Department of Neurosciences, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK.
Parkinson Foundation Centre of Excellence at King's College Hospital, London, UK.
Brain Behav. 2021 May;11(5):e02086. doi: 10.1002/brb3.2086. Epub 2021 Mar 1.
Identifying predictors of incident cognitive impairment (CI), one of the most problematic long-term outcomes, in Parkinson's disease (PD) is highly relevant for personalized medicine and prognostic counseling. The Nonmotor Symptoms Scale (NMSS) provides a global clinical assessment of a range of NMS, reflecting NMS burden (NMSB), and thus may assist in the identification of an "at-risk" CI group based on overall NMSB cutoff scores.
To investigate whether specific patterns of PD NMS profiles predict incident CI, we performed a retrospective longitudinal study on a convenience sample of 541 nondemented PD patients taking part in the Nonmotor Longitudinal International Study (NILS) cohort, with Mini-Mental State Examination (MMSE), NMSS, and Scales for Outcomes in PD Motor Scale (SCOPA Motor) scores at baseline and last follow-up (mean 3.2 years) being available.
PD patients with incident CI (i.e., MMSE score ≤ 25) at last follow-up (n = 107) had severe overall NMSB level, significantly worse NMSS hallucinations/perceptual problems and higher NMSS attention/memory scores at baseline. Patients with CI also were older and with more advanced disease, but with no differences in disease duration, dopamine replacement therapy, sex, and comorbid depression, anxiety, and sleep disorders.
Our findings suggest that a comprehensive baseline measure of NMS and in particular hallucinations and perceptual problems assessed with a validated single instrument can be used to predict incident CI in PD. This approach provides a simple, holistic strategy to predict future CI in this population.
识别帕金森病（PD）中认知障碍（CI）的预测因素至关重要，CI 是最具挑战性的长期预后之一，这对个性化医疗和预后咨询具有重要意义。非运动症状量表（NMSS）提供了一系列非运动症状的全面临床评估，反映了非运动症状负担（NMSB），因此可以根据总体 NMSB 截止分数协助识别“处于风险中”的 CI 群体。
为了研究 PD 非运动症状谱是否存在特定模式可以预测 CI 的发生，我们对参加非运动纵向国际研究（NILS）队列的 541 例非痴呆 PD 患者进行了回顾性纵向研究，这些患者在基线和最后一次随访（平均 3.2 年）时均具有 Mini-Mental State Examination（MMSE）、NMSS 和帕金森病运动量表的结果量表（SCOPA 运动量表）评分。
在最后一次随访时患有 CI（即 MMSE 评分≤25）的 PD 患者（n=107）具有严重的总体 NMSB 水平，在基线时 NMSS 幻觉/知觉问题和 NMSS 注意力/记忆评分显著更差。患有 CI 的患者年龄更大，疾病更严重，但疾病持续时间、多巴胺替代疗法、性别以及合并的抑郁、焦虑和睡眠障碍无差异。
我们的研究结果表明，基线时对 NMS 进行全面的评估，特别是使用经过验证的单一工具评估幻觉和知觉问题，可用于预测 PD 中的 CI 发生。这种方法提供了一种简单、整体的策略，可用于预测该人群的未来 CI。
