Rodríguez-Antigüedad Jon, Martínez-Horta Saül, Puig-Davi Arnau, Horta-Barba Andrea, Pagonabarraga Javier, de Deus Fonticoba Teresa, Jesús Silvia, Cosgaya Marina, García Caldentey Juan, Ávila-Rivera María Asunción, Caballol Nuria, Legarda Inés, Hernández Vara Jorge, Cabo Iria, López Manzanares Lydia, González Aramburu Isabel, Gómez Mayordomo Víctor, González Ardura Jessica, Dotor García-Soto Julio, Borrué Carmen, Solano Vila Berta, Álvarez Sauco María, Vela Lydia, Escalante Sonia, Cubo Esther, Mendoza Zebenzui, Pareés Isabel, Sánchez Alonso Pilar, Alonso Losada María G, López Ariztegui Nuria, Gastón Itziar, Ruíz Martínez Javier, Buongiorno María Teresa, Ordás Carlos, Valero Caridad, Puente Víctor, Kurtis Mónica, Blázquez Estrada Marta, Martínez-Martín Pablo, Mir Pablo, Santos-García Diego, Kulisevsky Jaime
Medicine Department, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Mas Casanovas 90, 08041, Barcelona, Spain.
J Neurol. 2025 Mar 5;272(3):246. doi: 10.1007/s00415-024-12808-0.
Parkinson’s Disease (PD)-associated subjective cognitive decline (PDSCD) is defined as cognitive complaints without objective cognitive impairment. Based on most studies, it is associated with a greater risk of cognitive decline and may represent a prodromal stage of cognitive impairment.
The main objectives are to identify cognitive progression patterns and clinical predictors of worse cognitive decline within a large PD-SCD cohort with a 4-year followup. All patients belong to the prospective observational multicenter study COPPADIS.
A total of 198 PD-SCD subjects were analyzed. Mean age was 60.9, mean disease duration 5.2, and mean PD-Cognitive Rating Scale (PD-CRS) 97.6. Subjects were classified as Progressors if their Reliable Change Index was ≤ − 1.64 at year 4, and as non-Progressors if it was > − 1.64 (− 1.64 corresponded to − 16 on the PD-CRS). Progressors had significantly higher age, Movement Disorders Society-Unified PD Rating Scale (MDS-UPDRS) III, levodopa equivalent daily-dose, Non-Motor Symptom Scale total score, memory-related cognitive complaints, and prevalence of REM-sleep behavior disorder (RBD) at baseline. A linear mixed-effects model showed divergent cognitive trajectories between Progressors and non-Progressors (estimate = − 26.8; p < 0.001), with no differences in motor trajectories. In the binary regression model, age (OR = 1.09; p = 0.001), MDS-UPDRS III (OR = 1.05, p = 0.008), and RBD (OR = 2.55, p = 0.010) at baseline were independent predictors of cognitive progression.
Subjects with PD-SCD do not consistently show cognitive decline, but rather exhibit a heterogeneous progression. Age, MDS-UPDRS III and RBD significantly increase the risk of a more aggressive cognitive phenotype. Future research on biomarkers will help explore additional cognitive predictors in PD-SCD.
帕金森病（PD）相关主观认知下降（PDSCD）被定义为无客观认知损害的认知主诉。根据大多数研究，它与认知下降风险增加有关，可能代表认知损害的前驱阶段。
主要目标是在一个进行了4年随访的大型PDSCD队列中确定认知进展模式和认知下降更严重的临床预测因素。所有患者均属于前瞻性观察性多中心研究COPPADIS。
共分析了198名PDSCD受试者。平均年龄为60.9岁，平均病程为5.2年，平均帕金森病认知评定量表（PD-CRS）评分为97.6。如果受试者在第4年的可靠变化指数≤ -1.64，则分类为进展者；如果> -1.64（-1.64对应于PD-CRS上的-16），则分类为非进展者。进展者在基线时年龄显著更大、运动障碍协会统一帕金森病评定量表（MDS-UPDRS）III评分更高、左旋多巴等效日剂量更高、非运动症状量表总分更高、与记忆相关的认知主诉更多以及快速眼动睡眠行为障碍（RBD）患病率更高。线性混合效应模型显示进展者和非进展者之间存在不同的认知轨迹（估计值 = -26.8；p < 0.001），运动轨迹无差异。在二元回归模型中，基线时的年龄（OR = 1.09；p = 0.001）、MDS-UPDRS III（OR = 1.05，p = 0.008）和RBD（OR = 2.55，p = 0.010）是认知进展的独立预测因素。
PDSCD受试者并非始终表现出认知下降，而是呈现出异质性进展。年龄、MDS-UPDRS III和RBD显著增加更具侵袭性认知表型的风险。未来关于生物标志物的研究将有助于探索PDSCD中更多的认知预测因素。
