特发性快速眼动睡眠行为障碍的认知功能研究

Cognitive functions of patients with idiopathic rapid eye movement sleep behavior disorder

目的探讨快速眼动睡眠行为障碍（RBD）患者的认知功能改变。方法选自中日友好医院神经内科自2011年1月至2014年3月收治的25例RBD患者，同时入组年龄、性别、文化程度匹配的健康对照者25例。所有患者均完成多导睡眠生理监测（PSG），记录眼球运动、下颌和肢体肌电活动、心电图、经鼻气流、胸腹部呼吸运动、血氧、鼾声，并录像监测患者的行为。使用Polysmith软件和视觉评估分析睡眠周期。认知功能通过简易精神状态检查（MMSE）和蒙特利尔认知评价（MoCA）NC表评估。结果RBD患者具有典型临床表现和电生理改变，表现为夜间发作性肢体活动或喊叫，REM睡眠中下颌或肢体肌电活动均不消失，呈相位性或特征性增高。RBD组的MMSE量表总分（28．44±1．58）低于健康对照组（29．12±0．971，差异无统计学意义（t=3．351，P=0．0731；而MoCA量表总分（24．72±2．70）明显低于健康对照组（27．68±0．80），差异具有统计学意义（t=27．598，p=0．0001；RBD组注意亚项、记忆亚项得分低于健康对照组，差异均有统计学意义（P〈0．05）；而言语亚项与健康对照组的差异无统计学意义（P=0．0831。RBD病程与MoCA量表总分、注意亚项、记忆亚项呈明显负相关关系（r=-0．638、-0．622、-0．626，P=0．003、0．014、0．008）。结论RBD患者存在明显的认知功能改变。MoCA量表对于识别认知异常较MMSE量表更加敏感，其中注意和记忆功能是RBD患者改变最为明显的方面。

Objective To investigate the changes of cognitive functions in patients with rapid eye movement sleep behavior disorder （RBD）. Methods Twenty-five patients fulfilled the diagnostic criteria of RBD according to the International Sleep Disorder Association （Second Edition）, admitted to our hospital from January 2011 to March 2014, were enrolled, and other 25 age and gender matched normal controls were recruited. All RBD patients were video-monitored during the recordings of electroencephalography, electrooculography, electromyography on chin and limbs, electrocardiography, nasal airflow, thoracic and abdominal respiratory movement, oxygen and snore. The sleep architecture was analyzed on the software of Polysmith and visual analysis. The cognitive functions were evaluated by Mini-Mental State Examination （MMSE） and Montreal Cognitive Assessment （MoCA）. Results Classical clinical manifestations and typical results of polysomnography were noted in RBD patients： paroxysmal increased activities of the limbs or shouting at night, and no disappearance of jaw or limb muscle activity during sleeping enjoyed a phase or characterized increase. The total MMSE scores in RBD patients （28.44±1.58） were lower than those in normal controls （29.12±0.97, t=3.351, P=0.073）; the total MoCA scores between RBD patients and normal controls were significantly different （24.72±2.70 vs. 27.68±0.80, t=27.598, P=0.000）, MoCA scores of attention and memory sub-items were significantlylower than those of normal controls （P〈0.05）, and those of language sub-items were lower without statistical significance as compared with those of normal controls （P=-0.083）. The courses of RBD had significantly negative correlations with MoCA scores, attention and memory sub-items （r=-0.638, -0.622 and -0.626, P=0.003, 0.014 and 0.008）. Conclusions The patients with RBD have obvious cognitive changes. MoCA is a better tool than MMSE to identify the cognitive impairment and the most significant cognitive impairment in RBD patients includes attention and memory dysfunctions.