早发性帕金森病与晚发性帕金森病神经心理学障碍的临床特征比较及相关性分析
发布时间：2018-09-13 11:15
【摘要】：目的:探讨早发性帕金森病(EOPD)与晚发性帕金森病(LOPD)患者合并抑郁的相关情况;探讨EOPD与LOPD合并轻度认知功能障碍(MCI)的发病率、影响因素以及相关认知损害亚领域之间的差异。方法:本研究纳入从2016年4月至2017年3月符合标准的在我院就诊的原发性帕金森病患者共92例,其中EOPD患者38例,LOPD患者54例。收集患者详细相关信息并采用Hoehn-Yahr分级、统一帕金森病评定量表第三部分(UPDRS-III)评分、汉密尔顿抑郁量表(HAMD)、简易精神状态量表(MMSE)和蒙特利尔认知评估量表(MoCA)分别评估患者的运动、抑郁和总体认知情况,同时配合Stroop色词测验、Rey听觉学习测验(RAVLT)、画钟测验、波士顿命名测验-30版本(BNT-30)和连线测验(TMT)评估患者的注意、记忆、执行、语言及视空间能力等5大认知亚领域情况,比较EOPD患者和LOPD患者的抑郁和认知功能障碍等神经心理学障碍,同时分析两组患者合并轻度认知功能障碍的相关影响因素。结果:(1)根据HAMD评测结果,38例EOPD患者中23例患者合并抑郁,占57.89%,15例患者无抑郁症状,占42.11%;54例LOPD患者中26例患者合并抑郁,占48.15%,28例患者无抑郁症状,占51.85%,两者之间差异无统计学意义(P=0.241);(2)EOPD和LOPD合并抑郁患者HAMD评分分值分别为19.74±1.91和18.77±1.18,差异有统计学意义(P=0.035);(3)根据MMSE和MOCA评估结果,9例EOPD患者合并MCI,占23.68%,29例患者无认知障碍,占76.32%;25例LOPD患者合并认知功能障碍,占46.30%,29例患者无认知障碍,占53.70%,差异有统计学意义(P=0.027);(4)EOPD和LOPD患者的MoCA评分分别为26.39±2.30和24.48±2.81,差异有统计学意义(P=0.001);(5)EOPD和LOPD合并MCI患者RAVLT评分结果如下:即刻记忆总分分别为46.42±11.33和37.57±12.30,差异有统计学意义(P=0.046);延迟回忆得分分别为5.18±1.56和4.13±1.17,差异有统计学意义(P=0.032);(6)EOPD和LOPD合并MCI患者Stroop色词评分结果:A部分得分分别为44.78±1.72和43.17±2.15,差异无统计学差异(P=0.055),B部分得分分别为44.78±1.39和40.22±2.89,差异有统计学意义(P0.001),C部分得分分别为37.89±1.90和34.17±1.47差异有统计学意义(P0.001);(7)EOPD和LOPD合并MCI患者TMT结果:TMT-A部分得分分别为70.78±4.32分和77.78±4.43分,差异有统计学差异(P0.001),TMT-B部分得分分别为159.22±2.22分和175.21±2.62分,差异有统计学差异(P0.001);(8)EOPD和LOPD合并MCI患者其他认知评估结果如下:画钟测验得分分别为6.89±0.78分和5.48±1.24分,BNT-30得分分别为27.00±1.22分和25.91±1.04分,差异有统计学差异(P值分别为0.004和0.017);(9)EOPD和LOPD患者一般资料比较:两组患者发病年龄(45.53±2.27)岁和(57.28±3.32)岁,差异有统计学意义(P0.001),性别、病程、Hoehn-Yahr分级、工作性质和UPDRS-III之间无统计学差异(P0.05);(10)EOPD组患者MoCA评分与工作性质呈正相关(r=-0.465,P=0.003),与HAMD评分呈负相关(r=0.390,P=0.015),与发病年龄、病程、目前年龄、性别、Hoehn-Yahr分级、UPDRS-III评分无明显相关性(P0.05);LOPD组患者MoCA评分与病程(r=-0.446,P=0.001)、目前年龄(r=-0.404,P=0.002)、Hoehn-Yahr分级(r=-0.430,P=0.001)级UPDRS-III评分(r=-0.361,P=0.007)呈负相关,与发病年龄、性别、工作性质、HAMD评分之间无明显相关性(P0.05)。结论:(1)本研究结果表明,初中以上学历的EOPD患者较LOPD患者抑郁症状严重,但其合并抑郁的发病率未见明显差异;(2)初中以上学历的EOPD患者较LOPD患者合并MCI发病率低;(3)EOPD合并MCI患者认知障碍表现为延迟回忆、注意力和视空间能力,LOPD合并MCI患者5个认知障碍领域均受损害;(4)EOPD患者认知功能与其工作性质明显有关,体力劳动的EOPD患者认知功能较脑力劳动的EOPD患者差;EOPD患者的认知功能与其抑郁症状呈负相关;LOPD患者认知功能与病程、目前年龄、运动障碍呈负相关。
[Abstract]:Objective: To investigate the association between early-onset Parkinson's disease (EOPD) and late-onset Parkinson's disease (LOPD) with depression, the incidence of EOPD and LOPD with mild cognitive impairment (MCI), the influencing factors and the differences in related cognitive impairment subfields. A total of 92 patients with primary Parkinson's disease were enrolled in our hospital, including 38 patients with EOPD and 54 patients with LOPD. Detailed information was collected and classified by Hoehn-Yahr, UPDRS-III, HAMD, MMSE and Montreal Cognitive Assessment Scale. (MoCA) assessed the patients'movement, depression, and general cognitive status, together with the Stroop Color Word Test, Rey Auditory Learning Test (RAVLT), Clock Drawing Test, Boston Naming Test-30 (BNT-30) and Wired Test (TMT) assessed the patients' attention, memory, execution, language and visual spatial ability in five cognitive sub-fields, and compared the patients with EOPD. Results: (1) According to the results of HAMD, 23 of 38 patients with EOPD had