Wills Anne-Marie A, Elm Jordan J, Ye Rong, Chou Kelvin L, Parashos Sotirios A, Hauser Robert A, Bodis-Wollner Ivan, Hinson Vanessa K, Christine Chadwick W, Schneider Jay S
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Medical University of South Carolina, Division of Biostatistics & Epidemiology, Charleston, SC, USA.
Parkinsonism Relat Disord. 2016 Dec;33:127-133. doi: 10.1016/j.parkreldis.2016.10.005. Epub 2016 Oct 8.
Clinical cohort studies suggest that mild cognitive impairment (MCI) is common in early Parkinson's disease (PD). The objectives of this paper were to describe cognitive function in a large clinical trial of early treated PD patients at baseline and over time using two brief cognitive screening tests.
In total 1741 participants were enrolled in the NINDS Exploratory Trials in Parkinson's disease (NET-PD) Long-term Study-1 (LS-1). The Symbol Digit Modalities Test (SDMT) was collected annually. The SCales for Outcomes in PArkinson's disease-COGnition (SCOPA-COG) was collected at baseline and at year 5. The trial was stopped early based on a planned interim analysis after half the cohort completed 5 years of follow-up. The median length of follow-up was 4 years (range 3-6 years). Predictors of cognitive change were examined using cross sectional (baseline) and longitudinal multivariable linear regression.
The mean (SD) change from baseline to 5 years was -1.9 (5.1) for the SCOPA-COG and -2.1 (11.1) for the SDMT. Age and baseline UPDRS motor scores were associated with a more rapid decline in SDMT scores and 5 year SCOPA-COG scores. Male gender was associated with more rapid decline in SDMT. Self-reported income was a novel predictor of baseline cognitive function, even adjusted for educational status, although not significantly associated with change over time.
This large prospective cohort study demonstrated mild cognitive decline in early treated Parkinson's disease. The study identified income level as a novel predictor of cognitive function.
临床队列研究表明，轻度认知障碍（MCI）在早期帕金森病（PD）中很常见。本文的目的是使用两项简短的认知筛查测试，描述早期接受治疗的PD患者在一项大型临床试验中的基线认知功能以及随时间的变化情况。
共有1741名参与者纳入了国立神经疾病和中风研究所帕金森病探索性试验（NET-PD）长期研究-1（LS-1）。每年收集符号数字模式测试（SDMT）结果。在基线和第5年收集帕金森病认知功能结局量表（SCOPA-COG）。在队列的一半完成5年随访后，根据计划的中期分析提前终止了试验。随访的中位时长为4年（范围3 - 6年）。使用横断面（基线）和纵向多变量线性回归分析认知变化的预测因素。
SCOPA-COG从基线到5年的平均（标准差）变化为-1.9（5.1），SDMT为-2.1（11.1）。年龄和基线统一帕金森病评定量表（UPDRS）运动评分与SDMT评分和5年SCOPA-COG评分的更快下降相关。男性与SDMT评分的更快下降相关。自我报告的收入是基线认知功能的一个新的预测因素，即使在调整了教育程度后也是如此，尽管与随时间的变化无显著关联。
这项大型前瞻性队列研究表明，早期接受治疗的帕金森病存在轻度认知下降。该研究确定收入水平是认知功能的一个新的预测因素。
