Doiron Maxime, Langlois Mélanie, Dupré Nicolas, Simard Martine
School of Psychology, Laval University, Quebec City, Canada.
Centre de Recherche de l'Institut Universitaire en Santé Mentale de Québec, Quebec City, Canada.
Int J Geriatr Psychiatry. 2018 Feb;33(2):288-297. doi: 10.1002/gps.4735. Epub 2017 May 16.
Hypertension, dyslipidemia, diabetes, and obesity are well-established risk factors for cognitive impairment and dementia in older adults. In contrast, previous studies that have assessed the impact of vascular risk factors (VRFs) on cognition in Parkinson's disease (PD) have had methodological limitations and reported conflicting findings. We address this question in a large well-characterized cohort of de novo PD patients.
A total of 367 untreated and non-demented patients aged 50 years and older with early PD (H&Y = 1.0-2.0) underwent a comprehensive clinical and neuropsychological assessment at baseline and 24 months later. A series of linear mixed models were used to determine the effects of VRFs on cognition while controlling for patient and disease characteristics. The outcomes included norm-referenced Z-scores of global cognition, visuospatial skills, verbal episodic memory, semantic verbal fluency, attention, and working memory tests.
A longer history of hypertension and a higher pulse pressure were significant predictors of lower Z-scores on immediate and delayed free recall, recognition, and verbal fluency tests. On average, every 10 mmHg increase in pulse pressure was associated with a 0.08 reduction on the cognitive Z-scores. The effects were independent of age, education, disease duration, motor impairment, medication, and depressive symptoms. Other VRFs were not associated with cognitive outcomes.
Our results are consistent with previous studies suggesting that hypertension exerts a detrimental effect on memory and verbal fluency in early PD. Management of blood pressure and cardiovascular health may be important to reduce risk of cognitive decline in PD. Copyright © 2017 John Wiley & Sons, Ltd.
高血压、血脂异常、糖尿病和肥胖是老年人认知障碍和痴呆症公认的危险因素。相比之下，以往评估血管危险因素（VRF）对帕金森病（PD）认知影响的研究存在方法学局限性，且结果相互矛盾。我们在一个特征明确的新发PD患者大样本队列中探讨了这个问题。
共有367名年龄在50岁及以上、早期PD（H&Y = 1.0 - 2.0）且未接受治疗、无痴呆的患者在基线和24个月后接受了全面的临床和神经心理学评估。使用一系列线性混合模型来确定VRF对认知的影响，同时控制患者和疾病特征。结果包括全球认知、视觉空间技能、言语情景记忆、语义言语流畅性、注意力和工作记忆测试的常模参照Z分数。
高血压病史较长和脉压较高是即时和延迟自由回忆、识别及言语流畅性测试中Z分数较低的显著预测因素。平均而言，脉压每升高10 mmHg，认知Z分数就会降低0.08。这些影响独立于年龄、教育程度、病程、运动障碍、药物治疗和抑郁症状。其他VRF与认知结果无关。
我们的结果与之前的研究一致，表明高血压对早期PD患者的记忆和言语流畅性有不利影响。控制血压和心血管健康对于降低PD患者认知衰退风险可能很重要。版权所有© 2017约翰威立国际出版公司。
