Goldman Jennifer G, Jagota Priya, Matar Elie
Medical Division, JPG Enterprises LLC, Chicago, IL, USA.
Department of Neurology, Barrow Neurological Institute, Phoenix, AZ, USA.
Expert Rev Neurother. 2025 Feb;25(2):189-209. doi: 10.1080/14737175.2025.2450668. Epub 2025 Jan 10.
Cognitive impairment in Parkinson's disease (PD) substantially affects patient outcomes, function, and quality of life. PD-related cognitive dysfunction is often heterogeneous in clinical presentation and rates of progression. As cognitive changes occur in many people with PD, it is essential to evaluate cognition, provide education, and implement management strategies for cognitive symptoms.
This article describes the symptomatology, epidemiology, risk factors, and pathobiology of cognitive impairment in PD. Additionally, the article provides an overview of evidence-based management and other therapeutic and coping strategies for cognitive impairment and dementia in PD. Comment is offered on challenges and opportunities for trials and emerging therapeutics targeting cognitive symptoms or decline.
While our understanding of cognitive dysfunction in PD has grown, effective and safe therapeutics are still needed to not only treat cognitive impairment and dementia symptomatically but also slow down or prevent cognitive decline. Further research is needed to elucidate the pathobiology of PD cognitive impairment, develop validated biomarkers reflecting cognitive change, and ultimately, integrate clinical and biological frameworks. Consensus regarding cognitive evaluations, definitions, and criteria of cognitive impairment, evaluating functional abilities in the context of cognitive impairment, and determining optimal outcome measures for clinical trials remain unmet needs.
帕金森病（PD）中的认知障碍会严重影响患者的预后、功能和生活质量。与PD相关的认知功能障碍在临床表现和进展速度上往往具有异质性。由于许多PD患者会出现认知变化，因此评估认知、提供教育并实施认知症状的管理策略至关重要。
本文描述了PD中认知障碍的症状学、流行病学、危险因素和病理生物学。此外，本文还概述了基于证据的管理以及针对PD中认知障碍和痴呆的其他治疗及应对策略。针对针对认知症状或衰退的试验和新兴疗法的挑战与机遇进行了评论。
虽然我们对PD中认知功能障碍的理解有所增加，但仍需要有效且安全的疗法，不仅要对症治疗认知障碍和痴呆，还要减缓或预防认知衰退。需要进一步研究以阐明PD认知障碍的病理生物学，开发反映认知变化的经过验证的生物标志物，并最终整合临床和生物学框架。在认知评估、认知障碍的定义和标准、在认知障碍背景下评估功能能力以及确定临床试验的最佳结局指标方面仍存在未满足的需求。
