Pillai Jagan A, Bonner-Jackson Aaron, Floden Darlene, Fernandez Hubert, Leverenz James B
Lou Ruvo Center for Brain Health Cleveland Clinic Cleveland OH.
Neurological Institute Cleveland Clinic Cleveland OH.
Mov Disord Clin Pract. 2018 Mar 23;5(3):283-289. doi: 10.1002/mdc3.12606. eCollection 2018 May-Jun.
How accurate are mild cognitive impairment (MCI) patients in assessing their cognitive and functional deficit is often unclear to the clinician. The accuracy of patient self-appraisal in Parkinson's disease-MCI (PD-MCI) has received less attention than amnestic MCI (a-MCI) often associated with Alzheimer's disease. We evaluated if PD-MCI patients demonstrate accurate self-appraisal of their cognitive deficits compared to patients with amnestic a-MCI or non-amnestic MCI (na-MCI).
This cross-sectional cohort study included, 30 PD-MCI, 33 a-MCI, and 17 na-MCI patients. Self-appraisal was assessed by comparing responses of caregivers and patients on a validated self-rating questionnaire of cognitive and functional impairments. All patients completed a full neuropsychological evaluation and depression screening measure. Univariate ANOVA, regression, and correlational analyses were employed to identify group differences in self-appraisal scores and relationships between cognitive and functional impairment, depression measures, and self-appraisal scores.
Self-appraisal scores for PD-MCI did not differ significantly from a-MCI and na-MCI. In the PD-MCI group, higher depression scores were associated with lower self-appraisal scores (i.e, patients assessed cognition as worse than caregivers). In a stepwise regression model with self-appraisal scores as the dependent variable, only the depression score was significant predictor among PD-MCI and accounted for 50% of the variance.
Our findings suggest that impaired patient self-appraisal is equally likely to occur in PD-MCI as in a-MCI and na-MCI patients. Among PD-MCI, depression was the strongest predictor of impaired patient self-appraisal. Impaired insight into cognitive impairment and depression should be considered in both care and research with PD patients.
临床医生常常不清楚轻度认知障碍（MCI）患者评估自身认知和功能缺陷的准确性如何。帕金森病-MCI（PD-MCI）患者自我评估的准确性相较于常与阿尔茨海默病相关的遗忘型MCI（a-MCI）受到的关注更少。我们评估了与遗忘型a-MCI或非遗忘型MCI（na-MCI）患者相比，PD-MCI患者对其认知缺陷的自我评估是否准确。
这项横断面队列研究纳入了30例PD-MCI患者、33例a-MCI患者和17例na-MCI患者。通过比较护理人员和患者在一份经过验证的认知和功能障碍自评问卷上的回答来评估自我评估。所有患者均完成了全面的神经心理学评估和抑郁筛查测量。采用单因素方差分析、回归分析和相关分析来确定自我评估分数的组间差异以及认知和功能障碍、抑郁测量与自我评估分数之间的关系。
PD-MCI的自我评估分数与a-MCI和na-MCI没有显著差异。在PD-MCI组中，较高的抑郁分数与较低的自我评估分数相关（即患者评估的认知情况比护理人员评估的更差）。在以自我评估分数为因变量的逐步回归模型中，在PD-MCI中只有抑郁分数是显著的预测因素，且占方差的50%。
我们的研究结果表明，PD-MCI患者自我评估受损的情况与a-MCI和na-MCI患者同样可能发生。在PD-MCI患者中，抑郁是患者自我评估受损的最强预测因素。在对PD患者的护理和研究中均应考虑到对认知障碍和抑郁的洞察力受损情况。
