Department of Neurology, University Hospital 12 de Octubre, Madrid, Spain.
J Neurol Sci. 2011 Nov 15;310(1-2):176-82. doi: 10.1016/j.jns.2011.06.054. Epub 2011 Jul 21.
Population-based assessments of cognitive function in patients with early Parkinson's disease (PD) are rare. We examined whether patients with early PD have cognitive deficits when compared with matched controls
All participants were age 65 years or older (median=76 years) and were enrolled in the Neurological Disorders in Central Spain (NEDICES) study in central Spain. We identified all participants with early PD (<5 years duration) (N=46). These were matched to 138 controls. Neuropsychological test scores were compared in PD patients vs. controls. In logistic regression models, we adjusted for the effects of confounding variables. In these models, the dependent variable was the neuropsychological test score (lowest quartile vs. all other quartiles) and the independent variable was PD vs. control.
Sixteen of 46 patients (34.8%) with early PD were previously undiagnosed. Subjective memory complaint was present in 27 (58.7%) PD patients vs. 51 (37.0%) controls (p=0.010). In logistic regression models that adjusted for gender, education, and depressive symptoms or antidepressant use, PD patients performed less well on the 37-item version of the Mini-Mental State Examination (p=0.04), animal (p<0.001) and fruit fluency (p=0.04) as well as in a delayed free recall memory test (p=0.04) than controls.
In this population-based sample of older patients with early PD, the rate of subjective and object cognitive impairment was appreciable. Patients with PD of less than five years duration performed relatively poorly on tests of global cognition, verbal fluency and memory. Clinicians should be vigilant to these cognitive difficulties even in the early stages of PD.
人群中对早期帕金森病（PD）患者认知功能的评估较为少见。我们研究了与匹配的对照组相比，早期 PD 患者是否存在认知缺陷。
所有参与者年龄均在 65 岁及以上（中位数=76 岁），并参与了西班牙中部的神经紊乱（NEDICES）研究。我们确定了所有早期 PD（<5 年病程）的患者（N=46），并将其与 138 名对照组相匹配。比较 PD 患者与对照组的神经心理学测试评分。在逻辑回归模型中，我们调整了混杂变量的影响。在这些模型中，因变量是神经心理学测试评分（最低四分位数与所有其他四分位数），自变量是 PD 与对照组。
46 名早期 PD 患者中有 16 名（34.8%）之前未被诊断。27 名（58.7%）PD 患者有主观记忆主诉，而 51 名（37.0%）对照组中有主观记忆主诉（p=0.010）。在调整了性别、教育、抑郁症状或使用抗抑郁药的逻辑回归模型中，PD 患者在 37 项简易精神状态检查（p=0.04）、动物（p<0.001）和水果流畅性（p=0.04）以及延迟自由回忆记忆测试（p=0.04）的得分均低于对照组。
在这个基于人群的、有早期 PD 的老年患者样本中，主观和客观认知障碍的发生率较高。病程不到 5 年的 PD 患者在总体认知、语言流畅性和记忆力测试中表现相对较差。即使在 PD 的早期阶段，临床医生也应警惕这些认知困难。
