Department of Psychology, University of Kentucky, Lexington, KY, USA.
Department of Neurology, University of Kentucky, Lexington, KY, USA.
Neuropsychol Rev. 2022 Mar;32(1):149-160. doi: 10.1007/s11065-021-09502-7. Epub 2021 Apr 16.
Mild cognitive changes, including executive dysfunction, are seen in Parkinson's Disease (PD). Approximately 30% of individuals with PD develop Parkinson's disease dementia (PDD). Mild cognitive impairment (MCI) has been identified as a transitional state between normal cognition and dementia. Although PD-MCI and its cognitive correlates have been increasingly studied as a risk indicator for development of PDD, investigations into the PD-MCI construct have yielded heterogeneous findings. Thus, a typical PD-MCI cognitive profile remains undefined. The present meta-analysis examined published cross-sectional studies of PD-MCI and cognitively normal PD (PD-CN) groups to provide aggregated effect sizes of group test performance by cognitive domain. Subsequently, longitudinal studies examining PD-MCI to PDD progression were meta-analyzed. Ninety-two cross-sectional articles of PD-MCI vs. PD-CN were included; 5 longitudinal studies of PD-MCI conversion to PDD were included. Random effects meta-analytic models were constructed resulting in effect sizes (Hedges' g) for cognitive domains. Overall performance across all measures produced a large effect size (g = 0.83, 95% CI [0.79, 0.86], t = 0.18) in cross-sectional analyses, with cognitive screeners producing the largest effect (g = 1.09, 95% CI [1.00, 1.17], t = 0.19). Longitudinally, overall measures produced a moderate effect (g = 0.47, 95% CI [0.40, 0.53], t = 0.01), with measures of executive functioning exhibiting the largest effect (g = 0.70, 95% CI [0.51, 0.89], t = 0.01). Longitudinal effects were made more robust by low heterogeneity. This report provides the first comprehensive meta-analysis of PD-MCI cognitive outcomes and predictors in PD-MCI conversion to PDD. Limitations include heterogeneity of cross-sectional effect sizes and the potential impact of small-study effects. Areas for continued research include visuospatial skills and visual memory in PD-MCI and longitudinal examination of executive dysfunction in PD-MCI.
轻度认知改变，包括执行功能障碍，见于帕金森病（PD）。大约 30%的 PD 患者会发展为帕金森病痴呆（PDD）。轻度认知障碍（MCI）已被确定为正常认知与痴呆之间的过渡状态。虽然 PD-MCI 及其认知相关性已作为发展为 PDD 的风险指标进行了越来越多的研究，但对 PD-MCI 结构的研究结果存在异质性。因此，典型的 PD-MCI 认知特征仍未确定。本荟萃分析检查了 PD-MCI 和认知正常 PD（PD-CN）组的已发表横断面研究，以提供按认知域分组的测试表现的汇总效应大小。随后，对 PD-MCI 向 PDD 进展的纵向研究进行了荟萃分析。纳入了 92 篇 PD-MCI 与 PD-CN 的横断面研究文章；纳入了 5 项 PD-MCI 向 PDD 转化的纵向研究。构建了随机效应荟萃分析模型，得出了认知域的效应大小（Hedges'g）。横断面分析中，所有指标的整体表现产生了较大的效应大小（g=0.83，95%CI[0.79，0.86]，t=0.18），认知筛查产生的效应最大（g=1.09，95%CI[1.00，1.17]，t=0.19）。纵向研究中，整体指标产生了中等效应（g=0.47，95%CI[0.40，0.53]，t=0.01），执行功能测量的效应最大（g=0.70，95%CI[0.51，0.89]，t=0.01）。低异质性使纵向效应更加稳健。本报告首次对 PD-MCI 向 PDD 转化的 PD-MCI 认知结局和预测因素进行了全面的荟萃分析。局限性包括横断面效应大小的异质性和小样本研究效应的潜在影响。需要继续研究的领域包括 PD-MCI 中的视空间技能和视觉记忆以及 PD-MCI 中执行功能的纵向研究。
