Spontaneous Parkinsonism Is Associated With Cognitive Impairment in Antipsychotic-Naive Patients With First-Episode Psychosis: A 6-Month Follow-up Study
Spontaneous Parkinsonism Is Associated With Cognitive Impairment in Antipsychotic-Naive Patients With First-Episode Psychosis: A 6-Month Follow-up Study
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DOI：
10.1093/schbul/sbt125
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发表时间：
2014-09-01
影响因子：
6.6
通讯作者：
Peralta, Victor
中科院分区：
文献类型：
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作者：
Cuesta, Manuel J.;Sanchez-Torres, Ana M.;Peralta, Victor
现在有越来越多的证据表明，帕金森综合征和其他锥体外系症状在从未接触过抗精神病药物的首发精神病患者中非常普遍。然而，帕金森综合征在这一人群中的神经认知相关性仍有待澄清。一个样本包括100个连续的首次发作精神病的药物初治患者参加了这项研究，并随访6个月。77名患者在3个时间点（基线、1个月和6个月）完成了评估，包括临床和认知检查以及运动异常的特定评估。采用SAS量表对锥体外系症状进行评估，并采用标准评估量表对每个运动领域进行评估。建立线性混合模型，探讨帕金森综合征评分与认知功能障碍之间的纵向关系。帕金森综合征评分与记忆、执行功能和注意力缺陷有显著的纵向关联。自发性帕金森综合征（基线时的SAS总分和运动功能减退及强直分项评分）显示出较高的6个月认知功能障碍预测值。此外，他们对神经系统软征异常也有很高的预测价值，但对运动障碍、静坐不能和单纯紧张性异常没有预测价值。在SAS量表上，没有发现眉间流涎或震颤子评分的预测值。这些结果强调了在开始给予抗精神病药物之前评估帕金森症状的相关性，作为精神病疾病的核心表现，对认知障碍具有较高的预测价值。
There is now growing evidence that parkinsonism and other extrapyramidal signs are highly prevalent in patients with first-episode psychosis who have never been exposed to antipsychotic drugs. However, the neuro-cognitive correlates of parkinsonism in this population remained to be clarified. A sample comprising 100 consecutive drug-naive patients with first-episode psychosis were enrolled on the study and followed up for 6 months. Seventy-seven completed assessments at 3 time points (baseline, 1 mo, and 6 mo), involving clinical and cognitive examinations and a specific assessment of motor abnormalities. The Simpson-Angus Scale (SAS) was used for the assessment of extrapyramidal signs, and each motor domain was evaluated with a standard assessment scale. Linear mixed models were built to explore the longitudinal relationships between parkinsonism scores and cognitive impairment. Parkinsonism scores showed significant strong longitudinal associations with deficits in memory, executive functioning, and attention. Spontaneous parkinsonism (total SAS score and hypokinesia and rigidity subscores at baseline) showed high 6-month predictive values for cognitive impairment. In addition, they also had high predictive values for neurologic soft-sign abnormalities but not for dyskinesia, akathisia, and pure catatonic abnormalities. No predictive value was found for glabella-salivation or tremor subscores on the SAS scale. These results emphasize the relevance of the assessment of parkinsonism signs prior to starting to administer antipsychotic drugs, as core manifestations of psychotic illness with a high predictive value for cognitive impairment.