伴或不伴神经源性直立性低血压的帕金森病患者认知损害的临床特点  

Clinical characteristics of cognitive impairment in patients with Parkinson disease with or without neurogenic orthostatic hypotension

作　　者：薛晓帆[1,2] 曾景荣[2] 宋海霞 邢英琦 陈彪[2] 周立春[1] 许二赫[2] XUE Xiaofan;ZENG Jingrong;SONG Haixia(Department of Neurology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100043,China;不详)

机构地区：[1]首都医科大学附属北京朝阳医院神经内科,北京100043 [2]首都医科大学宣武医院神经内科,北京100054 [3]河北省石家庄市人民医院神经内科,河北石家庄050030

出　　处：《中风与神经疾病杂志》2023年第6期530-535,共6页Journal of Apoplexy and Nervous Diseases

基　　金：北京市自然科学基金青年项目(7224333)。

摘　　要：目的帕金森病(Parkinson disease,PD)认知障碍患者的重要危险因素之一就是以自主神经功能失调为病理机制的体位性低血压(Oorthostatic hypotension,OH)。但是,不同认知水平与神经源性OH在PD患者中的直接关系目前尚不清楚。本研究旨在PD患者中伴或不伴神经源性OH患者与认知障碍的关系,同时观察在不同认知域的评分上,有症状的和无症状的PD合并神经源性OH患者是否存在差异。方法回顾性收集来自首都医科大学宣武医院神经内科病房的79例PD患者,其中19例有症状的OH患者,20例无症状的OH患者,以及40例不伴有OH的患者。所有患者完善逐波血压及激活站立实验去评估有无OH,同时应用OH问卷去鉴别有症状的和无症状的OH患者。应用全面的神经心理量表去评价认知功能。应用单因素方差分析及Kruskal-Wallis检验来确定OH与认知功能障碍的关系,以及不同认知域在不同类别患者中的特征。结果在所有类型的PD患者中受教育年限与认知水平呈正相关。有症状的OH患者更容易在早期出现较差的词语延迟记忆功能。不伴有OH的PD痴呆更容易损害视空间/执行功能。结论我们的发现为PD认知障碍患者提供了一个新的视角,有症状的OH患者更容易累及记忆功能,这可能和OH潜在的病理生理机制相关。Objective Orthostatic hypotension(OH),a result of autonomic dysfunction,is an important risk factor for cognitive impairment in patients with Parkinson disease(PD).However,the direct relationship between cognitive levels and neurogenic OH in patients with PD remains unclear.We aimed to investigate the relationship between cognitive dysfunction and neurogenic OH in patients with PD,and compare the scores of various cognitive domains between patients with PD with asymptomatic OH and those with symptomatic OH.Methods We retrospectively included 79 patients with PD in the Department of Neurology,Xuanwu Hospital,Capital Medical University,including 19 with symptomatic OH,20 with asymptomatic OH,and 40 without OH.All the patients were examined for the presence or absence of OH by beat-to-beat blood pressure monitoring and the active stand test.The OH questionnaire was used to distinguish between symptomatic and asymptomatic OH.Cognitive function was assessed using a global neuropsychological scale.We used one-way analysis of variance and the Kruskal-Wallis test to determine the association between OH and cognitive dysfunction as well as the characteristics of different cognitive domains in different types of patients.Results There was a positive correlation between the years of education and the levels of cognitive function in all PD groups.Patients with symptomatic OH were more likely to develop poor delayed verbal recall at an earlier stage.Patients without OH had impairment in visual space/executive function more frequently.Conclusion Our findings provide new insights into PD with cognitive impairment that patients with symptomatic OH may be more prone to memory impairment due to the underlying pathophysiological mechanism of OH.

关 键 词：帕金森病 体位性低血压 认知障碍 记忆功能 

分 类 号：R742.5[医药卫生—神经病学与精神病学]