帕金森病患者快速眼球运动睡眠行为障碍临床特征及相关因素

目的分析伴快速眼球运动睡眠行为障碍(REM sleep behavior disorder,RBD)帕金森病(Parkinson’s disease,PD)患者的临床特征,探讨RBD的相关因素。方法连续入组PD患者63例,根据REM睡眠行为异常问卷-香港版(RBDQ-HK)分为PD+RBD组(n=28)和PD-RBD组(n=35)。采用统一帕金森病评定量表(UPDRS)、HoehnYahr(H-Y)分级比较两组运动症状严重程度;采用非运动症状问卷(NMS±quest)比较非运动症状发生情况;采用蒙特利尔认知评估(MOCA)、贝克焦虑量表(BAI)、贝克抑郁量表(BDI)、Epworth嗜睡评分量表(ESS)比较认知、焦虑、抑郁和日间思睡等情况。结果 PD患者中RBD发生率为44.4%(28/63),PD+RBD组病程显著长于PD-RBD组(χ~2=12.733,P=0.002),年龄更大(t=-2.292,P=0.025),H-Y分级更高(χ~2=7.014,P=0.008),但在性别、发病年龄、起病类型、左旋多巴等效剂量上两组差异无统计学意义;在运动症状方面,PD+RBD组UPDRSⅡ、Ⅲ评分更高(t=-2.734,P=0.008;U=3.329,P=0.001);在非运动症状方面,PD+RBD组胃肠道功能及睡眠障碍、精神相关症状等方面发生率均显著高于PD-RBD组(P0.05),焦虑及抑郁在PD+RBD组中更常见(χ~2=3.958,P=0.047;χ~2=10.338,P=0.001),但在认知功能、日间思睡上两组差异无统计学意义。此外,便秘(OR=7.257)、长病程(OR=5.389)、高UPDRSⅢ评分(OR=1.060)与PD患者RBD相关。结论病程更长、年龄更大、运动症状及非运动症状受累更严重的PD患者易伴发RBD。便秘、长病程、高UPDRSⅢ评分可能是RBD的危险因素。     

帕金森病患者运动症状进展及运动并发症危险因素纵向分析

目的 观察帕金森病(Prkinson’s disease,PD)患者运动症状的进展及运动并发症的发生情况,探讨运动症状的进展速度及运动并发症发生的危险因素.方法 随访2007年在新华医院神经内科确诊的PD患者130例,随访时间为3年.采用统一PD评分量表(UPDRS)和H-Y分级评估及随访130例患者运动症状进展及运动并发症发生情况,统计并分析运动症状的进展速度及运动并发症发生的危险因素.结果 (1)PD患者H-Y分级平均年增长2.5％,UPDRSⅢ分数平均年增长3.1％;随访末患者吞咽困难发生率较基线增加23.0％;跌倒发生率增加16.7％;(2)异动症的独立危险因素为:随访末左旋多巴的剂量(OR=1.004,95％ CI 1.001 -1.006,P=0.008);症状波动的独立危险因素为:病程(OR=1.637,95％ CI l.083 -2.473,P=0.019),左旋多巴用药时间(OR =0.698,95％ CI0.494～0.987,P =0.042),入组时(OR=1.005,95％ CI 1.001～1.010,P=0.016)及随访末左旋多巴剂量( OR=1.014,95％ CI1.001～ 1.027,P =0.032).结论 随病程进展,PD患者的运动症状逐渐加重,吞咽困难和跌倒的发生率上升,运动并发症的发生率增加.左旋多巴的暴露总量是PD患者出现运动并发症的预测因素.     

