中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2013年
3期
177-181
,共5页
王莉%朱小群%江婵娟%陈先文%孙中武
王莉%硃小群%江嬋娟%陳先文%孫中武
왕리%주소군%강선연%진선문%손중무
帕金森病%脑白质疏松症%认知障碍%痴呆
帕金森病%腦白質疏鬆癥%認知障礙%癡呆
파금삼병%뇌백질소송증%인지장애%치태
Parkinson's disease%Leukoaraiosis%Cognition disorders%Dementia
目的 探讨脑白质疏松(LA)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 (3.0 T)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,β-0.600),脑深部白质(P =0.001,β=-0.678)及HY分期(P=0.035,β=-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.
目的 探討腦白質疏鬆(LA)對帕金森病(PD)患者認知功能的影響.方法 選取確診的PD患者63例,所有病例來自2011年9月至2012年7月安徽醫科大學第一附屬醫院神經內科就診患者,根據認知評分將其分為PD無認知損害組(PD-IC,n=23)、PD伴輕度認知損害組(PD-MCI,n=23)和PD癡呆組(PDD,n=17).運用簡易智能精神狀態檢查量錶(MMSE)、劍橋老年認知量錶中文版(CAMCOG-C)、臨床癡呆量錶(CDR)、語言流暢性測驗、畫鐘實驗(CDT)、老年抑鬱量錶(GDS)等對認知功能和抑鬱癥狀進行評定；運用PD統一評分量錶-運動(UPDRS-motor)和Hoehn-Yahr分期(HY)對PD運動功能進行評定；所有患者均行頭顱MRI (3.0 T)檢查,運用Scheltens視覺評定量錶評定LA的程度.結果 PD-IC組[(2.43-±2.79)分]和PD-MCI組[(4.48±4.33)分]的腦深部白質高信號(DHs)評分均顯著低于PDD組[(7.88±6.69)分,P值分彆為0.004和0.040],尤其體現在額葉[(1.09±1.31)分、(1.83±1.90)分、(3.24±2.64)分,均P＜0.05]和頂葉[(0.09±0.29)分、(0.65±1.03)分、(1.53 ±2.32)分,均P＜0.05],三組之間的腦室徬白質高信號(PVHs)[(1.57±1.75)分、(2.52 ±2.37)分、(3.24±2.64)分,均P＞0.05]、基底節[(0.09±0.42)分、(0.30±0.77)分、(0.53±1.33)分,均P＞0.05]和幕下白質高信號[(-)分、(0.13 ±0.63)分、(0.18 ±0.73)分,均P＞0.05]差異無統計學意義.DHs與年齡(P =0.003)、MMSE(P=0.009)、語言流暢性評分(P =0.009)、CAMCOG-C中的定嚮力(P =0.047)及執行功能(P =0.027)具有顯著相關性.多元迴歸分析顯示PD患者MMSE與文化程度(P ＜0.001,β-0.600),腦深部白質(P =0.001,β=-0.678)及HY分期(P=0.035,β=-0.480)具有相關性,與腦深部白質關繫最為密切.結論 DHs與PD患者多箇認知領域錶現齣相關性,尤其是執行功能；PD患者MMSE與DHs關繫最為顯著,DHs能夠促進PD患者認知功能損害.
목적 탐토뇌백질소송(LA)대파금삼병(PD)환자인지공능적영향.방법 선취학진적PD환자63례,소유병례래자2011년9월지2012년7월안휘의과대학제일부속의원신경내과취진환자,근거인지평분장기분위PD무인지손해조(PD-IC,n=23)、PD반경도인지손해조(PD-MCI,n=23)화PD치태조(PDD,n=17).운용간역지능정신상태검사량표(MMSE)、검교노년인지량표중문판(CAMCOG-C)、림상치태량표(CDR)、어언류창성측험、화종실험(CDT)、노년억욱량표(GDS)등대인지공능화억욱증상진행평정；운용PD통일평분량표-운동(UPDRS-motor)화Hoehn-Yahr분기(HY)대PD운동공능진행평정；소유환자균행두로MRI (3.0 T)검사,운용Scheltens시각평정량표평정LA적정도.결과 PD-IC조[(2.43-±2.79)분]화PD-MCI조[(4.48±4.33)분]적뇌심부백질고신호(DHs)평분균현저저우PDD조[(7.88±6.69)분,P치분별위0.004화0.040],우기체현재액협[(1.09±1.31)분、(1.83±1.90)분、(3.24±2.64)분,균P＜0.05]화정협[(0.09±0.29)분、(0.65±1.03)분、(1.53 ±2.32)분,균P＜0.05],삼조지간적뇌실방백질고신호(PVHs)[(1.57±1.75)분、(2.52 ±2.37)분、(3.24±2.64)분,균P＞0.05]、기저절[(0.09±0.42)분、(0.30±0.77)분、(0.53±1.33)분,균P＞0.05]화막하백질고신호[(-)분、(0.13 ±0.63)분、(0.18 ±0.73)분,균P＞0.05]차이무통계학의의.DHs여년령(P =0.003)、MMSE(P=0.009)、어언류창성평분(P =0.009)、CAMCOG-C중적정향력(P =0.047)급집행공능(P =0.027)구유현저상관성.다원회귀분석현시PD환자MMSE여문화정도(P ＜0.001,β-0.600),뇌심부백질(P =0.001,β=-0.678)급HY분기(P=0.035,β=-0.480)구유상관성,여뇌심부백질관계최위밀절.결론 DHs여PD환자다개인지영역표현출상관성,우기시집행공능；PD환자MMSE여DHs관계최위현저,DHs능구촉진PD환자인지공능손해.
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 Scalemotor (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,β =0.600),DHs (P =0.001,β =-0.678) and HY (P =0.035,β =-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.
