帕金森病的认知评估：在受教育程度较低的人群中应用运动障碍学会的建议。

Cognitive evaluation in Parkinson's disease: applying the Movement Disorder Society recommendations in a population with a low level of formal education.

机构信息

Universidade Federal de Minas Gerais, Faculdade de Medicina, Laboratório Interdisciplinar de Investigação Médica, Belo Horizonte MG, Brazil.

The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Department of Psychiatry and Behavioral Sciences, Neuropsychiatry Program, Texas, United States.

出版信息

Arq Neuropsiquiatr. 2023 Feb;81(2):119-127. doi: 10.1055/s-0042-1759761. Epub 2023 Mar 22.

DOI:10.1055/s-0042-1759761

PMID:36948198

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10033198/

Abstract

BACKGROUND

The diagnosis of cognitive disorders in Parkinson disease (PD) can be very challenging. Aiming at establishing uniform and reliable diagnostic procedures, the International Parkinson's Disease and Movement Disorder Society (MDS) commissioned task forces to delineate diagnostic criteria for mild cognitive impairment (MCI) and dementia in PD.

OBJECTIVES

To investigate the applicability of the MDS recommendations for cognitive evaluation in a Brazilian sample of patients with PD with low levels of formal education.

METHODS

A total of 41 patients with PD were subjected to a comprehensive neuropsychological evaluation based on tests proposed by the MDS, which included the Mini-Mental State Examination, the Mattis Dementia Rating Scale (MDRS), the Trail Making Test (TMT) parts A and B, in addition to language and memory skills assessment. Neuropsychiatric and daily functioning features were also evaluated. Spearman correlation analyses were used to evaluate the association between the scores obtained in the cognitive scales and demographic/clinical variables.

RESULTS

Although none of the participants had a formal diagnosis of dementia, 50% presented some degree of cognitive impairment when considering the results of the MDRS. Of note, a noticeable number of patients was not able to complete the full neuropsychological assessment. The TMT part B was the most difficult task, being completed by only 22 participants (54%). As expected, the greater the educational level, the better the performance on the cognitive tests. Better motor function was also associated with better scores in cognition.

CONCLUSIONS

Adopting strict inclusion/exclusion criteria and a comprehensive clinical evaluation, we found remarkable limitations for the MDS recommendations when individuals with low educational levels are considered. A revision of the current guidelines is necessary considering differences among populations, especially related to formal education.

摘要

背景

帕金森病（PD）认知障碍的诊断极具挑战性。为了建立统一、可靠的诊断程序，国际帕金森病和运动障碍学会（MDS）委托工作组为 PD 的轻度认知障碍（MCI）和痴呆制定诊断标准。

目的

调查 MDS 认知评估建议在巴西低教育水平 PD 患者样本中的适用性。

方法

共 41 名 PD 患者接受了基于 MDS 建议的全面神经心理学评估，包括简易精神状态检查、Mattis 痴呆评定量表（MDRS）、连线测试（TMT）A 部分和 B 部分，以及语言和记忆技能评估。还评估了神经精神和日常功能特征。采用 Spearman 相关分析评估认知量表评分与人口统计学/临床变量之间的相关性。

结果

尽管没有参与者被正式诊断为痴呆，但考虑到 MDRS 的结果，50%的参与者存在一定程度的认知障碍。值得注意的是，相当数量的患者无法完成完整的神经心理学评估。TMT B 部分是最困难的任务，只有 22 名参与者（54%）能够完成。正如预期的那样，教育程度越高，认知测试的表现越好。运动功能越好，认知评分也越好。