帕金森病患者认知功能特点及合并快动眼睡眠障碍对认知功能的影响

目的探讨帕金森病(PD)患者的认知功能特点及PD合并快动眼睡眠障碍(PD-RBD)对认知功能的影响。方法选取PD患者50例(PD组),PD-RBD患者15例(PD-RBD组),健康对照者50名(对照组)。收集3组研究对象的详细人口学资料和临床信息,进行完整的认知功能评估,分析比较PD、PD-RBD患者和健康对照组的认知功能特点。结果单因素方差分析结果显示各组间差异有统计学意义的区域:包括RVLT再认、Rey-Osterrieth复杂图形模仿时间和评分、流畅性测试、符号数字转换测试、Stroop色词测试时间及连线测试的A和B部分。两两比较中,PD-RBD组在RVLT再认、Rey-Osterrieth复杂图形模仿时间、Stroop色词测试时间及连线测试B部分表现最差。结论 PD患者认知功能受损与RBD密切相关,RBD可能是PD认知功能障碍的重要危险因素。     

帕金森病和睡眠呼吸暂停综合征患者认知功能障碍特点的研究进展

帕金森病（Parkinson Disease,PD）是一种常见的中老年系统性慢性神经变性疾病,可引起视空间、执行功能、记忆、语言等多个认知域损害。睡眠呼吸暂停综合征（Sleep Apnea Syndrome,SAs）是PD患者常见的睡眠呼吸障碍之一,且其本身也可以导致患者记忆、一般学习能力、注意力等多方面认知功能障碍。现阶段PD合并SAS的发生率呈逐渐上升趋势,严重影响了患者的生活质量。但PD患者合并SAS后,其认知功能障碍特点尚不清楚,也未见报道。现对PD和SAS的认知功能障碍特点作一综述。     

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。     

帕金森病患者认知功能障碍与抑郁临床分析

目的探讨帕金森病(PD)患者的认知功能障碍及抑郁的特点及关系。方法对50例PD患者和42例对照组进行认知功能及抑郁评定和分析。结果 PD组同对照组相比,简易精神状况检查(MiniMental State Examination,MMSE)及蒙特利尔认知评估(Montreal Cognitive Assessment,MOCA)量表各因子分,除语言因子分外均有显著性差异(P<0.05),汉密尔顿抑郁量表(Hamilton depression scale,HAMD)均分和抑郁自评量表(Self-rating Depression Scale,SDS)均分均有显著性差异(P<0.05),抑郁严重程度与认知功能损害成正相关(r=0.438)。结论 PD患者存在认知功能障碍与抑郁,抑郁可能是导致认知功能下降的重要因素。     

帕金森病伴发认知功能障碍的相关因素分析

目的 探讨认知功能障碍在帕金森病中（Parkinson＇s disease,PD）的发生率及其影响因素.方法 对确诊的PD患者采用蒙特利尔认知评价量表（Montreal Cognitive Assessment MOCA中文版）、汉密尔顿抑郁量表（Hamilt depression scale,HAMD）及Webster功能评分量表进行评定分析PD伴发认知功能障碍的发生情况和相关影响因素.结果 PD伴发认知功能障碍者50例,认知功能障碍的发生率为76.9%,病程、文化程度、Webster评分、HAMD评分与帕金森病伴发认知功能障碍的发生均有统计学意义（P＜0.05）,年龄、性别、婚姻状况、经济情况与帕金森伴发认知功能障碍的发生均无统计学意义（P＞0.05）.回归分析发现病程和PD病情严重程度是PD患者伴发认知功能障碍的危险因素.结论 PD患者有较高认知功能障碍的发生率,PD伴发认知功能障碍的发生可能与PD患者的病程、文化程度、PD患者病情的严重程度及抑郁有关.     

