Department of Neurology, Yonsei University College of Medicine, 50, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea.
J Neurol. 2021 Nov;268(11):4203-4212. doi: 10.1007/s00415-021-10529-2. Epub 2021 May 4.
To investigate the association between cognitive function at baseline and the progression of motor disability in Parkinson's disease (PD).
We consecutively enrolled 257 drug-naïve patients with early-stage PD (follow-up > 2 years) who underwent a detailed neuropsychological test at initial assessment. Factor analysis was conducted to yield four cognitive function factors and composite scores thereof: Factor 1 (visual memory/visuospatial), Factor 2 (verbal memory), Factor 3 (frontal/executive), and Factor 4 (attention/working memory/language). The global cognitive composite score of each patient was calculated based on these factors. Subsequently, we assessed the effect of baseline cognitive function on long-term motor outcomes, namely levodopa-induced dyskinesia (LID), wearing-off, freezing of gait (FOG), and rate of longitudinal increases in levodopa-equivalent dose (LED).
Cox regression analysis demonstrated that higher Factor 3 (frontal/executive) composite scores (i.e., better cognitive performance) were associated with early development of LID [hazard ratio (HR), 1.507; p = 0.003], whereas higher Factor 1 (visual memory/visuospatial) composite scores (i.e., better cognitive performance) were associated with a lower risk for FOG (HR 0.683; p = 0.017). We noted that higher global cognitive composite scores were associated with a lower risk for developing FOG (HR 0.455; p = 0.045). The linear mixed model demonstrated that higher global cognitive composite scores and better cognitive performance in visual memory/visuospatial function were associated with slower longitudinal increases in LED.
These findings suggest that baseline cognitive profiles have prognostic implications on several motor aspects in patients with PD.
探讨基线认知功能与帕金森病（PD）运动功能障碍进展的关系。
我们连续纳入了 257 例初诊、未经药物治疗的早期 PD 患者（随访时间＞2 年），这些患者在初始评估时接受了详细的神经心理学测试。我们进行了因子分析，得出了四个认知功能因子及其综合评分：因子 1（视觉记忆/视空间）、因子 2（语言记忆）、因子 3（额叶/执行功能）和因子 4（注意力/工作记忆/语言）。基于这些因子，计算每位患者的整体认知综合评分。随后，我们评估了基线认知功能对长期运动结局的影响，包括左旋多巴诱导的运动障碍（LID）、开-关现象、冻结步态（FOG）以及左旋多巴等效剂量（LED）的纵向增加率。
Cox 回归分析表明，较高的因子 3（额叶/执行功能）综合评分（即认知表现较好）与 LID 的早期发生相关（风险比 [HR]，1.507；p=0.003），而较高的因子 1（视觉记忆/视空间）综合评分（即认知表现较好）与 FOG 的风险降低相关（HR 0.683；p=0.017）。我们发现，较高的整体认知综合评分与 FOG 的发生风险降低相关（HR 0.455；p=0.045）。线性混合模型表明，较高的整体认知综合评分和更好的视觉记忆/视空间功能认知表现与 LED 的纵向增加速度较慢相关。
这些发现表明，基线认知特征对 PD 患者的多个运动方面具有预后意义。
