背景:建立了持续皮下阿朴吗啡输注(CSAI)对帕金森病(PD)运动并发症的疗效。然而,其对认知和行为的影响仍存在争议。本系统综述的主要目的是描述有关CSAI对认知和行为的影响的现有文献,并确定每个研究的质量。
方法:PubMed/Medline,Embase,APAPsycInfo®,搜索了Cochrane图书馆的数据库,遵循PRISMA的建议。只有纵向研究评估CSAI对认知的影响(全球认知,执行功能,视觉空间能力,语言,记忆,注意,社会认知)和/或行为(抑郁,焦虑,冷漠,精神病症状,冲动控制障碍,包括PD中的神经精神波动)。纳入研究的质量也通过问卷进行评估。
结果:23项纵向研究评估了CSAI对认知和/或行为的影响。总的来说,结果暗示了积极的影响,特别是在执行功能和情感识别方面。然而,有一些认知减慢和长期全球认知恶化的报告。在行为层面,没有研究显示CSAI的显著不良反应.偶尔,抑郁症的轻微改善,焦虑,冷漠,并报告了神经精神波动。然而,只有4项研究符合良好质量标准,缺乏认知方面的对照研究.
结论:结果表明,CSAI对PD的认知和行为没有明显的负面影响。这种治疗甚至显示出减少某些症状如神经精神波动的希望。然而,由于许多研究的方法限制,无法得出有力的结论。需要进一步的多中心对照试验来证实这些结果。
BACKGROUND: The efficacy of continuous subcutaneous apomorphine infusion (CSAI) for motor complications of
Parkinson\'s disease (PD) is established. However, its effect on cognition and behavior remains controversial. The main objective of this systematic review was to describe the existing literature on the effects of CSAI on cognition and behavior and to determine the quality for each study.
METHODS: PubMed/Medline, Embase, APA PsycInfo®, and Cochrane Library databases were searched, following PRISMA recommendations. Only longitudinal studies evaluating the effect of CSAI on cognition (global cognition, executive functions, visuospatial abilities, language, memory, attention, social cognition) and/or behavior (depression, anxiety, apathy, psychotic symptoms, impulse control disorders, neuropsychiatric fluctuations) in PD were included. The quality of the included studies was also assessed with a questionnaire.
RESULTS: Twenty-three longitudinal studies evaluated the effect of CSAI on cognition and/or behavior. Overall, results were suggestive of positive effects, notably on executive functions and emotion recognition. However, there were some reports of cognitive slowing and long-term global cognitive deterioration. At the behavioral level, no study showed significant adverse effect of CSAI. Occasionally, a slight improvement of depression, anxiety, apathy, and neuropsychiatric fluctuations was reported. Nevertheless, only four studies met good quality criteria and controlled study regarding cognition were lacking.
CONCLUSIONS: The results suggest that CSAI has no obvious negative effects on cognition and behavior in PD. This treatment even shows promise in reducing certain symptoms such as neuropsychiatric fluctuations. However, due to methodological limitations in many studies, no robust conclusions can be drawn. Further multicenter controlled trials are needed to confirm these results.