睡眠质量对轻中度帕金森病患者认知功能的影响

目的 探讨睡眠质量对轻中度帕金森病患者认知功能的影响.方法 选取71例PD患者为研究对象,采用简易精神状态检查量表（MMSE）和蒙特利尔认知评估表（MoCA,北京版）评定患者的认知功能,匹兹堡睡眠质量指数（PSQI）评定患者的认知功能,比较不同睡眠情况患者的认知水平和不同认知水平患者的睡眠质量,以及两者之间的相关性.结果 71例PD患者均为轻中度PD患者,其中出现睡眠障碍的患者有37例（52.1％）.睡眠障碍组统一帕金森评分量表（UPDRS）评分为（45.7±15.9）分高于睡眠正常组（35.8±13.8）分,MoCA（20.5±5.3）分和MMSE（25.7±3.3）分低于睡眠正常组（23.7±4.2）,（27.5±2.6）分,差异均有统计学意义（P＜0.05）.49例（69.0％）患者出现认知功能障碍,其中轻度认知功能障碍28例（39.4％）,痴呆21例（29.6％）.痴呆组MMSE评分为（23.0±1.7）分,为轻度痴呆.PD伴痴呆患者睡眠质量差,PSQI（8.9±4.5）分高于认知功能正常组（5.2±3.3）分,差异有统计学意义（P＜0.01）.存在睡眠障碍的PD患者认知障碍患病率高（P＜0.05）.结论 轻中度PD患者睡眠障碍发生率高.病情的严重程度影响PD患者的睡眠质量,病情重的PD患者,睡眠障碍的发生率高.睡眠质量差的PD患者认知功能减退,伴痴呆的PD患者的睡眠质量更差.     

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临床分析

目的分析帕金森病(PD)患者睡眠障碍发生情况及可能影响因素。方法采用统一帕金森病评定量表(UPDKS)、Hoehn-Yahr分级表、汉密尔顿抑郁量表、改良Webster评分、匹兹堡睡眠质量指数(PQSI)、爱泼沃斯思睡量表(ESS)及简明精神状态量表(MMSE)对PD患者病情及睡眠情况进行评定,并与对照组进行对照分析。结果62例PD患者中53例(85.5%)有睡眠障碍,其中失眠46例(86.8%),异态睡眠39例(73.6%),白天睡眠障碍36例(69.2%),与对照组对比均有显著差异(P<0.05)。结论PD患者睡眠障碍较为常见,主要表现为失眠、异态睡眠、日间嗜睡、睡眠发作等,其程度与抑郁、病情严重度及多巴胺能药物剂量等有关。     

帕金森病患者睡眠障碍的临床分析

目的探讨帕金森病(PD)患者睡眠障碍的临床特征、睡眠质量评价,并分析其相关影响因素。方法采用匹兹堡睡眠质量指数量表(PSQI)、爱泼沃斯嗜睡量表(ESS)、简明精神状态量表(MMSE)、UPDRS-Ⅲ分量表、Hoehn-Yahr(H-Y)分级、综合医院焦虑/抑郁情绪测定表(HAD)及自制的睡眠情况及用药调查表分别对170例PD患者的睡眠状况、疾病严重程度、认知状况、抑郁程度、病程、多巴胺能药物应用等情况进行评定和计算。结果在170例PD患者中有141例睡眠质量差,发生率为82.9%。其中入睡困难102例(60.0%),睡眠破碎96例(56.5%),白天过度嗜睡59例(34.7%),睡眠运动障碍81例(47.7%)。多因素逐步线性回归分析显示PSQI总分与UPDRS-Ⅲ评分、H-Y分级、HAD评分、MMSE评分、左旋多巴日平均剂量及年龄相关,而与性别和病程长短无关;ESS仅与UPDRS-Ⅲ评分、左旋多巴日平均剂量相关。结论PD患者总体睡眠质量差,睡眠障碍的发生率高,主要表现为入睡困难、睡眠破碎、睡眠运动障碍、白天过度嗜睡等。PD患者睡眠障碍状况受病情严重程度、认知状态、抑郁、年龄、多巴胺能药物应用等因素影响,而与性别、PD病程长短无关。     

帕金森病与睡眠障碍

帕金森病(Parkinson’s disease,PD)是一种常见的老年性疾病,其主要病理变化是中枢神经系统多巴胺能(DA)神经元进行性变性、缺失,导致临床出现静止性震颤,肌强直,运动障碍等表现。随着多导睡眠仪(Polysomno-gram,PSG)用于临床,近年来发现许多帕金森病患者伴有睡眠障碍。现就其发作类型、PSG特点、相关因素以及治疗方法加以综述。     

