特发性震颤患者认知功能障碍特点的分析

Characteristics of cognitive dysfunction in essential tremor patients

目的探讨特发性震颤(ET)患者认知功能障碍的特点及其影响因素。方法选取西安交通大学第一附属医院神经内科确诊的ET患者及年龄、性别及受教育程度匹配的健康志愿者作为研究对象,进行一般人口学资料登记、震颤部分评分,采用简明精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)、日常生活能力量表(ADL)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)测评。结果最后纳入88例ET和匹配的63例健康志愿者,MMSE提示31.82%的ET患者具有认知功能障碍,其中定向力、短程记忆、计算力、语言能力、复述、阅读理解、三级命令及画图得分显著低于健康志愿者(P<0.01),定向力的损害最严重(K=0.624,S=0.726),三级命令损伤相对较小(K=0.274,S=0.319);MoCA测评结果显示,86.36%的ET患者认知功能障碍明显高于健康志愿者(P<0.05),其中ET患者的视空间与执行力、画钟、命名、注意力、"100-7"、语言能力、抽象思维、记忆力及定向力得分显著低于健康志愿者(P<0.01),视空间与执行能力的损害最严重(K=0.651,S=0.786,P<0.01),对"100-7"损伤相对较小(K=0.406,S=0.484,P<0.01)。年龄、受教育程度对ET患者认知功能障碍有影响(P<0.05),ADL分数与认知功能呈负相关(相关系数为-0.375和-0.383,P<0.001),当去除焦虑抑郁影响后,起病年龄、震颤分级与认知功能障碍具有相关性(P<0.05),将上述影响因素代入二元Logistic回归模型,发现受教育程度对模型具有贡献(P<0.05)。结论 ET患者存在广泛认知障碍;年龄、受教育程度、日常生活能力障碍、起病年龄和震颤程度分级对认知功能障碍具有影响。

Objective To explore the characteristics and influencing factors of cognitive dysfunction in patients with essential tremor （ET）. Methods We recruited ET patients diagnosed by the Department of Neurology of the First Affiliated Hospital of Xi＇an Jiaotong University and healthy volunteers who matched the ET patients in age, gender and education level for the study. We recorded all the patients＇ demographic information, tremor degree, and family history based on the family tree. All the participants were tested by MMSE, MoCA, ADL, HAMD and HAMA. Results There were 88 ET patients and 63 normal subjects included in the study. According to MMSE, 31.82% of the patients had cognitive dysfunctions, with orientation, short-term memory, calculation ability, language skills, retelling, reading comprehension, three-level command and drawing being significantly lower than those of the healthy volunteers （P〈0. 01）; orientation was the most serious damage in cognitive function domain （K =0. 624, S=0. 726）; three-level command was the least serious damage （K = 0. 274, S=0. 319）. According to MoCA, 86.36% of the ET patients had cognitive dysfunction higher than normal people （P〈0.05）; visual space and execution, clock drawing task, thinking and orientation were significantly lower than normal naming, attention, ＂100-7＂, language skills, abstract people （P〈0.01） ; the most serious damage in cognitivefunction domain was visual space and execution domain was ＂100-7＂ （K=0. 406, S：0. 484） ADL scores showed negative correlation with （K--0.651, S = 0. 786）; the least serious damage cognitive function Education level and age affected cognitive dysfunction （P〈O. 05）. cognitive function （correlation = - 0. 375 and - 0. 383, respectively ; P〈0. 001）. After the effects of anxiety and depression were excluded, onset age and tremor grading were correlated with cognitive dysfunction （P〈0.05）. When the above factors were put into binary Logistic regression model, education level was found to be contributed to the model （P〈0.05）. Conclusion Patients with ET widely suffer from cognitive impairment. Age, education level, daily life disability, age of onset, and tremor degree classification can affect cognitive dysfunction.