Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.
Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.
Cortex. 2022 Jan;146:161-172. doi: 10.1016/j.cortex.2021.11.001. Epub 2021 Nov 12.
Cognitive and visual impairments in Parkinson's Disease Psychosis (PDP) raise the question of whether a specific profile of impaired cognition and visual function is linked to vulnerability to visual hallucinations (VHs). Previous studies have limited sample sizes and only included a sub-sample of tests. This is the first meta-analysis quantifying visuo-cognitive impairments in PDP patients across a spectrum of tests and taking into account potential confounding factors such as levodopa medication, illness duration and general cognitive ability.
Compare visual processing and cognitive performance between PD patients with and without VHs (PDVH and PDnoVH).
Four databases (PubMed, PsychINFO, Scopus, WebOfScience) were searched for studies on visual and/or cognitive performance of PDnoVH and PDVH published up to 02/2020. For each task, means and SDs were extracted and standardized-mean-differences (SMDs) between-groups calculated. Effect-sizes (Hedges' g) were calculated for all comparisons and synthesized in random-effects meta-analyses with robust-variance-estimation (accounting for multiple correlated measures within each study per cognitive/visual domain). Publication bias was assessed with funnel plots and Egger intercept.
N = 99 studies including 2508 PDVH patients (mean age 68.4 years) and 5318 PDnoVH (mean age 66.4 years) were included in the seven meta-analyses. PDVH patients performed worse than PDnoVH across all measures of cognition and visual processing, with the greatest between-group effect-sizes in executive functions, attention, episodic memory and visual processing. Study characteristics were not significantly associated with between-group differences in the domains investigated. Age-differences were significantly associated with performance differences in general cognition, working memory and executive functions.
Models of PDVH need to incorporate a wider range of cognitive and processing domains than currently included. There is a need for studies disentangling the temporal relationship between cognitive/visual deficits and VHs as early identification of risk before the onset of VHs could mitigate later outcomes such as progression to dementia.
帕金森病精神病（PDP）中的认知和视觉障碍提出了一个问题，即是否存在特定的认知和视觉功能障碍模式与易患视觉幻觉（VH）有关。以前的研究样本量有限，并且仅包括测试的子样本。这是第一次通过量化帕金森病患者在一系列测试中的视认知障碍，并考虑到左旋多巴药物、疾病持续时间和一般认知能力等潜在混杂因素，来对帕金森病患者进行荟萃分析。
比较有和无 VH（PDVH 和 PDnoVH）的 PD 患者的视觉处理和认知表现。
在四个数据库（PubMed、PsychINFO、Scopus、WebOfScience）中搜索了截至 2020 年 2 月发表的关于 PDnoVH 和 PDVH 的视觉和/或认知表现的研究。为每个任务提取平均值和标准差，并计算组间标准化均数差异（SMD）。对所有比较计算效应大小（Hedges' g），并在随机效应荟萃分析中进行综合，使用稳健方差估计（考虑每个认知/视觉域中每个研究的多个相关测量值）。使用漏斗图和 Egger 截距评估发表偏倚。
纳入了 99 项研究，包括 2508 名 PDVH 患者（平均年龄 68.4 岁）和 5318 名 PDnoVH 患者（平均年龄 66.4 岁），这些研究被纳入了 7 项荟萃分析。与 PDnoVH 患者相比，PDVH 患者在所有认知和视觉处理测量中表现更差，在执行功能、注意力、情景记忆和视觉处理方面的组间效应最大。研究特征与研究中调查的各个领域的组间差异无显著相关性。年龄差异与一般认知、工作记忆和执行功能的表现差异显著相关。
需要将更广泛的认知和处理领域纳入 PDVH 模型。需要进行研究以厘清认知/视觉缺陷与 VH 之间的时间关系，因为在 VH 发作之前尽早识别风险可以减轻痴呆等后期结果的发生。
