Weintraub Daniel, Simuni Tanya, Caspell-Garcia Chelsea, Coffey Christopher, Lasch Shirley, Siderowf Andrew, Aarsland Dag, Barone Paolo, Burn David, Chahine Lama M, Eberling Jamie, Espay Alberto J, Foster Eric D, Leverenz James B, Litvan Irene, Richard Irene, Troyer Matthew D, Hawkins Keith A
Departments of Psychiatry and Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA.
Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Mov Disord. 2015 Jun;30(7):919-27. doi: 10.1002/mds.26170. Epub 2015 Mar 4.
This study was undertaken to determine the prevalence and correlates of cognitive impairment (CI) and neuropsychiatric symptoms (NPS) in early, untreated patients with Parkinson's disease (PD).
Both CI and NPS are common in PD and impact disease course and quality of life. However, limited knowledge is available about cognitive abilities and NPS.
Parkinson's Progression Markers Initiative (PPMI) is a multi-site study of early, untreated PD patients and healthy controls (HCs), the latter with normal cognition. At baseline, participants were assessed with a neuropsychological battery and for symptoms of depression, anxiety, impulse control disorders (ICDs), psychosis, and apathy.
Baseline data of 423 PD patients and 196 HCs yielded no between-group differences in demographic characteristics. Twenty-two percent of PD patients met the PD-recommended screening cutoff for CI on the Montral Cognitive Assessment (MoCA), but only 9% met detailed neuropsychological testing criteria for mild cognitive impairment (MCI)-level impairment. The PD patients were more depressed than HCs (P < 0.001), with twice as many (14% vs. 7%) meeting criteria for clinically significant depressive symptoms. The PD patients also experienced more anxiety (P < 0.001) and apathy (P < 0.001) than HCs. Psychosis was uncommon in PD (3%), and no between-group difference was seen in ICD symptoms (P = 0.51).
Approximately 10% of PD patients in the early, untreated disease state met traditional criteria of CI, which is a lower frequency compared with previous studies. Multiple dopaminergic-dependent NPS are also more common in these patients compared with the general population, but others associated with dopamine replacement therapy are not or are rare. Future analyses of this cohort will examine biological predictors and the course of CI and NPS. © 2015 International Parkinson and Movement Disorder Society.
本研究旨在确定早期未治疗的帕金森病（PD）患者认知障碍（CI）和神经精神症状（NPS）的患病率及其相关因素。
CI和NPS在PD中均很常见，并影响疾病进程和生活质量。然而，关于认知能力和NPS的了解有限。
帕金森病进展标志物倡议（PPMI）是一项针对早期未治疗的PD患者和健康对照（HCs）的多中心研究，后者认知正常。在基线时，参与者接受了一套神经心理测试，并评估了抑郁、焦虑、冲动控制障碍（ICD）、精神病和冷漠症状。
423例PD患者和196例HCs的基线数据显示，两组在人口统计学特征上无差异。22%的PD患者在蒙特利尔认知评估（MoCA）中达到了PD推荐的CI筛查临界值，但只有9%的患者符合轻度认知障碍（MCI）水平损害的详细神经心理测试标准。PD患者比HCs更抑郁（P<0.001），达到临床显著抑郁症状标准的人数是HCs 的两倍（14%对7%）。PD患者也比HCs经历更多的焦虑（P<0.001）和冷漠（P<0.001）。精神病在PD中不常见（3%），ICD症状在两组之间无差异（P = 0.51）。
大约10%处于早期未治疗疾病状态的PD患者符合CI的传统标准，这一频率低于先前的研究。与一般人群相比，这些患者中多种多巴胺能依赖性NPS也更常见，但与多巴胺替代治疗相关的其他症状则不常见或罕见。对该队列的未来分析将研究CI和NPS的生物学预测因素及其病程进展。© 2015国际帕金森和运动障碍协会。
