临床异质性的帕金森病认知障碍分析

目的 评估不同临床亚型的帕金森病(PD)患者的认知功能.方法 基于原发性PD患者的临床表现,采用聚类分析的统计学方法将原发性PD患者(n=106)分为5组,比较不同亚组间的蒙特利尔认知评测量表(MoCA)评测结果.结果 可将患者聚类为5组:早发组(A组,n=35);快速进展组(B组,n=6);震颤为主组(C组,n=36);单纯非震颤组(D组,n=18);非震颤为主-抑郁组(E组,n=11);各组间MoCA得分不同,得分正常与异常比例不同,其中E组得分[(19.00±5.47)分]明显低于A组[(23.66±3.51)分],差异有统计学意义(P＜0.05);E组在画钟表[(1.73±1.01)分与(2.66±0.59)分,t=-2.904,P=0.013]、警觉性[(0.55±0.52)分与(0.91±0.28)分,t=-2.241,P=0.045]、语义流畅性[(0.64±0.51)分与(0.97±0.17)分,t=-3.429,P=0.001]、定向力[(4.91±1.38)分与(5.80±0.47)分,t=-3.321,P=0.020]等方面损害重于A组.结论 PD患者认知功能损害常见,认知功能损害存在异质性.

Assessment of cognitive impairment based on the clinical heterogeneity of idiopathic Parkinson's disease

Objective To assess cognitive impairment of patients with idiopathic Parkinson's disease(PD)of different clinical subgroups. Methods The cluster analysis approach was used to classify PD patients on the basis of their clinical features, and then compare their cognitive function according their Montreal Cognitive Assessment (MoCA)score. Results One-hundred and six patients were divided into 5 groups by means of cluster analysis:A. young-onset(n = 35), B. rapid disease progression(n = 6); C. tremor dominant(n = 36), D. haplo-non-tremor dominant(n =18),E. non-tremor dominant with depression(n = 11). The MoCA score and proportion of abnormal scores differed among the 5 groups significantly,especially between the subgroup E(19.00 ±5.47)and the subgroup A(23. 66 ± 3.51)(P ＜ 0. 05), the former was more seriously impaired in clock drawing task(1.73 ± 1. 01 vs.2. 66 ±0. 59 ,t = -2. 904,P =0. 013), alertness(0. 55 ±0. 52 vs. 0. 91 ±0. 28 ,t = -2. 241 ,P =0. 045),semantic fluency(0. 64 ±0. 51 vs. 0. 97 ±0. 17 ,t = -3. 429,P =0. 001)and orientation domains than the latter(4. 91 ± 1.38 vs. 5.80±0.47,t = -3.321,P =0.020). Conclusions The cognitive impairment in PD patients are common as well as heterogeneous.