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.     

帕金森病患者视空间障碍及其相关因素的分析

目的 探讨帕金森病(PD)患者视空间障碍情况及其与相关因素的关系. 方法 选择自2007年4月至6月在广州6家医院门诊或住院部连续就诊并且同意参与本次调查的PD患者共107例,用复制立方体评估PD患者的视空间能力,并选用Hoehn-Yahr分级、PD统一评分量表第2部分(UPDRS-Ⅱ)、UPDRS-Ⅲ、UPDRS-Ⅴ、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HRSD)、Fuld物体记忆测验(FOM)、言语流畅性测验(RVR)、韦氏成人智力量表积木测验(WAIS-BD)、韦氏成人量表数字广度测验(WAIS-DS)、简易精神状态量表(MMSE)、神经精神科问卷(NPI)、睡眠量表、Epworth嗜睡量表(ESS)、非运动并发症等量表评估PD患者的运动症状、神经精神症状、认知及日常生活能力.用Spearman相关分析分析视空间能力与各相关因素的双变量相关性,用二分类Logistic回归分析视空间障碍与相关因素的关系. 结果 在107例PD患者中有59例(55.14%)出现视空间损害.Spearman相关分析表明,视空间能力与发病年龄、性别、Hoehn-Yahr分级、病程、UPDRS-Ⅱ、UPDRS-Ⅲ、FOM、RVR、WISC-BD、WAIS-DS、焦虑状态、痴呆等相关(P＜0.05).经二分类Logistic回归分析发现.Hoehn-Yahr分级及病程是视空间障碍的危险因素,而RVR及WISC-BD是视空间障碍的保护因素. 结论 PD患者视空间障碍的发生可能与病情分级、病程、语言流畅性、图像识别及构造能力等有关,临床上可以通过改善患者运动症状及训练患者的语言能力、图像识别及构造能力等综合治疗来改善患者的视空间能力.     

基于低频振幅算法静息态磁共振研究帕金森病伴视空间功能障碍患者相关脑区功能的变化

目的 探讨伴视空间功能障碍的帕金森病(Parkinson disease,PD)患者低频振幅(amplitude of low-frequency fluctuations,ALFF)变化特点,以揭示视空间功能障碍相关脑区的神经元活动和可能有关的神经病理学机制.方法 纳入32例帕金森病患者(PD),所有受试者均完成画钟...     

帕金森病患者面孔识别障碍的早期诊断：事件相关电位N170无优势

摘要：背景：认知障碍通常和PD伴随。临床工作者发现和干预PD早期的认知功能损害并且延缓痴呆的发生和恶化是PD治疗的一个十分重要的方面,但是目前缺乏客观和敏感的检测方法。目的 评估轻中度PD患者的认知功能,确定筛查PD认知损害敏感的筛查量表;研究事件相关电位（event-related potential, ERP）N170成分在视空间功能障碍帕金森病（PD）患者中的变化,探讨在PD中代表视空间功能损害的电生理参数和探索视空间损害的认知过程。设计：一个非随机的,对照研究于2008年10月-2009年5月在解放军总医院ERP工作室进行。参加者：50例PD患者,包括32例男性和18例女性,参与此研究。所有受试者均符合英国PD协会脑库的PD临床诊断标准。所有受试者的病程是7.2±3.7年,H-Y分级为1-3级。 方法 所有受试者进行神经心理学量表评估后,被分为2组：视空间功能受损组（group1,n=30）和视空间功能正常组（group2, n=20）。两组在年龄、性别比例和受教育年限上是相匹配的。我们采用面孔学习-再认的实验模式,利用ERP技术,记录10导联脑电数据,测量面孔特异性的N170的成分。此外,正确反应时和正确反应率也被记录。对N170的峰潜伏期和波幅、行为学指标和神经心理学量表评分进行统计学分析。主要的结果测量：所有的脑电数据均是在离线状态下使用ASA3.1软件进行分析。我们使用MATLAB R2006b软件在120-220ms之间,计算最小波幅及其对应的潜伏期来作为N170的波幅和潜伏期。结果 两组间MMSE评分无统计学差异。group1的蒙特利尔认知评估量表（MOCA）评分和视空间测试项目的评分明显低于group2（P<0．05）。group1对需要识别面孔的正确识别率低于group2（P<0．05）,2组间正确反应时间比较无统计学意义。group1仅在T6导联已识别出的面孔诱发N170的波幅高于group2（P<0．05）,在其余各导联分别在2种事件下所诱发N170的波幅及潜伏期两组间比较差异无统计学意义。group1在F7、F8、O1 导联N170潜伏期在两种事件下比较差异有统计学意义（P<0．05）,在T5导联N170的波幅在两种事件下比较差异有统计学意义（P<0．05）,在group1其余导联N170的潜伏期和波幅在在两种事件下比较差异无统计学意义,在group2的所有导联N170的潜伏期和波幅在两种事件下比较差异无统计学意义。结论 蒙特利尔认知评估量表可用于PD患者早期认知损害的评估,面孔再认的实验方法对于检测PD患者视空间能力损害具有临床价值。N170代表面孔识别的结构编码,两组间N170的潜伏期和波幅无统计学差异表明在轻中度PD患者的视空间功能损害发生在非结构编码阶段。在group2中两种事件诱发的N170的潜伏期和波幅存在统计学差异而在group1中却无统计学差异提示PD的视空间功能损害影响面孔的认知。我们可以在面孔学习阶段测量N170的潜伏期和波幅观察其变化或者探索其他的反应视空间功能变化的ERP成分。     

