Predicting cognitive decline with non-clinical markers in Parkinson's disease (PRECODE-2).
Predicting cognitive decline with non-clinical markers in Parkinson's disease (PRECODE-2).
复制标题
利用帕金森病的非临床标志物预测认知能力下降 (PRECODE-2)。
DOI：
10.1007/s00415-019-09250-y
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发表时间：
2019
影响因子：
6
通讯作者：
Yousaf T
中科院分区：
文献类型：
--
作者：
Yousaf T
目的探讨基线[123 I]FP-CIT SPECT和CSF标记物是否能预测PD患者的认知功能损害（CI），并提供最危险的PD患者的概况。方法将帕金森病进展标记物倡议数据库中的262例原发PD患者在36个月随访时分为两组：MoCA定义的诊断：莫卡评分< 26的PD患者;神经心理学测试定义的诊断：具有MoCA定义的诊断并且至少两个测试评分（6个;不考虑测试领域）比健康对照的平均评分低1.5标准差的PD患者。CI的预测变量分为十分位数，为我们提供了理想的截止值为每个variable.ResultsAt 36个月的随访，108/262（41.2%）PD患者CI定义的莫卡，其中40/108（37.0%）有神经心理学测试定义的CI。基线CSF Aβ42（风险比[HR]：0.996，置信区间[CI]：0.992- 0.999，p = 0.025），CSF总tau蛋白（[HR]：1.023，[CI]：1.002- 1.044，p = 0.031）和尾状核[123 I]FP-CIT SPECT摄取（[HR]：0.332，[CI]：0.115- 0.960，p = 0.042）是CI的预测因子。CSF Aβ42降低的患者（< 384.6 pg/mL），CSF总tau增加（> 45.0 pg/mL）和尾状核[123 I]FP-CIT SPECT摄取减少（< 1.82）在36个月随访时患CI的风险为65%。结论我们报告了一个特征性特征（CSF Aβ42减少，CSF总tau增加和尾状核[123 I]FP-CIT SPECT摄取减少），能够识别有发生CI风险的早期PD患者。这些结果证实了先前报告的CSF Aβ42降低、CSF总tau升高和多巴胺能完整性降低与PD认知功能下降相关。
ObjectivesTo investigate whether baseline [123I]FP-CIT SPECT and CSF markers can predict cognitive impairment (CI) in PD patients, and provide a profile of those most at risk.Methods262 de novo PD patients from the Parkinson’s Progression Markers Initiative database were stratified into two CI groups at the 36-month follow-up: MoCA-defined diagnosis: PD patients who had a MoCA score < 26; neuropsychological test-defined diagnosis: PD patients with MoCA-defined diagnosis and at least two test scores (of six; irrespective of test domain) greater than 1.5 standard deviation below the mean score in healthy controls. Predictive variables of CI were divided into deciles, providing us with ideal cutoff values for each variable.ResultsAt the 36-month follow-up, 108/262 (41.2%) PD patients had CI as defined by the MoCA, of which 40/108 (37.0%) had neuropsychological test-defined CI. Baseline CSF Aβ42 (hazard ratio [HR]: 0.996, confidence interval [CI]: 0.992–0.999,p= 0.025), CSF total tau ([HR]: 1.023, [CI]: 1.002–1.044,p= 0.031) and caudate [123I]FP-CIT SPECT uptake ([HR]: 0.332, [CI]: 0.115–0.960,p= 0.042) were predictors of CI. Patients with reduced CSF Aβ42 (< 384.6 pg/mL), increased CSF total tau (> 45.0 pg/mL) and reduced caudate [123I]FP-CIT SPECT uptake (< 1.82) had a 65% risk of developing CI at 36-month follow-up.ConclusionWe report a characteristic profile (reduced CSF Aβ42, increased CSF total tau and reduced caudate [123I]FP-CIT SPECT uptake) that enables identification of early PD patients at risk of developing CI. These findings confirm previous reports of low CSF Aβ42, elevated CSF total tau and reduced dopaminergic integrity being associated with cognitive decline in PD.