Department of Neurology, Juntendo University, 2-1-1, Hongo, Bunkyo ward, Tokyo, 113-0033, Japan.
Department of Neurology, Juntendo University, 2-1-1, Hongo, Bunkyo ward, Tokyo, 113-0033, Japan; Stroke Center, Jichi Medical University Hospital, Tochigi, 3311-1, Yakushiji, Shimotsuke-shi, 329-0498, Japan; Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi, 3311-1, Yakushiji, Shimotsuke-shi, 329-0498, Japan.
J Neurol Sci. 2018 Oct 15;393:39-44. doi: 10.1016/j.jns.2018.08.009. Epub 2018 Aug 8.
Cerebral microbleeds (CMBs) are often observed in Parkinson's disease (PD); however, their association with cognitive decline has been unclear. We performed a retrospective analysis of 124 cases of clinically diagnosed PD to determine the association between the presence of CMBs and cognitive decline.
Of the 124 participants, 21 (16.9%) was diagnosed as PDD in this cohort. CMBs were observed significantly more frequently in the PDD than in the PD (47.6% vs 7.8%, P < .001). The presence of both deep/infratentorial (40% vs 14.9%, P < .05) and strictly lobar (75% vs 12.9%, P < .001) CMBs were associated with PDD. The values of cognitive scales such as Mini-Mental State Examination and the Hasegawa Dementia Scale-revised, were also significantly lower in the presence of each type of CMB. A multivariable logistic regression analysis showed the presence of strictly lobar CMBs as well as a male gender, orthostatic hypotension, periventricular hyperintensity on magnetic resonance imaging were significantly associated with PDD in this cohort.
This study showed the presence of CMBs, especially strictly lobar type, was strongly associated with PDD. We suspect that the burden of small vessel disease and cerebral amyloid angiopathy may be related to the development of cognitive decline in PD, and a prospective study enrolling more cases is warranted.
脑微出血（CMB）在帕金森病（PD）中经常观察到；然而，其与认知能力下降的关系尚不清楚。我们对 124 例临床诊断为 PD 的患者进行了回顾性分析，以确定 CMB 的存在与认知能力下降之间的关系。
在这组 124 名参与者中，21 名（16.9%）被诊断为 PDD。与 PD 相比，PDD 中 CMB 的发生率明显更高（47.6%比 7.8%，P<0.001）。深部/幕下（40%比 14.9%，P<0.05）和严格的皮质下（75%比 12.9%，P<0.001）CMB 的存在与 PDD 相关。认知量表（如简易精神状态检查和 Hasegawa 痴呆量表修订版）的评分值在每种 CMB 存在的情况下也明显较低。多变量逻辑回归分析显示，严格的皮质下 CMB 的存在以及男性、直立性低血压、磁共振成像上的脑室周围高信号与该队列中的 PDD 显著相关。
本研究表明 CMB 的存在，特别是严格的皮质下类型，与 PDD 密切相关。我们怀疑小血管疾病和脑淀粉样血管病的负担可能与 PD 中认知能力下降的发展有关，需要进行更多病例的前瞻性研究。