早期帕金森病患者语音性语言工作记忆的特点

目的探讨早期帕金森病(PD)患者语音性语言工作记忆损害及其特点。方法仿制并修订了Smith工作记忆检查软件,对临床确诊的早期PD患者和对照组进行音节性和声调性语言工作记忆检查。结果 PD组(24例)音节性语言工作记忆检查成绩[(92.97±5.70)%]较对照组(24例)成绩[(96.09±3.97)%]明显降低,差异有统计学意义(P0.05)。按音节和声调相同与否进行分层分析结果显示,在同音不同凋时PD患者语言工作记忆成绩明显低于对照组(P0.05),且以右侧肢体起病的PD患者正确率较对照组明显降低(P0.05);PD组(30例)声调性语言工作记忆检查成绩[(72.16±10.85)%]较对照组(30例)成绩[(79.48±9.31)%]显著下降,差异有统计学意义(P0.05)。分层分析结果表明,在同音不同调和同调不同音两种情况下,PD患者语言工作记忆成绩明显低于对照组(P0.05),且以右侧肢体起病的PD患者较对照组明显降低(P0.05)。结论早期PD患者音节及声调性语言工作记忆均受损,音节和声调的语言工作记忆可能由同一神经环路加工。右侧肢体起病的PD患者音节与音调工作记忆受损,提示左侧大脑半球在音节和声调工作记忆处理中起重要作用。     

早期帕金森病患者语言工作记忆特点

目的探讨帕金森病(PD)患者视觉语言工作记忆损害及其特点。方法仿制并修订了Smith工作记忆检查软件,对确诊的PD患者和对照组进行语言工作记忆检查。结果PD组(31例)语义性语言工作记忆检查的成绩(84.8%±9.1%)较对照组(30例)成绩(88.9%±7.2%)低,但差异无统计学意义(t=-1.935,P=0.058),PD组(28例)语音性语言工作记忆检查的成绩(83.6%±7.7%)较对照组(30例)成绩(88.4%±6.2%)显著下降,差异有统计学意义(t=-2.298,P=0.034)。右侧肢体起病的患者语义性(t=-2.075,P=0.044)和语音性(t=-2.593,P=0.013)语言工作记忆的成绩较左侧肢体起病的患者下降,差异有统计学意义。结论早期的PD患者存在语音性语言工作记忆的损害,语义性语言工作记忆相对保留。提示语音和语义性语言工作记忆加工应用不同的神经环路。     

帕金森病记忆功能障碍及机制

帕金森病（Parkinson’s disease，PD）是一种进行性神经退行性疾病。资料显示，有10万加拿大人和0．3％的美国人。患有PD。在我国，PD的发病率为15／10万-119／10万。。PD临床症状以震颤、肌僵直、运动减少及姿势调节障碍为主要特征。但近年来发现，PD患者有逐渐进展的记忆功能下降。测试发现，约有50％的早期PD患者有轻度认知障碍。随着病程的发展，     

