帕金森病轻度认知障碍的特点、相关因素及其对生活质量的影响

Features and related factors of mild cognitive impairment and its impacts on the quality of life in Parkinson's disease

目的探讨帕金森病(PD)伴发轻度认知障碍(PD-MCI)的特点、相关因素及其对生活质量的影响。方法收集2010年4月至2011年8月就诊于北京天坛医院神经内科的122例帕金森病患者的人口学资料;完成Hoehn-Yahr分期、帕金森病统一评定量表第Ⅱ部分(UPDRS-Ⅱ)及第Ⅲ部分(UPDRS-Ⅲ)、临床痴呆评定量表(CDR)、简易精神状态量表(MMSE)、蒙特利尔认知评估量表(MoCA)、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、爱泼沃斯思睡量表(ESS)、疲劳量表(FS-14)、日常生活能力问卷(ADL)及39项帕金森病生活质量问卷(PDQL-39)的评测。结果 (1)根据量表评测结果,122例PD患者中67例为轻度认知功能障碍(PD-MCI组),占54.92%,47例为无认知功能障碍(PD-NCI组),占38.52%;(2)PD-MCI组与PD-NCI组MoCA评分分别为(19.93±3.50)分和(26.74±1.48)分,有统计学差异(P=0.00);(3)PD-MCI组与PD-NCI组各认知域得分比较如下:视空间与执行功能(2.43±1.62)分和(4.06±0.97)分,命名(2.69±0.61)分和(2.98±0.15)分;注意力与计算力(5.01±1.16)分和(5.87±0.49)分;语言(2.19±0.88)分和(2.83±0.38)分;抽象思维(0.93±0.8)分和(1.74±0.57)分;延迟记忆(1.19±1.26)分和(3.28±1.23)分;定向力(5.49±0.84)分和(5.89±0.48)分,PD-MCI组注意力与计算力、延迟记忆、视空间及执行功能的得分明显低于PD-NCI组(P值分别为0.00、0.00和0.00);(4)人口学因素:PD-MCI组与PD-NCI组受教育时间分别为(8.51±0.53)年和(11.86±0.51)年,有统计学差异(P=0.00);年龄、起病年龄、病程及性别比例无统计学差异;(5)PD-MCI组与PD-NCI组运动功能比较:Hoehn-Yahr分期为(2.29±0.09)期和(2.00±0.10)期;UPDRS-Ⅲ评分为(27.76±1.31)分和(23.62±1.56)分,有统计学差异(P值分别为0.03和0.04);(6)PD-MCI与PD-NCI组非运动症状发生率比较:焦虑为13.43%和6.38%、抑郁为71.64%和76.60%、疲劳为38.81%和46.81%、日间睡眠障碍为29.86%和19.15%,均无统计学差异;(7)PD-MCI组与PD-NCI组日常生活活动能力和生活质量比较:UPDRS-Ⅱ为(14.13±0.64)分和(11.72±0.65)分,ADL为(43.87±1.56)分和(38.13±2.04)分,PDQL-39为(135.23±3.26)分和(144.66±3.02)分,均有统计学差异(P值分别为0.01、0.03和0.04);(8)PD-MCI组MoCA评分与UPDRS-Ⅲ评分(r=-0.26,P=0.01)、Hoehn-Yahr分期(r=-0.20,P=0.03)、UPDRS-Ⅱ评分(r=-0.23,P=0.01)和ADL评分(r=-0.22,P=0.02)呈负相关;与受教育程度时间(r=0.50,P=0.00)及PDQL-39评分(r=0.22,P=0.02)呈正相关;与起病年龄、年龄、病程、临床分型、HAMA评分、HAMD评分、FS-14评分及ESS评分无明显相关性。结论 PD-MCI发病率高,以注意力与计算力、延迟记忆、视空间及执行功能障碍为主要表现;PD-MCI与运动障碍及受教育时间明显相关,并严重影响患者的生活质量,应对PD-MCI尽早识别、及时治疗,提高PD患者的生活质量。

