Cognitive Outcomes of Advanced Therapies in Parkinson's Disease: A Systematic Review of Apomorphine and Levodopa–Carbidopa Intestinal Gel Therapies

IF 3.9 2区医学 Q1 CLINICAL NEUROLOGY European Journal of Neurology Pub Date : 2025-02-11 DOI:10.1111/ene.70077

Chiara Longo, Costanza Papagno

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Abstract

Background

Parkinson's disease (PD) treatments, such as apomorphine (APO) and levodopa–carbidopa intestinal gel (LCIG), represent advanced therapeutic options for managing motor symptoms. However, clear selection criteria and well-defined cognitive outcomes are lacking. This systematic review specifically aimed to address these gaps by assessing the cognitive impact of APO and LCIG in PD patients.

Methods

A systematic review was conducted following PRISMA guidelines, with searches in PubMed, Web of Science, Scopus, and Embase. Two authors screened studies based on key inclusion criteria, including at least two cognitive tests, and a follow-up of 6 months or more. The risk of bias was evaluated using the Newcastle–Ottawa Scale (NOS).

Results

Fifteen studies were identified (7 APO and 8 LCIG). APO generally preserved cognitive function over a 12-month follow-up, with some decreases in visuospatial memory and executive functions. LCIG, with a 28-month follow-up, showed more extensive cognitive decline, particularly in patients with pre-existing impairments. Variability in cognitive tests made direct comparisons difficult.

Discussion

APO may have a more favorable cognitive profile than LCIG. However, differences in follow-up duration, moderate risk of bias, and inconsistent cognitive assessments warrant cautious interpretation. Improved patient selection and comprehensive cognitive evaluations are recommended for future practice.

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帕金森氏病高级治疗的认知结局：阿波啡和左旋多巴-卡比多巴肠道凝胶治疗的系统综述

帕金森氏病（PD）治疗，如阿波啡（APO）和左旋多巴-卡比多巴肠道凝胶（LCIG），是控制运动症状的先进治疗选择。然而，缺乏明确的选择标准和明确的认知结果。本系统综述特别旨在通过评估APO和LCIG对PD患者认知的影响来解决这些差距。方法按照PRISMA指南进行系统评价，检索PubMed、Web of Science、Scopus和Embase。两位作者根据关键纳入标准筛选研究，包括至少两次认知测试，以及6个月或更长时间的随访。偏倚风险采用纽卡斯尔-渥太华量表（NOS）进行评估。结果共发现15例（APO 7例，LCIG 8例）。在12个月的随访中，APO通常保留了认知功能，但视觉空间记忆和执行功能有所下降。在28个月的随访中，LCIG显示出更广泛的认知能力下降，特别是在已有损伤的患者中。认知测试的可变性使直接比较变得困难。APO可能比LCIG有更有利的认知概况。然而，随访时间的差异、中等偏倚风险和不一致的认知评估需要谨慎解释。建议在未来的实践中改进患者选择和全面的认知评估。

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来源期刊

European Journal of Neurology 医学-临床神经学

CiteScore

9.70

自引率

2.00%

发文量

418

审稿时长

1 months

期刊介绍： The European Journal of Neurology is the official journal of the European Academy of Neurology and covers all areas of clinical and basic research in neurology, including pre-clinical research of immediate translational value for new potential treatments. Emphasis is placed on major diseases of large clinical and socio-economic importance (dementia, stroke, epilepsy, headache, multiple sclerosis, movement disorders, and infectious diseases).