Institut des Maladies Neurodégénératives-Clinique (IMNc), University Hospital Bordeaux, Bordeaux, France; Inserm, UMR1219, Bordeaux Population Health Research Center, Bordeaux University, ISPED, F33000, Bordeaux, France.
Inserm, UMR1219, Bordeaux Population Health Research Center, Bordeaux University, ISPED, F33000, Bordeaux, France.
Parkinsonism Relat Disord. 2020 Oct;79:40-46. doi: 10.1016/j.parkreldis.2020.08.022. Epub 2020 Aug 15.
Prodromal non-motor symptoms precede, often by decades, motor signs and diagnosis of Parkinson's disease. It is however still uncertain if cognitive changes belong to the spectrum of non-motor prodromal Parkinson's disease. Thanks to the very long-term follow-up of the PAQUID population-based cohort, we assessed trajectories of cognitive complaints and functioning over a 13-year period before the diagnosis of late onset Parkinson's disease.
This study relies on a matched nested case-control sample selected from the cohort. Of the 3777 initial subjects of the cohort, 43 developed incident Parkinson's disease over the follow-up. The mean age at diagnosis was 78.0 (standard deviation = 5.8) years and 46.5% were men. These cases were matched to 86 elderly control subjects. Scores of different cognitive domains, daily function, and depressive symptoms were described throughout the follow-up using mixed-effects models.
No significant global cognitive decline preceded the diagnosis of late onset Parkinson's disease. However, psychomotor speed appeared significantly slower 2 years before the diagnosis and depressive symptoms 12 years before. Global score of instrumental activities of daily living became altered 2-3 years preceding the diagnosis of late onset Parkinson's disease, including the use of public transportation that was altered ten years before the diagnosis.
In late onset Parkinson's disease, while global cognitive functions seem preserved, psychomotor speed starts to decline 2 years before the diagnosis and activities of daily living are also impacted. Depressive symptoms appear very early in the prediagnosic phase.
前驱非运动症状先于帕金森病的运动征象和诊断出现，通常早几十年出现。然而，认知变化是否属于帕金森病前驱非运动谱仍不确定。由于基于人群的 PAQUID 队列的长期随访，我们评估了在诊断为迟发性帕金森病之前的 13 年内认知主诉和功能的变化轨迹。
本研究依赖于从队列中选择的匹配嵌套病例对照样本。在队列的 3777 名初始受试者中，有 43 名在随访期间发生了偶发性帕金森病。诊断时的平均年龄为 78.0 岁（标准差=5.8），46.5%为男性。这些病例与 86 名老年对照匹配。使用混合效应模型描述了不同认知域、日常功能和抑郁症状在整个随访过程中的评分。
在诊断为迟发性帕金森病之前，没有明显的整体认知下降。然而，在诊断前 2 年，精神运动速度明显减慢，在诊断前 12 年，抑郁症状明显。在诊断为迟发性帕金森病之前的 2-3 年内，包括使用公共交通工具，工具性日常生活活动的总体评分开始发生改变，而在诊断前 10 年，公共交通工具的使用情况发生了改变。
在迟发性帕金森病中，虽然整体认知功能似乎保持不变，但精神运动速度在诊断前 2 年开始下降，日常生活活动也受到影响。抑郁症状在诊断前的早期阶段就已经出现。
