帕金森病认知障碍的可调节危险因素：前瞻性队列研究的系统评价和荟萃分析。

Modifiable risk factors for cognitive impairment in Parkinson's disease: A systematic review and meta-analysis of prospective cohort studies.

机构信息

Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China.

Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.

出版信息

Mov Disord. 2019 Jun;34(6):876-883. doi: 10.1002/mds.27665. Epub 2019 Mar 14.

DOI:10.1002/mds.27665

PMID:30869825

Abstract

BACKGROUND

Cognitive impairment is a common and devastating manifestation in Parkinson's disease (PD). We aimed to identify modifiable risk factors for PD with cognitive impairment.

METHODS

We systematically searched PubMed and the Cochrane Library from June 1937 to September 2018 and included prospective cohort studies with random-effects model used to combine estimates. Primary analyses for all types of cognitive impairments and subgroup analyses for separate outcomes were conducted.

RESULTS

A total of 31,298 articles were identified, of which 32 articles with 18 factors met the inclusion criteria for meta-analysis. In the primary analysis, 9 modifiable risk factors were found to increase the risk of PD with cognitive impairment, including postural-instability-gait disorder (relative risk = 3.76, 95% confidence interval = 1.36-10.40), hallucinations (relative risk = 3.09, 95% confidence interval = 1.61-5.93), orthostatic hypotension (relative risk = 2.98, 95% confidence interval = 1.41-6.28), cerebrovascular disease (relative risk = 1.52, 95% confidence interval = 1.01-2.28), diabetes mellitus (relative risk = 1.47, 95% confidence interval = 1.13-1.92), obesity (relative risk = 1.38, 95% confidence interval = 1.15-1.65), cardiac disease (relative risk = 1.35, 95% confidence interval = 1.17-1.56), alcohol consumption (relative risk = 1.32, 95% confidence interval = 1.15-1.52), and smoking (relative risk = 1.31, 95% confidence interval = 1.14-1.50). In the subgroup analysis, postural-instability-gait disorder subtype, orthostatic hypotension and hallucinations may increase the risk of dementia in PD. A total of 37 articles were included in the systematic review, in which 9 risk factors and 1 protective factor were additionally associated in single studies with the risk of PD with cognitive impairment, and 5 factors were associated with specific cognition domains.

CONCLUSIONS

Effective interventions in the management of PD symptoms, comorbidities, and lifestyles may be promising to reduce PD with cognitive impairment risk. © 2019 International Parkinson and Movement Disorder Society.

摘要

背景

认知障碍是帕金森病（PD）的一种常见且具有破坏性的表现。我们旨在确定具有认知障碍的 PD 的可改变风险因素。

方法

我们系统地检索了 1937 年 6 月至 2018 年 9 月的 PubMed 和 Cochrane 图书馆，并纳入了使用随机效应模型进行合并估计的前瞻性队列研究。对所有类型的认知障碍进行了主要分析，并对单独的结局进行了亚组分析。

结果

共确定了 31298 篇文章，其中有 32 篇文章中的 18 个因素符合荟萃分析的纳入标准。在主要分析中，发现 9 个可改变的风险因素会增加 PD 合并认知障碍的风险，包括姿势不稳-步态障碍（相对风险=3.76，95%置信区间=1.36-10.40）、幻觉（相对风险=3.09，95%置信区间=1.61-5.93）、直立性低血压（相对风险=2.98，95%置信区间=1.41-6.28）、脑血管疾病（相对风险=1.52，95%置信区间=1.01-2.28）、糖尿病（相对风险=1.47，95%置信区间=1.13-1.92）、肥胖（相对风险=1.38，95%置信区间=1.15-1.65）、心脏病（相对风险=1.35，95%置信区间=1.17-1.56）、酒精摄入（相对风险=1.32，95%置信区间=1.15-1.52）和吸烟（相对风险=1.31，95%置信区间=1.14-1.50）。在亚组分析中，姿势不稳-步态障碍亚型、直立性低血压和幻觉可能会增加 PD 患者痴呆的风险。系统评价共纳入 37 篇文章，其中 9 个风险因素和 1 个保护因素在单项研究中与 PD 合并认知障碍的风险相关，另外 5 个因素与特定认知领域相关。