双任务范式下帕金森病患者步态自动性研究  

Study on gait automaticity in patients with Parkinson's disease under dual⁃task paradigm

作　　者：张鑫源 卢杰威 王岳 舒智林 王金[3] 程元元 朱志中[4] 于洋[4] 于宁波 韩建达 巫嘉陵[3] ZHANG Xin-yuan;LU Jie-wei;WANG Yue;SHU Zhi-lin;WANG Jin;CHENG Yuan-yuan;ZHU Zhi-zhong;YU Yang;YU Ning-bo;HAN Jian-da;WU Jia-ling(Grade 2020,Clinical College of Neurology,Neurosurgery and Neurorehabilitation,Tianjin Medical University,Tianjin 300070,China;College of Artificial Intelligence,Tianjin Huanhu Hospital,Tianjin 300350,China;Tianjin Key Laboratory of Intelligent Robotics,Nankai University,Tianjin 300071,China;Department of Neurology,4Department of Rehabilitation Medicine,Tianjin Huanhu Hospital,Tianjin 300350,China)

机构地区：[1]天津医科大学神经内外科及神经康复临床学院,300070 [2]南开大学人工智能学院天津市智能机器人技术重点实验室,天津300071 [3]天津市环湖医院神经内科,300350 [4]天津市环湖医院康复医学科,300350

出　　处：《中国现代神经疾病杂志》2022年第10期898-902,共5页Chinese Journal of Contemporary Neurology and Neurosurgery

基　　金：国家自然科学基金资助项目(项目编号:U1913208);国家自然科学基金资助项目(项目编号:61873135);天津市医学重点学科(专科)建设项目(项目编号:TJYXZDXK⁃052B);天津市卫生健康科技项目(项目编号:TJWJ2022MS033);天津市研究生科研创新项目(项目编号:2021YJSS161)。

摘　　要：目的探讨认知⁃运动双任务对帕金森病患者步态自动性的影响。方法共纳入2020年6月至2021年12月在天津市环湖医院诊断与治疗的45例原发性帕金森病患者,分别在拟多巴胺药“关”期和“开”期执行认知单任务、运动单任务和认知⁃运动双任务,记录减数正确个数以及采用三维步态分析仪提取步速和步幅参数,并计算双任务成本。结果与单任务相比,帕金森病患者“关”期和“开”期执行双任务时均步速减慢(t=11.909,P=0.000;t=11.621,P=0.000)、步幅缩短(t=9.027,P=0.000;t=9.991,P=0.000),而减数正确个数差异均无统计学意义(t=0.651,P=0.519;t=1.205,P=0.234)。帕金森病患者“关”期步速双任务成本(Z=⁃4.148,P=0.000)和步幅双任务成本(Z=⁃4.114,P=0.000)均高于“开”期,而减数双任务成本差异无统计学意义(Z=⁃1.005,P=0.315)。帕金森病患者“关”期和“开”期步速双任务成本均与简易智能状态检查量表评分呈负相关(r_(s)=⁃0.474,P=0.000;r_(s)=⁃0.461,P=0.000),而与统一帕金森病评价量表第三部分评分呈正相关(r_(s)=0.446,P=0.002;r_(s)=0.428,P=0.003)。结论帕金森病患者在执行双任务时步速减慢、步幅缩短,存在较高的跌倒风险,拟多巴胺药可有效改善步态自动性,认知功能下降可能导致帕金森病患者步态自动性下降。Objective To investigate the effect of cognitive⁃motor dual⁃task on gait automaticity in patients with Parkinson's disease(PD).Methods A total of 45 patients with primary PD in Tianjin Huanhu Hospital were selected from June 2020 to December 2021.Cognitive single task,motor single task and cognitive⁃motor dual⁃task in the"off"and"on"states of dopaminergic medication were performed.The correct number of subtractions was recorded to measure cognitive performance.A three⁃dimensional gait analyzer was used to extract the parameters of stride length and gait velocity,and the dual⁃task cost(DTC)was calculated to measure gait automaticity.Results Compared with single task,patients with PD showed slower gait velocity(t=11.909,P=0.000;t=11.621,P=0.000),shortened stride length(t=9.027,P=0.000;t=9.991,P=0.000),while there was no significant difference in the correct number of subtraction(t=0.651,P=0.519;t=1.205,P=0.234)during both"off"and"on"states.In patients with PD,the DTC of gait velocity(Z=⁃4.148,P=0.000)and stride length(Z=⁃4.114,P=0.000)in the"off"state was higher than that in the"on"state,while the DTC for subtraction had no significant difference(Z=⁃1.005,P=0.315).The DTC of gait velocity in the"off"and"on"states of patients with PD was negatively correlated with the Mini⁃Mental State Examination(MMSE)score(r_(s)=⁃0.474,P=0.000;rs=⁃0.461,P=0.000),but positively correlated with Unified Parkinson's Disease Rating ScaleⅢ(UPDRSⅢ)score(r_(s)=0.446,P=0.002;r_(s)=0.428,P=0.003).Conclusions Patients with PD have a significant decrease in stride length and gait velocity,and higher risk of falling when performing dual⁃task.Dopaminergic medication can improve the gait automaticity of patients,and cognitive decline may lead to gait automaticity disorder in patients with PD.

关 键 词：帕金森病 步态分析 认知储备 

分 类 号：R742.5[医药卫生—神经病学与精神病学]