Department of Neuroscience, University of Pisa, Pisa I56125, Italy.
J Neurol Neurosurg Psychiatry. 2012 Jun;83(6):601-6. doi: 10.1136/jnnp-2011-301874. Epub 2012 Apr 4.
(1) To establish the prevalence of mild cognitive impairment (MCI) in newly diagnosed drug-naive patients with Parkinson's disease adopting recently proposed and more conservative preliminary research criteria. (2) To investigate the relation between cognitive performances, MCI and motor dysfunction.
132 consecutive newly diagnosed drug-naive PD patients and 100 healthy controls (HCs) underwent a neuropsychological evaluation covering different cognitive domains. Moreover, on the basis of the Unified Parkinson's Disease Rating Scale II/III, different motor scores were calculated and patients were classified in motor subtypes. 11 patients were excluded from the analysis during clinical follow-up which was continued at least 3 years from the diagnosis; therefore, the final sample included 121 patients.
MCI prevalence was higher in PD (14.8%) patients than in HCs (7.0%). PD patients reported lower cognitive performances than HCs in several cognitive domains; HCs also outperformed cognitively preserved PD patients in tasks of episodic verbal memory and in a screening task of executive functions. MCI-PD patients presented a more severe bradykinesia score than non-MCI PD patients and patients mainly characterised by tremor had better performances in some cognitive domains, and specific cognitive-motor relationships emerged.
Although the adoption of more conservative diagnostic criteria identified a lower MCI prevalence, we found evidence that newly diagnosed drug-naive PD patients present a higher risk of MCI in comparison with HCs. Axial symptoms and bradykinesia represent risk factors for MCI in PD patients and a classification of PD patients that highlights the presence/absence of tremor, as proposed in this study, is probably better tailored for the early stages of PD than classifications proposed for more advanced PD stages.
(1) 采用最近提出的更为保守的初步研究标准，确定新诊断的未经药物治疗的帕金森病患者中轻度认知障碍（MCI）的患病率。(2) 研究认知表现、MCI 与运动功能障碍之间的关系。
132 例连续新诊断的未经药物治疗的 PD 患者和 100 例健康对照者（HCs）接受了涵盖不同认知领域的神经心理学评估。此外，根据统一帕金森病评定量表 II/III，计算了不同的运动评分，并根据运动亚型对患者进行了分类。在临床随访过程中有 11 例患者被排除在分析之外，随访时间从诊断开始至少持续 3 年；因此，最终样本包括 121 例患者。
PD 患者的 MCI 患病率（14.8%）高于 HCs（7.0%）。与 HCs 相比，PD 患者在几个认知领域的认知表现更差；在情景性言语记忆任务和执行功能筛查任务中，HCs 也优于认知保留的 PD 患者。MCI-PD 患者的运动迟缓评分比非 MCI-PD 患者更严重，而主要表现为震颤的患者在一些认知领域表现更好，并且出现了特定的认知-运动关系。
尽管采用了更为保守的诊断标准，MCI 的患病率有所降低，但我们发现新诊断的未经药物治疗的 PD 患者与 HCs 相比，MCI 的风险更高。轴性症状和运动迟缓是 PD 患者发生 MCI 的危险因素，如本研究中所提出的，根据是否存在震颤对 PD 患者进行分类可能比针对更晚期 PD 阶段提出的分类更适合 PD 的早期阶段。
