嗅觉减退觉知力的缺失与轻度认知障碍帕金森病患者的关系

发布时间：2018-08-16 20:01

【摘要】：背景与目的帕金森病(Parkinson's disease,PD)是一种神经系统变性疾病,病程进展缓慢,多见于中老年人。临床主要表现为静止性震颤、运动迟缓、姿势步态异常等症状。随着对PD研究的不断进展和深入,越来越多的学者发现除了其经典的运动症状外,自主神经功能紊乱、感觉障碍、睡眠异常、认知功能改变等非运动症状也为其重要的临床表现。其非运动症状之间可能存在着某些关联。嗅觉障碍和认知障碍在临床表现较为常见,二者不仅加重了PD患者其他的临床症状,而且还能导致PD患者生活质量严重下降,还增加PD的死亡率和病死率。目前关于嗅觉障碍和认知障碍的发病机制及在PD患者中两者之间的联系尚不明确。有研究报道,认知障碍PD患者有时并没有认知到他们的嗅觉功能障碍。因此,嗅觉减退觉知力的缺失可能与PD患者的认知障碍有关。近年来,Hely等在多年对PD患者随访研究中指出,PD患者出现认知障碍的比例高达40%,认知障碍对患者日常生活的影响比较显著,是决定患者生活质量的关键因素之一。有研究表明,伴有认知障碍的PD患者其嗅觉障碍、抑郁、幻觉等症状更为常见。嗅觉障碍作为非运动症状之一,与认知功能存在一定的联系。从神经解剖学上分析,嗅脑包括额、颞叶皮质等与认知功能相关的一些神经结构。在人类的认知行为中,嗅脑也起着重要的作用,嗅脑部分功能的反映为可表现为嗅觉功能。当嗅脑发生病理变化时,嗅觉障碍与认知障碍可能同时发生。本研究旨探讨嗅觉减退觉知力的程度和非痴呆PD患者的认知状况之间的关系,通过评估PD患者的嗅觉功能和认知功能,进一步探讨了存在轻度认知障碍的PD患者嗅觉功能之间的关系,为更深入了解PD非运动症状之间的联系提供了可能,为临床医师早发现,早诊断,更好的管理轻度认知障碍PD患者提供了参考和依据。方法共纳入32例原发性PD患者及24例性别、年龄、受教育程度与病例组相匹配的健康志愿者。采集多有参与者一般信息,按简易智能精神状态检查量表(MMSE)和蒙特利尔认知评估量表(Mo CA)评分对所有参与者的认知状况进行筛查和评估。选用OE嗅觉测试法(Open Essence)和嗅觉自行评估法来评估嗅觉障碍程度。嗅觉自我评测问卷评分和OE评分的百分比来评估嗅觉缺失觉知力的程度。采用Hoehn-Yahr分级量表(Hoehn-Yahr,HY分期)和统一帕金森病评定量表运动检查部分(Unified Parkinson's Disease Rating Scale motor part,UPDRS PartⅢ)评定PD患者的病情严重程度。统计所有参与者的各种量表评分,并进行统计分析。结果1.在32例PD患者中,20例PD-CN患者(62.5%)和12例PD-MCI患者(37.5%)。PD-MCI组、PD-CN组和HC组在性别、受教育年限间的差异无统计学意义(P=0.32)。然而,PD-MCI组和PD-CN组之间的年龄差异具有统计学意义(P0.05)。PD-MCI组的Mo CA得分明显低于PD-CN组(P0.001)或HC组(P0.001)。2.在嗅觉测试中,PD-MCI组、PD-CN组和HC组三组间的单向方差分析差异具有统计学意义(p0.05)。PD-MCI组、PD-CN组和HC组间的OE评测三组间的单向方差分析差异具有统计学意义(p0.001)。12个PD-MCI患者中有7个患者(58.3%)表现出嗅觉功能障碍,20个PD-CN患者中有5个患者表现出嗅觉功能障碍(20.0%)。根据Scheffe事后检验,PD-MCI组和PD-CN组得分明显低于HC组(p0.001和p0.001)。此外,与PD-CN组相比(表1),PD-MCI组的嗅觉自我评测得分明显较低(p0.001)。3.在嗅觉减退觉知力评测中,PD-MCI组、PD-CN组和HC组间的嗅觉减退觉知力单向方差分析差异具有统计学意义(p0.001)。Scheffe事后检验表明,PD-MCI组得分明显高于PD-CN组(p0.001)。PD-CN组和HC组之间的差异无统计学意义(P=0.36)。结论PD患者出现的嗅觉减退和认知力损害两种非运动症状之间存在着相关性,额叶功能障碍与嗅觉功能障碍可能存在一定的关联,嗅觉减退的程度可预测PD患者早期痴呆的转归,为临床早发现,早诊断,更好的管理轻度认知障碍PD患者提供了参考。
[Abstract]:BACKGROUND & OBJECTIVE Parkinson's disease (PD) is a degenerative disease of the nervous system. The disease progresses slowly, mostly in middle-aged and elderly people. In addition to symptoms, non-motor symptoms such as autonomic nervous dysfunction, sensory disturbance, sleep disorders, cognitive changes are also important clinical manifestations. There may be some association between non-motor symptoms. It leads to a serious decline in the quality of life in PD patients and increases the mortality and mortality of PD. The pathogenesis of olfactory and cognitive impairment and the relationship between them are still unclear in PD patients. Deletion may be related to cognitive impairment in PD patients. In recent years, Hely et al. pointed out that 40% of PD patients have cognitive impairment. Cognitive impairment has a significant impact on daily life and is one of the key factors to determine the quality of life of PD patients with cognitive impairment. Olfactory dysfunction, depression, hallucinations and other symptoms are more common. As one of the non-motor symptoms, olfactory dysfunction is associated with cognitive function. Neuroanatomically, the olfactory brain includes some neural structures related to