Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan.
Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.
PLoS One. 2021 Jun 4;16(6):e0252451. doi: 10.1371/journal.pone.0252451. eCollection 2021.
To clarify the association of anosmia or constipation with cognitive dysfunction and disease severity in patients with Parkinson's disease (PD).
Newly diagnosed patients with PD (less than 5 years) without a clinical diagnosis of dementia were included from February 2017 to August 2018. The subjects were further divided into subgroups based on whether anosmia occurred and the grade of constipation. The severity of PD motor symptoms was rated using the Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS), and cognitive functions were evaluated by Montreal Cognitive Assessment (MoCA). Statistical analyses including t-tests, chi-square tests, multiple linear regression, and binary logistic regression were used to determine statistical significance.
A total of 107 newly diagnosed PD patients were included in this study. The MoCA score was significantly lower in the anosmia group (p < 0.001). Constipation was associated with impaired olfaction in a post-hoc test. The correlation coefficient between MoCA and UPSIT score was 0.41 (p < 0.001). Total anosmia and age were associated with cognitive dysfunction (MoCA < 26) (odds ratio, 2.63, p = 0.003; 1.10, p < 0.001, respectively). The anosmia group had a higher MDS-UPDRS part 3 score with β coefficient of 7.30 (p = 0.02). Furthermore, grade 3 constipation was associated with a higher MDS-UPDRS total score with β coefficient of 14.88 (p = 0.02).
Anosmia but not constipation was associated with cognitive impairment in PD patients. Nevertheless, severe constipation was associated with impaired olfaction and PD disease severity. We suggest that the propagation of α-synuclein from the olfactory route is distinct from the enteric nervous system, but the intercommunication between these two routes is complex.
阐明帕金森病（PD）患者嗅觉丧失或便秘与认知功能障碍和疾病严重程度的关系。
纳入 2017 年 2 月至 2018 年 8 月新诊断的 PD 患者（发病时间小于 5 年），且无痴呆的临床诊断。根据是否发生嗅觉丧失和便秘程度将患者进一步分为亚组。采用运动障碍协会赞助的帕金森病统一评定量表修订版（MDS-UPDRS）评估 PD 运动症状严重程度，采用蒙特利尔认知评估量表（MoCA）评估认知功能。采用 t 检验、卡方检验、多元线性回归和二项逻辑回归进行统计分析，以确定统计学意义。
共纳入 107 例新诊断的 PD 患者。嗅觉丧失组的 MoCA 评分显著较低（p < 0.001）。便秘与嗅觉丧失后验检验有关。MoCA 与 UPSIT 评分的相关系数为 0.41（p < 0.001）。全嗅觉丧失和年龄与认知功能障碍（MoCA < 26）相关（比值比分别为 2.63，p = 0.003；1.10，p < 0.001）。嗅觉丧失组 MDS-UPDRS 第 3 部分评分较高，β系数为 7.30（p = 0.02）。此外，便秘 3 级与 MDS-UPDRS 总分较高相关，β系数为 14.88（p = 0.02）。
嗅觉丧失而非便秘与 PD 患者的认知障碍相关。然而，严重便秘与嗅觉丧失和 PD 疾病严重程度相关。我们推测，α-突触核蛋白从嗅觉途径的传播不同于肠神经系统，但这两个途径之间的相互通讯是复杂的。
