Cognitive decline and quality of life in incident Parkinson's disease: The role of attention.
Cognitive decline and quality of life in incident Parkinson's disease: The role of attention.
复制标题
DOI：
10.1016/j.parkreldis.2016.04.009
复制
发表时间：
2016-06
影响因子：
4.1
通讯作者：
ICICLE-PD study group
中科院分区：
文献类型：
--
作者：
Lawson RA;Yarnall AJ;Duncan GW;Breen DP;Khoo TK;Williams-Gray CH;Barker RA;Collerton D;Taylor JP;Burn DJ;ICICLE-PD study group
帕金森病痴呆（PDD）与较差的生活质量（QoL）相关。在PDD发病之前，许多患者会经历进行性认知障碍。关于认知能力下降对生活质量影响的纵向研究很少。本研究旨在确定认知改变对PD事件队列生活质量的纵向影响。新近确诊的PD患者（n = 212）完成了神经心理学评估和生活质量测量；在18个月（n = 190）和36个月（n = 158）后重复这些研究。轻度认知障碍（PD-MCI）参照运动障碍协会的标准进行分类。主成分分析将10个神经心理测试减少到三个认知因素：注意力、记忆/执行功能和整体认知。基线PD-MCI对生活质量有显著影响（β = 0.2, p < 0.01）。对于发生痴呆的受试者（9%），认知功能对生活质量的影响更大（β = 10.3, p < 0.05）。多变量模型显示，注意缺陷具有最强的预测能力（β = - 2.3, p < 0.01）；简短的整体试验仅适度预测生活质量下降（β = - 0.4, p < 0.01）。PD-MCI与三年随访期间较差的生活质量相关。认知障碍对痴呆患者生活质量的影响更大。注意障碍是PD患者生活质量的重要决定因素。改善PD患者注意力集中的干预措施可能会改善患者的生活质量。PD-MCI受试者的生活质量下降速度比认知正常者快3倍。认知能力下降预示着36个月后生活质量的恶化。注意力下降是生活质量下降的最强认知预测因子。
Parkinson's disease dementia (PDD) is associated with poorer quality of life (QoL). Prior to the onset of PDD, many patients experience progressive cognitive impairment. There is a paucity of longitudinal studies investigating the effects of cognitive decline on QoL. This study aimed to determine the longitudinal impact of cognitive change on QoL in an incident PD cohort. Recently diagnosed patients with PD (n = 212) completed a schedule of neuropsychological assessments and QoL measures; these were repeated after 18 (n = 190) and 36 months (n = 158). Mild cognitive impairment (PD-MCI) was classified with reference to the Movement Disorder Society criteria. Principal component analysis was used to reduce 10 neuropsychological tests to three cognitive factors: attention, memory/executive function, and global cognition. Baseline PD-MCI was a significant contributor to QoL (β = 0.2, p < 0.01). For those subjects (9%) who developed dementia, cognitive function had a much greater impact on QoL (β = 10.3, p < 0.05). Multivariate modelling showed attentional deficits had the strongest predictive power (β = −2.3, p < 0.01); brief global tests only modestly predicted decline in QoL (β = −0.4, p < 0.01). PD-MCI was associated with poorer QoL over three years follow up. Cognitive impairment had a greater impact on QoL in individuals who developed dementia over follow-up. Impaired attention was a significant determinant of QoL in PD. Interventions which improve concentration and attention in those with PD could potentially improve QoL. Rate of QoL decline was three times faster in PD-MCI subjects compared those with normal cognition. Cognitive decline predicted worsening of QoL over 36 months. Decline in attention was the strongest cognitive predictor of declining QoL.