Correlation Between Attention Network Function And Fatigue In Patients With Parkinson’s Disease

Background and ObjectiveParkinson disease(PD),also known as tremor paralysis,is a neurodegenerative disease common in middle-aged and elderly people.It shows clinical disability with different degrees of motor and non-motor symptoms.The main motor performance of PD includes bradykinesia,resting tremor,muscle rigidity and posture balance disorder.In the past,PD was considered to be a simple dyskinesia disease.More and more studies have found that non-motor symptoms such as olfactory hypothermia,depression,constipation,fatigue,etc.have occurred before the onset of PD motor symptoms.At the same time,the current study found that cognitive dysfunction is a common non-motor symptom in PD patients,which exists in various stages of PD,mainly involving executive function and attention.Fatigue is one of the symptoms of disability in Parkinson’s disease.Fatigue is also a common,independent,non-motor symptom in Parkinson’s disease and persists throughout the disease,affecting up to 58% of PD patients and further worsening the patient’s quality of life.Fatigue is also thought to be related to the cognitive field.There is literature showing that fatigue plays an important role in cognitive impairment in multiple sclerosis.Attention is an important cognitive function,composed of complex systems that supervise different neural circuits,and can be defined by the ability to correctly assign processing resources to relevant stimuli.Michael Posner’s first attention to network theory points to at least three key types of super-mode attention,alerting,orienting,and execution,each of which has an independent network of functions and anatomy.A simple and reliable way to study these three attention networks is through Attention Networks Test(ANT),which was first proposed by Fan et al.Some studies have suggested that attention deficits exist in patients with early PD,but which aspect of the attention network that specifically affects PD patients has different conclusions.Although cognitive dysfunction has been widely confirmed in PD,it is unclear whether fatigue affects cognitive function and viceversa.The purpose of this study was to investigate the characteristics of attention network in PD patients and the relationship between fatigue symptoms and attention to network efficiency to better understand the relationship between fatigue and cognitive function.Further understanding the pathogenesis of fatigue and early identification and prediction of cognitive dysfunction patients with early intervention to reduce the patient’s condition further development and deterioration,improve patients’ quality of life,reduce the economic burden of patients’ families.Materials and MethodsOne hundred and two patients with Parkinson’s disease who were admitted and diagnosed in the Department of Neurology,Zhengzhou University Second Affiliated Hospital and Henan Provincial People’s Hospital from February 2018 to February 2019,and evaluated by the Fatigue Severity Scale.The patient’s fatigue symptoms were divided into PD fatigue group with FSS average score ≥4,and FSS average score <4 divided into PD non-fatigue group.At the same time,50 healthy volunteers whose age and gender matched the physical examination in our hospital were selected as control group.All patientswere evaluated by Hoehn-Yahr stages,unified Parkinson’s disease rating scale Part III,Mini-Mental Status Examination,Hamilton Depression Scale,Hamilton anxiety Scale and Pittsburgh Sleep Quality Index.ANT tests are performed on all participants.Results(1)There are 102 patients with Parkinson’s disease,46 patients had fatigue symptoms,and the incidence rate was 46.08%.(2)There was a statistically significant difference between the total RT of the PDF and PDnF patients and the RT of the HC group(P<0.001).The accuracy of patients in the PDF and PDnF groups was lower than that in the HC group,and the difference was statistically significant(P<0.001).There were statistically significant differences between the executive network function of the PDF and PDnF patients and the executive network function of the HC group(P<0.001).There was no statistically significant difference in the alert function and orientation function between the patients in the PDF and PDnF groups and the HC group.(3)There was no significant difference in the total RT between the PDF group and the PDnF group and the accuracy was statistically significantbetween the PDF group and the PDnF group(P<0.001).There was a statistically significant difference in the performance of the network between the PDF group and the PDnF group(P < 0.001).There was no statistically significant difference in alert network efficiency and directional function between the PDF group and the PDnF group.The total RT of PD patients was positively correlated with FSS score(r=0.212,P=0.032).The executive network function of PD patients was positively correlated with FSS score,the correlation was the strongest(r=0.539,P=0.000),directional network,alertness There was no correlation between the network and the FSS score(P>0.05),and the accuracy was negatively correlated with the FSS score(r=-0.429,P=0.000).Conclusions(1)The prevalence of fatigue in PD patients was 46.08%;(2)The PD patients’ attention to network function decline,mainly manifested in the impaired performance of the execution network function,while the attentional orientation network and alert network functions remain in the PD patients.(3)The existence of fatigue is related to the implementation network of PD patients with low efficiency.Fatigue is associated with cognitive impairment in PD patients.Fatigue may be one of the potential predictors of cognitive decline in PD patients.