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帕金森病中的认知障碍:诊断与评估工具

Cognitive impairment in Parkinson's disease: tools for diagnosis and assessment.

作者信息

Kulisevsky Jaime, Pagonabarraga Javier

机构信息

Movement Disorders Unit, Neurology Department, Hospital de Sant Pau, Barcelona, Spain.

出版信息

Mov Disord. 2009 Jun 15;24(8):1103-10. doi: 10.1002/mds.22506.

Abstract

Cognitive impairment (CI) and dementia are frequent and debilitating features associated with Parkinson's disease (PD). Formal neuropsychological examination is required to ascertain the degree and pattern of CI over the course of the disease. The use of different tools may explain heterogeneous data obtained from studies to date. Normative data for extensively used scales [Mattis Dementia Rating Scale (MDRS), Mini-Mental State Examination (MMSE)] is incomplete in PD populations. According to sample characteristics, statistical analyses, and methodological quality, 33 studies using scales not specific to PD (MDRS, MMSE, Cambridge Cognitive Assessment, FAB) or PD-specific scales (Mini-Mental Parkinson, Scales for Outcomes of Parkinson's disease-Cognition, Parkinson's Disease-Cognitive Rating Scale, and Parkinson Neuropsychometric Dementia Assessment) were eligible for the critical analysis of their appropriateness to assess cognition in PD. Of the four scales specifically designed for PD, the SCOPA-COG and the PD-CRS have undergone extensive and rigorous validation processes. While the SCOPA-COG mainly assesses "frontal-subcortical" cognitive defects, the PD-CRS also assesses "instrumental-cortical" functions, allowing better characterization of the different patterns of CI that may be present in PD from the earliest stages. The MMP and PANDA scales were designed as brief screening tests for CI and have not yet been subjected to extensive clinimetric evaluations. Further research on PD-specific tools seems mandatory to help establish accurate cut-off scores for the diagnosis of mild PDD, detect cognitive profiles more prone to the future development of dementia, and allow comparisons between different descriptive or interventional studies.

摘要

认知障碍(CI)和痴呆是帕金森病(PD)常见且使人衰弱的特征。需要进行正式的神经心理学检查以确定疾病过程中CI的程度和模式。使用不同的工具可能解释了迄今从研究中获得的异质性数据。广泛使用的量表[马蒂斯痴呆评定量表(MDRS)、简易精神状态检查表(MMSE)]在PD人群中的标准化数据并不完整。根据样本特征、统计分析和方法学质量,33项使用非PD特异性量表(MDRS、MMSE、剑桥认知评估、FAB)或PD特异性量表(简易精神帕金森量表、帕金森病认知结局量表、帕金森病认知评定量表和帕金森神经心理痴呆评估)的研究符合对其评估PD认知适宜性的批判性分析要求。在专门为PD设计的四个量表中,帕金森病认知功能统一评定量表(SCOPA-COG)和帕金森病认知评定量表(PD-CRS)已经历了广泛而严格的验证过程。虽然SCOPA-COG主要评估“额叶-皮质下”认知缺陷,但PD-CRS还评估“工具性-皮质”功能,从而能够更好地描述PD早期可能存在的不同CI模式。简易精神帕金森量表(MMP)和帕金森神经心理痴呆评估量表(PANDA)被设计为CI的简短筛查测试,尚未经过广泛的临床测量学评估。对PD特异性工具进行进一步研究似乎是必要的,以帮助建立轻度帕金森病痴呆(PDD)诊断的准确临界值,检测更易发展为未来痴呆的认知特征,并允许不同描述性或干预性研究之间进行比较。

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