Forbes Emily, Tropea Thomas F, Mantri Sneha, Xie Sharon X, Morley James F
Parkinson's Disease Research, Education and Clinical Center, Michael J. Crescenz Veterans Affairs Medical Center Philadelphia Pennsylvania USA.
Department of Neurology Perelman School of Medicine, University of Pennsylvania Philadelphia Pennsylvania USA.
Mov Disord Clin Pract. 2021 Jan 20;8(2):254-263. doi: 10.1002/mdc3.13143. eCollection 2021 Feb.
Cognitive impairment (CI) is one of the most feared and debilitating complications of PD. No therapy has been shown to slow or prevent CI in PD.
To determine associations between modifiable comorbidities, including cardiovascular disease risk factors, mood disorders, and sleep characteristics, and rate of cognitive decline in Parkinson's disease (PD).
Data from the Parkinson's Progression Markers Initiative (PPMI) cohort was queried for baseline cardiovascular disease risk factors, mood disorders, and sleep characteristics. Linear mixed- effects models (LME) were used to examine the association between baseline factors and change in cognition, evaluated by the Montreal Cognitive Assessment (MoCA) over time. Baseline comorbidities found to affect MoCA decline were assessed for an association with focal cognitive domains using LME.
Higher Body Mass Index (BMI) (β = -0.009, = 0.039), State Trait Anxiety Inventory (STAI) (β = -0.005, < 0.001), Geriatric Depression Scale (GDS) (β = -0.034, < 0.001), Epworth Sleepiness Scale (ESS) (β = -0.017, = 0.003), and REM Sleep Behavior Disorder Screening Questionnaire (RBDSQ) (β = -0.037, < 0.001) were associated with faster rates of MoCA decline. Using established cut-offs for clinically significant symptoms, being overweight, or the presence of depression, excessive day time sleepiness (EDS), and possible REM sleep behavior disorder (pRBD), were all associated with faster rate of cognitive decline.
Several modifiable baseline comorbidities are associated with faster rate of CI over time in patients with PD. These associations identify potential opportunities for early intervention that could influence CI in PD.
认知障碍（CI）是帕金森病（PD）最令人担忧且使人衰弱的并发症之一。尚无治疗方法被证明可减缓或预防PD中的CI。
确定可改变的共病（包括心血管疾病风险因素、情绪障碍和睡眠特征）与帕金森病（PD）认知衰退率之间的关联。
查询帕金森病进展标志物倡议（PPMI）队列的数据，以获取基线心血管疾病风险因素、情绪障碍和睡眠特征。使用线性混合效应模型（LME）来检验基线因素与认知变化之间的关联，认知变化通过蒙特利尔认知评估（MoCA）随时间进行评估。对于发现会影响MoCA衰退的基线共病，使用LME评估其与局灶性认知领域的关联。
较高的体重指数（BMI）（β = -0.009，P = 0.039）、状态特质焦虑量表（STAI）（β = -0.005，P < 0.001）、老年抑郁量表（GDS）（β = -0.034，P < 0.001）、爱泼沃斯思睡量表（ESS）（β = -0.017，P = 0.003）和快速眼动睡眠行为障碍筛查问卷（RBDSQ）（β = -0.037，P < 0.001）与MoCA衰退速度加快相关。使用已确定的具有临床意义症状的临界值，超重、存在抑郁、日间过度嗜睡（EDS）以及可能的快速眼动睡眠行为障碍（pRBD）均与认知衰退速度加快相关。
PD患者中，几种可改变的基线共病与随时间推移更快的CI发生率相关。这些关联确定了可能影响PD中CI的早期干预潜在机会。
