Cognitive Outcomes of Advanced Therapies in Parkinson's Disease: A Systematic Review of Apomorphine and Levodopa–Carbidopa Intestinal Gel Therapies
Bibliographic record
Abstract
BACKGROUND: Parkinson's disease (PD) treatments, such as apomorphine (APO) and levodopa-carbidopa intestinal gel (LCIG), represent advanced therapeutic options for managing motor symptoms. However, clear selection criteria and well-defined cognitive outcomes are lacking. This systematic review specifically aimed to address these gaps by assessing the cognitive impact of APO and LCIG in PD patients. METHODS: A systematic review was conducted following PRISMA guidelines, with searches in PubMed, Web of Science, Scopus, and Embase. Two authors screened studies based on key inclusion criteria, including at least two cognitive tests, and a follow-up of 6 months or more. The risk of bias was evaluated using the Newcastle-Ottawa Scale (NOS). RESULTS: Fifteen studies were identified (7 APO and 8 LCIG). APO generally preserved cognitive function over a 12-month follow-up, with some decreases in visuospatial memory and executive functions. LCIG, with a 28-month follow-up, showed more extensive cognitive decline, particularly in patients with pre-existing impairments. Variability in cognitive tests made direct comparisons difficult. DISCUSSION: APO may have a more favorable cognitive profile than LCIG. However, differences in follow-up duration, moderate risk of bias, and inconsistent cognitive assessments warrant cautious interpretation. Improved patient selection and comprehensive cognitive evaluations are recommended for future practice.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.025 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.009 | 0.009 |
| Bibliometrics | 0.007 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".