快速眼球运动睡眠行为障碍患者的神经心理学评价及其与客观睡眠的相关性  

Neuropsychological performance of rapid eye movement sleep behavior disorder patients and its correlations with objective sleep parameters

作　　者：张轩[1] 王金莹 叶静怡 万亚会 崔林阳[1] 朱晓冬[1] 张美云[1] 程焱[1] 薛蓉[1] ZHANG Xuan;WANG Jingying;YE Jingyi(Tianjin Medical University General Hospital Airport Hospital,Tianjin 300070,China)

机构地区：[1]天津医科大学总医院空港医院

出　　处：《中风与神经疾病杂志》2019年第5期406-411,共6页Journal of Apoplexy and Nervous Diseases

摘　　要：目的评价快速眼球运动睡眠行为障碍(rapid eye movement sleep behavior disorder,RBD)患者的神经心理学表现,并进一步分析其与客观睡眠参数的相关性。方法收集就诊于天津医科大学总医院神经内科门诊并由视频多导睡眠监测(v-PSG)确诊的22例RBD患者及23例性别、年龄、受教育程度匹配的,并经v-PSG排除RBD的健康对照者,对两组研究对象进行神经心理学评价,包括简易精神状态检查(MMSE)、听觉词语学习测试(AVLT)、Rey复杂图形测试(RCFT)、画钟测试(CDT)、数字符号转换测试(SDMT)、连线测试A和B(TMTA和TMTB)、Stroop色词测试A、B、C、动物流畅性测试(AFT)、城市流畅性测试(CFT)、动物-城市交替流畅性测试、波士顿命名测试(BNT),比较两组之间神经心理学表现与客观睡眠参数的差异,并分析RBD组神经心理学表现与客观睡眠参数的相关性。结果与对照组相比,RBD组的MMSE评分减少,AVLT即刻记忆总分减少,短延时回忆词语数减少,长延时回忆词语数减少,RCFT、TMTA、TMTB、Stroop色词测试A、B、C用时增加,非快速眼动期(NREM)-Ⅰ期睡眠比例增多,NREM-Ⅱ、NREM-Ⅲ睡眠比例减少,周期性肢体运动指数(PLMI)增高,以上差异均具有统计学意义(P<0.05)。RBD患者中,睡眠效率分别与SDMT及CFT得分呈正相关(分别为r=0.491,P=0.020;r=0.436,P=0.043),与TMTA用时呈负相关(r=-0.654,P=0.001),总睡眠时间与RCFT及BNT得分呈正相关(分别为r=0.600,P=0.003;r=0.482,P=0.023),与TMTA用时(r=-0.573,P=0.005)呈负相关。结论RBD患者总体认知功能下降,神经心理学受损领域为言语记忆能力、视空间能力、执行功能,并且存在客观睡眠结构紊乱、腿动指数增高。总睡眠时间减少和睡眠质量下降可能恶化RBD患者的神经心理学表现。Objective To evaluate the neuropsychological performance of RBD patients and its correlations with objective sleep parameters. Methods Twenty-two RBD patients diagnosed by video-polysomnography(v-PSG) in neurology clinic of TianJin Medical University General Hospital and Twenty-three healthy gender,age and education-level matched subjects were enrolled.Subjects underwent neuropsychological tests,including mini-mental state examination(MMSE),Auditory verbal learning test(AVLT),Rey Complex Figure Test(RCFT),Clock Drawing Test(CDT),Symbol digit modalities test(SDMT),Trail Making Test A and B(TMT A and TMT B),Stroop test A,B and C,Animal fluency test(AFT),City fluency test(CFT),Animal-City fluency test,Boston naming test(BNT).Neuropsychological performance and objective sleep parameters were compared between the two groups,correlations between neuropsychological performance and objective sleep parameters in RBD group were analysed.Results Compared with the control group,RBD patients performed worse in MMSE,immediate memory,short and long delay recall of AVLT,time of RCFT,TMT A,TMT B,Stroop A,Stroop B,Stroop C with significant difference(P<0.05);the mean percentage of NREM-Ⅰ sleep increased,NREN-Ⅱ and NREM-Ⅲ sleep decreased,periodic leg movement index increased in RBD patients.Furthermore,lower sleep efficiency was correlated with decreased SDMT score(r =0.491,P =0.020),CFT score(r =0.436,P =0.043) and more time of TMT A(r =-0.654,P =0.001),lower total sleep time was correlated with less RCFT and BNT score(r =0.600,P =0.003;r = 0.482,P = 0.023),more time of TMT A(r =-0.573,P=0.005) in RBD patients.Conclusions RBD patients exhibited declined cognition,impaired multi-domain neuropsychological performance including vebral learning memory,exeuctive and visuospatial ability,disturbed objective sleep architecture,increased periodic leg movement index.Decreased total sleep time and sleep efficiency may contribute to neuropsychological performance deterioration in RBD patients.

关 键 词：快速眼球运动睡眠行为障碍 多导睡眠监测 神经心理学 睡眠特征 

分 类 号：R742[医药卫生—神经病学与精神病学]