帕金森病轻度认知障碍亚型的临床差异。
Clinical differences among mild cognitive impairment subtypes in Parkinson's disease.
机构信息
Department of Neurological Sciences, Rush University Medical Center, Chicago, IL 60612, USA.
出版信息
Mov Disord. 2012 Aug;27(9):1129-36. doi: 10.1002/mds.25062. Epub 2012 Jul 6.
Mild cognitive impairment is increasingly recognized as a construct in Parkinson's disease (PD) and occurs in about 25% of nondemented PD patients. Although executive dysfunction is the most frequent type of cognitive deficit in PD, the cognitive phenotype of PD mild cognitive impairment (PD-MCI) is broad. PD-MCI subtypes are represented by amnestic and nonamnestic domain impairment as well as single- and multiple-domain impairment. However, it is unclear whether patients with different PD-MCI subtypes also differ in other clinical characteristics in addition to cognitive profile. We studied 128 PD-MCI subjects at our Movement Disorders center, comparing clinical, motor, and behavioral characteristics across the PD-MCI subtypes. We found varying proportions of impairment subtypes: nonamnestic single domain, 47.7%; amnestic multiple domain, 24.2%; amnestic single domain, 18.8%; and nonamnestic multiple domain, 9.5%. Attentional/executive functioning and visuospatial abilities were the most frequently impaired domains. PD-MCI subtypes differed in their motor features, with nonamnestic multiple-domain PD-MCI subjects showing particularly pronounced problems with postural instability and gait. Differences among PD-MCI subtypes in age, PD duration, medication use, mood or behavioral disturbances, and vascular disease were not significant. Thus, in addition to differing cognitive profiles, PD-MCI subtypes differed in motor phenotype and severity but not in mood, behavioral, or vascular comorbidities. Greater postural instability and gait disturbances in the nonamnestic multiple-domain subtype emphasize shared nondopaminergic neural substrates of gait and cognition in PD. Furthermore, increased burden of cognitive dysfunction, rather than type of cognitive deficit, may be associated with greater motor impairment in PD-MCI.
轻度认知障碍在帕金森病(PD)中越来越被认为是一种结构,约 25%的非痴呆 PD 患者存在轻度认知障碍。虽然执行功能障碍是 PD 最常见的认知缺陷类型,但 PD 轻度认知障碍(PD-MCI)的认知表型广泛。PD-MCI 亚型表现为遗忘和非遗忘域损伤以及单域和多域损伤。然而,除了认知特征外,不同 PD-MCI 亚型的患者在其他临床特征上是否也存在差异尚不清楚。我们在我们的运动障碍中心研究了 128 名 PD-MCI 患者,比较了 PD-MCI 亚型之间的临床、运动和行为特征。我们发现不同的损伤亚型比例:非遗忘单域,47.7%;遗忘多域,24.2%;遗忘单域,18.8%;非遗忘多域,9.5%。注意力/执行功能和视空间能力是最常受损的领域。PD-MCI 亚型在运动特征上存在差异,非遗忘多域 PD-MCI 患者在姿势不稳和步态方面表现出特别明显的问题。PD-MCI 亚型在年龄、PD 病程、药物使用、情绪或行为障碍以及血管疾病方面的差异没有统计学意义。因此,除了认知特征不同外,PD-MCI 亚型在运动表型和严重程度上存在差异,但在情绪、行为或血管合并症方面没有差异。非遗忘多域亚型中姿势不稳和步态障碍更严重,强调了 PD 中步态和认知的共同非多巴胺能神经基础。此外,认知功能障碍的负担增加,而不是认知缺陷的类型,可能与 PD-MCI 中的更大运动障碍有关。