Cerff Bernhard, Maetzler Walter, Sulzer Patricia, Kampmeyer Malte, Prinzen Jos, Hobert Markus A, Blum Dominik, van Lummel Rob, Del Din Silvia, Gräber Susanne, Berg Daniela, Liepelt-Scarfone Inga
German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany.
Neurodegener Dis. 2017;17(4-5):135-144. doi: 10.1159/000460251. Epub 2017 Apr 26.
For the early diagnosis of Parkinson disease dementia (PDD), objective home-based tools are needed to quantify even mild stages of dysfunction of the activities of daily living (ADL).
In this pilot study, home-based physical behavior was assessed to examine whether it is possible to distinguish mild cognitive impairment (PD-MCI) from PDD.
Fifty-five patients with mild to severe Parkinson disease (PD) participated in this cross-sectional study. Based on comprehensive neuropsychological testing, PD patients were classified as cognitively nonimpaired (PD-NC), PD-MCI or PDD. For physical behavior assessments, patients wore the accelerometer DynaPort® (McRoberts) for 3 days. Ordinal logistic regression models with continuous Y were applied to correct results for motor impairment and depressive symptoms.
After excluding 7 patients due to insufficient wearing time, 48 patients with a mean of 2 recorded days were analyzed (17 PD-NC, 22 PD-MCI, 9 PDD). ADL-impaired PDD patients showed fewer sedentary bouts than non-ADL-impaired PD-MCI (p = 0.01, odds ratio [OR] = 8.9, 95% confidence interval [CI] = 1.8-45.2) and PD-NC (p = 0.01, OR = 10.3, CI = 1.6-67.3) patients, as well as a longer sedentary bout length (PD-NC: p = 0.02, OR = 0.1, CI = 0.02-0.65; PD-MCI: p = 0.02, OR = 0.14, CI = 0.03-0.69). These differences were mainly caused by fewer (PD-NC: p = 0.02, OR = 9.6, CI = 1.5-62.4; PD-MCI: p = 0.01, OR = 8.5, CI = 1.5-37.3) but longer sitting bouts (PD-NC: p = 0.03, OR = 0.12, CI = 0.02-0.80; PD-MCI: p = 0.04, OR = 0.19, CI = 0.04-0.93). Tests assessing executive function, visuoconstruction and attention correlated significantly with specific activity parameters (ρ ≥ 0.3; p < 0.05).
Objective assessment of physical behavior, in particular the detection of sedentary bouts, is a promising contributor to the discrimination between PD-MCI and PDD.
为了早期诊断帕金森病痴呆（PDD），需要基于家庭的客观工具来量化日常生活活动（ADL）功能障碍的轻度阶段。
在这项初步研究中，对基于家庭的身体行为进行评估，以检查是否有可能区分轻度认知障碍（PD-MCI）和PDD。
55例轻度至重度帕金森病（PD）患者参与了这项横断面研究。基于全面的神经心理学测试，PD患者被分类为认知未受损（PD-NC）、PD-MCI或PDD。对于身体行为评估，患者佩戴加速度计DynaPort®（麦克罗伯茨公司）3天。应用带有连续Y的有序逻辑回归模型来校正运动障碍和抑郁症状的结果。
由于佩戴时间不足排除7例患者后，对48例平均记录2天的患者进行了分析（17例PD-NC，22例PD-MCI，9例PDD）。ADL受损的PDD患者比未出现ADL受损的PD-MCI患者（p = 0.01，优势比[OR] = 8.9，95%置信区间[CI] = 1.8 - 45.2）和PD-NC患者（p = 0.01，OR = 10.3，CI = 1.6 - 67.3）久坐发作次数更少，且久坐发作持续时间更长（与PD-NC相比：p = 0.02，OR = 0.1，CI = 0.02 - 0.65；与PD-MCI相比：p = 0.02，OR = 0.14，CI = 0.03 - 0.69）。这些差异主要是由较少的（与PD-NC相比：p = 0.02，OR = 9.6，CI = 1.5 - 62.4；与PD-MCI相比：p = 0.01，OR = 8.5，CI = 1.5 - 37.3）但更长的坐姿发作导致的（与PD-NC相比：p = 0.03，OR = 0.12，CI = 0.02 - 0.80；与PD-MCI相比：p = 0.04，OR = 0.19，CI = 0.04 - 0.93）。评估执行功能、视觉构建和注意力的测试与特定活动参数显著相关（ρ≥0.3；p < 0.05）。
对身体行为的客观评估，特别是久坐发作的检测，有望有助于区分PD-MCI和PDD。
