76例帕金森病患者认知损害特征及影响生活质量因素的分析

发布时间：2018-05-24 16:52

  本文选题：帕金森病 + 认知功能　； 参考：《天津医科大学》2014年硕士论文

【摘要】：第一部分帕金森病患者认知损害特征的研究 目的首先通过对76例不同分期帕金森病(Parkinson's disease,PD)患者以及健康对照者认知功能的评估,从神经心理学方面分析PD患者合并认知损害的特点；另外对初次诊断为帕金森病的患者在服用左旋多巴前后分别实施认知功能评估,探讨左旋多巴对早期帕金森病患者认知功能的影响。 对象和方法收集我院神经内科门诊PD患者76例,其中初次诊断为PD的患者28例,正常对照组32例。采用神经心理测试评估其执行功能、注意力、记忆力、视空间功能、信息处理速度、语言流畅性等特定领域的单项认知功能及患者的总体认知功能。采用的认知评定量表包括简易精神状态量表(MMSE)、蒙特利尔认知评估量表(MoCA)、言语流畅性测验(VFT)、威斯康星卡片分类测验(WCST)、Benton线方向判断、定步调听觉连续加法测验(PASAT)、数字符号编码测验(DSCT)、加利福尼亚语言学习测试(CVLT)。同时收集PD患者的基本资料,包括年龄、性别、教育程度和Hoehn-Yahr分期。采用Hoehn-Yahr分期对PD疾病的严重程度进行评估,其中2.5期为疾病早期,≥2.5期为疾病晚期。对初次诊断为PD的患者在服用左旋多巴前及服药3个月后分别实施上述神经心理测试组的评估。 结果与对照组相比,早期组PD患者的WCST-64正确应答数减少、持续错误数增多,DSCT、PASAT得分均降低,差异有统计学意义(P0.05)；晚期组PD患者除WCST-64正确应答数、完成分类数减少、持续错误数增多,DSCT、 PASAT得分降低外,CVLT短时回忆和延迟回忆以及动物命名得分亦降低,同时MMSE、MoCA评分下降,差异有统计学意义(P0.05)；晚期组PD患者与早期组PD患者相比,DSCT、PASAT得分降低,CVLT短时回忆和延迟回忆的词语数减少,言语流畅性测验的动物命名和汉语词语列举得分均降低,MoCA评分下降,差异有统计学意义(P0.05)。入组PD患者服用左旋多巴前后认知功能变化的比较发现,患者的WCST-64正确应答数增多,持续错误数减少,DSCT、 PASAT得分升高,差异有统计学意义(P0.05),总体认知功能MoCA评分虽有升高,但无统计学意义(P=0.174)。 结论早期PD患者的认知功能受损主要表现在执行功能、注意力、信息处理速度方面；而晚期PD患者可存在广泛的认知功能损害,包括执行功能、信息处理速度、注意力、记忆力、语言流畅性均有受损,因此患者的总体认知功能评分差于正常对照者；左旋多巴对早期PD患者的部分认知功能有所改善,主要表现在患者的执行功能、信息处理速度、注意力有所好转。不同分期PD患者的认知损害表现不同,选择敏感的、恰当的评定量表可早期并准确发现PD患者的认知功能障碍,并且针对认知损害领域的不同,进行相应的社会心理治疗和认知障碍的康复治疗,可能会延迟或阻止痴呆的发生。 第二部分影响帕金森病患者生活质量因素的分析 目的通过对PD患者运动症状、非运动症状以及其它相关因素的量化评估,探讨影响帕金森病患者生活质量的主要因素。 对象和方法采用帕金森病生活质量问卷(PDQ-39)、帕金森病统一评定量表(UPDRS)、Hoehn-Yahr分期、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、帕金森睡眠量表(PDSS)、蒙特利尔认知评估量表(MoCA)以及简明疼痛评估量表(BPI)对76例帕金森病患者的生活质量、日常生活能力、运动功能、疾病严重程度、抑郁情绪、睡眠、认知功能和帕金森病相关疼痛等指标进行评估,同时记录患者的年龄和病程等基本资料,比较分析上述指标与帕金森病患者生活质量的相关性。 结果一元相关分析显示：UPDRS-Ⅱ、UPDRS-Ⅲ、PDSS、BPI、MoCA、 HAMD、HAMA、病程均与与PDQ-39SI呈显著相关性(P0.01),逐步回归分析显示：影响患者生活质量的主要因素依次是UPDRS-Ⅱ、 HAMD、BPI、MoCA、 PDSS(标准回归系数依次是0.370、0.296、0.268、-0.213、-0.190). 结论UPDRS-Ⅱ、HAMD、BPI、MoCA、PDSS与PD患者PDQ-39SI有着显著的影响。患者的日常活动受限、抑郁、疼痛、认知状况、睡眠障碍是影响帕金森病患者生活质量的重要因素。除运动症状外,还应重视PD患者的上述非运动症状并采取合适的干预和治疗措施,改善患者的生活质量。
[Abstract]:A study on cognitive impairment in patients with Parkinson ' s disease in the first part

