帕金森病患者轻度认知损害的特点及影响因素

目的：调查帕金森病（PD）患者轻度认知损害的发生率，分析帕金森病伴有轻度认知损害（MCI，即PD-MCI）的特点及影响因素。方法：应用根据年龄及教育程度调整的MMSE量表分界值筛选出整体认知功能正常的非痴呆PD患者112例，应用蒙特利尔认知评估（MoCA）量表评价认知功能，MoCA评分≥26分者入PD认知正常组（PD-NC组），〈26分者入PD轻度认知损害组（PD-MCI组），统计分析PD-MCI的发生率及其相关影响因素。同时选取55岁以上无明显躯体疾病的体检者115名作为对照组，MocA评分后分为对照认知正常组（C-NC组）及对照轻度认知损害组（C-MCI组），比较PD-MCI组与C-MCI组MoCA各因素评分的差异及认知功能改变的特点。结果：PD组MCI发生率为55．4％（62／112），对照组MCI发生率为27．8％（32／115），差异有统计学意义（X^2=17．73，P〈0．05）。PD-MCI组MoCA视空间和执行、注意力、定向分测验得分均低于C-MCI组，差异有统计学意义（P〈0．05）。单因素及Logistic回归分析显示统一帕金森评分量表Ⅲ得分越高，H-Y分级越大，HAMD分值越高则PD-MCI的发生率越高。结论：轻度认知损害在PD患者中较常见，主要表现为视空间和执行、注意力、定向等方面减退，且与运动障碍严重程度、抑郁相关。

The Characteristics and Influencing Factors of Parkinson's Disease with Mild Cognitive Impairment

Objective：To investigate the frequency of mild cognitive impairment in patients with Parkinson＇s disease （PD） and healthy controls over 55 years of age without dementia and to analyze the characteristics and influencing factors of PD with mild cognitive impairment. Methods：One hundred and twelve PD patients having a normal age and education adjusted MMSE score were included in the further study of MoCA testing. Patients with MoCA score no less than 26 were selected into normal control PD-NC group,and patients with MoCA score less than 26 into mild cognitive impaired PD-MCI group. The frequency and influencing factors of PD-MCI were statistically ana- lyzed. One hundred and fifteen healthy subjects over the age of 55 without dementia were selected as control group,which divided into normal control C-NC group and mild cognitive impaired C-MCI group by MoCA testing. Scores of MoCA subtests were used in PD-MCI group and C-MCI group to compare the difference and characterize of cognitive changes. Results：The incidence of MCI in PD-MCI group was 55.4%（62/112） and 27.8%（32/115） in C-MCI group,with a significant difference between these 2 groups （X^2=17.73,P〈0.05）. PD-MCI patients had lower scores in subtests of MoCA in visuospatial, executive,attention and orientation compared with C-MCI patients （P〈 0.05）. Univariate and logistic regression analysis revealed that a high frequency of PD-MCI occurred in patients with high UPDRS Ⅲ seore,H-Y stage,and HAMD score. Conclusion：MCI is common in patients with PD,and the main cognitive deficits involve visuospatial,executive,attention, and orientation,which is associated with severity of motor disturbances and depression.