帕金森病患者轻度认知损害的临床调查

目的 研究帕金森病(Parkinson's disease,PD)伴有轻度认知功能缺损(mild cognitiveimpairment,MCI,即PD-MCI)患者患病率及其神经心理学特征.方法 设立PD患者组(n=103)及健康对照组(n=32)进行比较.心理学测验工具由MMSE、痴呆评定量表及其他神经心理学测试组成,汉密尔顿抑郁量表用以评定患者的抑郁程度.结果 (1)21例(20.4%)PD患者被诊断为痴呆,37例(35.9%)患者认知功能完整,45例(43.7%)患者有MCI;(2)与认知正常的PD患者相比,PD-MCI患者年龄更大,PD起病更晚,且运动损害更为严重;(3)PD-MCI的患病率和神经心理学特征与PD症状主要累及何侧及分型有一定关系:左侧组比右侧组患者出现MCI的概率要高(74.2%和42.2%,χ2=7.589,P<0.05);震颤为主型患者与混合型患者相比,Stroop测词试验(SWT)的耗时(s)显著减少(80.8±39.9和94.4±30.0,t=3.332,P<0.01).结论在PD患者中,筛查出PD-MCI患者有着重要的临床意义,有助于临床医生针对性地处理不同PD患者,并易化对其预后的判断.

Clinical investigation of mild cognitive impairment in patients with Parkinson's disease

Objective To describe the prevalence and neuropsychological character of mild cognitive impairment (MCI) associated with Parkinson' s disease(PD-MCI). Methods One hundred and three PD patients and a control group of 32 healthy old subjects were chosen. Psychometric assessment included the Mini Mental State Examination, the Dementia Rating Scale and a series of neuropsychol ogicaltests. The Hamilton Rating Scale of Depression was used to assess depression in PD patients. Results (1)Twenty-one (20.4%) PD patients was diagnosed with dementia, 45 (43.7%) had a MCI and only 37(35.9%) had no cognitive impairment; (2) Subjects with PD-MCI were older, had a later onset of the PD,and displayed more severe motor symptoms compared with those without cognitive impairment; (3) The prevalence and neuropsychological profile of PD-MCI were thought to correlate with the dominating side and subtype of Parkinsonian symptoms, for patients with left-sided dominant symptoms had a significantly higher chance of suffering MCI than those with right-sided dominant symptoms, the ratio being 74.2% vs 42.2%,χ<'2 =7. 589,P <0.05; The tremor-dominant group took less time than the mixed group for Stroop word test measurement ((80.8±39.9) s vs (94.4±30.0) s,t=3.332,P<0.01). Conclusion Identification of MCI is of important clinical significance, which helps to treat patients differently and thus predict the prognosis.