depression, accounting for 57.89%, 15 patients had no depressive symptoms, accounting for 42.11%; 26 of 54 patients with LOPD had depression. And depression, accounting for 48.15%, 28 patients without depressive symptoms, accounting for 51.85%, there was no significant difference between the two (P = 0.241); (2) EOPD and LOPD with depression in patients with HAMD scores were 19.74 + 1.91 and 18.77 + 1.18, respectively, the difference was statistically significant (P = 0.035); (3) According to the MMSE and MOCA evaluation results, 9 patients with EOPD with MCI, accounting for 23.68%, 29 patients with depression. There was no cognitive impairment, accounting for 76.32%; 25 patients with LOPD complicated with cognitive impairment, accounting for 46.30%, 29 patients without cognitive impairment, accounting for 53.70%, the difference was statistically significant (P = 0.027); (4) MoCA scores of EOPD and LOPD patients were 26.39 (+ 2.30) and 24.48 (+ 2.81), respectively, with significant difference (P = 0.001); (5) RAVLT scores of EOPD and LOPD combined with MCI patients such as The total score of immediate memory was 46.42 [11.33] and 37.57 [12.30], and the difference was statistically significant (P = 0.046); the delayed memory score was 5.18 [1.56] and 4.13 [1.17], respectively, with significant difference (P = 0.032); (6) The Stroop color word score of EOPD and LOPD patients with MCI was 44.78 [1.72] and 43.17 [2.15], respectively. The difference (P = 0.055), the scores of part B were 44.78 (+ 1.39) and 40.22 (+ 2.89) respectively, the difference was statistically significant (P 0.001), the scores of part C were 37.89 (+ 1.90) and 34.17 (+ 1.47) (P 0.001); (7) The TMT scores of EOPD and LOPD patients with MCI were 70.78 (+ 4.32) and 77.78 (+ 4.43), respectively. The scores of TMT-B were 159.22 (+ 2.22) and 175.21 (+ 2.62) respectively, and the differences were statistically significant (P 0.001); (8) Other cognitive assessment results of EOPD and LOPD patients with MCI were as follows: Clock drawing test scores were 6.89 (+ 0.78) and 5.48 (+ 1.24), BNT-30 scores were 27.00 (+ 1.22) and 25.91 (+ 1.04), respectively (P The values were 0.004 and 0.017, respectively; (9) The general data of EOPD and LOPD patients were compared: the age of onset of EOPD and LOPD patients were 45.53 (+ 2.27) and 57.28 (+ 3.32) years, with significant differences (P 0.001), gender, course of disease, Hoehn-Yahr classification, work nature and UPDRS-III were not statistically different (P 0.05); (10) MoCA score and work nature of EOPD patients were positively correlated. (r = - 0.465, P = 0.003), nenegatively correlated with HAMDscore (r = - 0.390, P = 0.390, P = 0.015), but not significantly correlated with onsage, course, current age, current age, gender, Hoehn-Yahrgrade, UPDRS-III score (P 0.05); MoCAscore and course of disease (r = - 0.446, P = 0.446, P = 0.001), current age (r = - 0.404, P = 0.002), Hoehn-Yar (Hoehn =-Hohn-Yahr = - 0.430-Yahr, UPDRS-0.430.430, UPDRS-III score; UPDRS-III score in LOPD group MoCAscore and course (r = - In the meantime, it is necessary to study the relationship between the two. There was no significant correlation