帕金森病睡眠障碍与认知障碍关联性研究  

Study of relationship between sleep disorder and cognitive impairment in Parkinson disease

作　　者：胡运新 孙永奇 李璇 徐炎钟 成丽娜 HU Yunxin;SUN Yongqi;LI Xuan;XU Yanzhong;CHENG Li'na(Department of Neurology,the GuangDong 999 Brain Hospital,Guangzhou,Guangdong 510515,China)

机构地区：[1]广东三九脑科医院神经内科,广州510515

出　　处：《中国神经精神疾病杂志》2022年第1期14-20,共7页Chinese Journal of Nervous and Mental Diseases

基　　金：2019年广东省医学科学技术研究基金项目(编号:B201911)。

摘　　要：目的探讨帕金森病(Parkinson disease,PD)患者睡眠障碍与认知功能障碍的关系。方法收集2018年9月至2020年1月本院住院PD患者的临床资料进行回顾性分析,根据PD睡眠量表评估结果将患者分成睡眠障碍组与无睡眠障碍组,依靠帕金森病统一评分量表(MDS-UPDRS)评分和Hoehn-Yahr分期评估病情进展,分别通过简易精神状态检查量表、蒙特利尔认知评估量表、Stroop色词测验、言语流畅测验、数字广度测验评估认知功能,汉密尔顿抑郁量表、汉密尔顿焦虑量表评估情绪症状。结果共纳入研究对象111例,其中帕金森病睡眠障碍组86例,帕金森病无睡眠障碍组25例。与帕金森病无睡眠障碍组相比,帕金森病睡眠障碍组UPDRS II评分更高(15.0 vs.10.0,P=0.034),PD睡眠量表总分及亚项1(4.5 vs.7.0,P<0.001)、亚项3(3.0 vs.7.0,P<0.001)、亚项14(4.0 vs.9.0,P<0.001)、亚项15(2.50 vs.8.0,P<0.001)评分低;在非运动量表评估中,帕金森病睡眠障碍组较帕金森病无睡眠障碍组的简易精神状态检查量表(25.24±4.22 vs.22.23±5.47,P=0.013)、蒙特利尔认知评估量表(19.20±5.53 vs.15.73±5.57,P=0.007)评分降低,Stroop色词测验卡片A用时延长(4.60 vs.3.50,P<0.001),汉密尔顿焦虑量表(21.50 vs.15.00,P=0.002)和汉密尔顿抑郁量表(19.0 vs.13.0,P=0.002)评分增加,认知亚项包括总视空间和执行功能(2.00±1.41 vs.2.85±1.74,P=0.017)、注意力(4.14±1.72 vs.6.80±1.80,P<0.001)、定向力(4.61±1.47 vs.5.50±0.98,P<0.001)等分项得分较差。帕金森病睡眠障碍组出现认知功能障碍比例显著升高(76.7%vs.36.0%,P<0.001)。回归分析提示PD睡眠量表评分下降是认知功能受损的危险因素(OR=0.235,P<0.05)。结论PD患者伴有睡眠障碍者易出现认知功能障碍。Objective To investigate the relationship between sleep disorder and cognitive impairment in Parkinson’s disease(PD).Methods The clinical data of 111 PD patients from September 2018 to January 2020 were collected for retrospective analysis.According to the evaluation results of PD Sleep Scale(PDSS),the patients were divided into sleep disorder and normal sleep subgroups.The disease progress was assessed by MDS-UPDRS score and Hoehn&Yahr staging Montreal Cognitive Assessment Scale(MoCA),Stroop Color Word Test(CWT),verbal fluency test,digit span test,Hamilton Depression Scale(HAMD)and Hamilton Anxiety Scale(HAMA)were used to evaluate the cognitive function,and the cognitive content affected by sleep disorders was analyzed by regression analysis.Results One hundred and eleven patients were enrolled,including 86 patients with sleep disorders and 25 patients in normal sleep group.Compared with normal sleep group,sleep disorder group had a higher UPDRSⅡscore(15.0 vs.10.0,P=0.034),lower PDSS total score and PDSS 1(4.5 vs.7.0,P<0.001),PDSS 3(3.0 vs.7.0,P<0.001),PDSS 14(4.0 vs.9.0,P<0.001),PDSS 15 score(2.50 vs.8.0,P<0.001).Compared with normal sleep group,sleep disorder group had lower MMSE(25.24±4.22 vs.22.23±5.47,P=0.013)and MOCA(19.20±5.53 vs.15.73±5.57,P=0.007),longer Stroop Color word test card A(4.60 vs.3.50,P<0.001),and higher HAMA(21.50 vs.15.0,P=0.002)and HAMD scores(19.0 vs.13.0,P=0.002).The scores of cognitive sub items including total visual space and executive function(2.00±1.41 vs.2.85±1.74,P=0.017),attention(4.14±1.72 vs.6.80±1.80,P<0.001)and orientation(4.61±1.47 vs.5.50±0.98,P<0.001)were poorer.The proportion of cognitive impairment in PD patients with sleep disorders was significantly increased(76.7%vs.36.0%,P<0.001).The regression analysis showed that decreased PDSS sleep score was a risk factor for cognitive impairment(P<0.05).Conclusion PD patients with sleep disorders are more likely to have cognitive dysfunction.

关 键 词：帕金森病 睡眠障碍 认知功能 非运动症状 简易精神状态检查量表 蒙特利尔认知评估量表 汉密尔顿抑郁量表 

分 类 号：R742.5[医药卫生—神经病学与精神病学]