帕金森病合并痴呆患者的认知运动障碍及影响因素

目的观察帕金森疾病合并痴呆患者的认知运动等功能障碍及影响因素。方法选取我院2014年6月至2015年10月期间收治的100例帕金森病合并痴呆患者。通过对患者评估运动功能量表(Webster量表)、简易智能评估(MMSE)量表、日常生活能力(ADL)量表和蒙特利尔认知评估(Mo CA)量表,评估帕金森病合并痴呆患者的运动功能、智力水平、日常生活能力及认知功能;并探究认知功能障碍与病程长短、发病年龄、性别、文化程度、运动功能的关系。结果 100例帕金森病痴呆患者的Webster量表评分、Mo CA评分、MMSE评分以及ADL评分与临界值相比,均存在异常。患者的病程、发病年龄、性别可能对患者的认知功能障碍无明显作用;患者的文化程度、运动功能水平与患者的认知功能障碍存在显著的联系,且均为保护因子(OR1)。结论帕金森病合并痴呆患者存在运动功能障碍、智力障碍、日常生活能力障碍等认知及其他功能障碍。患者的文化程度、运动功能与患者的认知功能障碍存在显著的联系,且均为保护因子。     

帕金森病伴发认知功能障碍患者的临床特点及其与睡眠障碍的关系

目的 探讨帕金森病（PD）伴发认知功能障碍（CI）患者的临床特点及睡眠情况。方法 连 续纳入2014 年5 月—2017 年5 月就诊于北京天坛医院的394 例PD患者，按照CI程度将患者分为PD不 伴认知功能障碍（PD-NCI）组（94 例，23.86%）、PD 伴发轻度认知功能障碍（PD-MCI）组（177 例，44.92%） 及PD 伴发痴呆（PDD）组（123 例，31.22%）。收集患者的人口学资料，采用蒙特利尔认知评估（MoCA）量 表评价患者的认知功能，比较3 组患者总体认知功能及各认知领域情况；采用视频多导睡眠图（v-PSG） 评估患者的睡眠状况，并对PD 伴发CI 患者的MoCA 量表总分及各认知领域评分与v-PSG 结果进行相 关性分析。结果 3 组患者性别、起病年龄、受教育水平及病程差异均无统计学意义（P ＞ 0.05）。PDNCI 组、PD-MCI 组和PDD 组MoCA 量表总分依次明显降低，分别为（22.20±4.99）分、（17.17±4.36）分和 （10.73±4.85）分（F=143.146，P＜ 0.01），且MoCA 量表各认知领域评分依次明显降低（P ＜ 0.01）。与PDNCI 组比较，PD-MCI 组总睡眠时间减少，睡眠效率降低，觉醒次数增加（均P＜ 0.05）；与PD-MCI 组比较， PDD 组总睡眠时间减少，睡眠效率降低，觉醒次数增加（均P＜ 0.05）。PD 伴发CI 的患者的睡眠效率与 MoCA 量表总分及视空间功能、执行功能、延迟回忆和注意力评分均呈正相关（P＜ 0.05），觉醒次数与 MoCA 量表总分及延迟回忆和注意力评分均呈负相关（P ＜ 0.05）。结论 PD患者CI发生率较高，伴发 CI 的PD 患者总体认知功能及各认知领域均明显受损，总体睡眠时间减少，睡眠效率降低，觉醒次数增 加，并与总体认知功能及部分认知领域受损有关。     

帕金森病认知障碍的早期识别

认知功能障碍是帕金森病非运动症状的最常见表现之一,特定基因的突变与多态性、血浆及脑脊液中的某些生物标记物以及脑组织及功能改变的影像学表现均可能与帕金森病认知障碍的发生、发展相关.现从遗传学、血浆及脑脊液中的生物标记物以及影像学改变三方面对帕金森病认知障碍早期识别的研究现状及前景作一综述.     

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.     

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.     

