Department of Neurology, First Affiliated Hospital, China Medical University, Heping District, Shenyang, China.
Dement Geriatr Cogn Disord. 2010;30(1):64-70. doi: 10.1159/000314682. Epub 2010 Aug 5.
BACKGROUND/AIMS: Cognitive impairment (CI) is common in Parkinson's disease (PD), and the cognitive deterioration rate (CDR) is heterogeneous among PD patients. However, very few studies have reported on the association of PD features and risk factors with rapid CDR. The Montreal Cognitive Assessment (MoCA) is considered to be a sensitive and reliable approach to detect mild CI. In the present study, we sought to define and compare the cognitive profiles and clinical features of PD patients with slow or rapid CDRs, and then to identify the PD risk factors associated with rapid CDR.
A cross-sectional study of cognitive rate was performed using the MoCA in a cohort of 73 PD patients and 41 controls matched for age, sex and education level.
The rapid CDR group was characterized by older age (58.8 years in slow CDR vs. 64.1 in rapid CDR; p = 0.02), later age at disease onset (52.7 vs. 61.7 years; p < 0.001), a faster deterioration rate of movement symptoms (UPDRS III increment of 12.8 vs. 5.9/year; p < 0.001), a higher rate in multiple-domain CI (38.9 vs. 10.8%), and generally lower MoCA subscores for the Clock Drawing Test, attention, verbal fluency and abstraction. According to the univariate logistic regression model, onset age, movement deterioration rate, multiple domains CI and executive function CI were risk factors for rapid CDR. However, only the movement deterioration rate (p = 0.01) and onset age (p = 0.05) remained independent predictors for rapid CDR according to the multivariate logistic regression model.
The CI deterioration in a subset of PD patients appears to progress more rapidly. Identifying those PD patients may not only help to predict the development of PD dementia, but also facilitate therapeutic intervention at early disease stages.
背景/目的：认知障碍（CI）在帕金森病（PD）中很常见，PD 患者的认知恶化率（CDR）存在异质性。然而，很少有研究报道 PD 特征和危险因素与快速 CDR 的关系。蒙特利尔认知评估（MoCA）被认为是一种敏感和可靠的方法，可以检测轻度 CI。本研究旨在定义和比较 CDR 缓慢和快速的 PD 患者的认知特征和临床特征，然后确定与快速 CDR 相关的 PD 危险因素。
对 73 例 PD 患者和 41 例年龄、性别和教育程度相匹配的对照组进行 MoCA 认知率的横断面研究。
快速 CDR 组的特点是年龄较大（慢 CDR 组为 58.8 岁，快 CDR 组为 64.1 岁；p = 0.02），发病年龄较晚（52.7 岁 vs. 61.7 岁；p < 0.001），运动症状恶化速度较快（UPDRS III 增加 12.8 分 vs. 5.9 分/年；p < 0.001），多领域 CI 发生率较高（38.9% vs. 10.8%），一般 MoCA 测试、注意力、语言流畅性和抽象的子评分较低。根据单因素 logistic 回归模型，发病年龄、运动恶化率、多领域 CI 和执行功能 CI 是快速 CDR 的危险因素。然而，只有运动恶化率（p = 0.01）和发病年龄（p = 0.05）根据多因素 logistic 回归模型仍然是快速 CDR 的独立预测因素。
一部分 PD 患者的 CI 恶化似乎进展得更快。识别这些 PD 患者不仅有助于预测 PD 痴呆的发生，还可以在疾病早期阶段促进治疗干预。
