Gonzalez-Latapi Paulina, Bayram Ece, Litvan Irene, Marras Connie
Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, ON M5T2S8, Canada.
Parkinson and Other Movement Disorders Center, Department of Neurosciences, University of California San Diego, La Jolla, CA 92093, USA.
Behav Sci (Basel). 2021 May 13;11(5):74. doi: 10.3390/bs11050074.
Cognitive impairment is a common non-motor symptom in Parkinson's Disease (PD) and an important source of patient disability and caregiver burden. The timing, profile and rate of cognitive decline varies widely among individuals with PD and can range from normal cognition to mild cognitive impairment (PD-MCI) and dementia (PDD). Beta-amyloid and tau brain accumulation, oxidative stress and neuroinflammation are reported risk factors for cognitive impairment. Traumatic brain injury and pesticide and tobacco exposure have also been described. Genetic risk factors including genes such as , and may also play a role. Less is known about protective factors, although the Mediterranean diet and exercise may fall in this category. Nonetheless, there is conflicting evidence for most of the factors that have been studied. The use of inconsistent criteria and lack of comprehensive assessment in many studies are important methodological issues. Timing of exposure also plays a crucial role, although identification of the correct time window has been historically difficult in PD. Our understanding of the mechanism behind these factors, as well as the interactions between gene and environment as determinants of disease phenotype and the identification of modifiable risk factors will be paramount, as this will allow for potential interventions even in established PD.
认知障碍是帕金森病（PD）常见的非运动症状，是患者残疾和照料者负担的重要来源。PD患者的认知衰退时间、特征和速度差异很大，范围可从正常认知到轻度认知障碍（PD-MCI）和痴呆（PDD）。据报道，β-淀粉样蛋白和tau蛋白在脑内蓄积、氧化应激和神经炎症是认知障碍的危险因素。也有关于创伤性脑损伤以及接触杀虫剂和烟草的描述。包括某些基因等在内的遗传危险因素可能也起作用。关于保护因素了解较少，不过地中海饮食和运动可能属于此类。尽管如此，对于大多数已研究的因素，证据存在矛盾。许多研究中使用的标准不一致以及缺乏全面评估是重要的方法学问题。暴露时间也起着关键作用，尽管在PD中确定正确的时间窗历来都很困难。我们对这些因素背后机制的理解，以及基因与环境之间作为疾病表型决定因素的相互作用，还有可改变危险因素的识别至关重要，因为这将使我们即使在已确诊的PD中也能进行潜在干预。
