Purks Jennifer L, Arbatti Lakshmi, Hosamath Abhishek, Amara Amy W, Anderson Karen E, Chahine Lana, Eberly Shirley W, Kinel Daniel, Mantri Sneha, Mathur Soania, Oakes David, Standaert David G, Weintraub Daniel, Shoulson Ira, Marras Connie
Department of Neurology (JLP, DK, IS), University of Rochester, NY; Grey Matter Technologies (LA, AH, IS), a wholly owned subsidiary of Modality.ai, San Francisco, CA; Department of Neurology (AWA), University of Colorado Anschutz Medical Campus, Aurora; Departments of Psychiatry and Neurology (KEA), Georgetown University, Washington, DC; Department of Neurology (LC), University of Pittsburgh, PA; Department of Biostatistics and Computational Biology (SWE, DO), University of Rochester, NY; Department of Neurology (Sneha Mantri), Duke University, Durham, NC; PD Avengers (Soania Mathur), Toronto, Ontario, Canada; Department of Neurology (DGS), University of Alabama at Birmingham; Departments of Psychiatry and Neurology (DW), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; and Edmond J Safra Program in Parkinson's Disease (CM), University Health Network, University of Toronto, Ontario, Canada.
Neurol Clin Pract. 2024 Oct;14(5):e200334. doi: 10.1212/CPJ.0000000000200334. Epub 2024 Jul 2.
Cognitive impairment is experienced by up to 80% of people with Parkinson disease (PD). Little is known regarding the subjective experience and frequency of bothersome cognitive problems across the range of disease duration as expressed directly in patients' own words. We describe the types and frequency of bothersome cognitive symptoms reported verbatim by patients with PD.
Through the online Fox Insight study and the Parkinson Disease Patient Report of Problems, we asked patients with PD to self-report by keyboard entry up to five most bothersome problems and how these problems affect their functioning. Human-in-the-loop curation, natural language processing, and machine learning were used to categorize responses into 8 cognitive symptoms: memory, concentration/attention, cognitive slowing, language/word finding, mental alertness/awareness, visuospatial abilities, executive abilities/working memory, and cognitive impairment not otherwise specified. Associations between cognitive symptoms and demographic and disease-related variables were examined in our cross-sectional cohort using multivariate logistic regression.
Among 25,192 participants (55% men) of median age 67 years and 3 years since diagnosis (YSD), 8,001 (32%) reported a cognitive symptom at baseline. The 3 most frequently reported symptoms were memory (13%), language/word finding (12%), and concentration/attention (9%). Depression was significantly associated with bothersome cognitive problems in all domains except visuospatial abilities. Predictors of reporting any cognitive symptom in PD were depression (adjusted OR 1.5), increasing MDS-UPDRS Part II score (OR 1.4 per 10-point increment), higher education (OR 1.2 per year), and YSD 1, 2, 6-7, and 8-9 vs 0 YSD. Among individuals with at least one cognitive symptom, posterior cortical-related cognitive symptoms (i.e., visuospatial, memory, and language) were reported by 17% (n = 4325), frontostriatal-related symptoms (i.e., executive abilities, concentration/attention) by 7% (n = 1,827), and both by 14.2% (n = 1,020). Odds of reporting posterior cortical symptoms vs frontostriatal symptoms increased with age and MDS-UPDRS part II score, but not depression.
Nearly one-third of participants with PD, even early in the disease course, report cognitive symptoms as among their most bothersome problems. Online verbatim reporting analyzed by human-in-the-loop curation, natural language processing, and machine learning is feasible on a large scale and allows a detailed examination of the nature and distribution of cognitive symptoms in PD.
高达80%的帕金森病（PD）患者存在认知障碍。对于疾病病程各阶段中令人困扰的认知问题的主观体验及发生频率，我们所知甚少，而这些问题是患者用自己的语言直接表达出来的。我们描述了PD患者逐字报告的令人困扰的认知症状的类型及频率。
通过在线的Fox Insight研究以及帕金森病患者问题报告，我们要求PD患者通过键盘输入自我报告最多五个最令人困扰的问题以及这些问题如何影响他们的功能。通过人工参与整理、自然语言处理和机器学习，将回答分类为8种认知症状：记忆、注意力/专注力、认知迟缓、语言/找词困难、精神警觉性/意识、视觉空间能力、执行能力/工作记忆以及未另行说明的认知障碍。在我们的横断面队列中，使用多变量逻辑回归分析认知症状与人口统计学及疾病相关变量之间的关联。
在25192名参与者（55%为男性）中，年龄中位数为67岁，诊断后3年（YSD），8001名（32%）在基线时报告有认知症状。报告最频繁的3种症状为记忆（13%）、语言/找词困难（12%）和注意力/专注力（9%）。除视觉空间能力外，抑郁与所有领域中令人困扰的认知问题均显著相关。PD患者报告任何认知症状的预测因素为抑郁（调整后的比值比为1.5）、MDS-UPDRS第二部分评分增加（每增加10分比值比为1.4）、高等教育程度（每年比值比为1.2）以及与诊断后0年相比，诊断后1年、2年、6 - 7年和8 - 9年。在至少有1种认知症状的个体中，17%（n = 4325）报告了与后皮质相关的认知症状（即视觉空间、记忆和语言），7%（n = 1827）报告了与额纹状体相关的症状（即执行能力、注意力/专注力），14.2%（n = 1020）报告了两者。报告后皮质症状与额纹状体症状的比值比随着年龄和MDS-UPDRS第二部分评分增加而升高，但与抑郁无关。
近三分之一的PD患者，即使在疾病病程早期，也将认知症状报告为最令人困扰的问题之一。通过人工参与整理、自然语言处理和机器学习进行分析的在线逐字报告在大规模研究中是可行的，并且能够详细检查PD中认知症状的性质和分布。
Zotero 插件