파킨슨병 환자의 초기 치료로서 레보도파와 도파민 작용제가 인지기능에 미치는 효과
Comparative Cognitive Effects of Levo-Dopa Plus Carbidopa and Dopamine Agonist as an Initial Therapy of Parkinson's Disease
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background: Cognitive impairments are common in patients with Parkinson's disease (PD). However little is known about the cognitive effects of dopaminergic therapy. Methods: The study was a single-blind prospective study of 21 patients with PD. Each patient had received either levodopa (Sinemet®, n=8) or dopamine agonist (Requip®, n=13) during 24 consecutive weeks. Neuropsychological battery, including Korean version of Alzheimer’s Disease Assessment Scale – cognitive subscale (ADAS-Cog) and frontal-executive function part of SNSB (Seoul Neuropsychological Screening Battery), were performed two times, before and after the 24 weeks of management. Patients also received quantitative ratings of motor symptom severity and functional status using Unified Parkinson's Disease Rating Scale (UPDRS) before and after the dopaminergic therapy. Results: After six months of treatment, motor scale improved in both groups (p<0.05) without difference between the groups (p>0.05). In ADAS-Cog testing, Requip® group improved at more categories than Sinemet® group but without statistical difference (p>0.05). The results of frontal-executive function test did not differ between the groups, either. Conclusions: Our study does not provide an evidence that dopaminergic treatment improves cognitive functions in Parkinson’s disease. Furthermore, we found no significant difference in the effect on cognition between the two tested drugs and no difference in the results of the above-listed neuropsychological tests between the first and the last visits.
Abstract
Background: Cognitive impairments are common in patients with Parkinson's disease (PD). However little is known about the cognitive effects of dopaminergic therapy. Methods: The study was a single-blind prospective study of 21 patients with PD. Each patient had received either levodopa (Sinemet®, n=8) or dopamine agonist (Requip®, n=13) during 24 consecutive weeks. Neuropsychological battery, including Korean version of Alzheimer’s Disease Assessment Scale – cognitive subscale (ADAS-Cog) and frontal-executive function part of SNSB (Seoul Neuropsychological Screening Battery), were performed two times, before and after the 24 weeks of management. Patients also received quantitative ratings of motor symptom severity and functional status using Unified Parkinson's Disease Rating Scale (UPDRS) before and after the dopaminergic therapy. Results: After six months of treatment, motor scale improved in both groups (p<0.05) without difference between the groups (p>0.05). In ADAS-Cog testing, Requip® group improved at more categories than Sinemet® group but without statistical difference (p>0.05). The results of frontal-executive function test did not differ between the groups, either. Conclusions: Our study does not provide an evidence that dopaminergic treatment improves cognitive functions in Parkinson’s disease. Furthermore, we found no significant difference in the effect on cognition between the two tested drugs and no difference in the results of the above-listed neuropsychological tests between the first and the last visits.
참고문헌 (21)
- Brown RG, "How common is dementia in Parkinson’s disease", Lancet, 2, pp.1262~1265 (1984)
- Biggins CA, "A controlled, longitudinal study of dementia in Parkinson’s disease", J Neurol Neurosurg Psychiatry, 55, pp.566~571 (1992)
- Mayeux R, "An estimate of the incidence of dementia in idiopathic Parkinson’s disease", Neurology, 40, pp.1513~1517 (1990)
- Hughes TA, "A 10-year study of the incidence of and factors predicting dementia in Parkinson’s disease", Neurology, 54, pp.1596~1602 (2000)
- Emre M, "What causes mental dysfunction in Parkinson’s disease", Mov Disord, 18, pp.63~71 (2003)
- Caballol N, "Cognitive dysfunction and dementia in Parkinson disease", Mov Disord, 22, pp.358~366 (2007)
- Alexander GE, "Parallel organization of functionally segregated circuits linking basal ganglia and cortex", Annu Rev Neurosci, 9, pp.357~381 (1986)
- Mega MS, "Frontal-subcortical circuits and neuropsychiatric disorders", J Neuropsychiatry Clin Neurosci, 6, pp.358~370 (1994)
- Brozoski TJ, "Cognitive deficit caused by regional depletion of dopamine in prefrontal cortex of rhesus monkey", Science, 9, pp.126~140 (1979)
- Growdon JH, "Levodopa improves motor function without impairing cognition in mild non demented Parkinson’s disease patients", Neurology, 50, pp.1327~1331 (1998)
- Lange KW, "L-Dopa and frontal cognitive function in Parkinson’s disease", Adv Neurol, 60, pp.475~478 (1993)
- Nieoullon A, "Dopamine and the regulation of cognition and attention", Prog Neurobiol, 67, pp.53~83 (2002)
- Kulisevsky J, "Acute effects of levodopa on neuropsychological performance in stable and fluctuating Parkinson’s disease patients at different levodopa plasma levels", Brain, 116, pp.2121~2132 (1996)
- Smith LA, "Repeated administration of piribedil induces less dyskinesia than L-dopa in MPTP-treated common marmosets: a behavioural and biochemical investigation", Mov Disord, 17, pp.887~901 (2002)
- Brusa L, "Pramipexole in comparison to l-dopa: a neuropsychological study", J Neural Transm, 110, pp.373~380 (2003)
- Calne DB, "Criteria for diagnosing Parkinson’s disease", Ann Neurol, 32, pp.125~127 (1992)
- Laura S, "ADAS-COG and mental deterioration battery: different instruments for different aspects of cognitive decline in Alzheimer’s disease", Neurosci Res Commun, 35, pp.184~192 (2004)
- Youn JC, "Development of the Korean version of Alzheimer’s disease assessment scale", Int J Geriatr Psychiatry, 17, pp.797~803 (2002)
- Lieberman A, "Dementia in Parkinson’s disease", Ann Neurol, 6, pp.355~359 (1979)
- Skinner MH, "Atenolol compared with nifedipine: effect on cognitive function and mood in elderly hypertensive patients", Ann Int Med, 116, pp.615~623 (1992)
- Dimsdale JE, "Cognitive effects of beta blocker", Psychosom Res, 36, pp.229~236 (1992)