帕金森病与多系统萎缩-帕金森症型快速眼球运动睡眠行为障碍的比较研究

目的比较快速眼球运动睡眠行为障碍(rapid eye movement sleep behavior disorder,RBD)在帕金森病(Parkinson’s disease,PD)与多系统萎缩帕金森症型(multiple system atrophy parkinsonism type,MSA-P)前驱期及临床期发生率的不同,并探讨快速眼球运动睡眠行为障碍筛查问卷(Rapid eye movement sleep behavior disorder screening questionare,RBDSQ)评分的相关性因素。方法连续纳入发病5 y之内,无认知功能障碍的PD患者34例,MSA-P患者30例,详细收集其基线资料,对两组患者进行UPDRSⅢ评分、H-Y分期评分及RBDSQ评分,比较两组间RBD的发生率的差异,以及RBDSQ得分的相关性因素。结果 RBD在MSA-P前驱期的发生率(40.0%)显著高于其在PD前驱期的发生率(2.9%,χ~2=11.330,P=0.001),RBD在MSA-P临床期的发生率(63.3%)显著高于其中PD临床期的发生率(29.4%,χ~2=7.401,P=0.007),MSA-P患者RBDSQ评分显著高于PD患者RBDSQ评分(6.6±3.9 vs.4.7±3.4,Z=-2.084,P=0.037)。PD及MSA-P RBDSQ得分与病程、UPDRSⅢ评分、MMSE评分及疾病进展率等均无明确相关性。结论与PD组相比,MSA-P组前驱期及临床期RBD发生率均显著增高。认知功能正常的PD及MSA-P患者,RBDSQ评分与运动评分及认知功能评分无明确相关性。     

伴有快动眼睡眠行为障碍帕金森患者的震颤特征及多巴反应性

目的研究伴与不伴快动眼睡眠行为障碍(rapid eye movement sleep behavior disorder,RBD)的帕金森病(Parkinson disease,PD)患者的震颤特征及多巴反应性。方法根据2014年国际睡眠障碍分类第三版RBD的临床最低诊断标准,本研究采用RBD筛查问卷(RBD screening questionnaire,RBDSQ)量表来诊断临床很可能RBD(clinically probable RBD,cpRBD),将PD患者分为伴有cpRBD的PD(PD+cpRBD)与不伴有cpRBD的PD(PD-cpRBD)两组。对入组患者进行一般资料的收集,采用修订的H-Y分级、统一帕金森评分量表3.0版运动检查部分(UPDRS-Ⅲ)、MDS-UPDRS震颤量表对患者的运动功能进行评估,并且分别对两组患者首发侧肢体姿势性震颤、动作性震颤及静止性震颤的幅度进行评分,比较两组患者一般资料及震颤特征的差异性。对所有患者行急性左旋多巴冲击试验,将两组患者UPDRS-Ⅲ及MDS-UPDRS震颤量表评分最大改善率进行比较。结果共纳入42例伴有震颤的PD患者,PD+cpRBD组19例,PD-cpRBD组共23例,两组患者在性别、年龄、发病年龄、病程、关期UPDRS-Ⅲ评分及H-Y分级方面均无明显差异(P0.05)。与PD-cpRBD组相比,PD+cpRBD组关期震颤评分明显增高(t=2.379,P=0.022),震颤症状由首发侧肢体进展至对侧肢体的时间短(u=-2.133,P=0.033),首发侧肢体静止性震颤幅度大(u=-2.956,P=0.003),动作性震颤幅度大(u=-2.657,P=0.008)。口服左旋多巴/苄丝肼(200/50 mg)后,PD-cpRBD组的UPDRS-Ⅲ及震颤评分最大改善率均明显高于PD+cpRBD组(UPDRS-Ⅲ最大改善率u=-3.134,P=0.002;震颤评分最大改善率t=-3.189,P=0.003)。结论本研究表明,伴有cpRBD的PD患者震颤程度相对较重,以静止性震颤和动作性震颤为主,由首发侧肢体进展至对侧肢体的时间相对较短,对左旋多巴的反应性较差。     

帕金森病患者睡眠障碍情况3年半随访研究

目的随访观察帕金森病(PD)患者睡眠障碍情况的发生、发展及变化及相关因素。方法应用PD睡眠量表(PDSS)、统一PD评定量表第Ⅱ、Ⅲ部分(UPDRSⅡ、Ⅲ)、PD非运动症状(NMS)筛查问卷(NMSQ)、汉密尔顿抑郁及焦虑量表(HAMD及HAMA)、MMSE和蒙特利尔认知测验(Mo CA)等量表,在基线和3年半随访末对106例原发性PD患者的睡眠情况、日常生活能力、运动症状、抑郁、焦虑情绪及认知能力等方面进行评估,同时计算患者每日左旋多巴等效剂量(LED)。结果与基线(124.18±14.31)比较,患者PDSS总分在随访末(113.90±23.98)时明显下降(P0.001),其中梦境困扰、夜尿及白天过度嗜睡均明显降低(均P0.01)。随着疾病进展,PD患者睡眠障碍发生率在随访末时(77.08%)较基线时(53.77%)明显上升(P=0.001),失眠(包括入睡困难及保持睡眠困难)、肢体不安及不宁腿、梦境困扰、夜尿、白天过度嗜睡、震颤、肌肉痛性痉挛在随访中均明显升高(均P0.05)。多元线性回归分析显示,PD患者睡眠障碍与其年龄、UPDRSⅡ及Ⅲ、NMS、HAMD及HAMA评分和每日LED相关,而与MMSE、MOCA评分及病程长短等无关。结论PD患者睡眠障碍发生率高、表现类型多样,随着年龄增长、疾病进展逐渐加重,合并较多NMS、日常生活能力及运动症状严重及伴有抑郁、焦虑情绪的患者多存在睡眠障碍。     