between the scores of HAMD and age of onset (P 0.05). Conclusion: (1) EOPD patients with junior high school education or above had more severe depressive symptoms than LOPD patients, but there was no significant difference in the incidence of depression between them; (2) EOPD patients with junior high school education or above had more severe depressive symptoms than LOPD patients. The incidence of MCI was low in EOPD patients. (3) The cognitive impairment in EOPD patients with MCI was delayed memory, attention and visual spatial ability, and impaired in all five cognitive impairment areas in LOPD patients with MCI. (4) The cognitive function of EOPD patients was significantly related to the nature of their work. Cognitive function was negatively correlated with depressive symptoms, and cognitive function was negatively correlated with course of disease, current age and dyskinesia in LOPD patients.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R742.5
本文编号：2241016
[Abstract]:Objective: To investigate the association between early-onset Parkinson's disease (EOPD) and late-onset Parkinson's disease (LOPD) with depression, the incidence of EOPD and LOPD with mild cognitive impairment (MCI), the influencing factors and the differences in related cognitive impairment subfields. A total of 92 patients with primary Parkinson's disease were enrolled in our hospital, including 38 patients with EOPD and 54 patients with LOPD. Detailed information was collected and classified by Hoehn-Yahr, UPDRS-III, HAMD, MMSE and Montreal Cognitive Assessment Scale. (MoCA) assessed the patients'movement, depression, and general cognitive status, together with the Stroop Color Word Test, Rey Auditory Learning Test (RAVLT), Clock Drawing Test, Boston Naming Test-30 (BNT-30) and Wired Test (TMT) assessed the patients' attention, memory, execution, language and visual spatial ability in five cognitive sub-fields, and compared the patients with EOPD. Results: (1) According to the results of HAMD, 23 of 38 patients with EOPD had depression, accounting for 57.89%, 15 patients had no depressive symptoms, accounting for 42.11%; 26 of 54 patients with LOPD had depression. And depression, accounting for 48.15%, 28 patients without depressive symptoms, accounting for 51.85%, there was no significant difference between the two (P = 0.241); (2) EOPD and LOPD with depression in patients with HAMD scores were 19.74 + 1.91 and 18.77 + 1.18, respectively, the difference was statistically significant (P = 0.035); (3) According to the MMSE and MOCA evaluation results, 9 patients with EOPD with MCI, accounting for 23.68%, 29 patients with depression. There was no cognitive impairment, accounting for 76.32%; 25 patients with LOPD complicated with cognitive impairment, accounting for 46.30%, 29 patients without cognitive impairment, accounting for 53.70%, the difference was statistically significant (P = 0.027); (4) MoCA scores of EOPD and LOPD patients were 26.39 (+ 2.30) and 24.48 (+ 2.81), respectively, with significant difference (P = 0.001); (5) RAVLT scores of EOPD and LOPD combined with MCI patients such as The total score of immediate memory was 46.42 [11.33] and 37.57 [12.30], and the difference was statistically significant (P = 0.046); the delayed memory score was 5.18 [1.56] and 4.13 [1.17], respectively, with significant difference (P = 0.032); (6) The Stroop color word score of EOPD and LOPD patients with MCI was 44.78 [1.72] and 43.17 [2.15], respectively. The difference (P = 0.055), the scores of part B were 44.78 (+ 1.39) and 40.22 (+ 2.89) respectively, the difference was statistically significant (P 0.001), the scores of part C were 37.89 (+ 1.90) and 34.17 (+ 1.47) (P 0.001); (7) The TMT scores of EOPD and LOPD patients with MCI were 70.78 (+ 4.32) and 77.78 (+ 4.43), respectively. The scores of TMT-B were 159.22 (+ 2.22) and 175.21 (+ 2.62) respectively, and the differences were statistically significant (P 0.001); (8) Other cognitive assessment results of EOPD and LOPD patients with MCI were as follows: Clock drawing test scores were 6.89 (+ 0.78) and 5.48 (+ 1.24), BNT-30 scores were 27.00 (+ 1.22) and 25.91 (+ 1.04), respectively (P The values were 0.004 and 0.017, respectively; (9) The general data of EOPD and LOPD patients were compared: the age of onset of EOPD and LOPD patients were 45.53 (+ 2.27) and 57.28 (+ 3.32) years, with significant differences (P 0.001), gender, course of disease, Hoehn-Yahr classification, work nature and UPDRS-III were not statistically different (P 0.05); (10) MoCA score and work nature of EOPD patients were positively correlated. (r = - 0.465, P = 0.003), nenegatively correlated with HAMDscore (r = - 0.390, P = 0.390, P = 0.015), but not significantly correlated with onsage, course, current age, current age, gender, Hoehn-Yahrgrade, UPDRS-III score (P 0.05); MoCAscore and course of disease (r = - 0.446, P = 0.446, P = 0.001), current age (r = - 0.404, P = 0.002), Hoehn-Yar (Hoehn =-Hohn-Yahr = - 0.430-Yahr, UPDRS-0.430.430, UPDRS-III score; UPDRS-III score in LOPD group MoCAscore and course (r = - In the meantime, it is necessary to study the relationship between the two. There was no significant correlation between the scores of HAMD and age of onset (P 0.05). Conclusion: (1) EOPD patients with junior high school education or above had more severe depressive symptoms than LOPD patients, but there was no significant difference in the incidence of depression between them; (2) EOPD patients with junior high school education or above had more severe depressive symptoms than LOPD patients. The incidence of MCI was low in EOPD patients. (3) The cognitive impairment in EOPD patients with MCI was delayed memory, attention and visual spatial ability, and impaired in all five cognitive impairment areas in LOPD patients with MCI. (4) The cognitive function of EOPD patients was significantly related to the nature of their work. Cognitive function was negatively correlated with depressive symptoms, and cognitive function was negatively correlated with course of disease, current age and dyskinesia in LOPD patients.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R742.5
【参考文献】
相关期刊论文 前2条
1 李楠;徐心;;嗅觉障碍及其临床检测方法[J];中华临床医师杂志(电子版);2013年21期
2 陈生弟;陈海波;谭玉燕;;帕金森病痴呆的诊断与治疗指南[J];中华神经科杂志;2011年09期
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