脑白质高信号对帕金森病运动症状和认知损害的影响

Effect of white matter hyperintensities on motor symptoms and cognitive impairment in PD patients

目的探讨脑白质高信号(WMH)对帕金森病(PD)运动症状和认知损害的影响。方法回顾性纳入315例PD患者,根据Fazekas量表评分分为轻度WMH组191例,中度WMH组74例,重度WMH组50例。收集脑血管病相关危险因素,Hoehn-Yahr(H-Y)分级、世界运动障碍协会统一帕金森病评定量表第三部分(MDS-UPDRSⅢ)总分及震颤、强直、运动迟缓、步态姿势异常评分评估运动症状,用简易智能状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)评估认知功能,用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评估情绪,用3T MRI及Fazekas量表评估WMH程度,用Spearman相关和多元线性回归分析。结果 3组年龄、起病年龄、病程、MMSE和MoCA评分比较,有统计学差异(P<0.05,P<0.01)。3组H-Y分级、MDS-UPDRSⅢ总分、震颤、强直、运动迟缓、步态姿势异常、HAMA、HAMD评分及体位性低血压比例比较,无统计学差异(P>0.05)。多元线性回归分析校正年龄、病程、起病年龄、MoCA、同型半胱氨酸、缺血性脑卒中、高血压、吸烟、性别、体质量指数和心脏病等因素后,WMH与MMSE仍显著相关(β=-0.183,95%CI:-0.134^-0.007,P=0.029)。脑室旁WMH(r=-0.246,P=0.000;r=-0.235,P=0.000)和深部WMH(r=-0.192,P=0.001;r=-0.187,P=0.001)与MMSE和MoCA呈显著负相关。WMH与PD运动症状不相关(P>0.05)。结论 WMH对PD认知损害影响明显,临床需警惕PD伴发WMH,脑血管病二级预防可能对PD患者认知减退有潜在预防作用。

Objective To study the effect of white matter hyperintensities(WMH)on motor symptoms and cognitive impairment in PD patients.Methods Three hundred and fifteen PD patients were divided into mild WMH group(n=191),moderate WMH group(n=74)and severe WMH group(n=50)according to their Fazekas Scale score.The risk factors for cerebrovascular disease in PD patients were recorded.The severity of PD was staged according to the H-Y classification.The motor symptoms of PD patients(such as tremor,rigidity,bradykinesia and gait)were assessed according to MDS-UPDRSⅢtolal score.The cognitive function of PD patients was assessed according to MMSE and MoCA scores.The emotion of PD patients was assessed according to their HAMD and HAMA scores.The WMH were assessed according to the 3 T MRI and Fazekas Scale respectively and analyzed by Spearman correlation analysis and multivariate linear regression analysis respectively.Results A significant difference was detected in age,duration of PD,MMSE and MoCA scores in 3 groups(P<0.05,P<0.01).No significant difference was detected in H-Y staging,tremor,rigidity,bradykinesia,gait,HAMA and HAMD scores,and incidence of orthostatic hypotension(P>0.05).The WMH were negatively related with the MMSE score after adjustment for the confounding factors,including(age,durarion of PD,onset age of PD,MoCA score,serum Hcy level,ischemic stroke,hypertension,smoking,gender,BMI and heart disease(β=-0.183,95%CI:-0.134--0.007,P=0.029).Spearman correlation analysis showed that the paraventricular and deep WMH were negatively related with the MMSE and MoCA scores(r=-0.246,r=-0.235,P=0.000;r=-0.192,r=-0.187,P=0.001).No significant relation was found between WMH and motor symptoms(P>0.05).Conclusion WMH have no effect on cognitive impairment in PD patients.Attention should be paid to PD with WMH in clinical practice.Secondary prevention of cerebrovascular disease plays a potential role in preventing cognitive impairment in PD patients.