帕金森病患者的非运动症状三年随访

目的 随访观察帕金森病(PD)非运动症状的发生、发展及变化情况,研究其对患者生活质量的影响.方法 应用统一PD评分量表(UPDRS)第Ⅲ部分和第Ⅳ部分、PD非运动症状30问卷、PD生活质量问卷(PDQ-39)等量表,在基线和3年随访末对87例原发性PD患者进行评估,采用配对t检验、卡方检验、Spearman等级相关分析及分层回归分析等对各项数据进行统计.结果 随着疾病的进展,基线和3年随访末比较,患者的UPDRSⅢ评分由(22.21±11.31)分升至(30.49±11.68)分、UPDRSⅣ评分从(1.00±1.54)分到(2.94±3.12)分,非运动症状评分由(7.98±3.96)分至(12.35±5.12)分,PDQ-39评分由(28.11±22.88)分升至(36.65±26.95)分,均明显升高(t=-5.54、-5.75、-6.46、-5.29,均P=0.000).运动症状与非运动症状的加重均对生活质量的下降有影响.发生率较高的非运动症状如便秘、记忆障碍、夜尿等症状和发生率居中的抑郁焦虑症状在疾病早期就持续存在,而疼痛、多汗等非特异性症状(△R2=21.6％),流涎、排便不尽感等消化系统症状(△R2=23.4％)在随访过程中发生率明显上升,是导致随访中生活质量下降的主要原因.结论 PD非运动症状在疾病早期就出现,随着病程延长无论运动还是非运动症状均加重,生活质量下降.     

阻塞性睡眠呼吸暂停及快动眼睡眠期行为障碍对帕金森病患者认知功能的影响

目的观察伴阻塞性睡眠呼吸暂停(OSA)及快动眼睡眠期行为障碍(RBD)对帕金森病(PD)患者认知功能的影响。方法收集101例PD患者的临床资料,采用MMSE、蒙特利尔认知评估量表(MoCA)北京版评定患者认知功能,并对患者进行整夜多导睡眠监测(PSG)并对相关结果进行比较。结果根据PSG监测结果,将患者分为对照组34例、OSA组18例、RBD组34例及OSA+RBD组15例。与对照组比较,RBD组及OSA+RBD组MoCA评分显著降低(均P0.05)。与OSA+RBD组比较,RBD组体质量指数及PD组Epworth嗜睡量表评分显著降低,RBD组慢波睡眠比例显著升高(均P0.05)。与OSA组及OSA+RBD组比较,对照组及RBD组呼吸暂停低通气指数及氧减指数显著降低,最低脉搏氧饱和度显著升高(均P0.05);OSA组的觉醒次数较其他三组显著升高(均P0.05)。在相关分析中,PD患者的MoCA评分与RBD(r=0.324,P=0.001)、总睡眠时间(r=0.212,P=0.035)、睡眠效率(r=0.272,P=0.006)、非快速眼动睡眠2期时间(r=0.257,P=0.010)呈正相关。结论认知功能障碍在伴RBD的PD患者中很常见。PD患者认知功能与睡眠效率、总睡眠时间、非快速眼动睡眠2期时间及RBD显著相关。     

