帕金森病患者的视空间功能障碍

视空间功能障碍是帕金森病患者常见的一种认知功能损害,是指对于空间信息的分析和整合能力受损而引起的空间知觉障碍和空间行为障碍.其发生机制欠明,与脑内多水平的多巴胺浓度减低造成基底节、皮质及其之间的神经环路受损有关.帕金森病患者的视空间功能障碍表现多样,主要通过神经心理学测试检出,对患者的日常生活能力有一定影响,目前尚无有效的治疗方法.     

帕金森病患者认知功能障碍及其相关因素分析

帕金森病 (Ｐａｒｋｉｎｓｏｎｄｉｓｅａｓｅ,ＰＤ)是多见于中老年人的慢性神经系统变性疾病 ,它不仅有严重的运动功能障碍 ,认知功能障碍也很突出。而其认知功能障碍与哪些因素有关 ,仍然是需要研究的问题。我们对 40例ＰＤ患者认知功能进行测查 ,并与病程 ,运动功能障碍 ,受教育年限等因素进行相关性分析。资料 :　随机选择ＰＤ患者 40例 ,男 2 1例 ,女 19例 ,年龄 42～ 71岁 ,平均年龄 (6 0± 6 )岁 ,病程平均 4± 3年 ,平均受教育年限 8± 5年 ,全部患者均经头颅ＣＴ或ＭＲＩ检查 ,除有老年性脑改变外 ,未见特殊异常 ,临床上排除脑血管…     

帕金森病患者睡眠障碍相关因素分析

目的 探讨帕金森病患者睡眠障碍的临床表现及影响其睡眠质量的相关因素.方法 选取无锡市第四人民医院神经内科2009-01-2013-05确诊的帕金森病患者95例,采用匹兹堡睡眠质量指数量表（PSQI）判定患者是否睡眠障碍,通过症状自评量表（SCL-90）比较睡眠障碍有无患者身心健康状况,通过日常生活能力量表（ADL）比较睡眠障碍有无患者之间的差异.结果 本组患者睡眠障碍55例,发生率为58.00%.男女比1∶1.29,女性发生率高于男性,差异有统计学意义（P＜0.05）.其中,≥70岁睡眠障碍患者32例（68.05%）,50～69岁睡眠障碍20例（50.00%）,〈50岁睡眠障碍3例（37.50%）.帕金森病Ⅳ～Ⅴ期患者睡眠障碍39例（39/52,75.00%）,其次发生在Ⅱ～Ⅲ期13例（13/33,39.39%）,发生在Ⅰ期3例（3/10,30.00%）.晚期（Ⅳ～Ⅴ期）帕金森病患者睡眠障碍发生率为75.00%,明显高于早期帕金森病患者的30.00%,差异有统计学意义（P＜0.05）;帕金森病后睡眠障碍患者SCL-90 指标、ADL指标明显差于帕金森病后无睡眠障碍患者,差异均有统计学意义（P＜0.05）.结论 帕金森病患者易发生睡眠障碍,其发生率与性别、年龄、疾病进展程度有关,睡眠障碍可导致患者抑郁、焦虑、生活质量明显下降,临床治疗应做好相应措施.     

帕金森病患者自主神经功能障碍相关研究

目的 评估交感神经皮肤反应(sympathetic skin response,SSR)和PD自主神经症状量表(the scale for outcomes in PD for autonomic symptoms,SCOPA-AUT)对帕金森病(Parkinson disease,PD)患者自主神经功能损害的诊断价值及自主神经功能障碍影响因素.方法 应用SSR、SCOPA-AUT和统一帕金森病评分量表(unified Parkinson disease rating scale,UPDRS)对50例PD患者进行评估;应用SSR及SCOPA-AUT量表对33例对照组进行评估.结果 PD组四肢SSR的潜伏期及波幅与对照组相比差异有显著统计学意义(P<0.01或0.05).SCOPA-AUT总分(23.54±12.48)、消化系统症状(8.00±3.77)及泌尿系统症状评分(6.28±3.51)均高于对照组,差异有统计学意义(P<0.01).SCOPA.AUT总分与UPDRS评分、H&Y分级、Schwab和England日常生活得分显著相关,差异有统计学意义(P<0.01或0.05),与病程、年龄无明显的相关性(P>0.05).结论 PD患者自主神经功能障碍随着病情进展而加重,PD患者SCOPA-AUT评分与上、下肢SSR波幅呈负相关,SSR和SCOPA-AUT可作为评价PD患者自主神经功能障碍的客观量化临床指标.

