■帕金森病的精神症状负担包括抑郁症,焦虑,冷漠,精神病,和冲动控制障碍。然而,精神合并症与随后的预后和神经系统结局之间的关系尚不清楚.在这篇系统综述和荟萃分析中,在帕金森病患者中,我们旨在描述特定的精神病合并症与随后的预后和神经系统结局之间的关系:认知障碍,死亡,残疾,疾病进展,跌倒或骨折和护理院入院。
■我们搜索了MEDLINE,Embase,PsycINFO和AMED截至2023年11月13日,用于测量帕金森病患者疾病结果的纵向观察研究,有和没有特定的精神病合并症,和至少两名作者提取汇总数据。排除了对患有其他帕金森氏病的个体以及与精神症状高度重叠的结局指标的研究,以确保面部有效性。对于每个暴露-结果对,随机效应荟萃分析是基于标准化平均差异进行的,使用调整后的效果大小(如果可用)优先于未调整的效果大小。使用纽卡斯尔-渥太华量表评估研究质量。使用I2统计量评估研究之间的异质性,并使用漏斗图评估发表偏倚。PROSPERO研究注册号:CRD42022373072。
■有55项符合条件的研究纳入荟萃分析(n=165,828)。有关参与者性别的数据为164,514,其中99,182(60.3%)为男性,65,460(39.7%)为女性。研究质量大多较高(84%)。在精神病和认知障碍之间发现了显着的正相关(标准化平均差[SMD]0.44,[95%置信区间[CI]0.23-0.66],I230.9),精神病和疾病进展(SMD0.46,[95%CI0.12-0.80],I270.3%),抑郁症和认知障碍(SMD0.37[95%CI0.10-0.65],I227.1%),抑郁症和疾病进展(SMD0.46[95%CI0.18-0.74],I252.2),抑郁和残疾(SMD0.42[95%CI0.25-0.60],I27.9%),和冷漠和认知障碍(SMD0.60[95%CI0.02-1.19],I227.9%)。研究间异质性中等高。
■精神病,抑郁症,帕金森氏病中的冷漠和冷漠都与至少一种不良结果有关,包括认知障碍,疾病进展和残疾。这种关系是否因果关系尚不清楚,但是这些关联背后的机制需要探索。临床医生应认为这些精神合并症是帕金森病患者预后较差的标志。未来的研究应该调查潜在的机制,以及这些合并症的治疗可能会影响帕金森病的预后。
■惠康信托基金,英国国立卫生研究院(NIHR),国立卫生研究院(NIHR)生物医学研究中心(BRC)位于伦敦南部,莫兹利NHS基金会信托基金和伦敦国王学院,国立卫生研究院(NIHR)生物医学研究中心(BRC)在伦敦大学学院医院NHS基金会信托,国家大脑呼吁。
UNASSIGNED: The burden of psychiatric symptoms in Parkinson\'s disease includes depression, anxiety, apathy, psychosis, and impulse control disorders. However, the relationship between psychiatric comorbidities and subsequent prognosis and neurological outcomes is not yet well understood. In this systematic
review and meta-analysis, in individuals with Parkinson\'s disease, we aimed to characterise the association between specific psychiatric comorbidities and subsequent prognosis and neurological outcomes: cognitive impairment, death, disability, disease progression, falls or fractures and care home admission.
UNASSIGNED: We searched MEDLINE, Embase, PsycINFO and AMED up to 13th November 2023 for longitudinal observational studies which measured disease outcomes in people with Parkinson\'s disease, with and without specific psychiatric comorbidities, and a minimum of two authors extracted summary data. Studies of individuals with other parkinsonian conditions and those with outcome measures that had high overlap with psychiatric symptoms were excluded to ensure face validity. For each exposure-outcome pair, a random-effects meta-analysis was conducted based on standardised mean difference, using adjusted effect sizes-where available-in preference to unadjusted effect sizes. Study quality was assessed using the Newcastle-Ottawa Scale. Between-study heterogeneity was assessed using the I2 statistic and publication bias was assessed using funnel plots. PROSPERO Study registration number: CRD42022373072.
UNASSIGNED: There were 55 eligible studies for inclusion in meta-analysis (n = 165,828). Data on participants\' sex was available for 164,514, of whom 99,182 (60.3%) were male and 65,460 (39.7%) female. Study quality was mostly high (84%). Significant positive associations were found between psychosis and cognitive impairment (standardised mean difference [SMD] 0.44, [95% confidence interval [CI] 0.23-0.66], I2 30.9), psychosis and disease progression (SMD 0.46, [95% CI 0.12-0.80], I2 70.3%), depression and cognitive impairment (SMD 0.37 [95% CI 0.10-0.65], I2 27.1%), depression and disease progression (SMD 0.46 [95% CI 0.18-0.74], I2 52.2), depression and disability (SMD 0.42 [95% CI 0.25-0.60], I2 7.9%), and apathy and cognitive impairment (SMD 0.60 [95% CI 0.02-1.19], I2 27.9%). Between-study heterogeneity was moderately high.
UNASSIGNED: Psychosis, depression, and apathy in Parkinson\'s disease are all associated with at least one adverse outcome, including cognitive impairment, disease progression and disability. Whether this relationship is causal is not clear, but the mechanisms underlying these associations require exploration. Clinicians should consider these psychiatric comorbidities to be markers of a poorer prognosis in people with Parkinson\'s disease. Future studies should investigate the underlying mechanisms and which treatments for these comorbidities may affect Parkinson\'s disease outcomes.
UNASSIGNED: Wellcome Trust, UK National Institute for Health Research (NIHR), National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust and King\'s College London, National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) at University College London Hospitals NHS Foundation Trust, National Brain Appeal.