一部分患有 PD 病理的个体 (14-60%)。在非战略决策领域评估 EF 的任务可能有助于表明在运动衰退和认知障碍之前的 PD 病理早期发生的儿茶酚胺的适度损失。在这篇综述中，我们关注爱荷华赌博任务 (IGT) 为此目的的潜在效用，因为早期 PD 中多巴胺能和去甲肾上腺素能细胞体的丧失与与 EF 降低相关的儿茶酚胺功能缺陷之间存在显着重叠。因此，鉴于 PD 诊断后儿茶酚胺的流失已经在进行中，