Abstract：

Objective To investigate the diagnostic value of sympathetic skin response(SSR)and the scale for outcomes in PD for autonomic symptoms(SCOPA-AUT)in autonomic dysfunction and influencing factors of autonomic dysfunction in patients with parkinson's disease(PD).Methods SSR,SCOPA-AUT and unified Parkinson's disease rating scale(UPDRS)were used to evaluate 50 patients with PD.The results were taken from patients with PD and compared with those of 33 control subjects.Results It was significantly different to compare the SSR latency and amplitude of PD patients limbs with those of the normal controls.PD patients had more total SCOPA-AUT score(23.54 4±12.48)and domain scores in gastrointestinal(8.00 4±3.77)and urinary symptoms(6.28±3.51)compared to control subjects(P<0.01).There were significant correlations between the total score with UPDRS.Hoehn-Yabr scale or score of Schwab and England disability scale(P<0.01 or 0.05),and no correlation with duration or age(P>0.05).Conclusions Autonomic dysfunction of PD increased significantly with disease severity.There were significantly negative correlation between the total score of SCOPA-AUT with the limb SSR amplitude(P<0.05)in PD patients.SSR and SCOPA-AUT can act as an objective index to assess autonomic dysfunctions in patients with PD quantitatively.     

帕金森病患者的抑郁与认知功能障碍

目的探讨帕金森病(PD)患者的抑郁与认知功能障碍之间的关系。方法对60名PD患者和38名对照组进行抑郁和认知功能评定。结果PD组HAMD均分(16.8±0.6),对照组(7.2±2.8);PD组的认知功能与对照组相比下降;PD并抑郁患者的认知功能与PD并非抑郁患者的认知功能相比有显著性差异(P<0.05)。结论PD患者存在抑郁与认知功能障碍,抑郁可能是导致认知功能下降的重要因素。     

帕金森病患者工作记忆障碍研究

目的　探讨帕金森病 (PD)患者工作记忆状况。方法　仿制并修订了Smith工作记忆检查软件 ,对 6 6例PD患者及 6 0名对照者进行工作记忆检查。结果　早期PD患者视觉空间工作记忆正确率较对照组低 (分别为 82 8%± 12 1%,90 9%± 6 7%) ,差异有显著意义 (t=3 0 76 ,P <0 0 1) ,视觉物体形状工作记忆正确率与对照组相近 (6 9 2 %± 10 9%,72 7%± 8 1%) ,差异无显著意义 (t=1 389,P >0 0 5 ) ;中期PD患者视觉空间与物体形状工作记忆正确率 (分别为 6 9 6 %± 15 6 %,6 3 11%±5 4 %) ,均较对照组低 ,差异有极显著意义 (t=6 399、t=3 377,P <0 0 0 0 1、P <0 0 1) ;中期PD患者视觉空间与物体形状工作记忆正确率均较早期PD患者低 ,差异有显著意义 (t=2 6 14、t =2 140 ,P <0 0 5 ) ;早期PD患者视觉颜色工作记忆正确率与对照组相近 (6 5 1%± 11 4 %,6 9 9%± 10 1%) ,差异无显著意义 (t=1 6 81,P >0 0 5 )。相关性分析发现 ,Hoehn Yahr分级与工作记忆正确率呈负相关。　结论PD患者早期即有视觉空间工作记忆损伤 ,而视觉物体形状工作记忆及颜色工作记忆正常 ,随着疾病进展至中期 ,PD患者视觉空间与物体形状工作记忆均受损伤 ,且程度较早期加重。     

