Course of psychiatric symptoms and global cognition in early Parkinson disease
Course of psychiatric symptoms and global cognition in early Parkinson disease
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DOI：
10.1212/wnl.0000000000000801
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发表时间：
2014-09-16
期刊：
影响因子：
9.9
通讯作者：
Weintraub, Daniel
中科院分区：
文献类型：
--
作者：
de la Riva, Patricia;Smith, Kara;Weintraub, Daniel
目的：探讨帕金森病（PD）患者的神经精神症状（CNS）和认知功能的病程和预测因素。方法：采用帕金森病进展标志物研究（PD）的帕金森病初治、未治疗（入组时）患者和健康对照（HC）的横断面研究。参与者对整体认知和抑郁、焦虑、精神病、冲动控制障碍（ICD）、睡眠和觉醒、冷漠和疲劳的症状进行了系列评估。结果：可用的样本量如下：基线（PD = 423，HC = 196），12个月（PD = 261，HC = 145），24个月（PD = 96，HC = 83）。在所有时间点，PD患者比HC患者经历更多的抑郁、疲劳、冷漠和焦虑，PD患者的冷漠（p = 0.001）和精神病（p = 0.003）随时间增加。在任何一次访视中，抑郁症筛查阳性的PD患者中约有三分之二未服用抗抑郁药。PD患者的蒙特利尔认知评估评分随时间显著降低（p < 0.001），但变化与HC相当。在24个月的访问中，44%的患者已经在多巴胺替代治疗（DRT）至少1年，这组报告更多的事件ICD（p = 0.009）和过度的白天嗜睡（p = 0.03）。结论：多发性硬化是更常见的原发性，未经治疗的PD患者相比，一般人群，但他们也保持相对稳定的早期疾病，而全球认知略有恶化。相反，DRT的开始与其他几种疾病的发生频率增加有关。
Objective:To evaluate the course and predictors of neuropsychiatric symptoms (NPS) and cognition in patients with de novo Parkinson disease (PD).Methods:Cross-sectional study of the cohort of de novo, untreated (at enrollment) patients with PD and healthy controls (HCs) from the Parkinson's Progression Markers Initiative. Participants have serial assessments of global cognition and symptoms of depression, anxiety, psychosis, impulse control disorders (ICDs), sleep and wakefulness, apathy, and fatigue. Available data up to 24 months of follow-up were included.Results:The available sample size was as follows: baseline (PD = 423, HCs = 196), 12 months (PD = 261, HCs = 145), and 24 months (PD = 96, HCs = 83). Patients with PD experienced more depression, fatigue, apathy, and anxiety than HCs at all time points, and apathy (p = 0.001) and psychosis (p = 0.003) increased over time in patients with PD. Approximately two-thirds of patients with PD who screened positive for depression at any given visit were not taking an antidepressant. The Montreal Cognitive Assessment score decreased significantly over time in patients with PD (p < 0.001), but the change was comparable to that in HCs. At the 24-month visit, 44% of patients had been on dopamine replacement therapy (DRT) for at least 1 year, and this group reported more incident ICDs (p = 0.009) and excessive daytime sleepiness (p = 0.03).Conclusion:Multiple NPS are more common in de novo, untreated patients with PD compared with the general population, but they also remain relatively stable in early disease, while global cognition slightly deteriorates. In contrast, initiation of DRT is associated with increasing frequency of several other NPS.