帕金森病患者的认知障碍：一项大型纵向研究中主观和客观认知下降之间的关联。
Cognitive impairment in Parkinson's disease: Associations between subjective and objective cognitive decline in a large longitudinal study.
机构信息
Johns Hopkins University School of Medicine, Baltimore, MD, USA.
University of Rochester School of Medicine and Density, Rochester, NY, USA.
出版信息
Parkinsonism Relat Disord. 2020 Nov;80:127-132. doi: 10.1016/j.parkreldis.2020.09.028. Epub 2020 Sep 20.
BACKGROUND
Cognitive decline creates substantial morbidity and cost in Parkinson's disease (PD) and clinicians have limited tools for counseling patients on prognosis. We aimed to use data from a randomized, controlled trial of isradipine in Parkinson's disease (STEADY-PD III) to determine which objective cognitive domain deficits drive patient complaints of cognitive symptoms.
METHODS
Neuro-Quality of Life (Neuro-QoL) Cognition: General Concerns (GC), and Cognition: Executive Function (EF) (subjective measures), were administered at baseline, 1, 2, and 3 years in 324 people with PD. Baseline Montreal Cognitive Assessment (MoCA) was divided into 4 domains: visuospatial/executive, memory, attention, and language (objective measures). Spearman rank correlations and multiple regression models adjusted for other clinical variables evaluated associations between baseline Neuro-QoL domains and individual MoCA domains. Multiple regression models evaluated the association between baseline MoCA domain performance and Neuro-QoL change over three years. Cox proportional hazards predicted development of PD-MCI based on baseline and time-varying Neuro-QoL reporting.
RESULTS
Higher MoCA memory performance was associated with better Neuro-QoL-GC (β = 0.75, SE = 0.391, p = 0.05) and Neuro-QoL-EF (β = 0.81, SE = 0.36, p = 0.02) at baseline. There was a trend for baseline MoCA memory to predict the degree of subjective cognitive decline on the Neuro-QoL-EF (β = 0.70, SE = 0.42, p = 0.09). Baseline depression and anticholinergic use were associated with worsened Neuro-QoL-EF and Neuro-QoL-GC. Increasing subjective cognitive complaints in Neuro-QoL-EF were associated with development of PD-MCI over 3 years of follow-up (HR = 0.95, CI = 0.90-1.0, p = 0.039).
CONCLUSIONS
Objective memory impairment may be a stronger predictor than executive or visuospatial dysfunction for the presence of subjective cognitive complaints in early PD.
背景
认知能力下降给帕金森病（PD）患者带来了严重的发病率和医疗费用，而临床医生用于为患者提供预后咨询的工具非常有限。本研究旨在使用随机对照试验（STEADY-PD III）中关于异搏定治疗帕金森病的研究数据，确定哪些客观认知领域的缺陷会导致患者出现认知症状。
方法
Neuro-Quality of Life（Neuro-QoL）认知：一般关注（GC）和认知：执行功能（EF）（主观测量）在 324 名 PD 患者中分别于基线、1 年、2 年和 3 年进行测量。蒙特利尔认知评估（MoCA）的基线分为 4 个领域：视空间/执行功能、记忆、注意力和语言（客观测量）。Spearman 秩相关和多变量回归模型调整了其他临床变量，评估了基线 Neuro-QoL 领域与 MoCA 各领域之间的相关性。多变量回归模型评估了基线 MoCA 域性能与三年间 Neuro-QoL 变化之间的关系。Cox 比例风险预测基于基线和时变的 Neuro-QoL 报告，根据 PD-MCI 的发展情况进行预测。
结果
MoCA 记忆表现较好与 Neuro-QoL-GC（β=0.75，SE=0.391，p=0.05）和 Neuro-QoL-EF（β=0.81，SE=0.36，p=0.02）基线水平呈正相关。基线 MoCA 记忆与 Neuro-QoL-EF 上主观认知下降程度呈正相关（β=0.70，SE=0.42，p=0.09），但呈趋势性。基线抑郁和抗胆碱能药物的使用与 Neuro-QoL-EF 和 Neuro-QoL-GC 的恶化有关。Neuro-QoL-EF 中主观认知抱怨的增加与 3 年随访期间 PD-MCI 的发展有关（HR=0.95，CI=0.90-1.0，p=0.039）。
结论
与执行或视空间功能障碍相比，早期 PD 患者存在主观认知抱怨时，客观记忆障碍可能是一个更强的预测因素。
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