帕金森病患者轻度认知损害的临床调查

Clinical investigation of mild cognitive impairment in patients with Parkinson＇ s disease

目的研究帕金森病（Parkinson＇s disease，PD）伴有轻度认知功能缺损（mildcognitive impairment，MCI，即PD-MCI）患者患病率及其神经心理学特征。方法设立PD患者组（n=103）及健康对照组（n=32）进行比较。心理学测验工具由MMSE、痴呆评定量表及其他神经心理学测试组成，汉密尔顿抑郁量表用以评定患者的抑郁程度。结果（1）21例（20．4％）PD患者被诊断为痴呆，37例（35．9％）患者认知功能完整，45例（43．7％）患者有MCI；（2）与认知正常的PD患者相比，PD．MCI患者年龄更大，PD起病更晚，且运动损害更为严重；（3）PD-MCI的患病率和神经心理学特征与PD症状主要累及何侧及分型有一定关系：左侧组比右侧组患者出现MCI的概率要高（74．2％和42．2％，r=7．589，P〈0．05）；震颤为主型患者与混合型患者相比，Stroop测词试验（swr）的耗时（s）显著减少（80．84-39．9和94．4±30．0，t=3．332，P〈0．01）。结论在PD患者中，筛查出PD-MCI患者有着重要的临床意义，有助于临床医生针对性地处理不同PD患者，并易化对其预后的判断。

[Abstract] Objective To describe the prevalence and neuropsychological character of mild cognitive impairment （MCI） associated with Parkinson＇ s disease （PD-MCI）. Methods One hundred and three PD patients and a control group of 32 healthy old subjects were chosen. Psychometric assessment included the Mini Mental State Examination, the Dementia Rating Scale and a series of neuropsychological tests. The Hamilton Rating Scale of Depression was used to assess depression in PD patients. Results （ 1 ） Twenty-one （20.4%） PD patients was diagnosed with dementia, 45 （43.7%） had a MCI and only 37 （35.9%） had no cognitive impairment; （2） Subjects with PD-MCI were older, had a later onset of the PD. and displayed more severe motor symptoms compared with those without cognitive impairment;（ 3 ） The prevalence and neuropsychological profile of PD-MCI were thought to correlate with the dominating side and subtype of Parkinsonian symptoms, for patients with left-sided dominant symptoms had a significantly higher chance of suffering MCI than those with right-sided dominant symptoms, the ratio being 74. 2% vs 42. 2%, χ^2 = 7.589,P 〈 0. 05; The tremor-dominant group took less time than the mixed group for Stroop word test measurement （（80.8±39.9） svs （94.4±30.0） s,t=3.332,P〈0. 01）. Conclusion Identification of MCI is of important clinical significance, which helps to treat patients differently and thus predict the prognosis.