Holden Heather M, Schweer Corrin N, Tröster Alexander I
Department of Clinical Neuropsychology Barrow Neurological Institute Phoenix Arizona USA.
Mov Disord Clin Pract. 2021 Oct 16;9(1):69-75. doi: 10.1002/mdc3.13353. eCollection 2022 Jan.
Younger age of onset and mild cognitive impairment (MCI) are both independently associated with poorer quality of life (QOL) in Parkinson's disease (PD).
The primary objective was to determine whether MCI differentially impacts QOL in young-onset PD (YOPD) and typical-onset PD (TOPD).
YOPD patients (n = 77) were diagnosed at age 50 or younger, TOPD (n = 77) were diagnosed after age 50, and the groups were matched for cognitive status, education, and disease duration. Patients' cognitive status was classified as MCI or cognitively normal (CN) based on MDS Level II criteria. QOL was assessed using the Parkinson's Disease Questionnaire (PDQ-39). ANCOVAs were conducted for each PDQ-39 subscale, with age of onset and cognitive status as between-subjects factors and several covariates included.
An interaction for the Cognition domain revealed that in TOPD, PD-MCI patients reported poorer QOL than CN patients, whereas there was no effect of MCI on cognitive satisfaction in YOPD. There was a main effect of age on Emotional Well-Being, as YOPD reported poorer QOL than TOPD in this domain. There were main effects of cognitive status, with PD-MCI patients reporting worse QOL than CN patients in the domains of Social Support, Communication, ADLs, and Mobility.
The interaction revealed that PD-MCI has a greater impact on degree of cognitive concerns ("cognitive QOL") in TOPD versus YOPD. A more nuanced understanding of the effects of age of onset, MCI, and their interactions on QOL in PD will inform interventions aimed at improving quality of life in this population.
发病年龄较轻和轻度认知障碍（MCI）均与帕金森病（PD）患者较差的生活质量（QOL）独立相关。
主要目的是确定MCI对早发型帕金森病（YOPD）和典型发病帕金森病（TOPD）患者生活质量的影响是否存在差异。
YOPD患者（n = 77）在50岁及以下被诊断，TOPD患者（n = 77）在50岁以后被诊断，两组在认知状态、教育程度和病程方面进行匹配。根据MDS二级标准，将患者的认知状态分为MCI或认知正常（CN）。使用帕金森病问卷（PDQ-39）评估生活质量。对每个PDQ-39子量表进行协方差分析，将发病年龄和认知状态作为组间因素，并纳入几个协变量。
认知领域的交互作用显示，在TOPD中，PD-MCI患者报告的生活质量比CN患者差，而MCI对YOPD患者的认知满意度没有影响。年龄对情绪健康有主效应，因为YOPD患者在该领域报告的生活质量比TOPD患者差。认知状态有主效应，PD-MCI患者在社会支持、沟通、日常生活活动和移动性领域报告的生活质量比CN患者差。
交互作用表明，与YOPD相比，PD-MCI对TOPD患者的认知关注程度（“认知生活质量”）影响更大。对发病年龄、MCI及其相互作用对PD患者生活质量影响的更细致理解将为旨在改善该人群生活质量的干预措施提供依据。
