The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway.
JAMA Neurol. 2013 May;70(5):580-6. doi: 10.1001/jamaneurol.2013.2110.
Mild cognitive impairment (MCI) is common in Parkinson disease (PD), but the prognostic value of MCI in early PD is unknown.
To examine the course of MCI and its progression to dementia in an incident PD cohort.
Prospective longitudinal cohort study.
The Norwegian ParkWest study, an ongoing population-based study of the incidence, neurobiology, and prognosis of PD in western and southern Norway.
A population-based cohort of 182 patients with incident PD monitored for 3 years.
Serial neuropsychological tests of attention, executive function, verbal memory, and visuospatial skills were administered at baseline, 1 year, and 3 years. Patients were classified as having MCI and received a diagnosis of dementia according to published consensus criteria.
Significantly more patients with MCI than without MCI at baseline (10 of 37 [27.0%] vs 1 of 145 [0.7%]; relative risk, 39.2 [95% CI, 5.2-296.5]; P < .001) progressed to dementia during follow-up. Of those with MCI at baseline, 8 of 37 (21.6%) had MCI that reverted to normal cognition during follow-up. Mild cognitive impairment at the 1-year visit was associated with a similar progression rate to dementia (10 of 36 patients [27.8%]) and reversion rate to normal cognition (7 of 36 [19.4%]). However, among the 22 patients with persistent MCI at baseline and the 1-year visit, 10 (45.5%) developed dementia and only 2 (9.1%) had MCI that reverted to normal cognition by the end of study.
Mild cognitive impairment at PD diagnosis predicts a highly increased risk for early dementia. Repeated neuropsychological testing increases the prognostic accuracy of MCI with respect to early dementia development in PD.
轻度认知障碍（MCI）在帕金森病（PD）中很常见，但 MCI 在早期 PD 中的预后价值尚不清楚。
在一个 PD 新发病例队列中，研究 MCI 的病程及其向痴呆的进展。
前瞻性纵向队列研究。
挪威 ParkWest 研究，这是一项正在进行的、基于人群的研究，旨在研究挪威西部和南部 PD 的发病率、神经生物学和预后。
182 名 PD 新发病例的人群队列，随访 3 年。
在基线、1 年和 3 年时，进行了注意力、执行功能、言语记忆和视空间技能的连续神经心理学测试。根据发表的共识标准，患者被分类为 MCI，并接受痴呆诊断。
与无基线 MCI 的患者相比，基线时有 MCI 的患者显著更多（10/37 [27.0%] vs 1/145 [0.7%]；相对风险，39.2 [95%CI，5.2-296.5]；P<0.001）在随访期间进展为痴呆。在基线时有 MCI 的患者中，8/37（21.6%）的 MCI 在随访期间恢复为正常认知。在 1 年就诊时的轻度认知障碍与类似的痴呆进展率（36 例患者中的 10 例[27.8%]）和恢复为正常认知的比率（36 例患者中的 7 例[19.4%]）相关。然而，在基线时和 1 年就诊时持续存在 MCI 的 22 名患者中，10 名（45.5%）发展为痴呆，仅有 2 名（9.1%）的 MCI 在研究结束时恢复为正常认知。
PD 诊断时的轻度认知障碍预测早期痴呆的风险显著增加。重复的神经心理学测试提高了 MCI 在 PD 早期痴呆发展方面的预后准确性。
