多系统萎缩和帕金森病患者执行功能障碍研究

Analysis on executive dysfunction of patients with multiple system atrophy and Parkinson's disease

目的探讨多系统萎缩和帕金森病患者执行功能障碍特点。方法采用简易智能状态检查量表(MMSE)和蒙特利尔认知评价量表(Mo CA),以及Stroop色词测验(SCWT)、数字符号转换测验(DSST)/图形符号转换测验(GSST)、画钟测验(CDT)和连线测验(TMT)评价34例多系统萎缩患者[以小脑共济失调为主要表现型(MSA-C型)21例、以帕金森病综合征为主要表现型(MSA-P型)13例]和18例原发性帕金森病患者的整体认知功能和执行功能。结果各组受试者Mo CA评分差异有统计学意义(P=0.019),其中PD组和MSA-C型组患者评分低于对照组(P=0.015,0.002)。各组受试者SCWT测验各部分评分(P=0.035,0.013,0.012,0.037)、DSST评分(P=0.000)、GSST评分(P=0.000)、TMT评分(P=0.035)差异均有统计学意义,其中,MSA-C型组和MSA-P型组患者SCWT-A(P=0.004,0.045)、SCWT-B(P=0.001,0.036)和SCWT-D(P=0.023,0.010)评分均高于对照组,PD组、MSA-C型组和MSA-P型组患者SCWT-C评分(P=0.005,0.014,0.003)、DSST评分(P=0.003,0.000,0.000)和GSST评分(P=0.001,0.000,0.000)均高于对照组,仅MSA-P型组患者TMT评分高于对照组(P=0.006)。结论多系统萎缩和帕金森病患者均存在不同程度的执行功能障碍,SCWT和DSST/GSST测验有助于评价此类患者的执行功能障碍。

ObjectiveTo explore the characteristics of executive dysfunction of patients with multiple system atrophy（MSA） and Parkinson＇s disease（PD） by neuropsychological tests.Methods Mini-Mental State Examination（MMSE）, Montreal Cognitive Assessment（Mo CA）, Stroop Color- Word Test（SCWT）, Digital Symbol Substitution Test（DSST）/Graphic Symbol Substitution Test（GSST）, Clock Drawing Test（CDT） and Trail Making Test（TMT） were used to assess the overall cognitive and executive function of 34 patients with MSA [21 with cerebellar- predominant（MSA- C） and 13 with parkinsonism- predominant（MSA-P）], 18 patients with primary PD and 14 normal controls.Results There was significant difference in Mo CA score among different groups（P = 0.019）. PD and MSA-C groups had lower Mo CA score than thatin normal control group（P = 0.015, 0.002）. There were significant differences in each SCWT score（P =0.035, 0.013, 0.012, 0.037）, DSST（P = 0.000）, GSST（P = 0.000） and TMT（P = 0.035） among different groups. Among them, MSA- C and MSA- P groups had significantly higher SCWT- A（P = 0.004, 0.045）,SCWT-B（P = 0.001, 0.036） and SCWT-D scores（P = 0.023, 0.010） than those in normal control group. PD,MSA- C and MSA- P groups had significantly higher SCWT- C（P = 0.005, 0.014, 0.003）, DSST（P = 0.003,0.000, 0.000） and GSST scores（P = 0.001, 0.000, 0.000） than those in normal control group. MSA-P group had significantly higher TMT score than that in normal control group（P = 0.006）.Conclusions Patients with MSA and PD may present executive dysfunction to different degrees. SCWT and DSST/GSST tests areuseful in assessing executive dysfunction in those patients.