Avila Pérez Sofía, Koppelmans Vincent, Duff Kevin M, Ruitenberg Marit Fl
Department of Health, Medical and Neuropsychology, Leiden University, Leiden, the Netherlands.
Department of Psychiatry, University of Utah, Salt Lake City, UT, USA.
J Parkinsons Dis. 2025 Apr 29:1877718X251339585. doi: 10.1177/1877718X251339585.
Predicting which individuals with Parkinson's disease (PD) will develop cognitive deficits is challenging, but important towards selecting those individuals at higher risk of progression for personalized early intervention and enriching samples for clinical trials of disease modifying agents. To examine whether practice effects on cognitive tests across one-year are predictive of eventual cognitive impairment (CI) and dementia (PDD) in individuals with PD. Individuals with PD ( = 549) from the PPMI database who were cognitively intact at baseline were included for analysis. The Montreal Cognitive Assessment (MoCA) was administered at baseline and during annual follow-up visits over at least five years to determine if participants remained intact (MoCA ≥ 26) or developed CI (MoCA ≤ 25) or dementia (MoCA ≤ 21). Participants also completed a neuropsychological battery at baseline and again after a one-year interval. Practice effects on the cognitive tests across one-year were quantified with standardized regression-based change scores using PPMI data from cognitively intact subjects without PD. Based on MoCA scores, 39% of patients developed CI and 10% developed PDD during the study. Linear regressions revealed smaller practice effects across one year in people with PD than in controls. Within the PD group, Cox regression analyses showed that smaller practice effects on tests of various cognitive domains were associated with an increased risk for CI. For PDD, only practice effects on a measure of processing speed significantly predicted cognitive outcomes. These findings demonstrate that practice effects have prognostic value in long-term cognitive outcomes in PD. This has important implications for clinical care and research, as one-year practice effects could help identify individuals at risk for CI and PDD and enrich samples for future clinical trials. Limitations of the present study pertain to the classification of cognitive impairment on the basis of a screening instrument (i.e., the MoCA) without evidence of the absence/presence of functional impairment, and the clinical utility of the one-year interval.
预测哪些帕金森病（PD）患者会出现认知缺陷具有挑战性，但对于选择那些进展风险较高的个体进行个性化早期干预以及为疾病修饰药物的临床试验富集样本非常重要。为了研究为期一年的认知测试练习效应是否能预测PD患者最终的认知障碍（CI）和痴呆（PDD）。纳入了PPMI数据库中549名基线时认知功能完好的PD患者进行分析。在基线时以及至少五年的年度随访期间进行蒙特利尔认知评估（MoCA），以确定参与者是否仍保持完好（MoCA≥26）、是否发展为CI（MoCA≤25）或痴呆（MoCA≤21）。参与者在基线时还完成了一套神经心理测试，并在间隔一年后再次进行测试。使用来自无PD的认知功能完好受试者的PPMI数据，通过基于标准化回归的变化分数对为期一年的认知测试练习效应进行量化。根据MoCA评分，39%的患者在研究期间发展为CI，10%发展为PDD。线性回归显示，PD患者一年中的练习效应小于对照组。在PD组中，Cox回归分析表明，对各个认知领域测试的练习效应较小与CI风险增加相关。对于PDD，只有对处理速度测量的练习效应显著预测认知结果。这些发现表明，练习效应在PD的长期认知结果中具有预后价值。这对临床护理和研究具有重要意义，因为一年的练习效应有助于识别有CI和PDD风险的个体，并为未来的临床试验富集样本。本研究的局限性在于基于筛查工具（即MoCA）对认知障碍进行分类，而没有功能障碍存在/不存在的证据，以及一年间隔的临床效用。
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