帕金森病患者认知障碍影响因素研究

Study on the characteristics and influencing factors of cognitive impairment in Parkinson's disease

目的:探究帕金森病(Parkinson's disease,PD)患者认知障碍(CI)的影响因素。方法:纳入2020年7月至2021年2月就诊于天津医科大学总医院神经内科的PD患者80例,依据蒙特利尔认知评估量表(MoCA)评分,将患者分为认知正常组(MoCA评分≥26分)22例和认知障碍组(MoCA评分<26分)58例,其中帕金森病轻度认知障碍(PD-MCI)患者29例,帕金森病痴呆(PDD)患者29例。收集患者性别、起病年龄、患病时间,高血压、2型糖尿病(2-DM),吸烟、饮酒、饮茶,受教育年限,体位性低血压(nOH),左旋多巴等效剂量(LEDD),快速动眼睡眠期行为障碍-香港版问卷(RBDQ-HK),汉密尔顿抑郁量表17项(HAMD-17),MDS-统一帕金森病评定量表(MDS-UPDRS-Ⅱ、MDS-UPDRS-Ⅲ)、霍-亚分级(H-Y)、冻结步态(FOG),运动分型(震颤为主型(TD)、姿势不稳/步态障碍型(PIGD)、混合型)等临床资料。结果:认知障碍(PDCI)组与认知正常(PD-NC)组在FOG、受教育年限、MDS-UPDRS-Ⅱ评分、MDS-UPDRS-Ⅲ评分、H-Y分级上有统计学差异(P<0.05),在性别、高血压、2-DM、吸烟、饮酒、饮茶、nOH、RBD、运动分型及起病类型(早发、晚发)、患病时间、LEDD、HAMD评分上无统计学差异(P>0.05)。多因素分析显示受教育程度(OR=0.780,95%CI:0.625-0.974,P=0.028)、H-Y分级(OR=2.955,95%CI:1.126-7.751,P=0.028)是PD患者认知功能的独立影响因素。结论:合并FOG,低受教育年限,高H-Y分级、高MDS-UPDRS-Ⅱ、高MDS-UPDRS-Ⅲ评分的PD患者容易合并CI。

Objective:To explore the clinical characteristics,influencing factors of cognitive impairment in patients with Parkinson's disease(PD).Methods:According to Montreal Cognitive Assessment Scale(MoCA)score,80 PD patients admitted to the Tianjin Medical University General Hospital from July 2020 to February 2021 were divided into the cognitive normal(MoCA score≥26)group(n=22)and the cognitive impaired(MoCA score<26)group(n=48).Gender,age of onset,duration of disease,hypertension,type 2 diabetes(2-DM),smoking,drinking,drinking tea,years of education,orthostatic hypotension(nOH),levodopa equivalent daily dosage(LEDD),Rapid Eye Movement Sleep Behavior Disorder-Hong Kong Version Questionnaire(RBDQ-HK),Hamilton Depression Scale(HAMD-17),MDS-Unified Parkinson's Disease Rating Scale(MDS-UPDRS-Ⅱ,MDS-UPDRS-Ⅲ),Hoehn and Yahr Stage(H-Y),frozen gait(FOG),motor subtypes(TD,PIGD,IN)were collected.Results:There was a statistically difference between cognitive normal group and cognitive impaired group in FOG,years of education,MDSUPDRS-Ⅱscore,MDS-UPDRS-Ⅲscore,H-Y stage(P<0.05),while no significant difference in gender,hypertension,2-DM,smoking,drinking,drinking tea,nOH,RBD,motor subtypes,age of onset,duration of disease,LEDD,HAMD score(P>0.05).Years of education(OR=0.780,95%CI:0.625-0.974,P=0.028)and H-Y stage(OR=2.955,95%CI:1.126-7.751,P=0.028)were independent factors influencing the cognitive function of PD patients.Conclusions:PD patients with FOG,low education levels,high H-Y stage,high MDS-UPDRS-Ⅱscore,high MDS-UPDRS-Ⅲscore were prone to cognitive impairment.