脑白质疏松与帕金森病患者认知功能损害的相关性研究

摘要

Objective To explore the correlation between leukoaraiosis and the cognitive impairment in Parkinson disease (PD) patients. Method 120 patients from June 2015 to December 2016 in our hospital were selected as subjects investigated. According to the results of clinical examination and diagnosis, patients with mild cognitive impairment (MCI) were included in MCI group, patients with Parkinson disease dementia (PDD) were included in PDD group, and patients with non-cognitive impairment (NCI) were included in NCI group. Baseline data of three groups, neuropsychological test results [mini-mental state examination (MMSE) score, Cambridge cognitive examination-Chinese version (CAMCOG-C) score, unified Parkinson disease rating scale (UPDRS) motor examination score, Hoehn-Yahr staging (H-Y Staging) score] and brain white matter high signal score were compared among three groups. Used MMSE as the dependent variable, educational years, UPDRS exercise score, H-Y staging score and the deep white matter high signal scores were used as independent variables to do multivariate linear regression analysis. Regression analysis was used to observe the correlation between above indexes and MMSE. Result There was only education degree showing significant difference in the comparison of the baseline data (P < 0.05). The MMSE score and CAMCOG-C score in NCI group were significantly higher than those in MCI group (P < 0.05) and PDD group, the MMSE score and CAMCOG score in MCI group were significantly higher than those in PDD group (P < 0.05). The UPDRS motor examination score and H-Y staging score in NCI group were significantly lower than those in MCI group and PDD group, and the UPDRS motor examination score and H-Y staging score in MCI group were significantly lower than those in PDD group (P < 0.05). The white matter hyperintense signal score of periventricular, basal ganglia and tentorium of cerebellum had no differences among the three groups (P >0.05). The score of deep white matter in NCI group was significantly lower than those in MCI group and PDD group (P < 0.05), and the score of deep white matter signal in MCI group was significantly lower than that in PDD group (P < 0.05). The results of multivariate regression analysis showed that MMSE was significantly positively correlated with education, and it was significantly negatively correlated with H-Y staging score and deep white matter hyperintense signal score, and had the highest correlation with deep white matter hyperintense signal score. Conclusion The cognitive impairment of PD patients is the result of multiple factors, and the white matter porosity, especially the deep white matter lesion, may be an important factor in the impairment of cognitive function in patients, and its mechanism is to accelerate cognitive impairment and even PDD appearance.%目的 研究脑白质疏松与帕金森病(Parkinson disease,PD)患者认知功能损害的相关性.方法 选取本院2015年6月至2016年12月门诊就诊及住院的120例PD患者为研究对象,根据临床检查和诊断结果,将符合轻度认知损害(mild cognitive impairment,MCI)诊断标准的患者纳入MCI组,将符合帕金森病痴呆(Parkinson disease dementia,PDD)诊断标准的患者纳入PDD组,其余无认知损害(non-cognitive impairment,NCI)患者纳入NCI组.比较三组患者的基线资料、神经心理学测试结果 [简明精神状态检查量表(mini-mental state examination,MMSE)评分、剑桥老年认知量表中文版(Cambridge cognitive examination-Chinese version,CAMCOG-C)评分、统一帕金森评分量表(unified Parkinson disease rating scale,UPDRS)运动检查评分、Hoehn-Yahr分期(H-Y分期)评分]及脑白质高信号评分;以MMSE作为因变量,将单因素分析中教育年限、UPDRS运动检查评分、H-Y分期评分及深部白质高信号评分等具有显著差异的指标作为自变量进行多元线性回归分析,观察上述指标与MMSE的相关性.结果三组患者基线资料中仅教育年限具有显著差异(P<0.05).NCI组患者MMSE评分和CAMCOG-C评分均显著高于MCI组和PDD组(P<0.05),MCI组患者MMSE评分和CAMCOG-C评分均显著高于PDD组(P<0.05);NCI组患者UPDRS运动检查评分和H-Y分期评分均显著低于MCI组和PDD组(P<0.05),MCI组患者UPDRS运动检查评分和H-Y分期评分均显著低于PDD组(P<0.05).三组患者脑室旁白质、基底节白质及幕下白质高信号评分比较均无显著差异(P>0.05);NCI组患者深部白质高信号评分显著低于MCI组和PDD组(P<0.05),MCI组患者深部白质高信号评分显著低于PDD组(P<0.05).多元回归分析结果显示:MMSE与教育年限呈显著正相关,与H-Y分期评分和深部白质高信号评分呈显著负相关,且与深部白质高信号评分相关性最高(P<0.05).结论 PD患者认知功能损害为多因素共同作用的结果,而脑白质疏松尤其是深部白质病变可能是导致PD患者认知功能损害的重要因素,其作用机制为加速认知功能损害甚至PDD的出现.