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帕金森病伴发认知功能障碍患者的临床特点及其与睡眠障碍的关系
郭鹏左丽君连腾宏扈杨余舒扬金朝余秋瑾刘丽王瑞丹李丹凝 朴英善李丽霞朱荣彦丁杜宇高俊华赵慧张巍
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目的 探讨帕金森病(PD)伴发认知功能障碍(CI)患者的临床特点及睡眠情况。方法 连 续纳入2014 年5 月—2017 年5 月就诊于北京天坛医院的394 例PD患者,按照CI程度将患者分为PD不 伴认知功能障碍(PD-NCI)组(94 例,23.86%)、PD 伴发轻度认知功能障碍(PD-MCI)组(177 例,44.92%) 及PD 伴发痴呆(PDD)组(123 例,31.22%)。收集患者的人口学资料,采用蒙特利尔认知评估(MoCA)量 表评价患者的认知功能,比较3 组患者总体认知功能及各认知领域情况;采用视频多导睡眠图(v-PSG) 评估患者的睡眠状况,并对PD 伴发CI 患者的MoCA 量表总分及各认知领域评分与v-PSG 结果进行相 关性分析。结果 3 组患者性别、起病年龄、受教育水平及病程差异均无统计学意义(P > 0.05)。PDNCI 组、PD-MCI 组和PDD 组MoCA 量表总分依次明显降低,分别为(22.20±4.99)分、(17.17±4.36)分和 (10.73±4.85)分(F=143.146,P< 0.01),且MoCA 量表各认知领域评分依次明显降低(P < 0.01)。与PDNCI 组比较,PD-MCI 组总睡眠时间减少,睡眠效率降低,觉醒次数增加(均P< 0.05);与PD-MCI 组比较, PDD 组总睡眠时间减少,睡眠效率降低,觉醒次数增加(均P< 0.05)。PD 伴发CI 的患者的睡眠效率与 MoCA 量表总分及视空间功能、执行功能、延迟回忆和注意力评分均呈正相关(P< 0.05),觉醒次数与 MoCA 量表总分及延迟回忆和注意力评分均呈负相关(P < 0.05)。结论 PD患者CI发生率较高,伴发 CI 的PD 患者总体认知功能及各认知领域均明显受损,总体睡眠时间减少,睡眠效率降低,觉醒次数增 加,并与总体认知功能及部分认知领域受损有关。
基金项目:国家重点研发计划“重大慢性非传染性疾病防控研究”重点专项( 2016YFC1306000; 2016YFC1306300); 国家重点研发计划政府间国际科技创新合作重点专项(YS2017YFGH001141); 国家自然科学基金项目(81571229);北京市自然科学基金委员会-北京市教育委员会联合资助项目 (KZ201610025030);首都医科大学校自然科学基金(PYZ2018077);北京天坛医院 2015 年度青年科研基 金(2015-YQN-14)
Clinical characteristics of patients with Parkinson disease accompanied with cognitive impairment andits relationship with sleep disorders
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Abstract:
Objective To investigate the clinical characteristics of Parkinson disease( PD) patients accompanied with cognitive impairment( CI) and the sleeping status. Methods A total of 394 patients with PD in Beijing Tiantan Hospital from May 2014 to May 2017 were enrolled. According to CI level, the patients were divided into PD without cognitive impairment( PD-NCI) group( n=94,23.86%), PD with mild cognitive impairment( PD-MCI) group( n=177,44.92%), and PD with dementia( PDD) group( n=123,31.22%). The demographic data of the patients were collected and the cognitive function of the patients was evaluated by Montreal Cognitive Assessment Scale( MoCA). The general cognitive function and the cognitive domains of the three groups were compared. Sleep status was assessed by video polysomnography( v-PSG). The correlation between the total score of MoCA scale, cognitive domain score and the results of v-PSG in patients with PD and CI was analyzed. Results There was no statistical significance in the differences in gender, age of onset, education level and duration of disease among the 3 groups( P>0.05). The total score of MoCA scale in PD-NCI group, PD-MCI group and PDD group decreased one by one( 22.20±4.99),(17.17± 4.36) and( 10.73±4.85) (F=143.146,P < 0.01). The scores of MoCA scale in each cognitive field were significantly decreased in turn (P< 0.01). Compared with PD-NCI group, PD-MCI group had less total sleep time, lower sleep efficiency and increased arousal frequency( P<0.05). Compared with PD-MCI group, PDD group had less total sleep time, lower sleep efficiency and increased arousal frequency( P< 0.05). The sleep efficiency of PD-CI patients was positively correlated with the total score of MoCA scale, visual spatial function, executive function, delayed recall and attention score( P< 0.05). The number of arousal in PD-CI patients was negatively correlated with the total score of MoCA scale, delayed recall and attention score( P<0.05). Conclusions The incidence of CI was higher in PD patients. The overall cognitive function and cognitive fields of PD patients with CI were significantly impaired. The total sleep time decreased, the sleep efficiency decreased, and the number of awakenings increased, which was related to the impairment of the overall cognitive function and some cognitive fields.

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