Objective To analyze the cognitive impairment of Parkinson ' s disease ( PD ) and healthy controls in 76 patients with different stages of Parkinson ' s disease ( PD ) .
In addition , the cognitive function of patients with Parkinson ' s disease was assessed by cognitive function before and after administration of L - dopa , and the effect of L - dopa on cognitive function in patients with early Parkinson ' s disease was discussed .

Object and method were used to collect 76 cases of PD patients in Department of Internal Medicine Department of our hospital . Among them , 28 patients were diagnosed as PD and 32 in normal control group . The basic data of PD patients were assessed by using neuropsychological test . The cognitive assessment scale was included in the mental state scale ( MMSE ) , the Montreal Cognitive Assessment Scale ( MoCA ) , the fixed tone auditory continuous addition test ( VFT ) , the Wisconsin Card Sorting Test ( DSCT ) , the California Language Learning Test ( CVLT ) .

Results Compared with the control group , the number of correct responses of WCST - 64 in early group PD patients decreased , the number of persistent errors increased , the scores of DSCT and PASAT decreased , and the difference was statistically significant ( P0.05 ) .
In the late group , the number of patients with PD was decreased , the number of persistent errors increased , the DSCT and PASAT scores decreased , while the scores of MMSE and MoCA decreased , and the difference was statistically significant ( P0.05 ) .
Compared with early PD patients , the scores of DSCT , PASAT score decreased , the number of short - term memory and delayed recall of CVLT decreased , the scores of verbal fluency test decreased and the scores of Chinese words decreased , and MoCA score decreased , and the difference was statistically significant ( P0.05 ) .

Conclusion The impairment of cognitive function in early PD patients is mainly manifested in the aspects of executive function , attention and information processing speed .
Patients with advanced PD can have extensive cognitive impairment , including executive function , information processing speed , attention , memory and language fluency , so the overall cognitive function score of patients is worse than that of normal controls ;
Left - handed dopa has improved some cognitive functions in PD patients , mainly in the patient ' s performance , information processing speed and attention . The cognitive impairment of PD patients with different stages is different , and the sensitive and appropriate scales can be used to identify the cognitive impairment of PD patients .

Analysis of the factors influencing the quality of life in patients with Parkinson ' s disease

Objective To explore the main factors influencing the quality of life of PD patients by quantitative assessment of the symptoms , non - movement symptoms and other related factors of PD patients .

Objective To evaluate the quality of life , daily life , motor function , severity of disease , depression , sleep , cognitive function and related pain in 76 patients with Parkinson ' s disease by using PD Q - 39 , Parkinson ' s Disease Unified Rating Scale ( UPDRS ) , Hoehn - Yahr stage , Hamilton Depression Scale , Hamilton Anxiety Scale ( HAMA ) , Parkinson ' s Sleep Scale ( PDSS ) , Montreal Cognitive Assessment Scale ( MoCA ) , and Simple Pain Assessment Scale .

Results A meta - correlation analysis showed that UPDRS - 鈪，

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