帕金森病认知障碍及相关因素分析

Analysis of cognition disorder and its correlative factors in Parkinson disease

目的探讨帕金森病认知障碍及其影响因素。方法127例原发性帕金森病患者，收集年龄、发病年龄、病程、受教育时间、既往史、个人史和家族史等一般资料。采用帕金森病统一评价量表第3部分（UPDRSⅢ）和Hoehn-Yahr分级评价运动性症状严重程度；帕金森病统一评价量表第2部分（UPDRSⅡ）和日常生活活动能力问卷（ADL）评价日常生活活动能力；简易智能状态检查量表（MMSE）和蒙特利尔认知评价量表（MoCA）评价轻度认知障碍；Fuld物体记忆评价（FOM）、快速词汇测验（RVR）、积木测验（BD）和数字广度测验（DS）评价短时记忆、长时记忆和语言能力、视空间结构能力及注意力和瞬时记忆；汉密尔顿抑郁量表（HAMD）和汉密尔顿焦虑量表（HAMA）评价抑郁和焦虑症状。结果帕金森病患者普遍存在轻度认知障碍，与受教育时间（r=0．510，p=0．000）和ADL评分（r=0．452，P=0．000）呈正相关，与年龄（r=-0．466，P=0．000）、发病年龄（r=-0．418，P=0．000）、UPDRSHI评分（r=-0．330，P=0．000）、Hoehn-Yahr分级（r=-0．431，P=0．000）、HAMD评分（r=-0．229，P=0．000）和HAMA评分（r=-0．222，P=0．000）呈负相关，而与病程无相关性（r=0．012，P=0．893）；其中以受教育时间和Hoehn—Yahr分级对认知功能影响最为显著（R^2=0.260，0．388）。结论帕金森病患者早期即存在轻度认知障碍，可影响日常生活活动能力。蒙特利尔认知评价量表是筛选轻度认知障碍患者便捷、有效的方法。

Objective To evaluate the cognition disorder and its correlative factors in patients with idiopathic Parkinson disease （IPD）. Methods The general data （age, age at onset, duration, education, past history, personal history and family history） of 127 IPD patients were collected. Unified Parkinson Disease Rating Scale Ⅲ （UPDRS Ⅲ） and Hoehn-Yahr Scale were used to assess the severity of motor status. Unified Parkinson Disease Rating Scale Ⅱ （UPDRS Ⅱ ） and Activities of Daily Living Scale （ADL） were used to estimate daily life activities. Mini-Mental State Examination （MMSE） and Montreal Cognitive Assessment （MoCA） were used to assess mild cognition disorder. Fuld Object Memory Evaluation （FOM） was used to assess shortterm recall. Rapid Verbal Retrieve Test （RVR） was used to assess long-term recall and language ability. Block Design Test （BD） was used to assess visuospatial ability. Digit Span Test （DS） was used to assess attention and immediate recall. Hamilton Depression Rating Scale （HAMD） and Hamilton Anxiety Rating Scale （HAMA） were applied for assessment of depression and anxiety status. Results Patients with IPD commonly presented mild cognition disorder. The education and ADL score positively correlated with cognition disorder （r = 0.510, P = 0.000; r = 0.452, P = 0.000, respectively）. Age, age at onset, UPDRS Ⅲ score, Hoehn-Yahr Scale, HAMD score and HAMA score negatively correlated with cognition disorder （r=-0.466, -0.418, -0.330, -0.431, -0.229, -0.222, P=0.000, 0.000, 0.000, 0.000, 0.000, 0.000）. Tbere was no correlation between the duration and cognition disorder （r=0.012, P=0.893）. Education and Hoehn-Yahr Scale were main factors which can significantly influence cognition disorder （R^2= 0.260, 0.388）. Conclusion Patients in early stageof idiopathic Parkinson disease may present mild cognition disorder, which may influence the daily life activities. MoCA is found to be a viable and useful method for screening patients with mild cognition disorder.