早期帕金森病患者嗅觉与认知功能的相关性分析

Correlations between olfactory and cognitive functions in early stage Parkinson＇s disease

目的 观察早期帕金森病（PD）患者嗅觉与认知功能的一般特点及两者的相关性.方法 采用T＆T嗅觉测试液对2013年5月至2014年8月在苏州大学附属第二医院帕金森专科门诊及住院的63例Hoehn-Yahr分期位于1～2.5期之间的早期PD患者和同期55名年龄、性别相匹配的健康人进行嗅觉测试,并进行MoCA及MMSE量表评估.同时取得所有受试者的知情同意.T＆T嗅觉测试液分有5种嗅素,每种嗅素有5种不同的浓度级别,从低浓度到高浓度的赋予分值记为1～5.其中中间浓度3为标准嗅觉识别阈值,5种嗅素的平均值[（A＋B＋C＋D＋E）/5]作为受试者的总体嗅觉觉察阈值及嗅觉识别阈值.结果 （1）PD组嗅觉觉察阈值、识别阈值分别为（4.0±1.3、4.8±0.9）,较健康对照组的相应值（2.5±0.9、2.9±0.9）明显升高（P=0.000）.PD组MoCA及MMSE得分较健康对照组低[（23.7±3.0）分比（25.9±2.0）分,t=4.727,P=0.000;（27.8±1.9）分比（28.9±0.9）分,t=4.036,P=0.000].（2） Spearman相关分析显示PD组其嗅觉识别阈值与MoCA得分呈负相关关系（r=-0.385,P＜0.05）,嗅觉觉察阈值、识别阈值分别与视空间及执行能力负相关（r=-0.365,-0.403,P＜0.05）,嗅觉识别阈值与延迟记忆功能负相关（r=-0.299,P＜0.05）,而健康对照组则无以上发现.结论 早期帕金森病患者存在嗅觉功能及认知功能障碍,且两者之间存在着正相关性.

Objective To explore the general characteristics of olfactory and cognitive functions in early Parkinson＇s disease （PD） and examine their correlations.Methods The olfactory functions were assessed for 63 PD patients and 55 age and gender-matched normal subjects using T＆T olfactory assessment.The scales of mini-mental state examination （MMSE） and Montreal cognitive assessment （MoCA） were employed.The olfactory and cognitive parameters and their relationship were analyzed.There were five different odors in T＆T testing liquid and each odor had 5 concentration gradients.The level had an assigned value of 1 to 5 and number 3 represented the standard threshold of olfactory recognition.The mean value of five odors was overall olfactory detection or cognition threshold.Results （1） The olfactory detection and recognition thresholds were 4.0 ± 1.3/4.8 ± 0.9 in PD group versus 2.5 ± 0.9/2.9 ± 0.9 in normal controls.The scores of MoCA and MMSE were lower in PD group than those in controls （23.7 ± 3.0 vs 25.9 ±2.0,t =4.727,P =0.000; 27.8 ± 1.9 vs 28.9 ±0.9,t =4.036,P =0.000）.（2） Linear correlation analysis showed that olfactory recognition threshold was correlated negatively with MoCA scores.The olfactory detection and recognition thresholds were correlated negatively with the score of visualspatial perception and executive capability （r =-0.365,-0.403,P ＜ 0.05）.The olfactory recognition threshold was correlated negatively with the score of delayed memory （r =-0.299,P ＜ 0.05）.And this phenomenon was absent in controls.Conclusion Early PD patients have olfactory dysfunction and cognitive impairment.And these two non-motor symptoms are negatively correlated.