HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales.
Network Center for Biomedical Research on Neurodegenerative Diseases (CIBERNED), Instituto Carlos III.
Alzheimer Dis Assoc Disord. 2023;37(4):335-342. doi: 10.1097/WAD.0000000000000576. Epub 2023 Aug 22.
Mild cognitive impairment is common in Parkinson disease (PD-MCI). However, instability in this clinical diagnosis and variability in rates of progression to dementia raises questions regarding its utility for longitudinal tracking and prediction of cognitive change in PD. We examined baseline neuropsychological test and cognitive diagnosis predictors of cognitive change in PD.
Persons with PD, without dementia PD (N=138) underwent comprehensive neuropsychological assessment at baseline and were followed up to 2 years. Level II Movement Disorder Society criteria for PD-MCI and PD dementia (PDD) were applied annually. Composite global and domain cognitive z -scores were calculated based on a 10-test neuropsychological battery.
Baseline diagnosis of PD-MCI was not associated with a change in global cognitive z -scores. Lower baseline attention and higher executive domain z -scores were associated with greater global cognitive z -score worsening regardless of cognitive diagnosis. Worse baseline domain z -scores in the attention and language domains were associated with progression to MCI or PDD, whereas higher baseline scores in all cognitive domains except executive function were associated with clinical and psychometric reversion to "normal" cognition.
Lower scores on cognitive tests of attention were predictive of worse global cognition over 2 years of follow-up in PD, and lower baseline attention and language scores were associated with progression to MCI or PDD. However, PD-MCI diagnosis per se was not predictive of cognitive decline over 2 years. The association between higher executive domain z -scores and greater global cognitive worsening is probably a spurious result.
轻度认知障碍在帕金森病（PD-MCI）中很常见。然而，这种临床诊断的不稳定性以及向痴呆进展的速度的可变性，使得其在 PD 中的纵向跟踪和认知变化预测方面的实用性受到质疑。我们研究了 PD 患者认知变化的基线神经心理学测试和认知诊断预测因素。
无痴呆 PD（N=138）的 PD 患者在基线时接受全面的神经心理学评估，并在 2 年内进行随访。每年应用二级运动障碍协会的 PD-MCI 和 PD 痴呆（PDD）标准。基于 10 项神经心理学测试的组合整体和领域认知 z 分数进行计算。
基线 PD-MCI 诊断与全球认知 z 评分的变化无关。无论认知诊断如何，较低的基线注意力和较高的执行域 z 评分与全球认知 z 评分恶化程度更大相关。注意力和语言领域的基线较差域 z 评分与进展为 MCI 或 PDD 相关，而除执行功能外，所有认知领域的较高基线分数与临床和心理计量学恢复为“正常”认知相关。
在 PD 患者中，认知测试中注意力得分较低预示着 2 年的随访中全球认知状况恶化，而基线注意力和语言得分较低与进展为 MCI 或 PDD 相关。然而，PD-MCI 诊断本身并不能预测 2 年内的认知下降。执行域 z 评分较高与全球认知恶化程度更大之间的关联可能是一个虚假结果。
