Dementia and survival in Parkinson disease - A 12-year population study
Dementia and survival in Parkinson disease - A 12-year population study
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DOI：
10.1212/01.wnl.0000306632.43729.24
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发表时间：
2008-03-25
期刊：
影响因子：
9.9
通讯作者：
Aarsland, D.
中科院分区：
文献类型：
--
作者：
Buter, T. C.;van den Hout, A.;Aarsland, D.
背景：帕金森病（PD）患痴呆的风险很高，对帕金森病患者具有重要的临床后果。然而，痴呆症的绝对风险以及它如何影响帕金森病患者的生存尚不清楚。这些问题对于患者、其家人和服务提供者来说很重要，但需要长期研究。方法：本研究是一项前瞻性纵向队列研究，对象来自挪威的帕金森病患病率研究。患病日后 4、8、9、10、11 和 12 年对患者进行重新评估。根据《精神障碍诊断和统计手册》第三版修订版的痴呆症诊断标准基于半结构化护理人员访谈、认知评级量表和神经心理学测试。使用连续时间三态不可逆马尔可夫模型对从 PD 进展到 PD 并伴有痴呆和死亡进行建模。结果：总共纳入了 233 名 PD 患者，其中 140 名患者（60%，95% CI 54% 至 66%）在研究期结束时发展为痴呆。痴呆症的累积发病率随着年龄和帕金森病持续时间的增加而稳步增加，并且以生存率为条件，到 90 岁时会增加到 80% 至 90%。女性患有帕金森病的时间比男性长，患痴呆症的时间也更长。 70 岁时，患有帕金森病但未患痴呆症的男性的预期寿命为 8 年，其中 5 年预期无痴呆症，3 年预计患有痴呆症。结论：痴呆症是帕金森病患者生存的关键部分，必须在针对这种疾病的服务中做好规划。
Background: The risk for dementia in Parkinson disease (PD) is high, with important clinical consequences for patients with PD. However, the absolute risk of dementia and how it affects survival in PD are not known. Such questions are important for patients, their families, and service providers but require long-term studies.Methods: This study is a prospective longitudinal cohort study with patients from a prevalence study of PD in Norway. Patients were reassessed 4, 8, 9, 10, 11, and 12 years after prevalence day. A dementia diagnosis according to Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, criteria was based on a semistructured caregiver interview, cognitive rating scales, and neuropsychological tests. Progression from PD to PD with dementia and death was modeled using a continuous-time three-state irreversible Markov model.Results: A total of 233 PD patients were included, and 140 patients (60%, 95% CI 54% to 66%) had developed dementia by the end of the study period. The cumulative incidence of dementia steadily increases with age and duration of PD and, conditional on survival, increases to 80% to 90% by age 90 years. Women live with PD longer than men and spend more years with dementia. At age 70 years, a man with PD but no dementia has a life expectancy of 8 years, of which 5 years would be expected to be dementia free and 3 years would be expected to be with dementia.Conclusion: Dementia is a key part of survival in Parkinson disease and must be planned for in services for this condition.