Clinical Neurophysiology, Department of Neurosciences, Ophthalmology and Genetics, University of Genoa, Italy.
Neurobiol Aging. 2012 Jun;33(6):1127.e11-20. doi: 10.1016/j.neurobiolaging.2011.11.028. Epub 2012 Jan 5.
Subtle cognitive impairment can be detected in early Parkinson's disease (PD). In a consecutive series of de novo, drug-naive PD patients, we applied stepwise regression analysis to assess which clinical, neuropsychological, and functional neuroimaging (dopamine transporter [DAT] and perfusion single photon emission computed tomography [SPECT]) characteristics at baseline was predictive of cognitive decline during an average follow-up time of about 4 years. Decline both in executive (R(2) = 0.54; p = 0.0001) and visuospatial (R(2) = 0.56; p = 0.0001) functions was predicted by the couple of Unified Parkinson's Disease Rating Scale (UPDRS)-III score and caudate dopamine transporter (DAT) uptake in the less affected hemisphere (LAH). Verbal memory and language decline was predicted instead by caudate DAT uptake and brain perfusion in a posterior parieto-temporal area of the less affected hemisphere (R(2) = 0.42; p = 0.0005). No significant effect was shown for age, baseline neuropsychological scores, and levodopa equivalent dose at follow-up. The combined use of clinical structured examination and brain functional assessment by means of dual single photon emission computed tomography imaging appears as a powerful approach to predict cognitive decline in de novo PD patients.
早期帕金森病 (PD) 可检测到微妙的认知障碍。在一系列连续的新发、未经药物治疗的 PD 患者中，我们应用逐步回归分析来评估基线时哪些临床、神经心理学和功能神经影像学（多巴胺转运体 [DAT] 和灌注单光子发射计算机断层扫描 [SPECT]）特征可预测平均随访约 4 年期间的认知下降。执行功能（R(2) = 0.54；p = 0.0001）和视空间功能（R(2) = 0.56；p = 0.0001）下降均由统一帕金森病评定量表（UPDRS）-III 评分和未受影响侧（LAH）尾状核 DAT 摄取的耦合来预测。相反，语言记忆和语言下降则由尾状核 DAT 摄取和未受影响侧后顶颞叶区域的脑灌注来预测（R(2) = 0.42；p = 0.0005）。在随访时，年龄、基线神经心理学评分和左旋多巴等效剂量对认知下降无显著影响。联合使用临床结构检查和通过双重单光子发射计算机断层扫描成像进行大脑功能评估是一种预测新发 PD 患者认知下降的有力方法。
