帕金森病轻度认知障碍的临床特征、认知特点及相关因素分析
The clinical characteristics and cognitive features of mild cognitive impairment in Parkinson's disease and the analysis of relevant factors.
作者信息
Nie Kun, Gao Yuyuan, Mei Mingjin, Guo Manli, Huang Zhiheng, Wang Limin, Zhao Jiehao, Zhang Yuhu, Wang Lijuan
机构信息
Department of Neurology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Neuroscience Institute, No. 106 Zhongshan Er Road, Guangzhou, Guangdong Province 510080, PR China.
Department of Neurology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Neuroscience Institute, No. 106 Zhongshan Er Road, Guangzhou, Guangdong Province 510080, PR China.
出版信息
J Clin Neurosci. 2019 May;63:142-148. doi: 10.1016/j.jocn.2019.01.021. Epub 2019 Feb 4.
The purpose of this work is to investigate the clinical characteristics, cognitive impairment features, and subgroup types of Parkinson's disease (PD) subjects with mild cognitive impairment (PD-MCI) in the Chinese population and to analyze relevant risk factors for PD-MCI. A total of 234 non-dementia PD subjects were collected. Standardized neuropsychological assessments of overall cognitive level and four cognitive domains (memory, executive function, attention and visuospatial function) were performed using MDS Task Force diagnostic criteria for PD-MCI. PD-MCI subjects were further divided into four subgroups: nonamnestic single-domain impairment type (PD-naMCI-SD), nonamnestic multiple-domain impairment type (PD-naMCI-MD), amnestic single-domain impairment type (PD-aMCI-SD), and amnestic multiple-domain impairment type (PD-aMCI-MD). The clinical characteristics of and risk factors for all subgroups were analyzed. PD-MCI was found in 45.3% of the non-dementia PD subjects. Differences between the PD-MCI and PD with normal cognition groups with respect to age, age of onset, years of education, and motor symptom severity were significant (P < 0.05). The single-domain impairment type was the largest PD-MCI subgroup (52.83%). Memory and executive function impairment were most frequent (22.64% and 20.75%, respectively). Among the four subgroups, the number of years of education was significantly different (P = 0.003). The overall cognitive function in amnestic multiple-domain impairment type was significantly worse compared with that in those with single-domain impairment type. Regression analysis results showed that old age, high UPDRS-III score, and hyperhomocysteinemia were risk factors for PD-MCI, whereas high education level was a protective factor. Early prevention of MCI-related risk factors provides effective means to retard cognitive decline in PD patients.
本研究旨在探讨中国人群中轻度认知障碍帕金森病(PD-MCI)患者的临床特征、认知障碍特点及亚组类型,并分析PD-MCI的相关危险因素。共收集了234例非痴呆PD患者。采用MDS工作组PD-MCI诊断标准,对整体认知水平及四个认知领域(记忆、执行功能、注意力和视空间功能)进行标准化神经心理学评估。将PD-MCI患者进一步分为四个亚组:非遗忘型单领域损害型(PD-naMCI-SD)、非遗忘型多领域损害型(PD-naMCI-MD)、遗忘型单领域损害型(PD-aMCI-SD)和遗忘型多领域损害型(PD-aMCI-MD)。分析了所有亚组的临床特征及危险因素。在非痴呆PD患者中,45.3%存在PD-MCI。PD-MCI组与认知正常的PD组在年龄、发病年龄、受教育年限和运动症状严重程度方面存在显著差异(P<0.05)。单领域损害型是最大的PD-MCI亚组(52.83%)。记忆和执行功能损害最为常见(分别为22.64%和20.75%)。四个亚组之间的受教育年限存在显著差异(P=0.003)。遗忘型多领域损害型的整体认知功能明显差于单领域损害型。回归分析结果显示,老年、高UPDRS-III评分和高同型半胱氨酸血症是PD-MCI的危险因素,而高教育水平是保护因素。早期预防与MCI相关的危险因素为延缓PD患者认知功能衰退提供了有效手段。