Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Ann Clin Transl Neurol. 2020 Apr;7(4):449-461. doi: 10.1002/acn3.51022. Epub 2020 Apr 13.
To determine the evolution of numerous neuropsychiatric symptoms and cognitive abilities in Parkinson disease from disease onset.
Prospectively collected, longitudinal (untreated, disease onset to year 5), observational data from Parkinson's Progression Markers Initiative annual visits was used to evaluate prevalence, correlates, and treatment of 10 neuropsychiatric symptoms and cognitive impairment in Parkinson disease participants and matched healthy controls.
Of 423 Parkinson disease participants evaluated at baseline, 315 (74.5%) were assessed at year 5. Eight neuropsychiatric symptoms studied increased in absolute prevalence by 6.2-20.9% at year 5 relative to baseline, and cognitive impairment increased by 2.7-6.2%. In comparison, the frequency of neuropsychiatric symptoms in healthy controls remained stable or declined over time. Antidepressant and anxiolytic/hypnotic use in Parkinson disease were common at baseline and increased over time (18% to 27% for the former; 13% to 24% for the latter); antipsychotic and cognitive-enhancing medication use was uncommon throughout (2% and 5% of patients at year 5); and potentially harmful anticholinergic medication use was common and increased over time. At year 5 the cross-sectional prevalence for having three or more neuropsychiatric disorders/cognitive impairment was 56% for Parkinson disease participants versus 13% for healthy controls, and by then seven of the examined disorders had either occurred or been treated at some time point in the majority of Parkinson disease patients. Principal component analysis suggested an affective disorder subtype only.
Neuropsychiatric features in Parkinson disease are common from the onset, increase over time, are frequently comorbid, and fluctuate in severity.
从疾病发病开始，确定帕金森病中大量神经精神症状和认知能力的演变。
前瞻性收集，纵向（未治疗，发病至第 5 年），帕金森病进展标志物倡议年度就诊的观察数据，用于评估帕金森病患者和匹配的健康对照者中 10 种神经精神症状和认知障碍的患病率、相关性和治疗情况。
在基线评估的 423 名帕金森病患者中，有 315 名（74.5%）在第 5 年进行了评估。与基线相比，研究中的 8 种神经精神症状的绝对患病率在第 5 年增加了 6.2%至 20.9%，认知障碍增加了 2.7%至 6.2%。相比之下，健康对照组的神经精神症状频率在一段时间内保持稳定或下降。帕金森病患者的抗抑郁药和抗焦虑/催眠药的使用在基线时很常见，并随着时间的推移而增加（前者从 18%增加到 27%；后者从 13%增加到 24%）；抗精神病药和认知增强药物的使用在整个过程中都很少见（5 年后患者中有 2%和 5%）；而潜在有害的抗胆碱能药物的使用很常见，并随着时间的推移而增加。在第 5 年，帕金森病患者中有 3 种或更多神经精神障碍/认知障碍的横断面患病率为 56%，而健康对照组为 13%，到那时，在大多数帕金森病患者中，已经发生或已经治疗了七种检查疾病中的七种。主成分分析仅提示存在一种情感障碍亚型。
帕金森病患者的神经精神特征从发病开始就很常见，随着时间的推移而增加，经常并发，严重程度波动。
