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Brain and Nerve No to Shinkei Volume 40, Issue 3 （March 1988）

Brain and Nerve 脳と神経 40巻3号（1988年3月発行）

Japanese English

原著

パーキンソン病における認識機能—大脳基底核に認識機能は存在するか？ COGNITIVE FUNCTION IN PATIENTS WITH PARKINSONISM:IN RELATIONSHIP WITH FRONTAL LOBE SYMPTOMS 二橋宏嘉 ¹ , 吉田充男 ¹ Hiroyoshi Nihashi ¹ , Mitsuo Yoshida ¹ ¹自治医科大学神経内科 ¹Department of Neurology, Jichi Medical School pp.261-266

発行日 1988年3月1日 Published Date 1988/3/1

DOI https://doi.org/10.11477/mf.1406206073

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Abstract 文献概要
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　抄録　大脳基底核に認識機能が存在するか否かについて，大きな議論がある。前頭葉症状をテストするModified Wisconsin Card Sorting Test （MCST）を使用して，13例のパーキンソニズム患者を12例の対照群と比較検討した。MCST上，パーキンソニズム群では4例に誤りが見られた。その内容を検討すると，保続による誤りの率が高い。この保続による誤りの率を両群で検討すると，パーキンソニズム群では対照群と同じ分布を示すほかに，55％以上と高いところにもう一つのピークが存在し，このピークは上記の4例と合致した。さらに，臨床的な検討で，これらの症例は強制把握，Gegenhalten，口とがらし反射などの前頭葉症状を示すか，あるいはWAIS，長谷川式簡易知能テスト上，軽度ないし中等度の痴呆を示した。近年パーキンソン病で，大脳基底核以外の病変が報告され，MCSTは大脳基底核以外への病変の広がりを知る上で有用と考えられた。2例の尾状核萎縮が著明なchorea-acanthocytosisの患者の結果と合せると，大脳基底核それ自体には認識機能は存在しないとの結論にいたった。

Whether the basal ganglia have a cognitive function or not is a worldwide dispute. We have examined 13 parkinsonian patients and 12 age-matched non-parkinsonian controls using the Mo-dified Wisconsin Card Sorting Test (MCST). All 12 controls could achieve all 6 sets of categories which were successively changed. On the other hand, in the parkinsonians, 9 patients could achieve all 6 sets, but 4 patients could do only 4 to 0 sets. The difference between the two groups was statistically significant. These 4 patients who showed poor achievement on MCST had tendency showing higher percentage of perseverative er-rors. Taking the proportion of perseverative er-ror (PE) to total error (TE) revealed that the parkinsonian group had a peak ranged from 55% to 65% which meant higher occurence of perse-verative errors. When the 4 parkinsonians whose proportion of PE/TE on MCST was over 55% were excluded, a comparison of the parkinsonians with the controls showed no significant difference statistically in both groups. There were no clinical differences based upon Yahr's classifica-tion between the 4 parkinsonians with poor MCST score and those with the normal score. Among these parkinsonians whose proportion of PE/TE ranged from 55% to 65%, 3 cases showed apparent frontal lobe signs and 3 mild dementia on Wechsler Intelligence Scale for Adults. Two patients with chorea-acanthocytosis and showing a marked atrophy of the caudate nucleus were also examined. They showed excellent results on MCST.

The results indicate firstly that in the basal ganglia the cognitive function does not exist and secondly that MCST is a quite easy test to know the extent of the pathological processes outside the basal ganglia in the patients with parkinsonism.