帕金森病患者非运动症状的研究进展

帕金森病是以运动异常为特征的疾病,但其非运动症状却非常常见,这些症状包括精神行为异常、睡眠障碍、认知功能障碍、感觉异常、自主神经功能障碍等。它们发病率高,临床表现多样,病理机制复杂,诊断和临床评估困难,治疗难度大,严重影响帕金森病患者的生活质量,对照料者也有着极大的影响。但是帕金森病的非运动症状并没有被临床医生充分认识,临床上应该加强对其的认识和重视,使其评估常规化,争取早期诊断,早期干预,从而提高病人的生活质量。     

帕金森病轻度认知功能障碍的临床特点

目的 探讨帕金森病患者轻度认知功能障碍(PD-MCI)的临床特点。方法 纳入85例非痴呆的帕金森病(PD)患者,并进行临床资料的采集及相关量表评估。结果 PD-MCI组55例(64.7%),PD-认知正常组30例(35.3%)。PD-MCI组的年龄及发病时年龄显著高于PD-认知正常组(P<0.05),PD-MCI组MoCA评分中的视空间与执行功能、注意、语言、抽象、延迟回忆得分显著低于PD-认知正常组(P<0.01)。PD-MCI组的MoCA评分与UPDRS Ⅲ评分及发病年龄呈负相关,与受教育水平呈正相关。结论 与认知功能正常的PD患者比较,PD-MCI患者在视空间与执行功能、注意、语言、抽象、延迟回忆等方面均有损害,且认知损害程度与发病年龄、运动症状严重程度及受教育水平有关。     

早期帕金森病患者视觉空间翻转能力受损

目的探讨早期帕金森病(Parkinson disease,PD)患者视觉空间翻转能力的损害情况。方法对29例PD患者及29名健康对照者进行空间翻转测试检查,检查图片包括人体左手、右手、左足、右足以及被黑框挡住左灯或右灯的轿车车头图片,所有图片均有6个角度,要求受试者进行左右判断,以正确率作为比较两组成绩的指标。结果在对客体(车)进行翻转测试时,PD组成绩(89.7%±9.3%)与对照组成绩(91.5%±7.2%)差异无统计学意义(t=0.803,P=0.426),在对自体(手)进行翻转时,PD组成绩(82.5%±11.5%)明显差于对照组(91.5%±6.6%)(t=3.681,P=0.001);以左侧肢体起病者在对自体(手)进行翻转时的成绩(80.7%±16.4%)与对照组(91.5%±6.6%)比较无统计学差异(t=-1.817,P=0.109),以右侧肢体起病者对自体(手)进行翻转时的成绩(83.5%±9.6%)明显差于对照组(91.5%±6.6%)(t=-2.979,P=0.007);PD患者的空间翻转能力与MoCA评分呈正相关。结论早期PD患者存在视觉空间翻转能力受损,并且这种损害存在分离现象,即对自体的空间翻转能力受损,对客体的空间翻转能力相对保留;以右侧肢体起病者更易出现自体的空间翻转能力损害;PD患者的空间翻转能力与总体认知状况相关。     

帕金森病运动症状偏侧化的研究进展

帕金森病(PD)是一种以运动症状为主要表现的神经退行性疾病,常单侧起病,不同侧别的运动症状在疾病发展速度、非运动症状类型和治疗反应等方面存在差异。本文现围绕PD运动症状偏侧化的临床特点、潜在机制、影像表现及治疗差异等内容综述如下,以期为PD临床诊疗提供一定依据。     

帕金森病患者营养状况及其相关因素分析

目的研究帕金森病(PD)患者营养状况及其相关因素。方法收集180名PD患者为研究对象,应用量表系统性评估患者运动及非运动症状,采用微营养评定法(MNA-SF)评估营养状况。结果正常营养状态与非正常营养状态PD患者间病程、统一PD评分量表Ⅲ(UPDRSⅢ)、H-Y分期及非运动症状的差异均有统计学意义(P0.05~0.01)。二元Logistics回归结果显示H-Y分期(OR=2.35,95%CI:1.24~4.45,P=0.007)、抑郁情绪(OR=1.39,95%CI:1.25~1.67,P0.001)与非正常营养状态显著相关。结论 PD患者营养状况与其疾病本身、运动症状、非运动症状密切相关。     