Educational level and cognitive impairment in patients with Parkinson disease

Background and purposeParkinson disease (PD) is a risk factor for dementia. In addition, specific cognitive deficits can occur in PD patients without dementia. A patient's level of education could have an influence on the development of cognitive impairment in PD. The aim of this study was to examine the relationship between the level of education and cognitive performance in non-demented patients with PD.Material and methodsThirty-seven consecutive, nondemented PD patients and 40 healthy controls fulfilled the inclusion criteria and were enrolled in the case-control study. Each of the controls and PD patients were classified, for the purpose of this study, into one of three groups (low, intermediate, higher), categorized by the number of years of education. There were no differences in education and age between the controls and PD patients. All of the subjects were evaluated with a battery of neuropsychological tests: Mini-Mental State Examination, Trail Making Tests, Stroop Test, Mental Rotation Test, and Verbal Fluency Test.ResultsLess (low and intermediate) education was correlated with poor results from tests. The comparison of all groups of PD patients and controls demonstrated that PD subjects received lower test scores, especially for the low and intermediate groups. However, no statistically significant difference was reached between educationally advanced PD patients and the appropriate control subjects.ConclusionsAs compared to the controls, most non-demented PD patients presented executive-type cognitive dysfunction. The higher educational level, however, was associated with a lower risk of cognitive deterioration. We conclude that higher education might have protective effects in cognitive decline in PD.     

帕金森病与睡眠障碍

目前,帕金森病(PD)患者的运动症状如静止性震颤、运动迟缓、肌肉强直以及姿势步态异常等已为临床所熟悉;其非运动症状也逐渐引起重视,而非运动症状中的精神障碍、认知障碍和睡眠障碍是导致患者生活能力降低的三大原冈,其中以睡眠障碍最为显著[1].     

Cognitive profiling of Parkinson disease patients with mild cognitive impairment and dementia

BackgroundPrevalence of mild cognitive impairment (MCI) and dementia in Parkinson disease (PD) is variable because different classification criteria are applied and there is lack of consensus about neuropsychological tests and cut-off used for cognitive profiling. Given the important therapeutic consequences for patient management, we aimed at identifying suitable diagnostic cognitive tests and respective screening cut-off values for MCI and dementia in PD (PDD).MethodsWe evaluated 105 PD patients using an extensive neuropsychological battery categorized as PD without cognitive impairment (PD-CNT) (35%), PD-MCI (47%) and PDD (18%) based on established criteria and calculated Receiver Operating Characteristic (ROC) curves.ResultsWe found different sensitivity and specificity among neuropsychological tests in detecting PD-MCI and PDD. In particular performance in attention/set shifting, verbal memory and language abilities, discriminated both PD-MCI and PDD from PD-CNT. Abilities involved mainly in semantic retrieval mechanisms discriminated PD-CNT from PD-MCI but also PD-MCI from PDD. Finally deficits in executive and visual-spatial abilities were only affected in PDD.ConclusionOur data point to an independent and different load of each test in defining different PD cognitive statuses. These findings can help selection of appropriate cognitive batteries in longitudinal studies and definition of stage-specific therapeutic targets.     

帕金森病伴轻度认知功能障碍的研究进展

帕金森病伴发的轻度认知功能障碍，对患者的基本生活功能影响较小，但往往会演变成 帕金森痴呆，从而显著影响患者的生存质量及预后。因此，了解这一疾病，并对其进行早期干预具有十 分重要的意义。现从帕金森病轻度认知功能障碍的定义、临床表型、诊断标准、鉴别诊断、发病机制、危 险因素及治疗等方面进行综述，为相关研究提供参考。     