帕金森病患者的轻度认知功能障碍

目的评估帕金森病(Parkinson’s disease,PD)患者的认知功能状态,分析帕金森病合并轻度认知功能障碍(Parkinson’s Disease with Mild Cognitive Impairment,PD-MCI)的特点。方法纳入PD患者64例,采用神经心理测试组评估其注意、视空间、执行和记忆等认知域的功能。结果本组PD患者中,认知功能正常24例(37.5%),PD-MCI 30例(46.9%),帕金森病痴呆10例(15.6%)。在PD-MCI患者中,单个认知领域轻度损害(60.0%)较多个认知域型轻度认知损害(40.0%)更常见,累及较多的认知域依次为记忆(20例,66.7%),执行(13例,43.3%),视空间(12例,36.7%)。早期PD患者PD-MCI发生率为36.4%,痴呆发生率为3.0%;中晚期PD患者PD-MCI发生率为58.1%,痴呆发生率达29.0%,两组差异有显著性(χ2=18.222,P<0.001)。PD患者的病情程度与认知功能状态呈负相关(Spearman相关系数=-0.553,P<0.001)。结论轻度认知功能障碍(mild cogni-tive impairment,MCI)在PD患者中常见,即使在疾病早期,其发生率也较高,其中单个认知领域轻度损害较多个认知域型轻度认知损害更常见。PD患者的病情越严重,认知功能状态越差。     

Rapid eye movement sleep behavior disorder in treatment-naïve Parkinson disease patients

Objective

Rapid eye movement (REM) sleep behavior disorder (RBD) is a risk factor for dementia in Parkinson disease (PD) patients. The objectives of our study were to prospectively evaluate the frequency of RBD in a sample of treatment-naïve, newly diagnosed PD patients and compare sleep characteristics and cognition in RBD and non-RBD groups.

Methods

Fifty-seven newly diagnosed PD patients were consecutively recruited in a university medical center. All patients underwent two overnight polysomnography (PSG) sessions and were diagnosed with RBD according to the International Classification of Sleep Disorders, Second Revision criteria. Daytime sleepiness was measured in a multiple sleep latency test (MSLT). Cognition was assessed in a standard neuropsychologic examination.

Results

Seventeen PD patients (30%) met the criteria for RBD. The RBD patients and non-RBD patients did not significantly differ in mean age, gender ratio, disease duration, motor symptom subtype and severity, total sleep time, percentage of REM sleep, apnea–hypopnea index, mean oxygen saturation, and importantly cognitive performance. However, non-RBD patients had a significantly shorter mean daytime sleep latency than RBD patients (15 vs 18 min, respectively; P = .014).

Conclusion

A high frequency of RBD was found in our sample of 57 newly diagnosed PD patients. At this stage in the disease, RBD was not found to be associated with other sleep disorders or cognitive decline. Follow-up is needed to assess the risk for developing dementia in early-stage PD patients with RBD.     

Cognitive impairment is associated with Hoehn and Yahr stages in early,de novo Parkinson disease patients

IntroductionThe relationship between motor impairment and cognitive deterioration has long been described in Parkinson's disease (PD). The aim of the study was to compare cognitive performance of de novo PD patients in relation to the motor impairment severity according to Hoehn and Yahr (HY) stages.MethodsForty de novo PD patients at HY stage I and 40 patients at HY stage II completed a standardized neuropsychological battery. A multivariate analysis of covariance was used to compare cognitive performance between HY groups. Odds ratios (ORs) were employed to explore the risk of cognitive impairment between HY stages. Finally, the prevalence of mild cognitive impairment (MCI) was estimated for patients in HY stage I and II.ResultsPatients at HY stage I obtained better scores on neuropsychological tests than patients at HY stage II (p = 0.001). Univariate analysis of covariance revealed significant differences between HY stages on Rey's auditory verbal learning test -immediate recall (p < 0.0001), 10 points Clock Drawing Test (p = 0.002), and Rey-Osterrieth Complex Figure Test -copy (p < 0.0001). ORs of having cognitive impairment were greater for HY stage II than stage I group. MCI occurred in 7.5% of patients in HY stage I, and in 42.5% of patients in HY stage II.ConclusionIn de novo PD patients, the severity of motor impairment at the diagnosis is associated to cognitive deficits and higher risk of MCI.     

