Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
Faculty of Medicine, Dentistry and Health, The University of Sheffield, Sheffield, UK.
BMJ Ment Health. 2024 Jul 23;27(1):1-10. doi: 10.1136/bmjment-2024-301062.
Cognitive deficits are associated with poor quality of life and increased risk of development of dementia in patients with Parkinson's disease (PD) psychosis. The trajectory of cognitive decline in PD psychosis remains however unclear.
We examined this using data from the Parkinson's Progression Markers Initiative study.
We analysed data from patients with drug-naïve PD (n=676) and healthy controls (HC, n=187) over 5 years, and examined all cognitive measures assessed at each time point. We classified patients with PD into those who developed psychosis over the course of the study (PDP) and those without psychosis throughout (PDnP) using the Movement Disorders Society Unified Parkinson's Disease Rating Scale part I hallucinations/psychosis item. We used linear mixed-effect models with restricted maximum likelihood. Age, sex, ethnicity, education and neuropsychiatric and PD-specific symptoms were entered as covariates of interest.
There were no baseline cognitive differences between PD patient groups. There were differences in cognitive performance between PD and HC across the majority of the assessments.Patients with PDP exhibited greater cognitive decline over 5 years compared with PDnP across most domains even after controlling for sociodemographics, depression, sleepiness, rapid eye movement sleep behaviour disorder and motor symptom severity (immediate recall, b=-0.288, p0.003; delayed recall, b=-0.146, p0.003; global cognition, Montreal Cognitive Assessment, b=-0.206, p0.001; visuospatial, b=-0.178, p0.012; semantic fluency, b=-0.704, p0.002; processing speed, b=-0.337, p0.029).
Patients with PD psychosis exhibited decline in semantic aspects of language, processing speed, global cognition, visuospatial abilities and memory, regardless of sociodemographic characteristics, neuropsychiatric and motor symptoms. These cognitive domains, particularly semantic aspects of language may therefore play an important role in PD psychosis and warrant further investigation.
NCT01141023.
认知障碍与帕金森病（PD）患者的生活质量下降和痴呆风险增加有关。然而，PD 伴精神病患者的认知下降轨迹仍不清楚。
我们使用帕金森进展标志物倡议研究的数据对此进行了研究。
我们分析了 5 年内未经药物治疗的 PD 患者（n=676）和健康对照者（HC，n=187）的数据，并在每个时间点评估了所有认知测试。我们使用运动障碍协会统一帕金森病评定量表第 I 部分幻觉/精神病项将 PD 患者分为研究过程中出现精神病的患者（PDP）和整个过程中无精神病的患者（PDnP）。我们使用受限最大似然的线性混合效应模型。年龄、性别、种族、教育程度以及神经精神和 PD 特异性症状被作为感兴趣的协变量纳入。
PD 患者组之间在基线时无认知差异。在大多数评估中，PD 患者与 HC 之间的认知表现存在差异。即使在控制社会人口统计学因素、抑郁、嗜睡、快速眼动睡眠行为障碍和运动症状严重程度后，PDP 患者在 5 年内的认知下降程度也大于 PDnP 患者（即刻回忆，b=-0.288，p0.003；延迟回忆，b=-0.146，p0.003；蒙特利尔认知评估全局认知，b=-0.206，p0.001；视空间，b=-0.178，p0.012；语义流畅性，b=-0.704，p0.002；处理速度，b=-0.337，p0.029）。
无论社会人口统计学特征、神经精神和运动症状如何，PD 伴精神病患者均表现出语言的语义方面、处理速度、全局认知、视空间能力和记忆下降。因此，这些认知领域，特别是语言的语义方面可能在 PD 伴精神病中发挥重要作用，值得进一步研究。
NCT01141023。
