Muslimović Dino, Post Bart, Speelman Johannes D, De Haan Rob J, Schmand Ben
Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
J Int Neuropsychol Soc. 2009 May;15(3):426-37. doi: 10.1017/S1355617709090614.
This controlled prospective study examined the evolution and predictors of cognitive decline in Parkinson's disease (PD). Consecutive patients diagnosed at baseline with PD (n = 89), established PD (EPD) patients (n = 52) with a mean disease duration of 6.5 years, and healthy control subjects (n = 64) underwent extensive neuropsychological assessment twice, approximately 3 years apart. A standardized regression-based method, normative data, and multivariate normative comparisons were used to assess the cognitive course of PD. Cognitive performance of newly diagnosed patients decreased significantly over time, particularly on measures of psychomotor speed and attention and to a lesser extent on tests of memory, visuospatial skills, and executive functions. About 50% of the patients showed cognitive decline and 9% developed dementia. Similar results were observed in EPD patients. None of the baseline features predicted cognitive change in newly diagnosed patients, whereas age at disease onset and axial impairment (postural and gait disorders) contributed to decline in established patients. We conclude that within few years after diagnosis, PD patients show faster rate of cognitive decline than matched healthy subjects, particularly in domains of attention and psychomotor speed. Selection bias probably led to underestimation of the true extent of cognitive decline in established patients.
这项对照前瞻性研究考察了帕金森病（PD）患者认知功能衰退的演变过程及预测因素。对基线时确诊为PD的连续患者（n = 89）、平均病程为6.5年的确诊PD（EPD）患者（n = 52）以及健康对照者（n = 64）进行了两次全面的神经心理学评估，两次评估间隔约3年。采用基于标准化回归的方法、常模数据和多变量常模比较来评估PD患者的认知进程。新确诊患者的认知表现随时间显著下降，尤其是在心理运动速度和注意力方面，在记忆、视觉空间技能和执行功能测试方面下降程度较小。约50%的患者出现认知衰退，9%发展为痴呆。EPD患者也观察到类似结果。新确诊患者的基线特征均不能预测认知变化，而发病年龄和轴性损害（姿势和步态障碍）则导致确诊患者认知功能下降。我们得出结论，在诊断后的几年内，PD患者的认知衰退速度比匹配的健康受试者更快，尤其是在注意力和心理运动速度方面。选择偏倚可能导致对确诊患者认知衰退真实程度的低估。
