Siri Chiara, Cilia Roberto, Reali Elisa, Pozzi Beatrice, Cereda Emanuele, Colombo Aurora, Meucci Nicoletta, Canesi Margherita, Zecchinelli Anna L, Tesei Silvana, Mariani Claudio B, Sacilotto Giorgio, Zini Michela, Pezzoli Gianni
Parkinson Institute, Istituti Clinici di Perfezionamento, Milan, Italy.
Mov Disord. 2015 Apr 15;30(5):696-704. doi: 10.1002/mds.26160. Epub 2015 Mar 11.
This study investigated cognitive functions in Parkinson's disease (PD) patients with impulse control disorders (ICDs) and aimed to identify possible predictors of behavioral outcome. In this longitudinal cohort study, 40 PD outpatients with ICDs and 40 without, were matched for sex, age at PD onset, age and disease duration at cognitive assessment. All patients had two neuropsychological assessments at least 2 years apart (mean, 3.5 years). Multivariate logistic regression analysis was performed to identify predictors of ICDs remission at follow-up. The PD patients with and without ICDs had overall comparable cognitive performance at baseline. When evaluating changes between baseline and follow-up, we found significant group × time interactions in several frontal lobe-related tests, with the ICDs group showing a less pronounced worsening over time. ICDs remission was associated with better performance at baseline in working memory-related tasks, such as digit span (odds ratio [OR] = 2.69 [95% confidence interval (CI), 1.09-6.66]) and attentive matrices (OR=1.19 [95%CI, 1.03-1.37]). ICDs remitters and non-remitters had no remarkable differences in baseline PD-related features and therapy management strategies (including the extent of dopamine agonist dose reduction). In conclusion, ICDs in PD patients are not related to greater cognitive impairment or executive dysfunction, but rather show relatively lower cognitive decline over time. The impaired top-down inhibitory control characterizing ICDs is likely attributable to a drug-induced overstimulation of relatively preserved prefrontal cognitive functions. Full behavioral remission in the long term was predicted by better working memory abilities. © 2015 International Parkinson and Movement Disorder Society.
本研究调查了患有冲动控制障碍（ICD）的帕金森病（PD）患者的认知功能，旨在确定行为结果的可能预测因素。在这项纵向队列研究中，40名患有ICD的PD门诊患者和40名未患ICD的患者在性别、PD发病年龄、认知评估时的年龄和病程方面进行了匹配。所有患者至少间隔2年进行两次神经心理学评估（平均3.5年）。进行多变量逻辑回归分析以确定随访时ICD缓解的预测因素。患有和未患有ICD的PD患者在基线时总体认知表现相当。在评估基线和随访之间的变化时，我们在几项与额叶相关的测试中发现了显著的组×时间交互作用，ICD组随时间推移恶化程度较轻。ICD缓解与基线时在与工作记忆相关任务中的更好表现相关，如数字广度（优势比[OR]=2.69[95%置信区间（CI），1.09 - 6.66]）和注意力矩阵（OR = 1.19[95%CI，1.03 - 1.37]）。ICD缓解者和未缓解者在基线PD相关特征和治疗管理策略（包括多巴胺激动剂剂量减少的程度）方面没有显著差异。总之，PD患者的ICD与更严重的认知障碍或执行功能障碍无关，而是随时间显示出相对较低的认知下降。ICD所特有的自上而下抑制控制受损可能归因于药物对相对保留的前额叶认知功能的过度刺激。长期完全行为缓解可通过更好的工作记忆能力预测。©2015国际帕金森和运动障碍协会。
