血管危险因素、帕金森病中的脑白质病变与认知障碍：PACOS 纵向研究。
Vascular risk factors, white matter lesions and cognitive impairment in Parkinson's disease: the PACOS longitudinal study.
机构信息
Department of Medical, Surgical Sciences and Advanced Technologies, GF Ingrassia, University of Catania, Catania, Italy.
Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy.
出版信息
J Neurol. 2021 Feb;268(2):549-558. doi: 10.1007/s00415-020-10189-8. Epub 2020 Aug 31.
BACKGROUND
Vascular risk factors (VRFs) may be associated with cognitive decline in early Parkinson's disease (PD) but results are inconclusive. The identification of modifiable risk factors is relevant for prevention and treatment.
METHODS
Parkinson's disease (PD) patients of the PACOS cohort who underwent a baseline and follow-up neuropsychological evaluation were enrolled in the study. PD with Mild Cognitive Impairment (MCI) and dementia (PDD) were diagnosed according to the MDS criteria. A Baseline 1.5 T brain MRI was used to calculate the white matter lesions (WMLs) burden using the Wahlund visual scale. Laboratory data, presence of hypertension, diabetes and use of anti-hypertensive drugs were collected and the Framingham Risk (FR) score was calculated. VRFs predicting PD-MCI and PDD were evaluated using Cox proportional hazard regression model.
RESULTS
Out of 139 enrolled patients, 84 (60.4%) were classified as normal cognition (NC) and 55 (39.6%) as MCI at baseline. At follow-up 28 (33.3%) PD-NC developed MCI and 4 (4.8%) PDD (follow-up time 23.5 ± 10.3 months). Out of 55 PD-MCI patients at baseline, 14 (25.4%) converted to PDD. At multivariate analysis among PD-NC a systolic blood pressure (SBP) > 140 mmHg was the stronger predictor of MCI (adjHR 4.04; 95% CI 1.41-11.3) while the presence of MCI at baseline (adj HR 7.55; 95% CI 1.76-32.3) and a severe WMLs burden (adj HR 2.80; 95% CI 0.86-9.04) were the strongest predictors of PDD, even if this latter association has a trend towards significance.
CONCLUSION
Hypertension represents the most important modifiable risk factor for PD-MCI in the PACOS cohort, increasing the risk of about four times.
背景
血管危险因素（VRFs）可能与早期帕金森病（PD）患者的认知能力下降有关，但结果尚无定论。确定可改变的危险因素对于预防和治疗具有重要意义。
方法
本研究纳入了 PACOS 队列中接受基线和随访神经心理学评估的 PD 患者。根据 MDS 标准，将 PD 伴轻度认知障碍（MCI）和痴呆（PDD）诊断为 PD-MCI 和 PDD。使用基线时的 1.5T 脑 MRI 采用 Wahlund 视觉量表计算白质病变（WMLs）负荷。收集实验室数据、高血压、糖尿病的存在和使用抗高血压药物的情况，并计算 Framingham 风险（FR）评分。使用 Cox 比例风险回归模型评估预测 PD-MCI 和 PDD 的 VRFs。
结果
在纳入的 139 名患者中，84 名（60.4%）患者在基线时被归类为正常认知（NC），55 名（39.6%）为 MCI。在随访期间，28 名（33.3%）PD-NC 发展为 MCI，4 名（4.8%）PD-NC 发展为 PDD（随访时间 23.5±10.3 个月）。在基线时有 55 名 PD-MCI 患者中，14 名（25.4%）转为 PDD。多变量分析显示，PD-NC 中收缩压（SBP）>140mmHg 是 MCI 的更强预测因子（调整后 HR 4.04；95%CI 1.41-11.3），而基线时存在 MCI（调整后 HR 7.55；95%CI 1.76-32.3）和严重的 WMLs 负担（调整后 HR 2.80；95%CI 0.86-9.04）是 PDD 的最强预测因子，尽管这种关联具有显著趋势。
结论
高血压是 PACOS 队列中 PD-MCI 的最重要的可改变危险因素，风险增加约四倍。
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