cognitive function, such as frontal and temporal cortex. The purpose of this study was to explore the relationship between the degree of olfactory hypoesthesia and the cognitive status of non-dementia PD patients, and to further explore the existence of olfactory and cognitive impairment in PD patients by assessing their olfactory and cognitive functions. The relationship between olfactory function in patients with mild cognitive impairment and non-motor symptoms of PD provides a possibility for further understanding the relationship between PD and non-motor symptoms, and provides a reference and basis for clinicians to early discover, early diagnose and better manage patients with mild cognitive impairment. Healthy volunteers matched with the case group were screened and assessed with the Simple Mental State Examination Scale (MMSE) and Montreal Cognitive Assessment Scale (MOCA). OE olfaction test (Open Essence) and olfactory self-assessment were used to assess olfactory impairment. The degree of impairment was assessed by the percentages of olfactory self-assessment questionnaire score and OE score. The severity of PD was assessed by Hoehn-Yahr scale (HY stage) and Unified Parkinson's Disease Rating Scale motor part (UPDRS Part III). Results 1. Among 32 PD patients, 20 (62.5%) had PD-CN and 12 (37.5%) had PD-MCI. There was no significant difference in gender and length of education between PD-MCI, PD-CN and HC groups (P = 0.32). The score of MOCA in PD-MCI group was significantly lower than that in PD-CN group (P 0.001) or HC group (P 0.001). 2. In olfactory test, there was significant difference in one-way ANOVA among PD-MCI group, PD-CN group and HC group (P 0.05). There was significant difference in one-way ANOVA among PD-MCI group, PD-CN group and HC group (P 0.05). 7 out of 12 PD-MCI patients (58.3%) showed olfactory dysfunction, and 5 out of 20 PD-CN patients showed olfactory dysfunction (20.0%). According to Scheffe's post-mortem test, the scores of PD-MCI and PD-CN groups were significantly lower than those of HC group (p0.001 and p0.001). In addition, compared with PD-CN group (Table 1), the olfactory self-assessment of PD-MCI group was distinct. Significantly lower (p0.001). 3. In the evaluation of olfactory hypoesthesia, the difference of one-way ANOVA between PD-MCI group, PD-CN group and HC group was statistically significant (p0.001). Scheffe postmortem test showed that the score of PD-MCI group was significantly higher than that of PD-CN group (p0.001). There was no significant difference between PD-CN group and HC group (P = 0.36). There is a correlation between olfactory impairment and cognitive impairment. Frontal lobe dysfunction may be associated with olfactory impairment. The degree of olfactory impairment can predict the prognosis of early dementia in PD patients. It provides a basis for early detection, early diagnosis and better management of patients with mild cognitive impairment. Reference resources.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R742.5

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