Horne Kyla-Louise, MacAskill Michael R, Myall Daniel J, Livingston Leslie, Grenfell Sophie, Pascoe Maddie J, Young Bob, Shoorangiz Reza, Melzer Tracy R, Pitcher Toni L, Anderson Tim J, Dalrymple-Alford John C
New Zealand Brain Research Institute Christchurch New Zealand.
Department of Medicine University of Otago Christchurch New Zealand.
Mov Disord Clin Pract. 2021 Feb 18;8(3):390-399. doi: 10.1002/mdc3.13151. eCollection 2021 Apr.
Neuropsychiatric symptoms in Parkinson's disease (PD) may increase dementia (PDD) risk. The predictive value of these symptoms, however, has not been compared to clinical and demographic predictors of future PDD.
Determine if neuropsychiatric symptoms are useful markers of PDD risk.
328 PD participants completed baseline neuropsychiatric and MDS-Task Force-Level II assessments. Of these, 202 non-demented individuals were followed-up over a four-years period to detect conversion to PDD; 51 developed PDD. ROC analysis tested associations between baseline neuropsychiatric symptoms and future PDD. The probability of developing PDD was also modeled as a function of neuropsychiatric inventory (NPI)-total score, PD Questionnaire (PDQ)-hallucinations, PDQ-anxiety, and contrasted to cognitive ability, age, and motor function. Leave-one-out information criterion was used to evaluate which models provided useful information when predicting future PDD.
The PDD group experienced greater levels of neuropsychiatric symptoms compared to the non-PDD groups at baseline. Few differences were found between the PD-MCI and PD-N groups. Six neuropsychiatric measures were significantly, but weakly, associated with future PDD. The strongest was NPI-total score: AUC = 0.66 [0.57-0.75]. There was, however, no evidence it contained useful out-of-sample predictive information of future PDD (delta ELPD = 1.8 (SD 2.5)); Similar results held for PDQ-hallucinations and PDQ-anxiety. In contrast, cognitive ability (delta ELPD = 36 (SD 8)) and age (delta ELPD = 11 (SD 5)) provided useful predictive information of future PDD.
Cognitive ability and age strongly out-performed neuropsychiatric measures as markers of developing PDD within 4 years. Therefore, neuropsychiatric symptoms do not appear to be useful markers of PDD risk.
帕金森病（PD）中的神经精神症状可能会增加患痴呆症（PDD）的风险。然而，这些症状的预测价值尚未与未来PDD的临床和人口统计学预测因素进行比较。
确定神经精神症状是否为PDD风险的有用标志物。
328名PD参与者完成了基线神经精神和MDS任务组二级评估。其中，202名非痴呆个体在四年期间接受随访以检测是否转变为PDD；51人发展为PDD。ROC分析测试了基线神经精神症状与未来PDD之间的关联。发生PDD的概率也被建模为神经精神量表（NPI）总分、帕金森病问卷（PDQ）-幻觉、PDQ-焦虑的函数，并与认知能力、年龄和运动功能进行对比。采用留一法信息准则来评估哪些模型在预测未来PDD时提供了有用信息。
与非PDD组相比，PDD组在基线时经历了更严重的神经精神症状。在PD-MCI组和PD-N组之间几乎没有发现差异。六项神经精神指标与未来PDD有显著但微弱的关联。最强的是NPI总分：曲线下面积（AUC）=0.66[0.57-0.75]。然而，没有证据表明它包含未来PDD有用的样本外预测信息（差异预期对数点估计值（delta ELPD）=1.8（标准差2.5））；PDQ-幻觉和PDQ-焦虑也有类似结果。相比之下，认知能力（delta ELPD = 36（标准差8））和年龄（delta ELPD = 11（标准差5））提供了未来PDD有用的预测信息。
作为4年内发生PDD的标志物时，认知能力和年龄的预测能力明显优于神经精神指标。因此，神经精神症状似乎不是PDD风险的有用标志物。
