Pilotto Andrea, Turrone Rosanna, Liepelt-Scarfone Inga, Bianchi Marta, Poli Loris, Borroni Barbara, Alberici Antonella, Premi Enrico, Formenti Anna, Bigni Barbara, Cosseddu Maura, Cottini Elisabetta, Berg Daniela, Padovani Alessandro
Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy.
Department of Neurodegeneration, Hertie Institute of Clinical Brain Research, University of Tübingen, Tübingen, Germany.
J Alzheimers Dis. 2016;51(2):563-70. doi: 10.3233/JAD-150610.
Vascular risk factors have been associated with cognitive deficits and incident dementia in the general population, but their role on cognitive dysfunction in Parkinson's disease (PD) is still unclear. The present study addresses the single and cumulative effect of vascular risk factors on cognition in PD patients, taking clinical confounders into account. Standardized neuropsychological assessment was performed in 238 consecutive PD patients. We evaluated the association of single and cumulative vascular risk factors (smoking, diabetes, hypercholesterolemia, hypertension, and heart disease), with the diagnosis of PD normal cognition (PDNC, n = 94), mild cognitive impairment (PD-MCI, n = 111), and dementia (PDD, n = 33). The association between single neuropsychological tests and vascular risk factors was evaluated with covariance analyses adjusted for age at onset, educational levels, gender, disease duration, and motor performance. Age, educational levels, disease duration, and motor function were significantly different between PDNC, PD-MCI, and PDD. Heart disease was the only vascular factor significantly more prevalent in PDD compared with PDNC in adjusted analyses. Performance of tests assessing executive and attention functions were significantly worse in patients with hypertension, heart disease, and/or diabetes (p < 0.05). Heart disease is associated with dementia in PD, suggesting a potential window of intervention. Vascular risk factors act especially on attention and executive functions in PD. Vascular risk stratification may be useful in order to identify PD patients with a greater risk of developing dementia. These findings need to be verified in longitudinal studies.
血管危险因素与普通人群的认知缺陷和新发痴呆症相关，但它们在帕金森病（PD）认知功能障碍中的作用仍不清楚。本研究在考虑临床混杂因素的情况下，探讨血管危险因素对PD患者认知的单一和累积影响。对238例连续的PD患者进行了标准化神经心理学评估。我们评估了单一和累积血管危险因素（吸烟、糖尿病、高胆固醇血症、高血压和心脏病）与PD正常认知（PDNC，n = 94）、轻度认知障碍（PD-MCI，n = 111）和痴呆（PDD，n = 33）诊断之间的关联。通过对发病年龄、教育水平、性别、疾病持续时间和运动表现进行校正的协方差分析，评估单一神经心理学测试与血管危险因素之间的关联。PDNC、PD-MCI和PDD之间的年龄、教育水平、疾病持续时间和运动功能存在显著差异。在校正分析中，与PDNC相比，心脏病是PDD中唯一显著更常见的血管因素。高血压、心脏病和/或糖尿病患者的执行和注意力功能测试表现明显更差（p < 0.05）。心脏病与PD中的痴呆症相关，提示存在潜在的干预窗口。血管危险因素尤其影响PD患者的注意力和执行功能。血管风险分层可能有助于识别患痴呆症风险更高的PD患者。这些发现需要在纵向研究中得到验证。
