| Autor: |
Wang W; South London and Maudsley NHS Foundation Trust, London SE5 8AB, UK.; Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK., Baker K; Department of Mathematics, King's College London, London WC2R 2LS, UK., Umamahesan C; South London and Maudsley NHS Foundation Trust, London SE5 8AB, UK.; Institute of Pharmaceutical Science, King's College London, London SE1 9NH, UK., Gilmour S; Department of Mathematics, King's College London, London WC2R 2LS, UK., Charlett A; Institute of Pharmaceutical Science, King's College London, London SE1 9NH, UK.; Statistics, Modelling and Economics, UK Health Security Agency, London NW9 5EQ, UK., Taylor D; South London and Maudsley NHS Foundation Trust, London SE5 8AB, UK.; Institute of Pharmaceutical Science, King's College London, London SE1 9NH, UK., Young AH; South London and Maudsley NHS Foundation Trust, London SE5 8AB, UK.; Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK., Dobbs RJ; South London and Maudsley NHS Foundation Trust, London SE5 8AB, UK.; Institute of Pharmaceutical Science, King's College London, London SE1 9NH, UK.; Department of Gastroenterology, King's College Hospital, London SE5 9RS, UK., Dobbs SM; South London and Maudsley NHS Foundation Trust, London SE5 8AB, UK.; Institute of Pharmaceutical Science, King's College London, London SE1 9NH, UK.; Department of Gastroenterology, King's College Hospital, London SE5 9RS, UK. |
| Abstrakt: |
We question whether bradyphrenia, slowing of cognitive processing not explained by depression or a global cognitive assessment, is a nosological entity in idiopathic parkinsonism (IP). The time taken to break contact of an index finger with a touch-sensitive plate was measured, with and without a warning in the alerting signal as to which side the imperative would indicate, in 77 people diagnosed with IP and in 124 people without an IP diagnosis. The ability to utilise a warning, measured by the difference between log e -transformed reaction times (unwarned minus warned), was termed 'cognitive efficiency'. It was approximately normally distributed. A questionnaire on self- and partner perception of proband's bradyphrenia was applied. A multivariable model showed that those prescribed levodopa were less cognitively efficient (mean -5.2 (CI -9.5, -1.0)% per 300 mg/day, p = 0.02), but those prescribed the anti-muscarinic trihexyphenidyl were more efficient (14.7 (0.2, 31.3)% per 4 mg/day, p < 0.05) and those prescribed monoamine oxidase-B inhibitor (MAOBI) tended to be more efficient (8.3 (0.0, 17.4)%, p = 0.07). The variance in efficiency was greater within IP (F-test, p = 0.01 adjusted for any demographic covariates: coefficient of variation, with and without IP, 0.68 and 0.46, respectively), but not so after adjustment for anti-parkinsonian medication ( p = 0.13: coefficient of variation 0.62). The within-participant follow-up time, a median of 4.8 (interquartile range 3.1, 5.5) years (101 participants), did not influence efficiency, irrespective of IP status. Perception of bradyphrenia did not usefully predict efficiency. We conclude that both bradyphrenia and 'tachyphrenia' in IP appear to have iatrogenic components, of clinically important size, related to the dose of antiparkinsonian medication. Levodopa is the most commonly prescribed first-line medication: co-prescribing a MAOBI may circumvent its associated bradyphrenia. The previously reported greater efficiency associated with (low-dose) anti-muscarinic was confirmed. |
