帕金森病患者认知功能的临床分析

Clinical analysis of cognitive function in patients with Parkinson’s disease

目的探讨帕金森病(PD)患者认知功能的临床特点及其与病情的关联。方法选取2017年2月至2019年9月于北京大学深圳医院神经内科、老年病科门诊及病房就诊的原发性PD患者共96例,以蒙特利尔认知评估(MoCA)量表评定认知,行关期Hoehn-Yahr(H?鄄Y)分期评定。将PD患者分为早期组(H?鄄Y分期2期及以下)和中晚期组(H-Y分期2期以上),比较2组患者的认知功能;使用Logistic回归分析筛选认知功能障碍的保护因素或危险因素,使用相关分析法进行认知得分与H?鄄Y分期的线性相关性研究。结果入组PD患者中早期组51例,中晚期组45例,H?鄄Y分期主要集中在1~3期,占全部人群的90.63%。MoCA量表检出认知障碍患病率为67.71%,中晚期PD认知障碍发生率(77.8%)较早期(58.8%)高,差异具有统计学意义(P=0.047),2组患者在年龄、发病年龄、性别、临床首发症状以及受教育年限方面差异均无统计学意义(P>0.05),但中晚期组中位病程(8年)较早期组(4年)长,差异具有统计学意义(P<0.001)。早期组和中晚期组的MoCA量表总得分中位数分别为25分、21分,差异具有统计学意义(P=0.007),且在视空间与执行、命名、警觉性、抽象能力中显示出差别。Logistic回归分析发现受教育年限是认知功能的保护因素(P<0.001,OR=0.703),H-Y分期可能是认知功能的危险因素(P=0.035,OR=1.829)。相关性分析发现认知得分与受教育年限间存在正相关(r=0.610,P<0.001),与H?鄄Y分组间存在负相关(r=-0.320,P=0.002)。结论认知障碍在PD中发生率高,认知改变体现在视空间与执行能力、警觉性等方面,未发现年龄、性别、临床首发症状不同带来的认知差异。不可改变的受教育年限是认知功能的保护因素,H-Y分期与未来的认知损害风险有关。

Objective To explore the clinical characteristics of cognitive function in patients with Parkinson’s disease(PD)and its correlation with the condition.Methods A total of 96 patients with idiopathic PD,admitted to Department of Neurology and Geriatrics of Peking University Shenzhen Hospital from February 2017 to September 2019,were included.The Montreal cognitive assessment(MoCA)scale was used to evaluate the cognitive function of PD patients.All patients were assessed with Hoehn-Yahr(H-Y)stage during the off-period.Using the H-Y stage of 2 as a boundary,it was divided into early stage group(H-Y 2 and below)and middle to late stage group(above H-Y 2).The cognitive scores were compared between the two groups.Logistic regression analysis was used to screen for protective factors or risk factors for cognitive dysfunction,and correlation analysis was used to study the linear correlation between cognitive scores and H-Y stages.Results There were 51 patients in the early stage group and 45 in the middle to late stage group.The H-Y stage was mainly concentrated in stages 1-3,accounting for 90.63%of the total population.The prevalence of cognitive impairment detected by the MoCA scale was 67.71%,and the incidence of PD cognitive impairment in middle to late stage group was higher than the early stage group(77.8%vs 58.8%,P=0.047).There was no difference in age,age of onset,gender,clinical onset symptoms,and years of education between the two groups;while the course of disease showed different,the median course of disease in the middle to late stage group was longer than that of the early stage group(8 years vs 4 years,P<0.001).The total score of the MoCA scale was different(P=0.007),the median total score was 25 points and 21 points,showing differences in visuospatial and executive function,naming,alertness,and abstraction.Logistic regression analysis found that years of education was a protective factor of cognitive function(P<0.001,OR=0.703),and H-Y stage would be a risk factor(P=0.035,OR=1.829).Correlation analysis found that there was a positive correlation between cognitive score and years of education(r=0.610,P<0.001),and a negative correlation between cognitive score and the adjusted H-Y stages(r=-0.320,P=0.002).Conclusion Cognitive dysfunction has a high incidence in PD,mainly showed in visuospatial and executive function,alertness.No cognitive differences caused by age,gender,and clinical onset symptoms were found.Years of education cannot be changed,and it is a protective factor for cognitive function.H-Y stage is related to the risk of cognitive impairment in the future.