Movement Disorders and Neuromodulation Center, Department of Neurology, Weill Institute for Neuroscience, University of California, San Francisco, CA, United States; Mental Illness Research, Education, and Clinical Center, San Francisco Veteran's Affairs Health Care System, San Francisco, CA, United States; Parkinson's Disease Research Education and Clinical Center, San Francisco Veteran's Affairs Health Care System, San Francisco, CA, United States.
Movement Disorders and Neuromodulation Center, Department of Neurology, Weill Institute for Neuroscience, University of California, San Francisco, CA, United States; Parkinson's Disease Research Education and Clinical Center, San Francisco Veteran's Affairs Health Care System, San Francisco, CA, United States.
Prog Brain Res. 2022;269(1):3-37. doi: 10.1016/bs.pbr.2022.01.004. Epub 2022 Feb 4.
Epidemiology is the study of the distribution of disease in human populations, which is important in evaluating burden of illness, identifying modifiable risk factors, and planning for current and projected needs of the health care system. Parkinson's disease (PD) is the second most common serious neurodegenerative illness and is expected to further increase in prevalence. Cognitive changes are increasingly viewed as an integral non-motor feature in PD, emerging even in the prodromal phase of the disease. The prevalence of PD-MCI ranges from 20% to 40% depending on the population studied. The incidence of PD-dementia increases with duration of disease, with estimates growing from 3% to 30% of individuals followed for 5 years or less to over 80% after 20 years. There are several challenges in estimating the frequency of cognitive change, including only recently standardized diagnostic criteria, variation depending on exact neuropsychological evaluations performed, and differences in population sampling. Clinical features associated with cognitive decline include older age, increased disease duration and severity, early gait dysfunction, dysautonomia, hallucinations and other neuropsychiatric features, the presence of REM behavior disorder, and posterior predominant dysfunction on neuropsychological testing. There is increasing evidence that genetic risk factors, in particular GBA and MAPT mutations, contribute to cognitive change. Possible protective factors include higher cognitive reserve and regular exercise. Important sequelae of cognitive decline in PD include higher caregiver burden, decreased functional status, and increased risk of institutionalization and mortality. Many remaining uncertainties regarding the epidemiology of cognitive change in PD require future research, with improved biomarkers and more sensitive and convenient outcome measures.
流行病学是研究人类群体中疾病的分布，这对于评估疾病负担、确定可改变的风险因素以及规划当前和预计的医疗保健系统需求非常重要。帕金森病（PD）是第二常见的严重神经退行性疾病，预计其患病率将进一步增加。认知变化越来越被视为 PD 的一个重要的非运动特征，甚至在疾病的前驱期就已经出现。根据研究人群的不同，PD-MCI 的患病率在 20%至 40%之间。PD 痴呆的发病率随疾病持续时间的增加而增加，估计从 5 年内随访的 3%至 30%的个体增加到 20 年后超过 80%的个体。估计认知变化的频率存在几个挑战，包括仅最近标准化的诊断标准、取决于所进行的精确神经心理学评估的变化以及人群抽样的差异。与认知下降相关的临床特征包括年龄较大、疾病持续时间和严重程度增加、早期步态功能障碍、自主神经功能障碍、幻觉和其他神经精神特征、REM 行为障碍的存在以及神经心理学测试中后部功能障碍。越来越多的证据表明，遗传风险因素，特别是 GBA 和 MAPT 突变，导致认知变化。可能的保护因素包括更高的认知储备和定期锻炼。PD 认知下降的重要后果包括更高的照顾者负担、功能状态下降以及增加的机构化和死亡率风险。PD 认知变化的流行病学仍存在许多不确定性，需要进一步研究，包括改善生物标志物和更敏感、方便的结果测量。
