脑小血管病对帕金森病患者认知和情感障碍的影响

Influence of cerebral small vessel disease on cognitive and emotional impairment in patients with Parkinson's disease

目的探讨脑小血管病对帕金森病(PD)患者认知、情感障碍的影响。方法选取2021年9月至2022年10月在呼伦贝尔市人民医院神经内科住院及门诊就诊的PD患者131例作为研究对象,其中56例原发性PD患者为PD组,75例原发性PD合并脑小血管病(CSVD)为PD合并CSVD组。对患者的一般资料、相关量表及影像数据进行采集、分析。对比2组患者的认知和情感量表数据之间存在差异,以及脑小血管病的影像学负荷得分及各个类型与患者的认知和情感量表数据之间的相关性。结果2组高血压病史、糖尿病病史、甘油三酯(TG)、高密度脂蛋白胆固醇、同型半胱氨酸、体位性低血压及简易智力状态检查量表(MMSE)、蒙特利尔认知评估量表(MOCA)、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、CSVD总负荷得分等指标比较,差异均具有统计学意义(P<0.05)。CSVD总负荷得分与PD合并CSVD组患者的TG呈显著正相关(P=0.044)。PD合并CSVD组患者的CSVD总负荷得分与患者的MMSE、MOCA认知得分呈明显负相关(P<0.01);脑白质高信号(WMH)、脑微出血(CMB)、腔隙(LA)与患者的MMSE认知得分呈明显负相关(P<0.05);WMH、LA与患者的MOCA认知得分呈明显负相关(P<0.05)。PD合并CSVD组患者的CSVD总负荷得分与患者的HAMA、HAMD情绪得分呈明显正相关(P<0.001)。WMH、周围血管间隙、CMB与患者的HAMA情绪得分呈明显正相关(P<0.05);LA、CMB与患者的HAMD情绪得分呈明显正相关(P=0.005)。结论CSVD总负荷得分可以客观评估CSVD严重程度对PD患者非运动症状的影响,为临床医生监测PD患者病情及后续管理PD患者提供一个新的方向。

Objective To investigate the influence of cerebral small vessel disease(CSVD)on cognitive and emotional impairment in patients with Parkinson's disease(PD).Methods A total of 131 patients with PD were hospitalized or attended the outpatient service of Department of Neurology,Hulunbuir People's Hospital,from September 2021 to October 2022 were enrolled,among whom there were 56 patients with primary PD(PD group)and 75 patients with primary PD combined with CSVD(PD+CSVD group).The patients were analyzed in terms of general information,scores of related scales,and imaging data,and the two groups were compared in terms of the scores of cognitive and affective scales and the correlation of the imaging load scores and types of CSVD with the scores of cognitive and affective scales.Results There were significant differences between the two groups in history of hypertension,history of diabetes,triglyceride(TG),high⁃density lipoprotein cholesterol,homocysteine,supine/orthostatic hypotension,Mini⁃Mental State Examination(MMSE)score,Montreal Cognitive Assessment(MoCA)score,Hamilton Anxiety Scale(HAMA)score,Hamilton Depression Scale(HAMD)score,and CSVD load score(P<0.05).For the patients in the PD+CSVD group,CSVD load score was significantly positively correlated with TG(P=0.044)and was significantly negatively correlated with MMSE and MOCA cognitive scores(P<0.01).White matter hypertensity(WMH),cerebral microbleeds(CMB),and lacunar space(LA)were significantly negatively correlated with MMSE cognitive scores(P<0.05),and WMH and LA were significantly negatively correlated with MOCA cognitive scores(P<0.05).For the patients in the PD+CSVD group,CSVD load score was significantly positively correlated with HAMA and HAMD emotional scores(P<0.001).WMH,peripheral vascular space,and CMB were significantly positively correlated with HAMA emotional scores(P<0.05),and LA and CMB were significantly positively correlated with HAMD emotional scores(P=0.005).Conclusions Total CSVD load score can objectively evaluate the influence of CSVD severity on the non⁃motor symptoms of PD patients,which provides a new direction for monitoring the condition of PD patients and performing subsequent management among clinicians.