Parkinson disease-associated cognitive impairment
Parkinson disease-associated cognitive impairment
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帕金森病相关认知功能障碍
DOI：
10.1038/s41572-021-00280-3
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发表时间：
2021-07-01
影响因子：
81.5
通讯作者：
Weintraub, Daniel
中科院分区：
文献类型：
--
作者：
Aarsland, Dag;Batzu, Lucia;Weintraub, Daniel
帕金森病（PD）是第二常见的神经退行性疾病，影响>1%的≥ 65岁的人口，并且到2030年患病率将增加一倍。除了PD的定义性运动症状外，还出现多种非运动症状;其中，认知障碍很常见，可能发生在任何疾病阶段。认知能力的下降通常是缓慢和阴险的，但在某些情况下是迅速的。最近，重点一直放在早期认知变化上，其中执行和视觉空间障碍是典型的，并可能伴有记忆障碍，增加了早期进展为痴呆症的风险。早期进展为痴呆症的其他风险因素包括幻视、年龄较大和生物标志物变化，如皮质萎缩，以及功能成像和脑脊液中的阿尔茨海默型变化，以及EEG上的减慢和频率变化。然而，PD认知功能下降的机制仍不清楚。路易体和阿尔茨海默型病理的皮质参与是关键特征，但可能涉及多种机制。胆碱酯酶抑制剂是唯一的高水平循证治疗，但其他药物和非药物策略正在测试中。挑战包括识别疾病修饰疗法以及寻找生物标志物以更好地预测认知衰退并识别早期和快速认知障碍的高风险患者。认知障碍在帕金森病患者中很常见，严重程度不等。本书回顾了帕金森病认知障碍的流行病学、病理生理学、诊断和治疗，并描述了对患者生活质量的影响和该领域的未来前景。
Parkinson disease (PD) is the second most common neurodegenerative disorder, affecting >1% of the population >= 65 years of age and with a prevalence set to double by 2030. In addition to the defining motor symptoms of PD, multiple non-motor symptoms occur; among them, cognitive impairment is common and can potentially occur at any disease stage. Cognitive decline is usually slow and insidious, but rapid in some cases. Recently, the focus has been on the early cognitive changes, where executive and visuospatial impairments are typical and can be accompanied by memory impairment, increasing the risk for early progression to dementia. Other risk factors for early progression to dementia include visual hallucinations, older age and biomarker changes such as cortical atrophy, as well as Alzheimer-type changes on functional imaging and in cerebrospinal fluid, and slowing and frequency variation on EEG. However, the mechanisms underlying cognitive decline in PD remain largely unclear. Cortical involvement of Lewy body and Alzheimer-type pathologies are key features, but multiple mechanisms are likely involved. Cholinesterase inhibition is the only high-level evidence-based treatment available, but other pharmacological and non-pharmacological strategies are being tested. Challenges include the identification of disease-modifying therapies as well as finding biomarkers to better predict cognitive decline and identify patients at high risk for early and rapid cognitive impairment.Cognitive impairment is common in patients with Parkinson disease and ranges in severity. This Primer reviews the epidemiology, pathophysiology, diagnosis and treatment of cognitive impairment in Parkinson disease and describes the effects on patient quality of life and the future outlook for the field.