Longo Chiara, Papagno Costanza
Department of Neurology, "Santa Chiara Hospital", Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy.
Center for Mind/Brain Sciences (CIMeC), University of Trento, Rovereto, Italy.
Eur J Neurol. 2025 Feb;32(2):e70077. doi: 10.1111/ene.70077.
Parkinson's disease (PD) treatments, such as apomorphine (APO) and levodopa-carbidopa intestinal gel (LCIG), represent advanced therapeutic options for managing motor symptoms. However, clear selection criteria and well-defined cognitive outcomes are lacking. This systematic review specifically aimed to address these gaps by assessing the cognitive impact of APO and LCIG in PD patients.
A systematic review was conducted following PRISMA guidelines, with searches in PubMed, Web of Science, Scopus, and Embase. Two authors screened studies based on key inclusion criteria, including at least two cognitive tests, and a follow-up of 6 months or more. The risk of bias was evaluated using the Newcastle-Ottawa Scale (NOS).
Fifteen studies were identified (7 APO and 8 LCIG). APO generally preserved cognitive function over a 12-month follow-up, with some decreases in visuospatial memory and executive functions. LCIG, with a 28-month follow-up, showed more extensive cognitive decline, particularly in patients with pre-existing impairments. Variability in cognitive tests made direct comparisons difficult.
APO may have a more favorable cognitive profile than LCIG. However, differences in follow-up duration, moderate risk of bias, and inconsistent cognitive assessments warrant cautious interpretation. Improved patient selection and comprehensive cognitive evaluations are recommended for future practice.
帕金森病（PD）的治疗方法，如阿扑吗啡（APO）和左旋多巴 - 卡比多巴肠凝胶（LCIG），是管理运动症状的先进治疗选择。然而，缺乏明确的选择标准和明确的认知结果。本系统评价旨在通过评估APO和LCIG对PD患者的认知影响来填补这些空白。
按照PRISMA指南进行系统评价，在PubMed、科学网、Scopus和Embase中进行检索。两位作者根据关键纳入标准筛选研究，包括至少两项认知测试以及6个月或更长时间的随访。使用纽卡斯尔 - 渥太华量表（NOS）评估偏倚风险。
共识别出15项研究（7项关于APO，8项关于LCIG）。在12个月的随访中，APO总体上保留了认知功能，视觉空间记忆和执行功能有所下降。在28个月的随访中，LCIG显示出更广泛的认知衰退，尤其是在已有损伤的患者中。认知测试的变异性使得直接比较变得困难。
APO的认知情况可能比LCIG更有利。然而，随访时间的差异、中度偏倚风险和不一致的认知评估需要谨慎解读。建议在未来的实践中改进患者选择和进行全面的认知评估。