高同型半胱胺酸血症与帕金森病认知功能的相关性研究

目的探究高同型半胱胺酸血症与帕金森病认知功能相关性。方法选取我院收治的130例帕金森病患者作为试验组,同期的健康体检人员110例作为对照组,对影响认知功能的可能危险因素进行Logistic回归分析,并将轻度认知功能障碍患者、痴呆患者及健康人群血清高同型半胱胺酸含量进行对比。结果经Logisitc非条件回归分析可见,年龄、文化程度、吸烟、高血压、糖尿病、高密度脂蛋白、低密度脂蛋白、血清总胆固醇、血浆同型半胱氨酸为认知功能障碍的危险因素。对照组与帕金森非认知障碍组、帕金森认知障碍组的血浆同型半胱氨酸含量相比差异均具有统计学意义(t=3.45,P0.05;t=6.43,P0.05)。帕金森非认知功能障碍组与帕金森认知功能障碍组的血浆同型半胱氨酸含量相比差异具有统计学意义(t=5.23,P0.05)。结论帕金森病认知功能障碍患者同型半胱胺酸含量明显高于无认知功能障碍的帕金森病患者及健康人群,高同型半胱胺酸血症为帕金森病认知功能障碍的危险因素,可作为临床医师可靠的诊断依据。     

Visuospatial impairment in Parkinson's disease: The role of laterality

Asymmetry is one of the unique and mysterious features of Parkinson's disease (PD). Motor symptoms develop unilaterally either on the left (LPD) or the right side (RPD). Incongruent data are available whether the side of onset has an impact on cognition in PD. The objective of this study is to compare the visuospatial performance of RPD and LPD patients. Seventy-one non-demented, non-depressive and right-handed patients were categorized into RBD (n = 36) and LPD (n = 35) groups. Rey-Osterrieth Complex Figure Test (ROCF) was evaluated by both the Taylor's and Loring's scoring systems. Subsequently, we also performed subgroup analyses on patients having short disease duration (≤5 years, 15 RBD and 15 LPD patients). The standard analysis of ROCF (Taylor's system) did not reveal any differences; however, the utilization of the Loring's system demonstrated that LPD patients had significantly worse visuospatial performance than the RPD subjects (3.0 vs. 2.0 points, median, p = 0.002). Correlation between the number of spatial errors and the degree of asymmetry was significant (r = ?0.437, p = 0.001). However, this difference could not be observed in PD patients with short disease duration. LPD patients had worse visuospatial performance than the RPD subjects and the number of errors tightly correlated with the degree of asymmetry and long disease duration.     

帕金森病患者轻度认知功能损害

目的 探讨帕金森病(PD)患者伴轻度认知功能损害(MCI)即PD-MCI的特征及其相关因素.方法 采用多种量表[MMSE、Hoehn-Yahr分期、Webster评分、PD统一评分量表-运动(UPDRS-motor)及剑桥老年认知检查量表中文版(CAMCOG-C)]评估PD患者的病情严重程度、运动和认知功能;应用Petersen改良标准诊断PD-MCI.结果 89例PD患者中,认知正常(PDCOGNL)56例(63%),PD-MCI 20例(22%),PD痴呆(PDD)13例(15%).PD-MCI组较PDCOGNL组在定向、语言、记忆、注意、执行、思维、知觉等方面均存在明显损害,两组年龄和起病年龄差异无统计学意义,受教育程度差异有统计学意义(PD-MCI:4.4±4.3,PDCOGNL:7.1±4.9;q=3.270,P<0.05);PD-MCI组的年龄、起病年龄及受教育程度较PDD组差异均无统计学意义;而PDD组较PDCOGNL组在年龄、起病年龄、受教育程度等方面差异均有统计学意义(q=-4.913、-4.997、4.740,均P<0.01);3组间病程差异无统计学意义.Hoehn-Yahr分期、Webster评分及UPDRS-motor评分与PD认知功能均存在负相关.结论 PD-MCI是PD认知正常与PDD之间的过渡状态,存在多个区域的认知损害;高龄、起病年龄迟、受教育程度低可能是PD认知损害的危险因素;疾病严重程度及运动功能与PD认知功能存在着负相关.     

