摘要
目的探讨脑白质疏松（IA）对帕金森病（PD）患者认知功能的影响。方法选取确诊的PD患者63例，所有病例来自2011年9月至2012年7月安徽医科大学第一附属医院神经内科就诊患者，根据认知评分将其分为PD无认知损害组（PD-IC，n=23）、PD伴轻度认知损害组（PD-MCI，n=23）和PD痴呆组（PDD，n=17）。运用简易智能精神状态检查量表（MMSE）、剑桥老年认知量表中文版（CAMCOG-c）、临床痴呆量表（CDR）、语言流畅性测验、画钟实验（CDT）、老年抑郁量表（GDS）等对认知功能和抑郁症状进行评定；运用PD统一评分量表-运动（UPDRS-motor）和Hoehn-Yahr分期（HY）对PD运动功能进行评定；所有患者均行头颅MRI（3．0T）检查，运用Scheltens视觉评定量表评定LA的程度。结果PD-IC组[（2．43±2．79）分]和PD-MCI组[（4．48±4．33）分]的脑深部白质高信号（DHs）评分均显著低于PDD组[（7．88±6．69）分，P值分别为0．004和0．040]，尤其体现在额叶[（1．09±1．31）分、（1．83±1．90）分、（3．24±2．64）分，均P〈0．05]和顶叶[（0．09±0．29）分、（0．65±1．03）分、（1．53±2．32）分，均P〈0．05]，三组之间的脑室旁白质高信号（PVHs）[（1．57±1．75）分、（2．52±2．37）分、（3．24±2．64）分，均P〉0．05]、基底节[（0．09±0．42）分、（0．30±0．77）分、（0．53±1．33）分，均P〉0．05]和幕下白质高信号[（-）分、（0．13±0．63）分、（0．18±0．73）分，均P〉0．05]差异无统计学意义。DHs与年龄（P=0．003）、MMSE（P=0．009）、语言流畅性评分（P=0．009）、CAMCOG-C中的定向力（P=0．047）及执行功能（P=0．027）具有显著相关性。多元回归分析显示PD患者MMSE与文化程度（P〈0．001，B=0．600），脑深部白质（P=0．001，B=-0．678）及HY分期（P=0．035，B=-0．480）具有相关性，与脑深部白质关系最为密切。结论DHs与PD患者多个认知领域表现出相关性，尤其是执行功能；PD患者MMSE与DHs关系最为显著，DHs能够促进PD患者认知功能损害。
Objective To explore the role of leukoaraiosis （LA） on the cognitive function in patients with Parkinson disease （PD）. Methods The cohort for this study included 63 patients with PD, whom were divided into 3 groups according to cognitive status ： with intact cognition （ PD-IC, n = 23 ）, with mild cognitive impairment （PD-MCI, n = 23） and with dementia （PDD, n = 17）. All the patients were recruited from the Department of Neurology, First Affiliated Hospital, Anhui Medical University between September 2011 and July 2012. The cognitive functions were evaluated by mini-metal state examination （MMSE）, the Cambridge cognitive examination-Chinese version （CAMCOG-C）, clinical dementia rating （CDR）, clock drawing task （CDT） and verbal fluency test, etc. Depression symptoms were assessed by the geriatric depression scale （GDS） while motor symptoms by the Unified Parkinson＇s Disease Rating Scale- motor （UPDRS-motor） and the Hoehn and Yahr scale（HY）. All the patients underwent magnetic resonance imaging （MRI） with a 3.0-T system. LA was rated using the semiquantitative visual rating system proposed by scheltens et al. Results Both the PD-IC （2. 43±2. 79） and PD-MCI （4. 48±4. 33 ） groups showed significantly lower deep hyperintensities （DHs） scores than the PDD group （7.88 ± 6. 69, P = 0. 004 and 0. 040, respectively）, especially in frontal （ 1.09 ± 1.31 ; 1.83 ± 1.90 ; 3.24 ± 2. 64, P 〈 0. 05 ） and parietal areas （0.09± 0. 29 ; 0. 65 ± 1.03 ; 1.53 ± 2. 32, P 〈 0. 05 ）. There were no significant differences in periventricular （ 1.57 ＋ 1.75 ; 2. 52 ± 2. 37 ; 3.24 ± 2. 64, P 〉 0. 05 ）, basal ganglia （ 0. 09 ± 0. 42 ; 0. 30 ±0. 77 ; 0. 53 ± 1.33, P 〉0. 05） and infratentorial white matter hyperintensities scores （ -- ; 0. 13 ± 0. 63 ; 0. 18 ± 0.73, P 〉 0. 05 ） among three groups. The DHs showed a significant correlation with age（ P = 0. 003 ）, MMSE（ P = 0. 009 ）, verbal fluency test （ P = 0. 009 ）, orientation （ P = 0. 047 ） and executive function （ P = 0. 027 ） in CAMCOG-C. The multiple regression analysis showed that the MMSE scores were associated significantly with education （ P 〈 0. 001,15 = 0. 600）, DHs （ P = 0. 001,15 = - 0. 678 ） and HY （P = 0. 035,15 = -0. 480）. DHs were the most significantly associated with MMSE scores. Conclusion There was a significant correlation between DHs and multiple domain cognitive impairment in PD, especially in executive function. DHs, which were the most significantly variable associated with MMSE scores, may contribute to cognitive impairment in PD.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2013年第3期177-181,共5页
National Medical Journal of China
基金
安徽省教育厅自然科学基金（KJ2011A170）
关键词
帕金森病
脑白质疏松症
认知障碍
痴呆
Parkinson＇s disease
Leukoaraiosis
Cognition disorders
Dementia
