Alves Guido, Larsen Jan Petter, Emre Murat, Wentzel-Larsen Tore, Aarsland Dag
The Norwegian Center for Movement Disorders, Stavanger, Norway.
Mov Disord. 2006 Aug;21(8):1123-30. doi: 10.1002/mds.20897.
The objective of this study was to assess the temporal relationship between changes in predominant motor symptoms and incident dementia in Parkinson's disease (PD). A community-based sample of 171 nondemented patients with PD was followed prospectively and examined at baseline and after 4 and 8 years. The motor subtype of Parkinsonism was classified into tremor-dominant (TD), indeterminate, or postural instability gait difficulty (PIGD) subtype at each visit, based on defined items in the Unified Parkinson's Disease Rating Scale, subscales II and III. Dementia was diagnosed according to DSM-III-R criteria, based on clinical interview, cognitive rating scales, and neuropsychological examination. Logistic regression was used to analyze the relationship between subtype of Parkinsonism and dementia. Transition from TD to PIGD subtype was associated with a more than threefold increase in the rate of Mini-Mental State Examination decline. Compared to patients with persistent TD or indeterminate subtype, the odds ratio for dementia was 56.7 (95% CI: 4.0-808.4; P = 0.003) for patients changing from TD or indeterminate subtype to PIGD subtype, and 80.0 (95% CI: 4.6-1400.1; P = 0.003) for patients with persistent PIGD subtype. Patients with TD subtype at baseline did not become demented until they developed PIGD subtype, and dementia did not occur among patients with persistent TD subtype of Parkinsonism. In a substantial proportion of PD patients who develop postural instability and gait disorder during the course of the disease, this transition is associated with accelerated cognitive decline and highly increased risk for subsequent dementia. These findings raise the question whether PIGD and dementia share common or parallel neuropathology.
本研究的目的是评估帕金森病（PD）中主要运动症状变化与新发痴呆之间的时间关系。对171例非痴呆PD患者的社区样本进行前瞻性随访，并在基线、4年和8年后进行检查。根据统一帕金森病评定量表第二和第三分量表中的定义项目，在每次就诊时将帕金森综合征的运动亚型分为震颤为主型（TD）、不确定型或姿势不稳步态障碍（PIGD）亚型。根据DSM-III-R标准，通过临床访谈、认知评定量表和神经心理学检查来诊断痴呆。采用逻辑回归分析帕金森综合征亚型与痴呆之间的关系。从TD亚型向PIGD亚型的转变与简易精神状态检查评分下降率增加三倍以上相关。与持续TD或不确定亚型的患者相比，从TD或不确定亚型转变为PIGD亚型的患者患痴呆的优势比为56.7（95%CI：4.0-808.4；P=0.003），持续PIGD亚型的患者为80.0（95%CI：4.6-1400.1；P=0.003）。基线时为TD亚型的患者在出现PIGD亚型之前未发生痴呆，帕金森综合征持续TD亚型的患者未发生痴呆。在相当一部分病程中出现姿势不稳和步态障碍的PD患者中，这种转变与认知功能加速衰退以及随后患痴呆的风险大幅增加相关。这些发现提出了一个问题，即PIGD和痴呆是否共享共同或平行的神经病理学。
