伴随策略的丰富环境对帕金森病患者认知功能及血清脑源性神经营养因子水平的影响

Effects of enriched environment with accompanying strategy on cognitive function and serum brain-derived neurotrophic factor level in patients with Parkinson’s disease

目的观察利用伴随策略建立的丰富环境(EE)对帕金森病(PD)患者认知功能及血清脑源性神经营养因子(BDNF)水平的影响。方法以增加自主物理、运动和社会刺激为总原则,制定伴随策略的EE,进行随机单盲队列研究。利用随机数字表的单双数按顺序将首次诊断的88例PD认知功能障碍患者分为试验组(45例,常规药物治疗联合EE干预)和对照组(43例,常规药物治疗)。采用蒙特利尔认知评估量表(MoCA)、简易智力状态检查量表(MMSE)评分进行认知功能评价;采用酶联免疫吸附测定法,在试验首日和第48周分别检测血清BDNF水平,对上述数据进行组内和组间对比分析。以Pearson分析血清BDNF水平与认知功能评分的相关性。结果试验第48周末,试验组的血清BDNF水平显著高于对照组和试验首日(P<0.05);试验组的MMSE、MoCA评分变化值均小于对照组,血清BDNF水平变化值大于对照组(P<0.05)。两组血清BDNF水平变化值与MMSE、MoCA评分变化值呈正相关(P<0.05)。结论利用伴随策略建立的EE可提高PD患者的血清BDNF水平并可能因此延缓认知功能的减退。

Objective To observe the effects of enriched environment(EE)established by accompanying strategy on cognitive function and serum brain-derived neurotrophic factor(BDNF)level in patients with Parkinson’s disease(PD).Methods Based on the general principle of increasing autonomic physical,motor and social stimuli,the EE with accompanying strategy was formulated and a randomized single blind cohort study was conducted.According to the odd and even numbers of random number table,the 88 PD patients with cognitive impairment diagnosed for the first time were divided into experimental group(45 cases,conventional drug therapy combined with EE intervention)and control group(43 cases,conventional drug treatment).The cognitive function was evaluated by Montreal cognitive assessment(MoCA)scale and mini-mental state examination(MMSE);the serum BDNF level was detected by enzyme-linked immunosorbent assay(ELISA)on the first day and the 48 th week of the experiment respectively,and the above data were compared and analyzed within and between groups.Pearson was used to analyze the correlation between serum BDNF level and cognitive function scores.Results At the end of the 48 th week of the experiment,the serum BDNF level of the experimental group was significantly higher than that of the control group and on the first day of the experiment(P<0.05).The changes of MMSE and Mo CA scores of the experimental group were lower than those of the control group,and the change of serum BDNF level was greater than that of the control group(P<0.05).There were positive correlation between the changes of serum BDNF level and the changes of MMSE and Mo CA scores in the two groups(P<0.05).Conclusion EE established by accompanying strategy can improve the level of serum BDNF in PD patients and may delay the decline of cognitive function.