帕金森病两种常见睡眠障碍关联性研究

研究背景阻塞性睡眠呼吸暂停低通气综合征(OSAHS)和快速眼动睡眠期行为障碍(RBD)是帕金森病(PD)两种常见睡眠障碍,本研究探讨帕金森病合并两种睡眠障碍的临床特点和睡眠参数变化,以及二者之间相互作用机制。方法采用统一帕金森病评价量表(UPDRS)、简易智能状态检查量表(MMSE)和蒙特利尔认知评价量表(MoCA)中文版、Epworth嗜睡量表(ESS)和匹兹堡睡眠质量指数(PSQI)、非运动症状问卷(NMSQuest)、帕金森病预后量表-自主神经功能部分(SCOPA-AUT)、39项帕金森病调查表(PDQ-39)和Hoehn-Yahr分期评价190例帕金森病患者运动症状、非运动症状(认知功能、睡眠质量、自主神经功能等)和病情严重程度,并行多导睡眠图监测记录睡眠参数。结果共73例合并阻塞性睡眠呼吸暂停低通气综合征患者,其中22例同时发生快速眼动睡眠期行为障碍(PD+OSAHS+RBD组),51例不发生快速眼动睡眠期行为障碍(PD+OSAHS-RBD组)。PD+OSAHS+RBD组患者UPDRSⅠ评分(P=0.015)、UPDRSⅡ评分(P=0.023)、ESS评分(P=0.002)、PSQI评分(P=0.048)、NMSQuest评分(P=0.001)和SCOPA-AUT评分(P=0.026),以及平均动脉血氧饱和度(P=0.029)、最低动脉血氧饱和度(P=0.001)、快速眼动睡眠期最低动脉血氧饱和度(P=0.000)、快速眼动睡眠期紧张性(P=0.000)和时相性(P=0.000)下颏肌电活动均高于PD+OSAHS-RBD组,而MoCA评分低于PD+OSAHS-RBD组(P=0.013)。相关分析显示,呼吸暂停低通气指数和氧减指数与NMSQuest(r_s=0.252,P=0.032;r_s=0.229,P=0.010)、SCOPA-AUT(r_s=0.322,P=0.005;r_s=0.247,P=0.037)和PDQ-39(r_s=0.340,P=0.004;r_s=0.269,P=0.023)评分呈正相关关系。结论帕金森病同时合并阻塞性睡眠呼吸暂停低通气综合征和快速眼动睡眠期行为障碍的患者认知功能障碍、日间嗜睡程度、自主神经功能障碍等非运动症状更加严重。尽管发生快速眼动睡眠期行为障碍的患者夜间动脉血氧饱和度较高,但并不能显著改善帕金森病合并阻塞性睡眠呼吸暂停低通气综合征患者总体缺氧症状。     

伴快速眼动睡眠行为障碍帕金森病患者临床特点及自主神经功能障碍变化

目的探讨伴快速眼动睡眠行为障碍(RBD)帕金森病(PD)患者的临床特点,及自主神经功能变化。方法收集2016年2月至2018年2月就诊于河北医科大学第一医院神经内科的102例PD患者。根据病史及多导睡眠图(PSG)结果将患者分为PD伴RBD组和PD不伴RBD组。比较两组患者统一帕金森病评定量表第3部分(UPDRS-Ⅲ)、Hochn-Yahr(H-Y)分级、汉密尔顿焦虑量表14项(HAMA-14)和汉密尔顿抑郁量表24项(HAMD-24)、匹兹堡睡眠指数量表(PSQI)、简易智能精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)、自主神经症状量表(SCOPA-AUT)、皮肤交感反应(SSR)检测的差别。结果 102例PD患者中PD伴RBD组54例,PD不伴RBD组48例。与PD不伴RBD组相比,PD伴RBD组病程明显延长,H-Y分级、UPDRS-Ⅲ、HAMA-14、HAMD-24、PSQI评分明显增高(均P0. 05),MoCA总评分、视空间与执行功能、语言功能评分均降低(均P0. 05)。PD伴RBD组SCOPA-AUT量表总分及消化、泌尿、心血管、体温调节系统得分较PD不伴RBD组增高(均P0. 05),PD伴RBD组SSR异常率高于PD不伴RBD组(85. 2%比62. 5%,P0. 05),潜伏期延长[中位数(四分位数间距):1. 35(0. 46)s比1. 27(0. 15)s,P0. 05],波幅下降[中位数(四分位数间距):1. 34(2. 21)mV比2. 87(0. 97)mV,P0. 05]。PD伴RBD组出现自主神经功能障碍的风险更高(OR=3. 450,95%CI:1. 332～8. 933)。结论伴RBD的PD患者病程长,运动症状和情绪、睡眠、认知功能、自主神经功能方面的非运动症状均较不伴RBD的PD患者更为明显,PD伴有RBD者出现自主神经功能障碍的风险更高。     

