Cognitive Ageing and Impairment Neurosciences Laboratory, School of Psychology, Social Work and Social Policy, University of South Australia, Australia.
Neurodegnerative Disease Group, Translational Neuropathology Laboratory, Adelaide Medical School, University of Adelaide, Australia.
Parkinsonism Relat Disord. 2019 Aug;65:20-31. doi: 10.1016/j.parkreldis.2019.04.020. Epub 2019 May 7.
To systematically review and meta-analyse conversion rates from normal cognition to Mild Cognitive Impairment (MCI) and dementia in Parkinson's disease (PD) patients. Reversion rates in patients with MCI (i.e. PD-MCI) were also investigated.
Electronic searches of PsycINFO, Medline and EBSCOhost were conducted in January 2018, with 1833 articles identified after duplicate removal. Articles were included if they assessed conversion/reversion in PD patients between normal cognition, PD-MCI and PD dementia (PD-D).
In total, 39 articles met the inclusion criteria, representing 4011 patients (mean age range 58-75; 61% male). Within three years, in those with PD and normal cognition, 25% (95%CI 20-30%) converted to PD-MCI and 2% (95%CI 1-7%) converted to dementia. Of those with PD-MCI, 20% (95%CI 13-30%) converted to dementia while 28% (95%CI 20-37%) reverted back to a state of normal cognitive function. The conversion rates to MCI and dementia were higher, and reversion rates lower, when follow-up was ≥3 years. When International Parkinson and Movement Disorder Society (MDS) criteria were used to diagnose MCI, Level I criteria were associated with a greater reversion estimate from PD-MCI to normal cognitive function.
These findings summarise the trajectory of cognitive impairment in PD and highlight that MCI is common in this patient group. Understanding cognitive trajectories in PD patients is important for patient care in terms of prognosis, as well as for identifying windows for intervention for cognitive symptoms. As the number of PD patients increases with an ageing population, this information can inform future policy and planning.
系统回顾和荟萃分析帕金森病（PD）患者从正常认知到轻度认知障碍（MCI）和痴呆的转化率。还调查了 MCI 患者（即 PD-MCI）的逆转率。
2018 年 1 月，在 PsycINFO、Medline 和 EBSCOhost 上进行了电子检索，去除重复项后共识别出 1833 篇文章。如果评估报告了 PD 患者在正常认知、PD-MCI 和 PD 痴呆（PD-D）之间的转换/逆转，则纳入研究。
共有 39 篇文章符合纳入标准，代表 4011 名患者（平均年龄范围为 58-75 岁；61%为男性）。在三年内，在认知正常的 PD 患者中，25%（95%CI 20-30%）转化为 PD-MCI，2%（95%CI 1-7%）转化为痴呆。在 PD-MCI 患者中，20%（95%CI 13-30%）转化为痴呆，而 28%（95%CI 20-37%）则恢复到正常认知功能状态。当随访时间≥3 年时，MCI 和痴呆的转化率更高，逆转率更低。当使用国际帕金森病和运动障碍协会（MDS）标准诊断 MCI 时，一级标准与从 PD-MCI 向正常认知功能的更大逆转估计相关。
这些发现总结了 PD 认知障碍的轨迹，并强调 MCI 在该患者群体中很常见。了解 PD 患者的认知轨迹对于预后患者护理很重要，也为认知症状的干预提供了窗口。随着人口老龄化导致 PD 患者数量的增加，这些信息可以为未来的政策和规划提供依据。
