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JPD:帕金森患者,长期的认知和运动障碍变化规律有何特点?

2022-03-20 freeman爱科学 MedSci原创

在三年的时间里,不同的PD运动表型有不同的神经心理学进展模式。

人们越来越努力地确定帕金森病(PD)中认知能力下降和发生痴呆的潜在风险因素。大约30-40%的帕金森病患者存在认知障碍,患病率在病程中不断增加,10年后可达50%,在诊断后20年达到80%。

与帕金森病相关的认知状况是异质性的。由于已知的前纹状体功能障碍,执行功能以及注意力和工作记忆方面的缺陷经常出现在PD的早期阶段。PD晚期的痴呆症发病率很高,约为50%,其认知状况通常与记忆和视觉空间能力的额外缺陷有关,这被认为是晚期颞顶功能障碍的反映。

患者可分为震颤主导型(TR-D)、姿势不稳步态障碍(PIGD)或未确定(ND)运动表型。还有人将患者分为震颤主导型、运动迟缓型和混合型表型。一些可改变的因素与PD的认知损害有关,我们以前曾表明,不同的认知特征与不同的运动表型有关。我们对LANDSCAPE队列的横断面报告,这是一项调查PD患者认知功能的多中心纵向观察研究,描述了TR-D患者的认知缺陷似乎不那么严重,而PIGD患者在执行功能方面表现较差,这又与非震颤运动评分呈负相关。

同样,运动表型也可能影响认知障碍的进展,因为有证据表明,PIGD患者不仅表现出更快的认知衰退,而且有更大的痴呆风险和更高的抑郁率。这可能与运动表型的作用和认知障碍的进展特别相关,因为最初表现为TR-D患者的病人往往在病程中转换为PIGD型。

藉此, 德国RWTH Aachen University Hospital的Jennifer Michels 利用DEMPARK/LANDSCAPE研究的长期数据,评估认知障碍的进展和运动表型对PD认知衰退的预测价值。

他们纳入了711名PD患者的人口统计学、临床和神经心理学六年的纵向数据(年龄:M = 67.57;67.4%为男性)。并计算了认知领域的Z转换综合得分。对年龄、性别、教育和疾病持续时间进行了分析控制。

为了尽量减少数据缺失和辍学,他们使用线性混合模型评估了442名PD患者的三年随访数据,以了解运动表型对认知能力下降的具体作用(年龄:M=66.10;68.6%的男性)。

他们发现:在疾病的过程中,运动症状增加,而MMSE和PANDA在所有亚组中保持稳定。

经过三年的随访,PIGD患者的整体认知能力明显下降,运动表型在注意力(β=-0.08,SE=0.003,p<0.006)和记忆功能方面存在差异,显示PIGD患者与ND组相比,每个月恶化-0.006(SE = 0.003,p = 0.046)。

此外,PIGD患者在日常生活中更经常遇到困难。

该研究的重要意义在于发现了:在三年的时间里,不同的PD运动表型有不同的神经心理学进展模式,早期的执行缺陷在后期的过程中产生了更多的失忆特征。特别是PIGD患者与TR-D和ND患者相比,随着时间的推移而恶化,突出表明这种运动表型的痴呆风险更大。

原文出处:
Michels J, Storch A, Linse K, et al. Long-Term Cognitive Decline Related to the Motor Phenotype in Parkinson’s Disease.

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    2022-04-17 qinhuang

    写的很好

    0

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    2022-03-24 qinhuang

    学习了

    0

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    2022-03-21 明二公子

    学习了

    0

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    2022-03-21 仁术2021

    不错,学习了。

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1212044, encodeId=9fdd1212044fd, content=写的很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d0d480788, createdName=qinhuang, createdTime=Sun Apr 17 23:59:24 CST 2022, time=2022-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1205691, encodeId=9e18120569126, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d0d480788, createdName=qinhuang, createdTime=Thu Mar 24 22:08:48 CST 2022, time=2022-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1368819, encodeId=0bcd1368819ee, content=<a href='/topic/show?id=b40b9423884' target=_blank style='color:#2F92EE;'>#运动障碍#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94238, encryptionId=b40b9423884, topicName=运动障碍)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a7b6284, createdName=FukaiBao, createdTime=Mon Mar 21 13:34:57 CST 2022, time=2022-03-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1204547, encodeId=83e5120454e16, content=学习了 , beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210715/616fc3ab029343e2bfeb665e382ab64f/81511186951542fcb876d02ae61bc3fe.jpg, createdBy=a5412034805, createdName=明二公子, createdTime=Mon Mar 21 09:49:02 CST 2022, time=2022-03-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1204512, encodeId=0f4a1204512a5, content=不错,学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210606/e8b96fdba070433da10cd357c0646807/28bf16f46e314caaad8396c0c7df7a04.jpg, createdBy=adb15496357, createdName=仁术2021, createdTime=Mon Mar 21 06:58:41 CST 2022, time=2022-03-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1204482, encodeId=50e41204482d1, content=受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/15/f4a39912ff6c27452e6ae02a2e312a5f.jpg, createdBy=6d8d1870826, createdName=果果love, createdTime=Sun Mar 20 23:02:25 CST 2022, time=2022-03-20, status=1, ipAttribution=)]
    2022-03-20 果果love

    受益匪浅

    0

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