Zhang Jin-Ru, Chen Jing, Yang Zi-Jiao, Zhang Hui-Jun, Fu Yun-Ting, Shen Yun, He Pei-Cheng, Mao Cheng-Jie, Liu Chun-Feng
Department of Neurology and Sleep Center, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004; Institute of Neuroscience, Soochow University, Suzhou, Jiangsu 215123; Beijing Key Laboratory for Parkinson's Disease, Beijing 100053, China.
Chin Med J (Engl). 2016 Feb 20;129(4):379-85. doi: 10.4103/0366-6999.176077.
Rapid eye movement (REM) sleep behavior disorder (RBD) may be a risk factor for cognitive impairment in patients with Parkinson's disease (PD). However, little is known regarding the relation between the severity of RBD and the different domains of cognitive impairment. The aim of this study was: (1) to investigate the domains of cognitive impairment in patients with PD and RBD, and (2) to explore risk factors for PD-mild cognitive impairment (PD-MCI) and the relationship between RBD severity and impairment in different cognitive domains in PD.
The participants were grouped as follows: PD without RBD (PD-RBD; n = 42), PD with RBD (PD + RBD; n = 32), idiopathic RBD (iRBD; n = 15), and healthy controls (HCs; n = 36). All participants completed a battery of neuropsychological assessment of attention and working memory, executive function, language, memory, and visuospatial function. The information of basic demographics, diseases and medication history, and motor and nonmotor manifestations was obtained and compared between PD-RBD and PD + RBD groups. Particular attention was paid to the severity of RBD assessed by the RBD Questionnaire-Hong Kong (RBDQ-HK) and the RBD Screening Questionnaire (RBDSQ), then we further examined associations between the severity of RBD symptoms and cognitive levels via correlation analysis.
Compared to PD-RBD subjects, PD + RBD patients were more likely to have olfactory dysfunction and their Epworth Sleepiness Scale scores were higher (P < 0.05). During neuropsychological testing, PD + RBD patients performed worse than PD-RBD patients, including delayed memory function, especially. The MCI rates were 33%, 63%, 33%, and 8% for PD-RBD, PD + RBD, iRBD, and HC groups, respectively. RBD was an important factor for the PD-MCI variance (odds ratio = 5.204, P = 0.018). During correlation analysis, higher RBDSQ and RBDQ-HK scores were significantly associated with poorer performance on the Trail Making Test-B (errors) and Auditory Verbal Learning Test (delayed recall) and higher RBD-HK scores were also associated with Rey-Osterrieth complex figure (copy) results.
When PD-RBD and PD + RBD patients have equivalent motor symptoms, PD + RBD patients still have more olfactory dysfunction and worse daytime somnolence. RBD is an important risk factor for MCI, including delayed memory. Deficits in executive function, verbal delayed memory, and visuospatial function were consistently associated with more severe RBD symptoms.
快速眼动（REM）睡眠行为障碍（RBD）可能是帕金森病（PD）患者认知障碍的一个危险因素。然而，关于RBD严重程度与认知障碍不同领域之间的关系知之甚少。本研究的目的是：（1）调查PD合并RBD患者的认知障碍领域，以及（2）探讨PD-轻度认知障碍（PD-MCI）的危险因素以及PD中RBD严重程度与不同认知领域损害之间的关系。
参与者分为以下几组：无RBD的PD患者（PD-RBD；n = 42）、有RBD的PD患者（PD + RBD；n = 32）、特发性RBD（iRBD；n = 15）和健康对照（HCs；n = 36）。所有参与者完成了一系列关于注意力和工作记忆、执行功能、语言、记忆和视觉空间功能的神经心理学评估。获取了基本人口统计学、疾病和用药史以及运动和非运动表现的信息，并在PD-RBD组和PD + RBD组之间进行了比较。特别关注通过香港RBD问卷（RBDQ-HK）和RBD筛查问卷（RBDSQ）评估的RBD严重程度，然后我们通过相关分析进一步研究了RBD症状严重程度与认知水平之间的关联。
与PD-RBD受试者相比，PD + RBD患者更易出现嗅觉功能障碍，且其爱泼沃斯嗜睡量表评分更高（P < 0.05）。在神经心理学测试中，PD + RBD患者的表现比PD-RBD患者更差，尤其是延迟记忆功能。PD-RBD、PD + RBD、iRBD和HC组的MCI发生率分别为33%、63%、33%和8%。RBD是PD-MCI变异的一个重要因素（优势比 = 5.204，P = 0.018）。在相关分析中，较高的RBDSQ和RBDQ-HK评分与连线测验B（错误）和听觉词语学习测验（延迟回忆）的较差表现显著相关，较高的RBD-HK评分也与雷-奥斯特里思复杂图形（临摹）结果相关。
当PD-RBD和PD + RBD患者有同等运动症状时，PD + RBD患者仍有更多嗅觉功能障碍和更严重的日间嗜睡。RBD是MCI的一个重要危险因素，包括延迟记忆。执行功能、言语延迟记忆和视觉空间功能的缺陷与更严重的RBD症状始终相关。
