认知功能对中国55岁及以上人群帕金森病前驱期风险影响的前瞻性队列研究
Influence of baseline cognitive function on risk of prodromal Parkinson's disease in Chinese adults aged 55 and older: A prospective cohort study
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摘要:
背景 帕金森病临床症状出现前已存在认知功能变化，但有关认知功能与帕金森病前驱期（pPD）关联性的研究较少。
目的 分析我国中老年人pPD检出概率，探讨其认知功能及不同认知域功能与pPD检出概率的关联性。
方法 利用“神经系统疾病专病社区队列研究”2018年（基线）和2020年（随访）调查数据，选择参加两轮调查、未患阿尔茨海默病和帕金森病的具有完整人口统计学、疾病史、认知功能评估和帕金森病风险因素调查数据的3911名55岁及以上中老年人作为研究对象。采用蒙特利尔认知测验中文版量表评估认知功能，按照国际帕金森病及运动障碍协会的诊断标准评估pPD检出概率并判定可能（检出概率30%~<80%）或极可能（检出概率≥80%）的pPD，采用多重线性回归模型分析基线认知功能与随访pPD检出概率的关联性。
结果 研究人群基线认知总评分以及记忆、执行力、视空间、语言、注意力和定向指数评分的中位数分别为23、12、9、6、5、14和6，随访pPD检出概率中位数0.87%，可能或极可能的pPD患者占0.4%。基线认知总评分四等分组的随访pPD检出概率分布差异有统计学意义（
χ 2=21.68，P <0.001）。较高的基线总体认知功能评分与较低的随访pPD检出概率相关b （95%CI）为0.994（0.988~0.999），P =0.040。调整混杂因素后，多重线性回归分析结果显示总体认知评分最高四分位数组pPD检出概率较最低四分位数组降低了10.7%（b =0.893，95%CI：0.794~0.992，P =0.034），且趋势具有统计学意义（趋势P =0.031）。较高的基线执行力、注意力和定向指数评分与较低的随访pPD检出概率有关，且具有统计学意义（均P <0.05）。结论 总体认知功能及执行力、注意力和定向功能减退可能增加中老年人pPD检出概率，提示早期认知干预对预防pPD具有重要意义。
Abstract:Background Changes in cognitive function exist before the onset of clinical Parkinson's disease. However, studies on association between cognitive function and prodromal Parkinson's disease (pPD) are limited.
Objective To estimate probability of pPD and assess its association with global and domain cognitive function in Chinese elders.
Methods Data were drawn from the Community-based Cohort Study on Nervous System Disease 2018 (baseline) and 2020 (follow-up). We selected 3911 residents aged 55 and above who participated the two waves, without Alzheimer's disease and Parkinson's disease, and with completed information on demographics, disease history, cognitive function test, and risk factors of Parkinson's disease. Cognitive function was assessed using the Chinese version of Montreal Cognitive Assessment Scale. Calculation of probability of pPD and assessment of possible (probability between 30% and <80%) or probable (probability ≥80%) pPD were performed according to the criteria published by the International Parkinson and Movement Disorder Society. Multiple linear regression model was employed to analyze the association between baseline cognitive function and follow-up probability of pPD.
Results The medians of scores of baseline global cognitive function and cognitive domains in terms of memory, execution, visuospatial function, language, attention, and orientation were 23, 12, 9, 6, 5, 14, and 6, respectively. The median of follow-up probability of pPD was 0.87%, and the proportion of participants with possible or probable pPD was 0.4%. The differences in the distribution of follow-up probability of pPD were significant in groups by baseline global cognitive score quartiles (
χ 2=21.68,P <0.001). A higher baseline global cognitive score was considerably related to a lower follow-up probability of pPD,b (95%CI)=0.994(0.988~0.999),P =0.040. After adjusting for selected confounders, the results of multiple linear regression analyses showed that the probability of pPD in the highest quartile group was decreased by 10.7% (b =0.893, 95%CI: 0.794-0.992,P =0.034) relative to the lowest quartile group, and the trend was significant (trendP =0.031). Higher baseline index scores of execution, attention, and orientation were highly related to a lower follow-up probability of pPD (allP <0.05).Conclusion Declines in global cognitive function and cognitive domains of execution, attention, and orientation may associate with a higher probability of pPD in middle-aged and elderly population, which suggests the significance of cognitive intervention in early stage for pPD prevention.
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