Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Mov Disord. 2017 Nov;32(11):1640-1645. doi: 10.1002/mds.27189. Epub 2017 Oct 24.
Prospective data on cognition in prodromal Parkinson's disease are limited. The objectives of this study were to assess in prodromal PD (1) if baseline cognition predicts conversion to clinical PD, (2) if baseline dopamine transporter binding predicts longitudinal changes in cognition, and (3) if impaired olfaction predicts future cognitive decline.
Prodromal participants were 136 hyposmic individuals enrolled in the Parkinson Associated Risk Study. We examined baseline neuropsychological test performance in PD converters versus nonconverters and the association between baseline dopamine transporter binding and change in cognition. An additional 73 normosmic individuals were included in analyses of the relationship between hyposmia and cognitive decline.
In prodromal participants, baseline cognitive scores did not significantly predict conversion, but converters performed numerically worse on 5 of the 6 cognitive domains assessed, with the greatest differences in executive function/working memory (0.68 standard deviation lower) and global cognition (0.64 standard deviation lower). Lower baseline dopamine transporter binding predicted greater future decline in processing speed/attention (P = 0.02). Hyposmia predicted greater future decline in language (P = 0.005) and memory (P = 0.01) abilities.
Given hyposmia in the general population predicts cognitive decline, the role of cognition in predicting conversion in prodromal PD needs to be assessed in large cohorts followed long-term. The dopamine system may be associated with changes in processing speed/attention in individuals at risk for PD. © 2017 International Parkinson and Movement Disorder Society.
关于前驱期帕金森病认知的前瞻性数据有限。本研究的目的是在前驱期帕金森病患者中评估：（1）基线认知是否可预测向临床帕金森病的转化；（2）基线多巴胺转运体结合是否可预测认知的纵向变化；（3）嗅觉障碍是否可预测未来认知下降。
前驱期参与者是来自帕金森病相关风险研究的 136 名嗅觉减退个体。我们比较了 PD 转化者与非转化者的基线神经心理学测试表现，以及基线多巴胺转运体结合与认知变化之间的关系。另外还纳入了 73 名嗅觉正常个体，分析嗅觉障碍与认知下降之间的关系。
在前驱期参与者中，基线认知评分与转化无显著相关性，但转化者在 6 项认知域中的 5 项评估中表现略差，执行功能/工作记忆（低 0.68 个标准差）和整体认知（低 0.64 个标准差）的差异最大。较低的基线多巴胺转运体结合预示着未来处理速度/注意力下降（P = 0.02）。嗅觉障碍预示着未来语言（P = 0.005）和记忆（P = 0.01）能力下降更明显。
鉴于一般人群中的嗅觉障碍可预测认知下降，因此需要在长期随访的大队列中评估认知在前驱期帕金森病转化预测中的作用。多巴胺系统可能与 PD 风险个体的处理速度/注意力变化有关。
