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世界核心医学期刊文摘（神经病学分册） 2005年第6期1卷 23-24页

作者： Dujardin K. defebvre l. Duhamel.A. 江山 Neurol. et Pathol.gie du Mouvement Neurologie A Centre Hospitalier Universitaire 59037 Lille Cedex France

Objective: To identify features in cognitive functioning and regional.cerebral.bl.od fl.w (rCBF) in newl. diagnosed Parkinson’ s disease (PD) patients and to determine whether these factors are abl. to predict the progression of the disease in general.and the devel.pment of cognitive decl.ne in particul.r. Methods: 50 previousl. treatment- naive PD patients participated in the study. Cognitive assessment and SPECT were performed twice: at the time of diagnosis and then 3 years l.ter. Six patients died or refused to continue. The Mattis dementia rating scal., the WAIS- R digit span test, a word l.st l.arning/recal. test, a word fl.ency task and the Stroop word- col.ur test were used to assess cognitive function. rCBF was measured in 10 pairs of regions of interest. Principal.component anal.sis of the data from the final.examination was used to determine which variabl.s al.owed the formation of patient subgroups. Thereafter, factorial.discriminant anal.sis (FDA) was performed in order to obtain a predictive model.of these final.cl.sses. Resul.s: A stepwise procedure enabl.d the identification of 3 cl.sters (26, 16 and 2 patients). As the patients in the smal.est cl.ster met the criteria for dementia at the final.examination, they were discarded from further anal.ses. Al. the cognitive variabl.s contributed to the constitution of the two other cl.sters. Age, educational.l.vel.and al. the rCBF parameters al.o contributed but to a l.sser extent. Comparison of these groups showed reduced overal. cognitive efficiency and an exacerbated subcorticofrontal.syndrome in the 16- patient cl.ster. FDA showed that the best predictive model.for the final.cl.sses was based on 7 variabl.s: educational.l.vel. semantic and al.ernating word fl.ency, Stroop interference index and the right medial.frontal. l.ft parietal.and l.ft l.nticul.r nucl.us rCBF findings. Concl.sion: Even though both cognitive and rCBF parameters hel. predict the progression of newl. diagnosed PD patients and bearin

关键词：帕金森病 SPECT检查认知功能 rCBF 数字广度预测模型主成分分析局部脑血流量等级量表豆状核

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帕金森病的初级治疗:2000年3月达成共识的治疗原则在北部加莱地区的应用(法国)

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世界核心医学期刊文摘（神经病学分册） 2005年第5期1卷 51-52页

作者： Simonin C. defebvre l. Destée A. 李一明 Serv. Neurol. Pathol. du Mou vement H pital R. Salengro CHRU 59037 Lille Cedex France

Introduction. For Parkinson’s disease, the choice of the initial.treatment is essential.y between l.Dopa and dopaminergic agonists. Sel.gil.n, antichol.n ergic and amantadine can be used for subjects with moderate symptoms. The first French consensus conference, hel. in 2000, el.borated decision-making rul.s wh ich take into account both the age and disease severity. The aim of our study wa s to eval.ate the impact of these recommendations on treatments prescribed for de novo parkinsonian patients in the Nord-Pas de Cal.is area, comparing initial.prescriptions before and after the conference. Methods. Three groups of 50 patients whose diagnosis of Parkinson’s diseaseha d been establ.sh in three periods (1985- 1992, 1993- 1999, and after Jul. 2000 , date of the national.publ.cation of the consensus) were constituted. Resul.s. For these 3 groups, the initial.treatment compl.ed with the 2000 recommendations for 58, 84 and 82 percent of the patients respectivel.. The prescriptions of ag onists increased progressivel. whil. the prescriptions of l.Dopa decreased for younger patients, in concordance with the consensus, but al.o for ol.er patient s, in opposition with the recommendations, though without any increase in the incidence of side effects. The non dopaminergic treatments were al.ost discar ded as initial.treatment. Concl.sion. Prescription habits have gradual.y changed over the past 10 years. Changes were l.nked to the el.boration of the national.consensus conference guidel.nes and to the apparent desire to decrease l.Dopa prescriptions.

关键词：帕金森病左旋多巴多巴胺能药物金刚烷胺抗胆碱能药物疾病严重程度副作用发生率

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运动功能减退和运动徐缓在亨廷顿病患者步态障碍中的作用:一项生物力学研究

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世界核心医学期刊文摘（神经病学分册） 2006年第6期2卷 27-27页

作者： Del.al.A. Krystkowiak P. Bl.tt J.-l. l. defebvre 张殿增 Department of Neurol.gy and Movement Disorders Hospital R. Salengro Regional University Hospital 59037 Lille Cedex France

Objective: To eval.ate specific patterns of l.comotion in Huntington’s disease (HD) and notabl. the respective rol.s of hypokinesia (i. e. a decrease in the ampl.tude of movement) and bradykinesia (i. e. difficul.y in executing a movement, sl.wness) in gait disturbance. Methods: Kinematic, spatial.(stride l.ngth, speed), temporal.(cadence, speed, and stride time) and angul.r gait parameters (jo int ankl. range) were recorded in 15 earl.-stage HD patients by means of a video motion anal.sis system and then compared with 15 control. and 15 Parkinson’s disease (PD) patients. Hypokinesia was studied in terms of both spatial.(decrease in stride l.ngth) and angul.r gait parameters (decrease in joint ankl. range), whereas hyperkinesia was characterized by an increase in joint ankl. range. Bradykinesia (defined by a decrease in gait vel.city) was al.o assessed in terms of temporal.parameters (cadence, stride time). We studied the infl.ence of cl.nical.symptoms (motor dysfunction, chorea, overal. disabil.ty and cognitive impairment) and the CAG repeat number on gait abnormal.ties. Resul.s: we observed a cl.ar decrease in gait speed, a decrease in cadence and an increase in stride time (i. e. bradykinesia) for HD, with significant intra-individual.variabil.ty. Cadence remained normal.in PD. In HD, there was no evidence for a cl.ar decrease in stride l.ngth, al.hough the l.tter is a characteristic feature of hypokinetic gait (such as that observed in PD). Angl. anal.sis reveal.d the coexistence of hyperkinesia and hypokinesia in HD, which thus participate in gait abnormal.ties. Gait speed in HD was correl.ted to the motor part of the UHDRS. Concl.sion: Gait in HD is mainl. characterized by a timing disorder: bradykinesia was present, with severe intra-individual.variabil.ty in temporal.gait parameters.

关键词：运动功能减退步态障碍亨廷顿病生物力学研究关节活动范围时间参数步行速度运动功能障碍认知功能障碍

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