Hertie Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, Eberhard Karls University Tübingen, Hoppe-Seyler Str. 3, 72076, Tübingen, Germany.
German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany.
J Neural Transm (Vienna). 2024 Oct;131(10):1159-1186. doi: 10.1007/s00702-024-02796-w. Epub 2024 Jul 8.
The ability to perform activities of daily living (ADL) function is a multifaceted construct that reflects functionality in different daily life situations. The loss of ADL function due to cognitive impairment is the core feature for the diagnosis of Parkinson's disease dementia (PDD). In contrast to Alzheimer's disease, ADL impairment in PD can be compromised by various factors, including motor and non-motor aspects. This narrative review summarizes the current state of knowledge on the association of cognition and ADL function in people with PD and introduces the concept of "cognitive ADL" impairment for those problems in everyday life that are associated with cognitive deterioration as their primary cause. Assessment of cognitive ADL impairment is challenging because self-ratings, informant-ratings, and performance-based assessments seldomly differentiate between "cognitive" and "motor" aspects of ADL. ADL function in PD is related to multiple cognitive domains, with attention, executive function, and memory being particularly relevant. Cognitive ADL impairment is characterized by behavioral anomalies such as trial-and-error behavior or task step omissions, and is associated with lower engagement in everyday behaviors, as suggested by physical activity levels and prolonged sedentary behavior. First evidence shows that physical and multi-domain interventions may improve ADL function, in general, but the evidence is confounded by motor aspects. Large multicenter randomized controlled trials with cognitive ADL function as primary outcome are needed to investigate which pharmacological and non-pharmacological interventions can effectively prevent or delay deterioration of cognitive ADL function, and ultimately the progression and conversion to PDD.
日常生活活动（ADL）功能的能力是一个多方面的结构，反映了不同日常生活情况下的功能。由于认知障碍导致的 ADL 功能丧失是帕金森病痴呆（PDD）诊断的核心特征。与阿尔茨海默病不同，PD 中的 ADL 损伤可能受到多种因素的影响，包括运动和非运动方面。这篇叙述性综述总结了目前关于 PD 患者认知与 ADL 功能之间关联的知识状况，并介绍了“认知 ADL”损伤的概念，用于那些与认知恶化相关的日常生活问题，这些问题主要是认知恶化的原因。认知 ADL 损伤的评估具有挑战性，因为自评、他评和基于表现的评估很少能区分 ADL 的“认知”和“运动”方面。PD 中的 ADL 功能与多个认知领域相关，注意力、执行功能和记忆尤为相关。认知 ADL 损伤的特征是行为异常，例如反复尝试行为或任务步骤遗漏，并且与日常行为参与度较低有关，这可以通过身体活动水平和久坐行为延长来提示。初步证据表明，身体和多领域干预可能总体上改善 ADL 功能，但证据受到运动方面的影响。需要进行大型多中心随机对照试验，以认知 ADL 功能为主要结局，以调查哪些药物和非药物干预可以有效预防或延迟认知 ADL 功能的恶化，最终预防 PDD 的进展和转化。
