Measuring mild cognitive impairment in patients with Parkinson's disease.
Measuring mild cognitive impairment in patients with Parkinson's disease.
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DOI：
10.1002/mds.25426
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发表时间：
2013-05
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通讯作者：
Duff-Canning S
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作者：
Marras C;Armstrong MJ;Meaney CA;Fox S;Rothberg B;Reginold W;Tang-Wai DF;Gill D;Eslinger PJ;Zadikoff C;Kennedy N;Marshall FJ;Mapstone M;Chou KL;Persad C;Litvan I;Mast BT;Gerstenecker AT;Weintraub S;Duff-Canning S
我们使用运动障碍协会提出的帕金森病伴轻度认知功能障碍（PD-MCI）新标准，检查了帕金森病伴轻度认知功能障碍（PD-MCI）及其亚型的频率和3种认知量表检测PD-MCI的准确性。帕金森病非痴呆患者完成了3项筛选试验的临床访视，1至3周后进行神经心理学测试。在139例患者中，46例符合PD-MCI的2级工作组标准，当受损的性能基于与正常评分的比较时。42例患者（93%）患有多领域MCI。在提供至少80%灵敏度的最低截止水平，蒙特利尔认知评估的特异性为44%，帕金森病认知结局量表的特异性为33%。简易精神状态检查不能达到80%的灵敏度在任何临界值。在提供至少80%特异性的最高临界水平下，所有检测的灵敏度均较低（≤ 44%）。当从估计的发病前水平下降被认为是认知障碍的证据时，139名患者中有110名被归类为PD-MCI，103名（94%）患有多领域MCI。我们观察到使用新的2级标准患有PD-MCI的患者比例存在显着差异，这取决于是否考虑智力功能从发病前水平下降。关于从发病前水平下降的操作方法的建议是一个未满足的需要。在检查的3种筛查试验中，没有一种仪器对PD-MCI提供良好的联合灵敏度和特异性。工作组1级标准推荐的其他测试可能代表更好的选择，这些应该是未来研究的主题。
We examined the frequency of Parkinson disease with mild cognitive impairment (PD-MCI) and its subtypes and the accuracy of 3 cognitive scales for detecting PD-MCI using the new criteria for PD-MCI proposed by the Movement Disorders Society. Nondemented patients with Parkinson’s disease completed a clinical visit with the 3 screening tests followed 1 to 3 weeks later by neuropsychological testing. Of 139 patients, 46 met Level 2 Task Force criteria for PD-MCI when impaired performance was based on comparisons with normative scores. Forty-two patients (93%) had multi-domain MCI. At the lowest cutoff levels that provided at least 80% sensitivity, specificity was 44% for the Montreal Cognitive Assessment and 33% for the Scales for Outcomes in Parkinson’s Disease-Cognition. The Mini-Mental State Examination could not achieve 80% sensitivity at any cutoff score. At the highest cutoff levels that provided specificity of at least 80%, sensitivities were low (≤44%) for all tests. When decline from estimated premorbid levels was considered evidence of cognitive impairment, 110 of 139 patients were classified with PD-MCI, and 103 (94%) had multi-domain MCI. We observed dramatic differences in the proportion of patients who had PD-MCI using the new Level 2 criteria, depending on whether or not decline from premorbid level of intellectual function was considered. Recommendations for methods of operationalizing decline from premorbid levels constitute an unmet need. Among the 3 screening tests examined, none of the instruments provided good combined sensitivity and specificity for PD-MCI. Other tests recommended by the Task Force Level 1 criteria may represent better choices, and these should be the subject of future research.