伴快速眼球运动睡眠行为障碍的帕金森病患者临床特征

目的 评价快速眼球运动睡眠行为障碍(RBD)在帕金森病(PD)患者中的患病率以及伴发RBD的PD患者临床特征.方法 2007年连续入组124例PD患者,采用非运动症状问卷(NMSquest)第25项问答结果调查PD患者中RBD患病率;将入选患者分为RBD组(78例)和非RBD组(13例),采用统一PD评分量表(UPDRS)、Hoehn-Yahr(H-Y)分级比较2组运动症状严重程度和运动并发症发生情况;选用NMSquest量表比较2组非运动症状发生情况,选用MMSE、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、帕金森病睡眠量表(PDSS)和Epworth嗜睡量表(ESS)比较2组认知功能、焦虑和抑郁、夜间睡眠障碍和日间思睡程度.结果 (1)RBD的患病率为62.9%(78/124);(2)RBD组患者的病程[(3.8±2.8)年]显著短于非RBD组[(5.0±2.5)年,t=-1.972,P=0.048],但在性别、年龄、起病年龄、发病类型、左旋多巴等效剂量(LDE)和用药种类上2组差异没有统计学意义;(3)在运动症状中RBD与非RBD组在H-Y分级、UPDRS-Ⅱ、Ⅲ、Ⅳ评分以及运动并发症发生率方面差异无统计学意义;(4)在非运动症状中胃肠道功能、自主神经系统功能、精神和睡眠活动等方面的不良症状在RBD组的发生率显著高于非RBD组,但是认知、焦虑和抑郁、夜间睡眠障碍和日间思睡的严重程度在2组间差异没有统计学意义.结论 RBD在PD患者中的患病率较高,伴发RBD的PD患者病程较短且非运动系统受累更加广泛.     

Factors related to clinically probable REM sleep behavior disorder in Parkinson disease

Rapid eye movement sleep behavior disorder (RBD) is commonly accompanied in Parkinson disease (PD). However, the underlying mechanism linking RBD to PD remains unclear. We interviewed and examined 447 consecutive patients with PD to investigate factors associated with the presence of RBD in PD patients. Using the minimal diagnostic criteria for parasomnias provided in the International Classification of Sleep Disorders-Revised (ICSD-R), 164 patients (36.5%) were diagnosed with clinically probable RBD (cpRBD). PD patients with cpRBD were older, had a longer duration of PD, a more severe level of disability, a longer duration of antiparkinsonian medication, and a lower proportion of their Unified Parkinson Disease Rating Scale (UPDRS) scores accounted for by tremor than those without RBD. Multivariate and univariate logistic regression analyses revealed that patient age, PD symptom duration (and, accordingly, more severe motor disability), tremor score, and proportion of the UPDRS score accounted for by tremor were significant factors associated with the presence of RBD in PD patients. The results of the present study support previous observations that PD with RBD may result from a different underlying pattern of neurodegeneration than PD without RBD.     

早期帕金森病患者快速眼动睡眠期行为障碍研究

目的探讨早期帕金森病患者快速眼动睡眠期行为障碍发生情况,以及帕金森病运动症状、非运动症状和快速眼动睡眠期行为障碍特点。方法共60例原发性帕金森病患者,采用统一帕金森病评价量表第二和第三部分(UPDRSⅡ和UPDRSⅢ)以及Hoehn-Yahr分期评价帕金森病非运动症状和运动症状,蒙特利尔认知评价量表评价认知功能,汉密尔顿焦虑量表和汉密尔顿抑郁量表评价焦虑和抑郁症状;中文版快速眼动睡眠期行为障碍筛查量表判断是否伴快速眼动睡眠期行为障碍,Epworth嗜睡量表(ESS)评价白天过度嗜睡程度;多导睡眠图监测睡眠障碍特征,包括下颌位相性肌电活动密度和快速眼动睡眠期肌肉失弛缓。结果 60例帕金森病患者中42例(70%)伴快速眼动睡眠期行为障碍(PD+RBD组),多导睡眠图监测其异常行为主要表现为上肢伸展抓握、肢体震颤抽搐、发笑、喊叫和怒骂等非暴力动作,仅2例出现暴力击打、蹬踢等异常行为。PD+RBD组患者年龄(P=0.024)、病程8年比例(P=0.000)、UPDRSⅡ(P=0.005)和UPDRSⅢ(P=0.001)评分、Hoehn-Yahr分期2级比例(P=0.007)、焦虑障碍(P=0.044)和抑郁障碍(P=0.001)比例,以及下颌位相性肌电活动密度(P=0.000)和快速眼动睡眠期肌肉失弛缓比例(P=0.000)均高于对照组,其中,PD+RBD组有16例(38.10%)快速眼动睡眠期行为障碍症状早于帕金森样症状5.20(3.91,6.51)年。结论年龄大、病程长、运动症状和非运动症状严重的帕金森病患者易伴发快速眼动睡眠期行为障碍,快速眼动睡眠期行为障碍可能是帕金森病的早期表现。多导睡眠图监测对早期帕金森病伴快速眼动睡眠期行为障碍的诊断有重要参考价值。     

