Gastrointestinal symptoms are predictive of trajectories of cognitive functioning in de novo Parkinson's disease
Gastrointestinal symptoms are predictive of trajectories of cognitive functioning in de novo Parkinson's disease
复制标题
DOI：
10.1016/j.parkreldis.2020.01.009
复制
发表时间：
2020-03-01
影响因子：
4.1
通讯作者：
Jacobs, Jonathan P.
中科院分区：
文献类型：
--
作者：
Jones, Jacob D.;Rahmani, Elizabeth;Jacobs, Jonathan P.
引言：认知和胃肠道（GI）症状等非运动症状在帕金森病（PD）中很常见。在PD中，GI症状通常先于运动症状出现。据推测，GI症状反映了微生物组-肠-脑轴的破坏，这导致免疫功能改变、慢性神经炎症和随后的神经变性。初步证据将肠道生态失调与PD病理学和运动症状严重程度联系起来。本研究探讨GI症状和认知功能障碍的严重程度之间的纵向关系，在新诊断的PD patients.Methods：帕金森氏病进展标志物倡议（PPMI）的二级数据分析包括423名新诊断的PD患者随访长达5年。参与者接受了处理速度，注意力，视觉空间功能，言语学习和言语延迟回忆的神经心理学测试。参与者被分为认知完整、轻度认知障碍或帕金森病痴呆。使用帕金森病自主神经结局量表（SCOPA-AUT）评估GI症状的频率。多水平模型（MLM）检查GI症状和认知功能障碍之间的纵向关系。结果：所有的认知结果预测的主要影响GI症状，或GI症状X场合相互作用项。具体而言，更严重的GI症状预测的是一个不太有利的轨迹上的字母流畅性，视觉空间，学习和记忆的测试性能。认知性能是唯一相关的GI症状和无关的非GI自主症状symptoms.Conclusions：胃肠道症状的存在可能作为认知功能障碍的早期标志物在PD。未来的研究应探讨肠道生态失调和认知障碍之间关系的具体机制。
Introduction: Non-motor symptoms such as cognitive and gastrointestinal (GI) symptoms are common in Parkinson's disease (PD). In PD, GI-symptoms often present prior to motor symptoms. It is hypothesized that GI-symptoms reflect disruptions of the microbiome-gut-brain axis, which leads to altered immune functioning, chronic neuroinflammation, and subsequent neurodegeneration. Initial evidence links gut-dysbiosis to PD pathology and motor symptom severity. The present study examines the longitudinal relationship between severity of GI-symptoms and cognitive impairment in newly diagnosed PD patients.Methods: A secondary data analysis of the Parkinson's Progression Markers Initiative (PPMI) included 423 newly diagnosed PD patients who were followed for up to 5 years. Participants underwent neuropsychological tests of processing speed, attention, visuospatial functioning, verbal learning and verbal delayed recall. Participant were classified as cognitive intact, mild cognitive impairment or Parkinson's disease dementia. Frequency of GI-symptoms were assessed with the Scales for Outcomes in Parkinson's Disease Autonomic (SCOPA-AUT). Multilevel models (MLM) examined the longitudinal relationship between GI symptoms and cognitive impairment.Results: All cognitive outcomes were predicted by the main effect of GI symptoms, or the GI-symptom X Occasion interaction term. Specifically, more severe GI-symptoms were predictive of a less favorable trajectory of performance on tests of letter fluency, visuospatial, learning and memory. Cognitive performance was uniquely associated with GI-symptoms and unrelated to non-GI autonomic symptoms.Conclusions: The presence of GI symptoms may serve as an early marker of cognitive impairment in PD. Future studies should examine specific mechanisms underlying the relationship between gut-dysbiosis and cognitive impairment.