Kognitivní porucha u Parkinsonovy nemoci

• Název práce v češtině: Kognitivní porucha u Parkinsonovy nemoci
• Název v anglickém jazyce: Cognitive Impairment in Parkinson’s Disease
• Klíčová slova: Parkinsonova nemoc, kognitivní funkce, mírná kognitivní porucha, poruchy hybnosti, pády, syndrom demence
• Klíčová slova anglicky: Parkinson’s disease, cognitive functions, dementia, gait disorder, falls, mild cognitive impairment
• Akademický rok vypsání: 2013/2014
• Typ práce: disertační práce
• Jazyk práce: čeština
• Ústav: Neurologická klinika 1. LF UK a VFN (11-00600)
• Vedoucí / školitel: prof. MUDr. Evžen Růžička, DrSc.
• Řešitel: skrytý - zadáno a potvrzeno stud. odd.
• Datum přihlášení: 12.09.2008
• Datum zadání: 16.06.2014
• Datum potvrzení stud. oddělením: 16.06.2014
• Datum a čas obhajoby: 08.09.2014 14:00
• Místo konání obhajoby: Neurologická klinika 1. LF UK a VFN
• Datum odevzdání elektronické podoby: 18.06.2014
• Datum proběhlé obhajoby: 08.09.2014
• Předmět: Obhajoba dizertační práce (B90002)
• Oponenti: prof. MUDr. Hana Papežová, CSc.

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Předběžná náplň práce

Abstrakt
Poruchy kognitivních funkcí se považují za součást tzv. non-motorických projevů Parkinsonovy nemoci (PN). Dochází k nim v důsledku rozvoje patologických změn v mozku a jejich postižení významně zhoršuje kvalitu života pacientů s PN. Tato práce popisuje strukturu a profil kognitivního deficitu u PN. Zaměřuje se detailním způsobem na dvě základní oblasti deficitu: exekutivní funkce a paměť. Na příkladu diagnostických jednotek vyvinutých pro popis postižení kognice u PN, jako je mírná kognitivní porucha (PN-MKP) a syndrom demence (PN-D), práce dokládá, že kognitivní poruchy u Parkinsonovy nemoci mají heterogenní strukturu a variabilní tíži. Neuropsychologické metody k vyšetření PN-D a PN-MKP však nebyly dosud plně k dispozici v české verzi. Mezi cíli této práce proto byly validační a normativní studie vybraných nástrojů k diagnostice PN-MKP a PN-D. V experimentální části pak byla testována hypotéza, zda motorické funkce jsou u PN úzce provázány s kognitivními a zda pacienti s PN a poruchou chůze s pády mají horší kognitivní výkon než pacienti bez pádů.
Pomocí celkem devíti validačních nebo normativních studií dokladujeme psychometrické vlastnosti a klinickou užitečnost jednotlivých nástrojů pro vyšetření paměti (paměťový test učení, kalifornský test verbálního učení, test prospektivní paměti, Groberové-Buschkeho test 16 slov), pozornost a exekutivní funkce (test cesty), aktivity denního života (dotazník funkčního stavu) či screening kognitivních funkcí (montrealský kognitivní test) na české populaci. V části experimentální dokládáme úzkou provázanost pádů u PN s vyšší mírou postižení kognitivních funkcí (syndrom demence) a zároveň s postižením hybnosti horních končetin (v testu dírkované desky).
Tyto výsledky poukazují na vazbu mezi progresí axiální složky postižení u PN (porucha chůze s pády) a rozvojem kognitivního deficitu. Dále do diagnostického vyšetření kognitivních funkcí u PN, ale i obecně u neurodegenerativních onemocnění zavádí několik validovaných metod v české verzi s rozsáhlým statistickým aparátem pro přesný odhad úrovně kognitivních funkcí.

Předběžná náplň práce v anglickém jazyce

Abstract
Cognitive impairment is considered as essential feature of non-motor symptoms in Parkinson’s disease (PD). It is a result of underlying pathological processes in the brain of PD patients and it leads to decreased quality of life. In this thesis an analysis of the structure and profile of cognitive impairment is presented with special emphasis on executive functions and memory. We take diagnostic entities developed for the description of PD cognitive spectrum such as mild cognitive impairment (PD-MCI) and dementia (PD-D) as examples of heterogeneity and different severity of cognitive impairment in PD. However, neuropsychological methods in Czech version that would measure these diagnotic units were not adequatly validated. In the experimental part we test a hypothesis, if gait disorder with falls in PD is interconnected with cognitive impairment, and if PD-fallers have more severe cognitive deficit than PD-non-fallers.
On the basis of nine validity or normative data studies we show psychometric properties and clinical utility of several basic neuropsychological methods in the Czech population for memory (Rey Auditory Verbal Learning Test, California Verbal Learning Test, Second Edition, Memory For Intentions Screening Test and Enhanced Cued Recall Test), sustained attention and executive functions (Trail Making Test), activities of daily living (Functional Activities Questionnaire) and general cognitive functioning (Montreal Cognitive Assessment). In the experimental part we document that PD-fallers are more often demented than PD-non-fallers and that their upper limbs motor deficits in the Grooved Pegboard Test are intertwined with their lower limbs gait disorder and falls.
These results reveal a strong relation between the progression of the axial deficits (gait disorder with falls) and more severe cognitive impairment in PD-fallers group. Moreover, we introduce several basic methods with robust statistical data and detailed psychometric analyses into the neuropsychological assessment of PD in the Czech Republic. These tests are helpful when estimating level of cognitive functioning not only in PD but in neurodegenerative diseases in general.