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遗传性帕金森病的认知和精神症状:系统评价。

Cognitive and psychiatric symptoms in genetically determined Parkinson's disease: a systematic review.

机构信息

CINAC-HM Puerta del Sur, CEU-San Pablo University, Móstoles, Madrid, Spain.

Department of Neurology IRCCS, Istituto Clinico Humanitas Rozzano, Milano, Italy.

出版信息

Eur J Neurol. 2020 Feb;27(2):229-234. doi: 10.1111/ene.14115. Epub 2019 Nov 28.

Abstract

The aim was to review the existing reports on cognitive and behavioural symptoms in monogenic forms of Parkinson's disease (PD) and to identify recurring patterns of clinical manifestations in those with specific mutations. A systematic literature search was conducted to retrieve observational studies of monogenic PD. Data pertaining to cognitive and psychiatric manifestations were extracted using standardized templates. The PRISMA guidelines were followed. Of the 1889 citations retrieved, 95 studies on PD-related gene mutations were included: 35 in SNCA, 35 in LRRK2, four in VPS35, 10 in Parkin, three in DJ1 and eight in PINK1. Nineteen studies (20%) provided adequate data from comprehensive cognitive assessment and 31 studies (32.6%) outlined psychiatric manifestations through the use of neuropsychiatric scales. Cognitive impairment was reported in all monogenic PD forms with variable rates (58.8% PINK1, 53.9% SNCA, 50% DJ1, 29.2% VPS35, 15.7% LRRK2 and 7.4% Parkin). In this regard, executive functions and attention were the domains most affected. With respect to psychiatric symptoms, depression was the most frequent symptom, occurring in 37.5% of PINK1 cases and 41.7% of VPS35 and LRRK2 cases. Co-occurrence of cognitive decline with visual hallucinations was evidenced. Widespread accumulation of Lewy bodies, distinctive of SNCA, PINK1 and DJ1 mutations, results in higher rates of cognitive impairment. Similarly, a higher degree of visual hallucinations is observed in SNCA mutations, probably owing to the more widespread accumulation. The lower rates of α-synuclein pathology in LRRK2 and Parkin may underpin the more benign disease course in these patients.

摘要

目的是回顾单基因帕金森病(PD)的认知和行为症状的现有报告,并确定具有特定突变的患者中临床症状的反复出现模式。进行了系统的文献检索,以检索单基因 PD 的观察性研究。使用标准化模板提取与认知和精神表现相关的数据。遵循 PRISMA 指南。在检索到的 1889 条引文中,纳入了 95 项与 PD 相关基因突变的研究:35 项与 SNCA 相关,35 项与 LRRK2 相关,4 项与 VPS35 相关,10 项与 Parkin 相关,3 项与 DJ1 相关,8 项与 PINK1 相关。19 项研究(20%)提供了来自全面认知评估的足够数据,31 项研究(32.6%)通过使用神经精神量表概述了精神表现。所有单基因 PD 形式都存在不同程度的认知障碍(58.8%的 PINK1、53.9%的 SNCA、50%的 DJ1、29.2%的 VPS35、15.7%的 LRRK2 和 7.4%的 Parkin)。在这方面,执行功能和注意力是受影响最严重的领域。就精神症状而言,抑郁症是最常见的症状,在 37.5%的 PINK1 病例和 41.7%的 VPS35 和 LRRK2 病例中出现。已证实认知能力下降与视幻觉并存。广泛积累的路易体,与 SNCA、PINK1 和 DJ1 突变有关,导致更高的认知障碍率。同样,在 SNCA 突变中观察到更高程度的视觉幻觉,可能是由于更广泛的积累。LRRK2 和 Parkin 中α-突触核蛋白病理学的较低发生率可能是这些患者疾病过程更为良性的原因。

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