Ebihara Takae, Gui Peijun, Ooyama Chika, Kozaki Koichi, Ebihara Satoru
Dept of Geriatric Medicine, Kyorin University School of Medicine, Tokyo, Japan.
Dept of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Sendai, Japan.
ERJ Open Res. 2020 Mar 9;6(1). doi: 10.1183/23120541.00108-2019. eCollection 2020 Jan.
Cough, an important respiratory symptom, predominantly involves the brainstem and the urge-to-cough (UTC) is modulated by the cerebral cortex. Lewy body disease is associated with decreased cough reflex sensitivity and central respiratory chemosensitivity. Additionally, the insula, associated with the UTC, shows decreased activation and atrophy in dementia with Lewy bodies (DLB). We investigated the relationships between cognition and cough reflex and the UTC and compared the differences in responses of patients with DLB and other dementia subtypes. We conducted a cross-sectional study within a geriatric ward of a university hospital involving elderly patients diagnosed with Alzheimer's disease (AD), DLB, or non-dementia (controls). The cough reflex sensitivities were estimated based on the lowest concentrations of inhaled citric acid that could induce ≥2 coughs (C) or ≥5 coughs (C). Subjects were asked to rate the UTC based on the threshold concentrations (C) using the modified Borg scale. C, C and C were negatively correlated with cognitive function in female participants but not in males (p<0.01). The cough reflex sensitivities expressed as C and C were significantly higher in the DLB group than in the AD and control groups (p<0.01 adjusted for gender). The UTC threshold expressed as C was also significantly higher in the DLB group, while the UTC log-log slope was less responsive in the DLB group than in the other groups. The cough reflex sensitivity and perceived UTC deteriorated in the DLB group more than in the other groups. This result might be valuable in treating patients with DLB.
咳嗽是一种重要的呼吸道症状，主要涉及脑干，而咳嗽冲动（UTC）受大脑皮层调节。路易体病与咳嗽反射敏感性降低和中枢呼吸化学敏感性降低有关。此外，与UTC相关的脑岛在路易体痴呆（DLB）中显示激活减少和萎缩。我们研究了认知与咳嗽反射及UTC之间的关系，并比较了DLB患者与其他痴呆亚型患者反应的差异。我们在一家大学医院的老年病房进行了一项横断面研究，纳入了被诊断为阿尔茨海默病（AD）、DLB或非痴呆（对照组）的老年患者。根据能诱发≥2次咳嗽（C）或≥5次咳嗽（C）的吸入柠檬酸最低浓度来估计咳嗽反射敏感性。受试者被要求使用改良的博格量表根据阈值浓度（C）对UTC进行评分。在女性参与者中，C、C和C与认知功能呈负相关，而在男性中则不然（p<0.01）。以C和C表示的咳嗽反射敏感性在DLB组显著高于AD组和对照组（经性别调整后p<0.01）。以C表示的UTC阈值在DLB组也显著更高，而DLB组的UTC对数-对数斜率比其他组反应性更低。DLB组的咳嗽反射敏感性和感知到的UTC比其他组恶化得更严重。这一结果可能对DLB患者的治疗有价值。
