帕金森病患者脑微出血与其认知功能障碍的关系研究

Relationship between cerebral microbleeds and cognitive dysfunction in patients with Parkinson's disease

目的探讨帕金森病(PD)患者脑微出血(CMBs)与其认知功能障碍的关系。方法选取2015年12月至2018年12月洛宁县人民医院神经内科收治的126例PD患者。根据是否合并CMBs分为CMBs组35例和非CMBs组91例。同时根据CMBs数量将CMBs患者分为2个亚组,即<6个组20例和≥6个组15例。根据认知功能是否正常分为认知功能正常组43例和认知功能异常组83例。比较CMBs组与非CMBs组、<6个组与≥6个组的认知功能[蒙特利尔认知评估量表(MoCA)评分]差异。并对PD患者认知功能异常的影响因素进行单因素和多因素Logsitic回归分析。结果两组性别、年龄、受教育年限、PD病程、吸烟、高血压及糖尿病等一般资料比较,差异无统计学意义(P>0.05)。CMBs组视空间与执行功能、注意、抽象、延迟回忆、定向评分及总分方面评分低于非CMBs组(P<0.05)。≥6个组视空间与执行功能、注意、定向及总分方面评分低于<6个组(P<0.05)。伴有CMBs、CMBs数≥6个是PD患者认知异常的独立影响因素(P<0.05)。结论伴有CMBs的PD患者存在不同程度的认知功能损害,尤其是CMBs数量≥6个者,其视空间与执行能力、注意、定向上损害更严重。故应对该类患者进行全面认知功能评估,以尽早识别、干预,以防PD痴呆的发生,改善患者预后。

【Objective】To investigate the relationship between cerebral microbleeds(CMBs)and cognitive dysfunction in patients with Parkinson's disease.【Methods】A total of 126 PD patients were selected.The patients were divided into CMBs group and non-CMBs group according to whether CMBs were combined or not.According to the number of CMBs,the patients were divided into 2 subgroups,<6 subgroups and≥6 subgroups.The differences of cognitive function(MoCA score)between CMBs group and non-CMBs group,between<6 groups and≥6 groups were compared.The influencing factors of cognitive dysfunction in PD patients were analyzed by univariate and multivariate logistic regression.【Results】The scores of visual space and executive function,attention,abstraction,delayed recall,orientation and total score in CMBs group were significantly lower than those in non CMBs group(P<0.05).The scores of visual space and executive function,attention,orientation and total score of≥6 groups were significantly lower than those of<6 groups(P<0.05).Univariate analysis showed that the proportion of years of education<7 years,WMH,combined CMBs and more than 6 CMBs in the cognitive impairment group were significantly higher than those in the normal cognitive group(P<0.05).Logistic regression analysis showed that the number of CMBs and CMBs≥6 was the independent influencing factor of cognitive impairment in PD patients(P<0.05).【Conclusion】PD patients with CMBs have different degrees of cognitive impairment,especially in patients with more than 6 CMBs,their visual space and executive ability,attention and orientation damage is more serious.Therefore,comprehensive cognitive function assessment should be carried out in such patients to identify and intervene as soon as possible,so as to prevent the occurrence of Parkinson's disease dementia and improve the prognosis of patients.