血管性帕金森综合征与帕金森病认知功能的比较

目的 比较血管性帕金森综合征(vascular parkinsonism,VaP)和帕金森病(Parkinson's disease,PD)患者的认知功能特点.方法 回顾性纳入2018年1月-2020年12月于华北理工大学附属医院首次就诊的VaP患者和PD患者.采用MMSE和MoCA量表评估PD患者和VaP患者的认知功...     

Polysomnographic predictors of sleep,motor and cognitive dysfunction progression in Parkinson's disease: a longitudinal study

ObjectiveTo assess the predictive value of polysomnographic (PSG) data in the prospective assessment of cognitive, motor, daytime and nighttime sleep dysfunction in Parkinson's Disease (PD) patients.MethodsPD patients were assessed at baseline with video-PSG and with cognitive (MoCA), Sleep (SCOPA-Sleep Nighttime and Daytime scores) and Motor (UPDRSIII) function scales at both baseline and four years later. Linear regression analysis was used to assess the relation between PSG variables at baseline and change in symptoms scores.ResultsWe included a total of 25 patients, 12 with rapid eye movement (REM) sleep behavior disorder (RBD) (in 8 PSG was inconclusive, due to lack of REM sleep). MoCA scores decreased significantly at follow-up, while SCOPA-Sleep Daytime and SCOPA-Sleep Nighttime and UPDRSIII did not vary. Lower N3 percentage at baseline was significantly associated with MoCA decrease. Higher Periodic Limb Movements in Sleep index (PLMS) and the presence of RBD were significantly associated with SCOPA daytime score increase. Higher global severity of RBD, tonic RSWA and total number of motor events during REM sleep were associated with SCOPA Nighttime score increase.ConclusionsThe present work suggests that PSG data could be useful for predicting PD cognitive and sleep dysfunction progression. Reduced SWS could predict deterioration of cognitive function, while baseline PLMS could be useful to predict worsening of daytime sleep dysfunction. Severity of RBD could be used for estimating nighttime sleep symptoms progression.     

Cardiac sympathetic index identifies patients with Parkinson's disease and REM behavior disorder

ObjectiveTo compare circadian autonomic fluctuations in patients with Parkinson's Disease (PD) with or without REM sleep behavior disorder (RBD) by using heart rate variability (HRV) analysis.MethodsThis is a case-control study including 20 PD patients with RBD (PD-RBD) and 20 PD patients without RBD (PD). In all patients, we measured the components of HRV in the frequency domain during 24-h with daytime and night time recordings. Selected variables considered were low-frequency (LF) influenced by the sympathetic system and high-frequency (HF) influenced by the parasympathetic system. Moreover, we calculated night-to-day ratio for both LF (cardiac sympathetic index) and HF (cardiac parasympathetic index) spectral components. Video-polysomnography was performed in all patients to diagnose RBD.ResultsBoth nocturnal LF and HF spectral power values were significantly higher in PD-RBD patients than in PD patients (P < 0.001 and P = 0.004 respectively). Moreover, in PD-RBD patients LF and HF values were higher at night than during the day while no difference between night time and daytime values was observed in patients with PD. Cardiac sympathetic index value was significantly higher in PD-RBD patients (median 1.83, range 1.65–3.66) than in PD patients (median 0.93, range 0.44–1.3) without overlap of individual values between groups (accuracy 100%). By contrast, cardiac parasympathetic index had sensitivity of 45% and specificity of 100% for differentiating between PD groups.ConclusionsCardiac sympathetic index distinguishes PD-RBD patients from those with PD on an individual basis, thus representing a valid help in everyday clinical practice for screening of RBD in PD patients.     