Objective To investigate the features and related factors of Parkinson＇s disease（PD） with mild cognitive impairment（PD-MCI） and its impact on the quality of life for PD patients. Methods 122 PD patients were recruited and collected for the general information. The patients were evaluated by Hoehn-Yahr stage, Unified Parkinson＇s Disease Rating Scale （UPDRS）Ⅱ and Ⅲ, Clinical Dementia Rating （CDR）, Mini-Mental State Examination（ MMSE）, Montreal Cognitive Assessment（ MoCA）, Hamilton Anxiety Rating Scale（ HAMA）, Hamilton Depression Rating Scale （ HAMD ）, The Epworth Sleepiness Scale （ ESS）, Fatigue Scale （ FS-14 ）, Ability of Daily Living Questionnaire（ADL） and Parkinson＇s Disease Quality of Life Questionnaire-39 （PDQL-39）. Results （ 1 ） 67 cases in 122 PD patients（54.92% ）were with mild cognitive impairment（PD-MCI） and 47 cases（38.52% ）were with no cognitive impairment（PD-NCI） ;（2）MoCA scores of PD-MCI and PD-NCI groups were 19. 93 ± 3.50 vs. 26. 74±1. 48, and the difference was statistically significant （ P = 0.00） ; （ 3 ） Scoring rates of each cognitive domain in PD- MCI and PD-NCI groups were as followed： visuo-spatial and executive function ： 2.43 ± 1.62 vs. 4. 06 ± 0. 97, naming ：2. 69 ± 0. 61 vs. 2. 98± 0. 15, attention and calculation： 5.01 ± 1, 16 vs. 5.87± 0.49, language ： 2. 19 ± 0. 88 vs. 2. 83±0. 38, abstraction ：0. 93 ±0. 88 vs. 1.74± 0. 57, delayed memory ： 1.19 ± 1.26 vs. 31 28± 1.23, orientation ： 5.49 ±0. 84 vs. 5.89±O. 48 ; Among which, scoring rates of attention and calculation, delayed memory, visuo-spatial and executive function in PD-MCI group were significantly higher than that in PD-NCI group （ P = 0. 00,0. 00 and 0. O0,respectively）;（4）The course of education in PD-MCI and PD-NCI groups were （8.51 ± O. 53 ）years vs. （ 11.86 ± 0. 51 ） years, and the difference was statistically significant （ P = 0. 00） ; the differences of age of onset, age, the course of disease and sex ratio were not significant; （5） Evaluations of motor function for PD-MCI and PD-NCI groups were as followed： Hoehn-Yahr stage： 2. 29± 0.09 vs. 2. 00 ±0. 10, UPDRS-m ： 27.76 ± 1.31 vs. 23.62 ± 1.56, which were all statistically significant （ P = 0. 03 and P = 0. 04, respectively） ; （6） The incidences of non-motor symptoms for PD-MCI and PD-NCI groups were as followed：anxiety： 13.43% vs. 6. 38%, depression： 71.64% vs. 76. 60%, fatigue ：38. 81% vs. 46. 81%, daytime sleep disorders ： 29. 86% vs. 19. 15 %, which were not statistically significant; （7）Comparison of quality of life for PD-MCI and PD-NCI groups were as followed： UPDRS-I1：14. 13 ± O. 64 vs. 11.72 ± 0. 65, ADL：43.87 ± 1.56 vs. 38.13 ± 2. 04, PDQL-39 ： 135. 23 ± 3.26 vs. 144. 66 ±3. 02, which were all statistically significant（P =0.01 ,P =0. 03 and P = 0.04 ,respectively） ; （8） MoCA score of PD-MCI group was negatively correlated with UPDRS-Ⅲ score （ r = - 0. 26, P = 0. 01 ）, Hoehn-Yahr stage （ r = - 0. 20, P = 0. 03 ）, UPDRS- Ⅱ score （ r = - 0. 23,P = 0. 01 ） and A DL score （ r = - 0. 22, P = 0. 02 ）, and was positively correlated with the course of education（ r = 0. 50, P = 0. 00 ） and PDQL-39 score （ r = 0. 22, P = 0. 02 ）, however was not correlated with age of onset, age, duration, clinical types and scores of HAMA, HAMD, FS-14 and ESS. Conclusions There is a high incidence of PD-MCI, which is mainly featured by the dramatic impairments in the cognitive domains of attention and calculation, delayed memory, visuo-spatial and executive function. PD-MCI is significantly correlated with the severity of movement dysfunction and course of education and severely compromised the quality of life for PD patients. Thus,it is very pivotal to recognize and treat PD-MCI at early stage in order to slow down the disease progression and improve the quality of life for the patients.