Dementia and cognitive impairment in Parkinson disease

Changes in cognitive function and disturbances in behavior are commonly seen in parkinsonian patients and they are inherent features of the disease. Estimates on the prevalence of dementia in this disorder are quite variable, ranging from 15 to 25%. Advanced age, depression, severity of akinesia, and the presence of dopaminomimetic psychosis, are considered as risk factors in the development of cognitive deterioration within this patient population. Cognitive dysfunction may manifest as relatively circumscribed deficits or overt dementia. The finding of mild cognitive deficits is common in Parkinson's disease, such as reduced flexibility, psychomotor slowing, reduction in learning capacity and information retrieval, and disturbances in visuospatial tasks. The most prevalent cognitive disturbance is an impairment in visuospatial tasks, not necessarily related to the degree of motor disability. Dementia, when present early on in the course of the disease may suggest alternative diagnoses (Diffuse Lewy body dementia, Alzheimer's disease with extrapyramidal features, Fronto-temporal dementia, etc.), while in those cases in whom the dementing disorder develops at a later stage, it is assumed to be an integral part of the disease, albeit corresponding to variable pathogenetic mechanisms.     

NREM sleep arousal-related disorders reflect cognitive impairment in Parkinson's disease

BackgroundSleep disorders and cognitive impairment are frequently reported in Parkinson's disease (PD) as non-motor disabling symptoms. While it is known that REM sleep Behaviour Disorder (RBD) in PD is associated with motor and cognitive decline, little is known about the neurobiological significance of NREM sleep arousal-related disorders.Objectives: to evaluate the cognitive and clinical correlates of arousal-related disorders in PD.MethodsClinical data and video-polysomnography were analysed from one hundred-seventy consecutive subjects with PD. Based on the neuropsychological assessment, the subjects were divided into three groups: no cognitive impairment (PD; n = 58), mild cognitive impairment (PD-MCI; n = 58) and overt dementia (PDD; n = 54).ResultsArousal-related disorders by history were reported in 32.9% of the subjects: 10.3% PD, 31.6% PD-MCI and 59.3% PDD (p = 0.001). Video-PSG captured arousal-related disorders in 1.7% PD, 21.2% MCI-PD and 35.6% PDD (p = 0.001). Arousal-related disorders and RBD were recorded in the same night in 7.7% PD, 9.8% MCI-PD and 15.6% PDD (p = 0.04). Patients with arousal-related disorders captured at V-PSG have a longer disease duration (p = 0.003), higher UPDRS score (p = 0.039), longer duration of treatment with levodopa (p = 0.017) and dopamine agonists (p = 0.018), worse H&Y staging (p = 0.001), lower MMSE score (p = 0.019) and more frequently hallucinations (p = 0.004). In multivariate analysis, cognitive impairment significantly increases the risk of arousal-related disorders (OR 3.387–95% CI 1.395–8.220, p = 0.007).ConclusionArousal-related disorders appear to be a marker of cognitive decline in PD. Recognizing arousal-related disorders should make clinicians aware of a possible cognitive decline in PD and eventually modify the therapeutic approach.     

Risk of cognitive impairment or dementia in relatives of patients with Parkinson disease

BACKGROUND: The evidence for increased risk of dementia in relatives of patients with Parkinson disease (PD) remains conflicting. OBJECTIVE: To study the risk of cognitive impairment or dementia in first-degree relatives of patients with PD. Design, Setting, and PARTICIPANTS: We conducted a historical cohort study of 1019 first-degree relatives of 162 patients with PD and of 858 relatives of 147 matched controls representative of the population of Olmsted County, Minnesota. In addition, we studied 2716 first-degree relatives of 411 patients with PD referred to Mayo Clinic. MAIN OUTCOME MEASURES: We administered via telephone a cognitive test directly to relatives or a dementia questionnaire to proxies. For relatives reported by proxies to have dementia, we obtained copies of their medical records to confirm the diagnosis. We also obtained dementia information from a medical records-linkage system. RESULTS: In the overall population-based sample, the risk of cognitive impairment or dementia was increased in relatives of patients with PD compared with relatives of controls (hazard ratio, 1.37; 95% confidence interval, 1.03-1.81; P = .03) and was particularly increased in relatives of patients with onset of PD at age 66 years or younger (youngest tertile; hazard ratio, 1.73; 95% confidence interval, 1.21-2.46; P = .003). The findings were consistent in several sensitivity analyses. In the referral-based sample, the risk of cognitive impairment or dementia in relatives increased with younger age at onset of PD but did not vary by other clinical characteristics. CONCLUSION: Cognitive impairment or dementia may share familial susceptibility factors with PD (genetic or nongenetic).