Functional evaluation of central cholinergic circuits in patients with Parkinson’s disease and REM sleep behavior disorder: a TMS study

Central cholinergic dysfunction has been reported in patients with Parkinson?s disease (PD) and hallucinations by evaluating short latency afferent inhibition (SAI), a transcranial magnetic stimulation protocol which gives the possibility to test an inhibitory cholinergic circuit in the human brain. REM sleep behavior disorder (RBD) was also found to be associated with cognitive impairment in PD patients. The objective of the study was to assess the cholinergic function, as measured by SAI, in PD patients with RBD (PD-RBD) and PD patients without RBD (PD-nRBD). We applied the SAI technique in 10 PD-RBD patients, in 13 PD-nRBD patients and in 15 age-matched normal controls. All PD patients and control subjects also underwent a comprehensive battery of neuropsychological tests. Mean SAI was significantly reduced in PD-RBD patients when compared with PD-nRBD patients and controls. Neuropsychological examination showed mild cognitive impairment in 9 out of the 10 PD-RBD patients, and in 5 out of the 13 PD-nRBD. SAI values correlated positively with neuropsychological tests measuring episodic verbal memory, executive functions, visuoconstructional and visuoperceptual abilities. Similar to that previously reported in the idiopathic form of RBD, SAI abnormalities suggest a cholinergic dysfunction in PD patients who develop cognitive impairment, and present findings indicate that RBD is an important determinant of MCI in PD.     

蒙特利尔认知评估量表在帕金森病认知障碍患者中的应用价值

目的 分析蒙特利尔认知评估(MoCA)量表(中文版)在筛查帕金森病(PD)患者中认知障碍的应用价值.方法 使用RoSA编制的,根据年龄及教育程度调整的MMSE分界值筛出整体认知功能正常的213例PD患者,并进一步使用MoCA量表对其进行分组,MoCA评分≥26分的PD患者入PD认知正常组(PD-NC组),MoCA评分<26分的PD患者入PD认知损害组(PD-CI组).比较2组患者MoCA各分测验分数的差异及认知功能改变的特点,并应用单因素及多元Logistic回归分析PD患者认知损害的影响因素.结果 (1)PD组患者中52.6%(112/213)的患者MoCA评分<26分;(2)与PD-NC组比较,PD-CI组在MoCA视空间和执行、命名、注意力、语言、抽象、延迟回忆、定向分测验中得分诸项比较均有统计学意义;(3)Logistic回归分析结果显示,低文化程度是PD患者认知损害的影响因素(OR:0.72,95%CI0.64～0.81,P<0.05).结论 MMSE正常者中仍然存在相当比例的患者MoCA评分异常.因此,临床上建议使用MoCA对PD患者认知水平进行测试,在患者未达到PD痴呆时,应结合患者的教育水平及时发现并处理患者认知损害症状,使PD患者得到及时治疗并能提高生活质量.

Abstract：

Objective To examine the application of Montreal Cognitive Assessment (MoCA) in Parkinson' s disease (PD) patients with normal general cognitive function by Mini-Mental State Examination (MMSE) evaluation.Methods PD patients were examined with MMSE, and those having a normal ageand education-adjusted MMSE score were included in the further study of MoCA testing.The patients with MoCA score not less than 26 were selected into normal control PD-NC group, and the patients with less than 26 into cognitive impaired PD-CI group.Scores of MoCA subtests were used in PD-CI group and PD-NC group to characterize cognitive changes in PD patients with mild cognitive impairment (MCI).MoCA score in PD-CI group used as dependent variable, and sex, educational level, age, course of disease, Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA), Self-rating depression Scale (SDS), Self-rating Anxiety Scale (SAS) and Unified Parkinson' s Disease Rating Scale (UPDRS) were used as independent variable, the risk factors of CI in PD patients was analysed by Linear Regression Analysis.Results There are 52.6% (112/213) PD patients with MMSE ≥ 26 while their MoCA < 26.Significant differences were observed in subtests of MoCA in visuospatial, executive, naming, attention,language, abstract, delayed recall and orientation between PD-CI group and PD-NC group (all P <0.01).Univariate and multivariate regression analysis showed that educational level is the most significant factor in PD-CI (OR:0.72, 95% CI 0.64-0.81, P < 0.05).Conclusions There is a high proportion of PD patients whose MMSE test showed normal but MoCA test showed cognitive impairment.MoCA examination was used to detect cognitive function of PD patients.Furthermore we suggest consider the education level in PD patients when evaluate their cognitive function.