Department of Neurology, University Hospital 12 de Octubre, Madrid, Spain.
Mov Disord. 2013 Feb;28(2):161-8. doi: 10.1002/mds.25148. Epub 2012 Dec 12.
Previous research has documented cognitive impairment in the early stages of Parkinson's disease (PD). It is not known when this decline starts or if decline progresses at an accelerated rate during the premotor period of the disorder. In this population-based prospective study of older people (≥65 years) from the Neurological Disorders in Central Spain (NEDICES) cohort, we compared the rates of cognitive decline in 3 groups: (1) non-PD elderly controls; (2) prevalent PD patients (those diagnosed with the disease at baseline, 1994-95); and (3) premotor PD subjects (those diagnosed with the disease at follow up, 1997-98, but not at baseline). A 37-item version of the Mini-Mental State Examination (37-MMSE) was administered in the 2 visits of the study. From 2487 participants (age, 72.8 ± 6.0 years), including 2429 controls, we recruited 21 premotor PD cases, and 37 prevalent PD cases. At baseline, the mean 37-MMSE score was 28.5 ± 4.7 in prevalent cases, 28.1 ± 4.6 in premotor cases, and 29.9 ± 5.0 in controls (P = .046). During the 3-year follow-up period, there was a significant score decline of 2.4 ± 4.6 points in prevalent cases versus 0.2 ± 4.1 points in premotor cases and 0.3 ± 4.0 points in controls (Kruskal-Wallis test, P = .03). In the NEDICES cohort, cognitive test scores of prevalent PD cases declined at a rate above and beyond that observed in premotor PD cases and in controls. The rate of cognitive decline in premotor PD and controls was similar. Our data suggest that a decline in global cognitive function does not occur in premotor PD.
先前的研究已经记录了帕金森病（PD）早期的认知障碍。目前尚不清楚这种下降何时开始，或者在该疾病的运动前期是否会以更快的速度进展。在这项基于人群的针对西班牙中部神经障碍（NEDICES）队列中老年人（≥65 岁）的前瞻性研究中，我们比较了 3 组人群的认知下降率：（1）非 PD 老年对照组；（2）现患 PD 患者（基线时诊断为该疾病，1994-95 年）；（3）运动前期 PD 患者（1997-98 年随访时诊断为该疾病，但基线时未诊断）。在研究的 2 次就诊中，我们使用了 37 项简短精神状态检查表（37-MMSE）的一个版本。在 2487 名参与者（年龄，72.8±6.0 岁）中，包括 2429 名对照者，我们招募了 21 名运动前期 PD 病例和 37 名现患 PD 病例。在基线时，现患病例的平均 37-MMSE 评分为 28.5±4.7，运动前期病例为 28.1±4.6，对照组为 29.9±5.0（P=0.046）。在 3 年的随访期间，现患病例的评分下降了 2.4±4.6 分，而运动前期病例和对照组分别下降了 0.2±4.1 分和 0.3±4.0 分（Kruskal-Wallis 检验，P=0.03）。在 NEDICES 队列中，现患 PD 病例的认知测试评分下降速度高于运动前期 PD 病例和对照组。运动前期 PD 和对照组的认知下降速度相似。我们的数据表明，在运动前期 PD 中，整体认知功能不会下降。
