Temporal sequence of incident mild cognitive impairment, incident parkinsonism, and risk of death in unimpaired community-dwelling older adults.

Andrea R Zammit, Lei Yu, Shahram Oveisgharan, Julie A Schneider, David A Bennett, Aron S Buchman
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Abstract

Background: Mild cognitive impairment (MCI) and parkinsonism affect many older adults. The objective of this study was to determine the sequence of their occurrence and associated risk of death.

Methods: 1,255 community-dwelling unimpaired participants from two epidemiological cohorts were examined annually. MCI was based on neuropsychological testing, and parkinsonism was based on the motor portion of the modified Unified Parkinson's Disease Rating Scale. A multi-state Cox proportional hazards model simultaneously examined incidences of MCI, parkinsonism, and death.

Results: Average age at baseline was 76.5 years (SD = 7.2) and 73% were female. Incident MCI occurred almost as commonly as incident parkinsonism, yet compared to no impairment, risk of death was higher for MCI (HR = 1.82, 95%CI=1.34, 2.47), but it was not different for parkinsonism (HR = 1.29; 95%CI = 0.95, 1.75). Risk of death for participants with incident MCI who progressed to parkinsonism (40%) was not significantly different from those with MCI alone (HR = 1.25, 95%CI = 0.93, 1.69). However, risk of death for participants with incident parkinsonism who progressed to MCI (51%) was significantly higher than those who did not progress (HR = 1.67, 95%CI = 1.27, 2.18), indicating that risk of death is highest with incidence of MCI.

Conclusions: The varied patterns of sequential occurrence of cognitive and motor impairment and associated risk of death suggests much greater heterogeneity than previously recognized. Further work is needed to determine the biology underlying the temporal evolution of these phenotypes, and if identification of the various subtypes improves risk stratification.

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在社区居住的无障碍老年人中,轻度认知障碍事件、帕金森病事件和死亡风险的时间顺序。
背景:轻度认知障碍(MCI)和帕金森病影响着许多老年人。本研究的目的是确定它们的发生顺序和相关的死亡风险。方法:每年对来自两个流行病学队列的 1,255 名居住在社区的无障碍参与者进行检查。MCI 以神经心理学测试为依据,帕金森病以改良的统一帕金森病评分量表的运动部分为依据。一个多州 Cox 比例危险模型同时检测了 MCI、帕金森病和死亡的发病率:基线时的平均年龄为 76.5 岁(SD = 7.2),73% 为女性。发生 MCI 的频率几乎与发生帕金森病的频率相同,但与无障碍相比,MCI 的死亡风险更高(HR = 1.82,95%CI = 1.34,2.47),而帕金森病的死亡风险则没有差异(HR = 1.29;95%CI = 0.95,1.75)。患有 MCI 并发展为帕金森病的参与者(40%)的死亡风险与仅患有 MCI 的参与者无显著差异(HR = 1.25;95%CI = 0.93,1.69)。然而,帕金森病患者中发展为MCI的患者(51%)的死亡风险明显高于未发展为MCI的患者(HR = 1.67, 95%CI = 1.27, 2.18),这表明死亡风险随着MCI发病率的升高而升高:认知障碍和运动障碍的相继发生以及相关死亡风险的不同模式表明,其异质性远大于之前所认识到的。还需要进一步研究,以确定这些表型在时间上演变的生物学基础,以及识别各种亚型是否能改善风险分层。
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