神经精神症状谱与帕金森病和轻度认知障碍患者认知能力下降的关联。
Association of Neuropsychiatric Symptom Profiles With Cognitive Decline in Patients With Parkinson Disease and Mild Cognitive Impairment.
机构信息
From the Department of Neurology (Y.-g.L., Y.B., S.K., S.H.Y., H.K.N., Y.H.S., P.H.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (Y.-g.L.), Ilsan Paik Hospital, Inje University College of Medicine, Goyang; Department of Neurology (M.P.), Chung-Ang University College of Medicine and Graduate School of Medicine, Gwangmyeong Hospital; Department of Neurology (S.H.J.), Sanggye Paik Hospital, Inje University College of Medicine; and Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea (P.H.L.).
出版信息
Neurology. 2023 Sep 19;101(12):e1186-e1195. doi: 10.1212/WNL.0000000000207623. Epub 2023 Jul 31.
BACKGROUND AND OBJECTIVES
Neuropsychiatric symptoms (NPS) are closely associated with cognitive decline in patients with Parkinson disease (PD). We investigated which profiles of NPS are associated with the risk of dementia in PD with mild cognitive impairment (PD-MCI).
METHODS
We retrospectively assessed 338 patients with PD-MCI from a single tertiary hospital, who underwent neuropsychological tests and a neuropsychiatric inventory (NPI) questionnaire. We conducted a factor analysis of the dichotomized presence of 12 NPI symptoms, yielding 3 NPI factors: factor 1, mood symptoms; factor 2, hyperactivity-related symptoms; and factor 3, psychotic symptoms. Factor analysis of the severity of NPI symptoms also identified similar NPI factors. The neuropsychiatric correlates of NPI factors were evaluated using general linear models for cognitive tests. Subsequently, we evaluated the hazard ratio (HR) of NPI factors on conversion to dementia.
RESULTS
A higher prevalence factor 1 score was associated with lower scores in the verbal memory (β = -0.15; 95% CI -0.24 to -0.06; = 0.001) and executive domains (β = -0.16; 95% CI -0.28 to -0.04; = 0.007), whereas higher severity factor 2 scores were associated with lower scores in the naming (β = -0.16; 95% CI -0.28 to -0.03; = 0.012), visuospatial (β = -0.24; 95% CI -0.41 to -0.07; = 0.005), and verbal memory domains (β = -0.15; 95% CI -0.24 to -0.05; = 0.005). A higher severity factor 3 score was associated with lower scores in the visuospatial domain (β = -0.25; 95% CI -0.46 to -0.07; = 0.007). Cox regression models demonstrated that the risk of dementia was increased in those with higher prevalence factor 1 (HR = 1.48, 95% CI 1.17-1.88, = 0.001) and factor 2 scores (HR = 1.27, 95% CI 1.07-1.51, = 0.007) and severity factor 3 score (HR = 1.52, 95% CI 1.29-1.80, < 0.001) after adjusting for age, sex, education, disease duration, scores for cognition and parkinsonism, and levodopa equivalent dose.
DISCUSSION
This study demonstrated that a higher burden of NPS is associated with dementia conversion in patients with PD-MCI.
背景与目的
神经精神症状（NPS）与帕金森病（PD）患者的认知能力下降密切相关。我们研究了哪些 NPS 特征与轻度认知障碍（PD-MCI）的 PD 患者发生痴呆的风险相关。
方法
我们回顾性评估了来自一家三级医院的 338 名 PD-MCI 患者，他们接受了神经心理学测试和神经精神障碍问卷（NPI）调查。我们对 12 种 NPI 症状的存在情况进行了二分法因子分析，得到 3 个 NPI 因子：因子 1，情绪症状；因子 2，与多动相关的症状；因子 3，精神病症状。对 NPI 症状严重程度的因子分析也确定了类似的 NPI 因子。使用一般线性模型对认知测试中的 NPI 因子进行了神经精神相关性评估。随后，我们评估了 NPI 因子对向痴呆转化的风险比（HR）。
结果
较高的 NPS 发生率因子 1 评分与言语记忆（β=-0.15；95%置信区间 -0.24 至 -0.06； = 0.001）和执行领域（β=-0.16；95%置信区间 -0.28 至 -0.04； = 0.007）的较低评分相关，而较高的严重程度因子 2 评分与命名（β=-0.16；95%置信区间 -0.28 至 -0.03； = 0.012）、视空间（β=-0.24；95%置信区间 -0.41 至 -0.07； = 0.005）和言语记忆领域（β=-0.15；95%置信区间 -0.24 至 -0.05； = 0.005）的较低评分相关。严重程度因子 3 评分较高与视空间领域的评分较低有关（β=-0.25；95%置信区间 -0.46 至 -0.07； = 0.007）。Cox 回归模型表明，在调整年龄、性别、教育程度、疾病持续时间、认知和帕金森病评分以及左旋多巴等效剂量后，具有较高 NPS 发生率因子 1（HR=1.48，95%置信区间 1.17-1.88， = 0.001）和因子 2 评分（HR=1.27，95%置信区间 1.07-1.51， = 0.007）以及严重程度因子 3 评分（HR=1.52，95%置信区间 1.29-1.80， ＜0.001）的患者，痴呆风险增加。
讨论
本研究表明，NPS 负担加重与 PD-MCI 患者的痴呆转化有关。
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