帕金森病认知障碍的饮食模式与营养干预：一项批判性叙述性综述

文献信息

中文摘要

背景/目的： 认知障碍影响大多数帕金森病（PD）患者；在无痴呆的PD患者中，25-40%存在轻度认知障碍，而营养建议往往超出证据支持。我们综述了饮食模式或营养补充剂改善确诊PD患者认知功能的人体证据，并将客观认知结局与患者自评结局及生物标志物结局区分开来。
方法： 按照SANRA报告标准进行的批判性叙述性综述。检索来源为PubMed、Embase、Web of Science和Cochrane CENTRAL（自建库至2026年9月29日）及参考文献列表。纳入证据集为在确诊特发性PD患者中开展、具有客观认知结局或专门评定的认知症状的对照干预研究，并按偏倚风险领域进行评价，依据明确规则进行分类。
结果： 共23项随机对照研究符合标准（5项饮食模式，18项补充剂）。6项研究报告了有利的组间差异（地中海饮食、一项生酮试点、肌酸-辅酶Q10、一种益生菌、藏红花和银杏叶提取物），但所有这些研究的受试者均少于100例，且认知终点状态异质。三项最大的试验未证实认知获益。其他报告显示比较无显著差异，或未提供组间认知效应估计；一项研究仅使用了评定的症状。没有研究显示持久的功能获益或降低向痴呆的进展。
结论： 尚无任何营养干预在PD中具有独立重复验证的、持久的认知疗效。营养充足性、纠正已记录的缺乏、吞咽困难护理以及个体化的左旋多巴-进餐时间安排仍是临床优先事项；地中海式饮食模式是合理的默认选择，而非认知治疗。

英文摘要

BACKGROUND/OBJECTIVES: Cognitive impairment affects most people with Parkinson's disease (PD); mild cognitive impairment is present in 25-40% of people with PD without dementia, and nutritional advice often exceeds the evidence. We reviewed the human evidence that dietary patterns or nutritional supplements improve cognition in established PD, separating objective cognitive outcomes from patient-rated and biomarker outcomes.
METHODS: Critical narrative review reported according to SANRA. Sources were PubMed, Embase, Web of Science and Cochrane CENTRAL (inception to 29 September 2026) and reference lists. Controlled intervention studies in established idiopathic PD with an objective cognitive outcome or a specifically rated cognitive symptom formed the evidence set, appraised on risk-of-bias domains and classified by an explicit rule.
RESULTS: Twenty-three randomized controlled studies met the criteria (five dietary patterns, 18 supplements). Favorable between-group differences were reported in six studies (Mediterranean diet, a ketogenic pilot, creatine-coenzyme Q10, a probiotic, saffron and ginkgo leaf extract), all with fewer than 100 participants and heterogeneous cognitive endpoint status. The three largest trials did not demonstrate cognitive benefit. Other reports showed nonsignificant comparisons or did not provide a between-group cognitive estimate; one used only a rated symptom. No study showed durable functional benefit or reduced progression to dementia.
CONCLUSIONS: No nutritional intervention has independently replicated, durable cognitive efficacy in PD. Nutritional adequacy, correction of documented deficiency, dysphagia care and individualized levodopa-meal timing remain the clinical priorities; a Mediterranean-style pattern is a reasonable default, not a cognitive treatment.