Department of Gerontology, Landesnervenklinik Wagner-Jauregg Linz, Linz, Austria.
J Neural Transm (Vienna). 2011 May;118(5):721-5. doi: 10.1007/s00702-011-0579-8. Epub 2011 Feb 1.
Thirty-three inpatients (22 females, 11 males, aged 79.4 ± 9.5 years) were investigated in this prospective cohort study to study the prevalence of polyneuropathy (PNP) and dementia in geriatric inpatients. Clinical and electrodiagnostic investigations, routine laboratory, including thyroid parameters, folic acid, vitamin B(12), homocysteine, neopterin, fibrinogen and glycosylated hemoglobin were measured in serum, the mini-mental state examination and computed tomographic scanning were performed in each patient. PNP was found clinically and electrodiagnostically in 96% of patients. Age was the most precipitating factor for PNP, and was significantly correlated to electrodiagnostic changes in the nerves investigated in both, upper and lower extremities, while clinical symptoms were confined only to the feet. Correlation was seen between homocysteine and the amplitude of the sural nerve (surAmpl) (rs = -0.406, p = 0.029) as well as the sural nerve conduction velocity (surNCV) (rs = -0.389, p = 0.037), and between neopterin and the grade of denervation (rs = 0.445, p = 0.014) in our patients. Neopterin and fibrinogen did not correlate significantly, but there was a trend to higher fibrinogen concentrations in patients with higher neopterin levels (rs = 0.344, p = 0.062). A trend of a correlation was seen between higher homocysteine concentrations and the number of changes in electrodiagnostic measurements (rs = 0.354, p = 0.055). Twenty-one of the 33 patients (64%) were demented, 9 (27%) presented clinically as mild cognitive impairment, 3 (9%) were not demented. Vascular risk factors were found in 83%: hypertension in 58%, hypercholesterinemia in 39%, cardiac disease in 36%, diabetes mellitus (DM) in 21%, peripheral arterial disease (PAD) in 9%. A significant correlation was found between homocysteine and folic acid concentrations (rs = -0.401, p = 0.028). Falls were reported in 48% of cases, indicating PNP as a risk factor in this group of patients. In conclusion, PNP was found very common with a high coincidence with dementia and a female preponderance, suggesting an influence on daily life (falls) in our subjects studied. PNP correlated significantly with markers for vascular disease as well as immune activation (homocysteine and neopterin) similar to earlier findings in patients with neurodegenerative disorders, suggesting common therapeutic options in patients with PNP and dementia.
本前瞻性队列研究调查了 33 名住院患者（22 名女性，11 名男性，年龄 79.4 ± 9.5 岁），旨在研究老年住院患者中多发性神经病（PNP）和痴呆的患病率。对每位患者进行临床和电诊断检查、常规实验室检查（包括甲状腺参数、叶酸、维生素 B(12)、同型半胱氨酸、新蝶呤、纤维蛋白原和糖化血红蛋白）、进行血清迷你精神状态检查和计算机断层扫描。96%的患者在临床上和电诊断上都发现了 PNP。年龄是 PNP 的最重要诱发因素，与上肢和下肢神经的电诊断变化显著相关，而临床症状仅局限于脚部。我们的患者中，同型半胱氨酸与腓肠神经（surAmpl）振幅(rs=-0.406，p=0.029)和腓肠神经传导速度(rs=-0.389，p=0.037)之间存在相关性，新蝶呤与去神经支配程度(rs=0.445，p=0.014)之间存在相关性。新蝶呤和纤维蛋白原之间没有显著相关性，但在新蝶呤水平较高的患者中，纤维蛋白原浓度有升高的趋势(rs=0.344，p=0.062)。同型半胱氨酸浓度与电诊断测量变化数量之间存在相关性趋势(rs=0.354，p=0.055)。33 名患者中有 21 名（64%）患有痴呆，9 名（27%）表现为轻度认知障碍，3 名（9%）未痴呆。发现 83%的患者存在血管危险因素：高血压 58%，高胆固醇血症 39%，心脏病 36%，糖尿病 21%，周围动脉疾病 9%。同型半胱氨酸和叶酸浓度之间存在显著相关性(rs=-0.401，p=0.028)。48%的病例报告有跌倒，表明 PNP 是该组患者的一个危险因素。总之，PNP 非常常见，与痴呆的发生率很高，且女性居多，提示其对我们研究对象的日常生活（跌倒）有影响。PNP 与血管疾病标志物以及免疫激活标志物（同型半胱氨酸和新蝶呤）显著相关，与神经退行性疾病患者的早期发现相似，提示 PNP 和痴呆患者有共同的治疗选择。