Association between cognition and function in patients with Parkinson disease with and without dementia

Patients with Parkinson's disease (PD) often have cognitive deficits from the time of diagnosis. Except in patients with dementia, the impact of cognitive symptoms on daily function is not well documented. This study had two objectives: (1) to determine the functional significance of cognitive deficits in nondemented patients with PD and (2) to assess the sensitivity of two measures of global cognitive abilities to identify individuals with impaired ADL function. One hundred eleven subjects with PD and a range of cognitive abilities were included. Of these, 20 were diagnosed with PDD. All subjects were assessed with the Mattis Dementia Rating Scale to two (DRS‐2) and the Mini‐Mental State Examination (MMSE). ADL function was reported by an informant using the Alzheimer's Disease Cooperative Study Activities of Daily Living Inventory (ADCS‐ADL). The ability of the DRS‐2 and MMSE to capture the impact of cognitive impairment on ADL function was assessed in the entire cohort and in subsets of nondemented individuals. After adjustment for covariates, cognition as measured by the DRS‐2 was strongly related to ADL function in the entire cohort (partial correlation coefficient = 0.55, P < 0.001). The association remained strong when only nondemented subjects were included (r = 0.42, P < 0.001). The DRS‐2 was significantly more accurate than the MMSE, particularly for detecting milder degrees of ADL impairment (ROC area = 0.87 vs. 0.75, P = 0.0008). Cognition is associated with impairment in ADL function, even in nondemented patients with PD. However, sensitive cognitive assessment measures may be needed to identify these functionally relevant impairments. © 2010 Movement Disorder Society     

帕金森病患者线粒体功能缺陷的研究

目的　探讨帕金森病 (PD)患者线粒体功能缺陷类型及其基因突变基础。方法　用溴化乙啶抑制人食管癌细胞系的线粒体DNA复制 ,制备出无线粒体DNA细胞系。将 2 0例PD患者组及2 0名正常对照组血小板与之融合 ,用选择性培养液挑选出融合细胞 ,大量培养后用极谱法测定线粒体酶复合体活性及抗氰呼吸。结果　以苹果酸和谷氨酸为底物时患者组 ( 1.2 5± 0 .0 8)明显低于正常对照组 ( 1.75± 0 .0 8) ,降低 2 8.6% ;以琥珀酸、维生素C和TMPD为底物时患者组与正常对照组差别无统计学意义。这些结果表明 ,线粒体酶复合体II～Ⅴ活性正常 ,以苹果酸和谷氨酸为底物的氧耗率的降低来源于酶复合体I活性受损。由于融合细胞核背景一致 ,其线粒体功能仅受mtDNA影响 ,因此本试验发现的患者酶复合体I缺陷来源于mtDNA的突变。抗氰呼吸PD患者组平均为 ( 8.76±0 .2 5 ) % ,正常对照组平均为 ( 6.2 0± 0 .10 ) % ,差异有显著意义 (P <0 .0 5 )。结论　PD患者线粒体酶复合体I活性降低 ,来源于线粒体DNA突变 ,可能导致自由基增多 ,在PD神经元变性中起重要作用。     

Evaluation of mild cognitive impairment subtypes in Parkinson's disease

Mild cognitive impairment in Parkinson's disease (PD‐MCI) is common and increases the risk for dementia. Establishing distinct PD‐MCI cognitive subtypes could be valuable for eventually predicting those most likely to convert to dementia. However, the study of PD‐MCI subtypes has not yielded consistent results among cohorts. To determine whether there are distinct cognitive subtypes among participants diagnosed with PD‐MCI in the Pacific Northwest Udall Center Clinical Consortium, we cognitively subtyped 95 patients with PD‐MCI, using the Movement Disorders Society Task Force diagnostic guidelines. Psychometric test scores were then subjected to principle components factor analysis to determine whether similar cognitive subgroups could be identified using statistical methodology. Multiple‐domain PD‐MCI was diagnosed in 95% of the sample, and a range of cognitive impairments were noted. Factor analysis yielded seven factors and demonstrated overlap of phonemic verbal fluency on two factors, as well as the loading of verbal fluency on the same factor as a visuospatial measure; however, these factors did not partition the sample into distinct cognitive subtypes. Separation of cognitive subtypes based on the current PD‐MCI criteria, or via statistical methods, may not provide sufficient information to describe distinct PD groups. Future efforts to validate the PD‐MCI criteria and identify combinations of genetic or other risk factors for cognitive impairment are warranted. © 2014 International Parkinson and Movement Disorder Society