帕金森病初诊患者自主神经病变与认知功能障碍的研究

Analysis of autonomic dysfunction and cognitive impairment in newly diagnosed Parkinson's disease

目的了解帕金森病(PD)初诊患者伴发自主神经功能障碍和认知功能障碍的情况,并探讨自主神经功能障碍严重程度与认知功能障碍严重程度的关系。方法选取PD初诊患者60例,记录一般人口学资料,并完成帕金森病统一评定量表第三部分(UPDRSⅢ)、帕金森病生活质量问卷(PDQ-39)等评测。采用自主神经症状量表(SCOPA-AUT)将患者分为有自主神经症状(AS)组和无自主神经症状(NAS)组,比较两组间UPDRSⅢ、PDQ-39、病程等情况。采用简易精神状态量表(MMSE)将患者分为无认知功能障碍(NCI)组、轻度认知功能障碍(MCI)组、痴呆组,比较3组间UPDRSⅢ、PDQ-39、病程是否存在差异,并采用多个独立样本非参数检验比较3组间AS情况。结果 (1)60例PD初诊患者中存在AS者41例(68.3%),无AS者19例(31.7%);AS组和NAS组UPDRSⅢ评分(19.66±6.11 vs.13.57±5.83)、PDQ-39评分(25.00±9.65 vs.14.42±8.02)比较有统计学差异(均P<0.05),两组间性别构成、文化程度、病程无统计学差异(均P>0.05)。(2)NCI组、MCI组、痴呆组UPDRSⅢ评分分别为(18.30±8.48)分、(18.62±6.19)分、(27.00±9.52)分,NCI组与MCI组比较差异无统计学意义(P>0.05),与痴呆组相比差异均有统计学意义(P<0.05);NCI组、MCI组、痴呆组PDQ-39评分、病程〔数据以中位数(四分位数间距)表示〕分别为(19.78±9.34)分、(23.55±7.84)分、(38.67±10.26)和0.8(0.8)年、1.1(1.6)年、1.7(1.5)年,3组间比较差异均有统计学意义(P<0.05);(3)NCI组、MCI组和痴呆组总SCOPA-AUT总分以及胃肠道、泌尿系统等各系统症状评分比较均无统计学差异(P>0.05)。结论 PD初诊患者存在不同程度的自主神经功能障碍和认知功能障碍,两者均影响患者生活质量,但自主神经功能障碍严重程度与认知功能障碍严重程度可能无明显关系。

Objective To analyze the features of autonomic dysfunction and cognitive impairment in newly diagnosed patients with Parkinson＇ s disease （PD）,and then explore the relationships between autonomic dysfunction and cognitive impairment.Methods Sixty newly diagnosed PD patients were recruited and collected for the general information.The patients were evaluated by the third part of Unified Parkinson＇ s Disease Rating Scale （UPDRSⅢ） and the 39-item Parkinson＇ s Disease Questionnaire （PDQ-39）.According to the scores of the scale for outcomes in PD-autonomic for autonomic symptoms （SCOPA-AUT）,patients were divided into the autonomic symptom （AS） and no autonomic symptom （NAS） groups,and the UPDRS Ⅲ,PDQ-39,disease duration were compared between the two groups.According to the mini-mental state examination （MMSE）score,patients were divided into no cognition impaired （PD-NCI）,mild cognitive impairment （PD-MCI） and dementia （PDD） groups,and the UPDRS Ⅲ,PDQ-39,disease duration were compared among the three groups.The multiple independent samples nonparametric test was adopted to compare AS among the three groups.Results （1） Forty-one cases in 60 newly diagnosed PD patients （68.3％） were in the AS group and 19 cases （31.7％） were in the NAS group.UPDRSⅢ scores of AS and NAS groups were （19.66±6.11） and （13.57±5.83）,and the difference was statistically significant （P＜0.05）.There were statistically significant differences between the groups of AS and NAS in PDQ-39,（25.00±9.65） vs.（14.42±8.02）.But there was no difference in disease duration [1.1 （0.6,2.1）] vs.[1.3 （0.7,2.5） years],gender composition or educational level （P ＞0.05,respectively）.（2） Thirty-four cases （56.7％） had no cognitive impairment （PD-NCI）,19 patients （31.7 ％） accompanied with mild cognitive impairment （PD-MCI）,and 7 cases （11.6 ％） were diagnosed as Parkinson＇ s disease dementia.UPDRSⅢ scores of PD-NCI,PD-MCI and PDD groups were （18.30±8.48）,（18.62±6.19）,and （27.00±9.52）.There was no difference between the groups of PD-NCI and PD-MCI （P ＞0.05）,but the difference was statistically significant when the above two groups were compared with the PDD group （P＜0.05）.The scores of PDQ-39 were （19.78±9.34）,（23.55±7.84）,（38.67± 10.26）,and the difference was significant.There were significant differences among PD-NCI,PD-MCI and PDD groups in disease duration [0.8 （0.8）,1.1 （1.6）,1.7 （1.5） years,P ＜ 0.05].（3） There were no significant differences among PD-NCI,PD-MCI and PDD groups in the scores of SCOPA-AUT,gastrointestinal,urinary and other system symptoms.Conclusions Many newly diagnosed PD patients have autonomic dysfunction and cognitive impairment,which affect the quality of life.But there is no relationship between autonomic dysfunction and cognitive impairment.