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帕金森病轻度认知障碍和痴呆进展认知的荟萃分析。

Meta-Analysis of Cognition in Parkinson's Disease Mild Cognitive Impairment and Dementia Progression.

机构信息

Department of Psychology, University of Kentucky, Lexington, KY, USA.

Department of Neurology, University of Kentucky, Lexington, KY, USA.

出版信息

Neuropsychol Rev. 2022 Mar;32(1):149-160. doi: 10.1007/s11065-021-09502-7. Epub 2021 Apr 16.

Abstract

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.

摘要

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。

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