Carlisle Tara C, Fought Angela J, Olson Kaitlin E, Lopez-Esquibel Natalie, Simpson Abigail, Medina Luis D, Holden Samantha K
Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States.
Behavioral Neurology Section, Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States.
Front Neurosci. 2023 Jun 26;17:1200347. doi: 10.3389/fnins.2023.1200347. eCollection 2023.
Longitudinal assessment of functional abilities in Parkinson's disease (PD) is needed to determine the efficacy of cognitive interventions in providing meaningful improvements in daily life. Additionally, subtle changes in instrumental activities of daily living may precede a clinical diagnosis of dementia and could aid earlier detection of and intervention for cognitive decline.
The primary goal was to validate the longitudinal application of the University of California San Diego Performance-Based Skills Assessment (UPSA). An exploratory secondary goal was to determine whether UPSA may identify individuals at higher risk of cognitive decline in PD.
Seventy participants with PD completed the UPSA with at least one follow-up visit. Linear mixed effects modeling was used to identify associations between baseline UPSA score and cognitive composite score (CCS) over time. Descriptive analysis of four heterogeneous cognitive and functional trajectory groups and individual case examples was performed.
Baseline UPSA score predicted CCS at each timepoint for functionally impaired and unimpaired groups ( < 0.01) but did not predict the rate change in CCS over time ( = 0.83). Participants displayed heterogenous trajectories in both UPSA and CCS during the follow-up period. Most participants maintained both cognitive and functional performance ( = 54), though some displayed cognitive and functional decline ( = 4), cognitive decline with functional maintenance ( = 4), and functional decline with cognitive maintenance ( = 8).
The UPSA is a valid measure of cognitive functional abilities over time in PD. Given the heterogeneity of functional and cognitive trajectories, this performance-based assessment did not predict cognitive decline with this relatively short follow-up. Further work is needed to understand longitudinal functional assessments in PD-associated cognitive impairment.
帕金森病（PD）患者功能能力的纵向评估对于确定认知干预措施在改善日常生活方面的疗效至关重要。此外，日常生活工具性活动的细微变化可能先于痴呆的临床诊断，并有助于更早地发现和干预认知衰退。
主要目标是验证加利福尼亚大学圣地亚哥分校基于表现的技能评估（UPSA）的纵向应用。一个探索性的次要目标是确定UPSA是否可以识别PD患者中认知衰退风险较高的个体。
70名PD患者完成了UPSA评估，并至少进行了一次随访。采用线性混合效应模型来确定基线UPSA评分与随时间变化的认知综合评分（CCS）之间的关联。对四个异质性认知和功能轨迹组以及个体病例进行了描述性分析。
在功能受损和未受损组中，基线UPSA评分在每个时间点都能预测CCS（<0.01），但不能预测CCS随时间的变化率（=0.83）。在随访期间，参与者在UPSA和CCS方面均表现出异质性轨迹。大多数参与者保持了认知和功能表现（=54），尽管有些参与者出现了认知和功能衰退（=4）、认知衰退但功能保持（=4）以及功能衰退但认知保持（=8）。
UPSA是评估PD患者随时间变化的认知功能能力的有效指标。鉴于功能和认知轨迹的异质性，在相对较短的随访期内，这种基于表现的评估未能预测认知衰退。需要进一步开展工作来了解PD相关认知障碍中的纵向功能评估。
