血管性帕金森综合征与帕金森病认知功能的比较

Comparison of Cognitive Function between Vascular Parkinsonism and Parkinson’s Disease

目的比较血管性帕金森综合征(vascular parkinsonism,VaP)和帕金森病(Parkinson’s disease,PD)患者的认知功能特点。方法回顾性纳入2018年1月-2020年12月于华北理工大学附属医院首次就诊的VaP患者和PD患者。采用MMSE和MoCA量表评估PD患者和VaP患者的认知功能状态,统一帕金森病评定量表第3部分(unified Parkinson’s disease rating scaleⅢ,UPDRSⅢ)评定患者的运动功能。比较2组临床资料和上述量表评分的差异。以MoCA<26分为认知障碍的标准,比较VaP合并认知障碍(VaP with cognition impairment,VPCI)亚组与PD合并认知障碍(PD with cognition impairment,PDCI)亚组间上述指标的差异。结果共纳入VaP组19例,PD组22例患者。VaP组高血压(78.9%vs.40.9%,P=0.014)、糖尿病(52.6%vs.22.7%,P=0.047)及脑白质病变(84.2%vs.36.4%,P=0.002)的发生率高于PD组,而PD组的高同型半胱氨酸血症发生率高于VaP组(72.7%vs.36.8%,P=0.021);VaP组的认知障碍发生率高于PD组(78.9%vs.45.5%,P=0.028),MMSE(中位数:24.0分vs.29.0分,P<0.001)、MoCA(中位数:17.0分vs.26.0分,P=0.002)和UPDRSⅢ(中位数:18.0分vs.33.5分,P<0.001)评分低于PD组。VPCI患者的MMSE(中位数:23.0分vs.27.0分,P=0.002)、MoCA(中位数:17.0分vs.22.0分,P=0.041)和UPDRSⅢ(中位数:18.0分vs.37.0分,P=0.004)评分均低于PDCI患者。结论与PD患者相比,VaP患者中合并认知功能障碍的比例更高,而且VaP患者的认知功能障碍较PD患者严重。

Objective To compare the cognitive function between the patients with vascular parkinsonism(VaP)and Parkinson’s disease(PD).Methods PD patients and VaP patients who were firstly admitted in North China University of Science and Technology Affiliated Hospital from January 2018 to December 2020 were enrolled in the retrospective study.MMSE and MoCA were used to evaluate the patients’cognitive function,and the unified Parkinson’s disease rating scale partⅢ(UPDRSⅢ)was used to evaluate the motor function.The scores of MMSE,MoCA,UPDRSⅢand baseline characteristics between PD patients and VaP patients were compared.Cognitive impairment was defined as MoCA<26.The differences in the above scores between VaP patients with cognition impairment(VPCI)and PD patients with cognition impairment(PDCI)were compared.Results A total of 19 VaP patients and 22 PD patients were enrolled in this study.VaP patients had higher incidence of hypertension(78.9%vs.40.9%,P=0.014),diabetes(52.6%vs.22.7%,P=0.047)and leukodystrophy(84.2%vs.36.4%,P=0.002)than PD patients,while PD patients had higher incidence of hyperhomocysteinemia than VaP patients(72.7%vs.36.8%,P=0.021);VaP patients had higher incidence of cognitive impairment(78.9%vs.45.5%,P=0.028)and lower scores of MMSE(24.0 vs.29.0,P<0.001),MoCA(17.0 vs.26.0,P=0.002)and UPDRSⅢ(18.0 vs.33.5,P<0.001)than PD patients.VPCI patients had lower scores of MMSE(23.0 vs.27.0,P=0.002),MoCA(17.0 vs.22.0,P=0.041)and UPDRSⅢ(18.0 vs.37.0,P=0.004)than PDCI patients.Conclusions VaP patients had higher incidence of cognition impairment and more severer cognition impairment than PD patients.