Parkinsonian signs in older people in a community-based study - Risk of incident dementia
Parkinsonian signs in older people in a community-based study - Risk of incident dementia
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DOI：
10.1001/archneur.61.8.1273
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发表时间：
2004-08-01
影响因子：
--
通讯作者：
Mayeux, R
中科院分区：
文献类型：
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作者：
Louis, ED;Tang, MX;Mayeux, R
研究背景：30%~ 40%的社区老年人出现轻度帕金森综合征。在一项横断面研究中，这些症状的严重程度在痴呆患者中高于非痴呆患者。目的：确定基线轻度帕金森症状是否是痴呆事件的预测因子。设计：一项前瞻性纵向研究，研究对象为基线时未患痴呆或帕金森病的社区居住老年人。方法：在纽约曼哈顿北方的华盛顿Height-Inwood社区，对1028名年龄≥ 65岁的居民进行神经系统检查。使用简化的统一帕金森病评定量表对帕金森病体征进行评定，得到帕金森病体征评分（范围，0-40）。使用考克斯比例风险模型评估痴呆症事件的风险。在一些分析中，从修改后的统一帕金森氏病评定量表的数据被分为3个领域：刚性，轴向功能，和震颤在rest.Results：随访的平均持续时间为5.6年，和224名参与者（21.8%）开发痴呆症。在一个考克斯模型中，基线帕金森症状评分为2比0的参与者发生痴呆的风险高57%（相对风险，1.56; 95%置信区间，1.04-2.33; P = 0.03）。在第二个考克斯模型中，基线帕金森症状评分与痴呆事件相关（相对危险度，1.08; 95%置信区间，1.01-1.16; P = 0.02）独立于基线年龄，教育，种族，糖尿病和stroke.Conclusions：基线轻度帕金森症状是痴呆事件的预测因子。虽然这些迹象是温和的，但它们不是良性的。脑影像学检查和尸检可能会进一步加深我们对轻度帕金森病体征的解剖和病理基础的了解。
Background: Mild parkinsonian signs occur in 30% to 40% of community-dwelling older people. In a cross-sectional study, the severity of these signs was greater in people with dementia than in people without dementia.Objective: To determine whether baseline mild parkinsonian signs are a predictor of incident dementia.Design: A prospective, longitudinal study of community-dwelling older people who did not have dementia or Parkinson disease at baseline.Methods: A neurological examination was performed on 1028 residents aged 65 years or older in the Washington Height-Inwood community in northern Manhattan, NY. Parkinsonian signs were rated with an abbreviated Unified Parkinson's Disease Rating Scale, resulting in a parkinsonian sign score (range, 0-40). The risk of incident dementia was assessed using Cox proportional hazards models. In some analyses, data from the modified Unified Parkinson's Disease Rating Scale were divided into 3 domains: rigidity, axial function, and tremor at rest.Results: The mean duration of follow-up was 5.6 years, and 224 participants (21.8%) developed dementia. In a Cox model, the risk of incident dementia was 57% higher in participants with a baseline parkinsonian sign score of 2 vs 0 (relative risk, 1.56; 95% confidence interval, 1.04-2.33; P = .03). In a second Cox model, the baseline parkinsonian sign score was associated with incident dementia (relative risk, 1.08; 95% confidence interval, 1.01-1.16; P = .02) independent of associations with baseline age, education, ethnicity, diabetes mellitus, and stroke.Conclusions: Baseline mild parkinsonian signs are a predictor of incident dementia. Although these signs are mild, they are not prognostically benign. Brain imaging and postmortem examinations might further our insight into the anatomical and pathological basis for mild parkinsonian signs.