Lin Fangju, Jia Weihua, Li Xuemei, Chen Ying, Wan Min
Department of Neurology, Beijing Shijingshan Hospital, Shijingshan Teaching Hospital of Capital Medical University, Beijing, 100043, People's Republic of China.
Department of Neurology, Affiliated Hospital of Weifang Medical University, Weifang, Shandong, 261031, People's Republic of China.
Neuropsychiatr Dis Treat. 2024 Jan 8;20:25-34. doi: 10.2147/NDT.S439131. eCollection 2024.
Parkinson's disease (PD) patients with freezing of gait (FOG) may present with complex and heterogeneous cognitive profiles. Owing to limited access to comprehensive neuropsychological battery in ordinary clinical practice, the Montreal Cognitive Assessment (MoCA) is likely to be easily available cognitive data for comparisons among studies. This study aims to explore the cognitive profiles stratified by education using MoCA in PD patients with FOG.
PD patients with FOG (FOG+, n = 52) and without FOG (FOG-, n = 71) were included in our study. MoCA items were categorized into five subsections (attention/working memory, executive function, episodic memory, language, and visuospatial function) referring to previously published criteria. Cognitive assessments were compared based on five subsections between groups stratified by three education levels (0-6 years, 7-12 years, and >12 years). The association of cognitive measurements with FOG were analyzed using binary logistic regression models with adjustment for variables.
The total scores and subscores of each subsection of MoCA were similar between two groups of each education level. Further detailed analysis showed that a composite measure labeled "Attention/working memory-Composite" (abbreviated to Attention-C), consisting of the scores of four items (target detection task, serial sevens, digit forward and backward, and sentence repetition), were lower significantly in FOG+ group compared with FOG- group in patients with education year ≤6 years. The significant association of Attention-C with FOG held true when controlling for disease duration, but not for H-Y stage, MDS-UPDRS III, HAMA, and HAMD.
Overall, our findings gave a hint that Attention-C derived from MoCA might be a potential factor associated with FOG in PD patients with lower education level (education year ≤ 6 years), which will need to be validated in future studies.
患有冻结步态（FOG）的帕金森病（PD）患者可能表现出复杂且异质的认知特征。由于在普通临床实践中难以获得全面的神经心理测验组合，蒙特利尔认知评估量表（MoCA）可能是研究间易于获取的认知数据，便于进行比较。本研究旨在使用MoCA探索在患有FOG的PD患者中按教育程度分层的认知特征。
本研究纳入了患有FOG的PD患者（FOG+组，n = 52）和未患有FOG的PD患者（FOG-组，n = 71）。根据先前发表的标准，将MoCA项目分为五个子部分（注意力/工作记忆、执行功能、情景记忆、语言和视觉空间功能）。基于三个教育水平（0 - 6年、7 - 12年和>12年）分层的组间，对五个子部分的认知评估进行比较。使用二元逻辑回归模型并对变量进行调整，分析认知测量与FOG的关联。
在每个教育水平的两组之间，MoCA各子部分的总分和分项得分相似。进一步的详细分析表明，在受教育年限≤6年的患者中，由四个项目（目标检测任务、连续减7、数字顺背和倒背以及句子复述）得分组成的复合指标“注意力/工作记忆 - 复合指标”（简称为注意力 - C）在FOG+组中显著低于FOG-组。在控制病程时，注意力 - C与FOG的显著关联仍然成立，但在控制H - Y分期、MDS - UPDRS III、汉密尔顿焦虑量表（HAMA）和汉密尔顿抑郁量表（HAMD）时则不然。
总体而言，我们的研究结果提示，来自MoCA的注意力 - C可能是受教育水平较低（受教育年限≤6年）的PD患者中与FOG相关的一个潜在因素，这需要在未来的研究中进行验证。