帕金森病患者视幻觉相关因素分析

目的研究帕金森病(PD)患者视幻觉(VHs)的发生率及相关因素。方法根据是否有VHs将367例PD患者分为VHs组及无VHs组。采用统一帕金森病评分量表第三部分(UPDRS-Ⅲ)、Hoehn-Yahr(H-Y)分期、非运动症状问卷(NMS-Quest)、帕金森病睡眠量表(PDSS)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、蒙特利尔认知评估量表(MoCA)评估患者的PD相关病情。结果 VHs组62例(16..9%),其中46例为复杂VHs(74.2%)。与无VHs组比较,VHs组患者病程显著延长,H-Y分期、UPDRSⅢ评分、多巴胺激动剂使用率显著增高(P0.05~0.01)。与无VHs组比较,VHs组患者NMS-Quest总分(除幻觉项)、消化道症状、近记忆/注意力减退、睡眠障碍得分显著升高(均P0.01),MoCA总分、注意力、抽象思维和定向力评分及PDSS量表评分显著降低(P0.05~0.01)。两组间HAMD及HAMA评分差异无统计学意义(均P0.05)。Logistic回归分析发现,病程(OR=1.081,95%CI:1.017~1.148,P=0.012)、使用多巴胺激动剂(OR=1.894,95%CI:1.031~3.482,P=0.040)、近记忆/注意力减退(OR=1.582,95%CI:1.148~2.179,P=0.005)、睡眠障碍(OR=1.388,95%CI:1.111~1.735,P=0.004)是VHs的危险因素;抽象思维(OR=0.620,95%CI:0.391~0.985,P=0.043)、定向力(OR=0.421,95%CI:0.181~0.977,P=0.044)是VHs的保护性因素。结论 VHs是PD患者常见的一种非运动性症状,其发生与PD病程、使用多巴胺受体激动剂、睡眠质量以及认知功能密切相关。     

Quantification of motor deficit in Parkinson's disease with a motor performance test series

Summary It was the purpose of the present study to quantify the expected motor deficit in parkinsonian patients with the computer assisted Motor Performance Test Series (MPS), version 05.87 by Schuhfried (1987) and to examine which of the motor test variables found correlate at a significance level of p<0.01 with items of motor examination recorded at neurological examination and activities of daily living of the Unified Parkinson's Disease Rating Scale (UPDRS), version 3.0.38 patients with idiopathic Parkinson's disease (PD) stages I–IV according to Hoehn and Yahr, aged 41 to 73 years were studied. The study design, i.e. initial rating by the physician followed immediately by testing of motor function with MPS was strictly adhered to in each patient.Physician's rating of rigor and the scores of the semiquantitative tests (finger taps, hand movements and alternating movements) as expression of hypokinesia and the activities of daily living correlated with the 3 factors of the Motor Performance Test Series at a highly significant level independent of disease stage. Tremor is only partly and never significantly reflected in the motor data measured. Stages I–II and II–IV (Hoehn and Yahr) differ significantly in the representative data of the Motor Performance Test Series.The results of the study support the assumption that MPS is a valid instrument for quantitative measurement of the motor deficit in parkinsonian patients, but that only some subtests are pathognomonic.     

Visuospatial impairment in Parkinson's disease

We explored the nature of the visuospatial deficit in Parkinson's disease (PD) and its progression as a function of disease duration. We compared the performance of 183 patients with idiopathic PD and 90 control subjects matched for age and education on six visuospatial measures. We divided patients into three groups according to the disease duration: early (1 to 4 years), middle (5 to 10 years), and advanced (greater than 10 years). Performance deteriorated in five of the six visuospatial measures, as a function of disease duration. However, the pattern of visuospatial decline depended on whether dementia was present. The results were not influenced by age or anticholinergic medication. These findings support the presence of visuospatial deficits in PD patients, with a changing pattern of impairment related to dementia and progression of the disease.