Clinical Neurology, Dept. of Neuroscience (DINOGMI), University of Genoa and IRCCS AOU San Martino-IST, Genoa, Italy.
Institute of Molecular Bioimaging and Physiology, National Research Council, Genoa, Italy.
Mov Disord. 2017 Dec;32(12):1738-1747. doi: 10.1002/mds.27190. Epub 2017 Nov 9.
Cognitive impairment is a frequent and disabling feature of Parkinson's disease. Identifying the factors able to predict cognitive worsening since the early stage may improve disease management. The objective of this study was to define the best predictors of future cognitive worsening in a group of patients with newly diagnosed PD and to propose cutoff values potentially useful at the individual level.
Fifty-four consecutive drug-naive patients with de novo PD were prospectively evaluated by clinical and neuropsychological assessment, resting EEG, and I-FP-CIT-SPECT and clinically classified into mainly motor, diffuse/malignant, and intermediate PD subtypes; they were then followed up for an average of 5 years. Cognitive outcome was defined by identifying cognitively stable or worsened patients.
Step-wise logistic regression selected the posterior qEEG mean frequency and I-FP-CIT-SPECT uptake at caudate level (P < 0.0001). The posterior qEEG mean frequency (cut point, 8.3 Hz) and the caudate I-FP-CIT-SPECT uptake (cut point, 2.3, specific to nondisplaceable binding ratio) achieved 82% and 80% of accuracy, respectively, in predicting cognitive outcome. Survival analysis showed decreasing expected time to cognitive worsening associated with scores below the established thresholds for qEEG and I-FP-CIT-SPECT and with the presence of a malignant clinical phenotype.
Resting EEG and I-FP-CIT-SPECT are good predictors of future cognitive worsening, in de novo drug-naive PD patients. Wherever available, these biomarkers could add valuable prognostic information to classification into different clinical phenotypes. © 2017 International Parkinson and Movement Disorder Society.
认知障碍是帕金森病的常见且致残特征。识别能够从早期预测认知恶化的因素可能会改善疾病管理。本研究的目的是确定一组新诊断为 PD 的患者中未来认知恶化的最佳预测因素，并提出潜在有用的个体水平截断值。
54 例连续的、未经药物治疗的初发 PD 患者前瞻性地接受了临床和神经心理学评估、静息 EEG、I-FP-CIT-SPECT，并根据临床分类为主要运动型、弥漫/恶性和中间型 PD 亚型；然后平均随访 5 年。认知结局定义为识别认知稳定或恶化的患者。
逐步逻辑回归选择了后部 qEEG 平均频率和纹状体水平的 I-FP-CIT-SPECT 摄取（P<0.0001）。后部 qEEG 平均频率（截断值为 8.3 Hz）和纹状体 I-FP-CIT-SPECT 摄取（截断值为 2.3，特定于不可置换结合比）分别在预测认知结局方面达到 82%和 80%的准确性。生存分析显示，与后部 qEEG 和 I-FP-CIT-SPECT 的既定阈值以下的评分以及恶性临床表型相关的认知恶化预期时间减少。
静息 EEG 和 I-FP-CIT-SPECT 是新诊断、未经药物治疗的 PD 患者未来认知恶化的良好预测指标。只要有可能，这些生物标志物可以为分类为不同的临床表型提供有价值的预后信息。
