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帕金森病患者认知障碍的特点及其对睡眠的影响

Clinical characteristics in Parkinson's disease patients with cognitive impairment and effects of cognitive impairment on sleep

摘要:

目的 分析伴认知障碍的帕金森病(PD)患者的临床特征、相关因素及临床异质性,并探讨认知障碍对PD患者睡眠的影响.方法 纳入本研究的对象系2008年9月至2013年3月在苏州大学附属第二医院PD专病门诊就诊的患者及睡眠中心住院的PD患者,将其分为认知正常组[蒙特利尔认知评价量表(MoCA) ≥26分](n=51)和认知障碍组(MoCA< 26分)(n=79).两组均于“关”期进行UPDRSⅢ部分的运动功能评价及H-Y分级评定.运用汉密尔顿抑郁量表(HAMD-24项)、Epworth嗜睡量表(ESS)、帕金森病生活质量量表(PDQ),对其抑郁程度、嗜睡情况及生活质量进行评定.采用多导睡眠图(PSG)检测对其睡眠参数进行分析.结果 PD患者中认知障碍的发生比例为60.76%,认知障碍组较认知正常组的HAMD评分[(10±7)分比(7±4)分]更高、发生幻觉(40.50%比19.60%)及快速眼动睡眠期行为障碍(RBD)的比例(63.29%比39.21%)更大、H-Y分级[2.5(2.0~3.0)比2.0(2.0~2.5)]更高,UPDRSⅢ评分[(22±10)分比(19±10)分]更高,服用左旋多巴的等效剂量更大[(511±302) mg/d比(380 ±272)mg/d](均P<0.05),差异均有统计学意义.不同起病侧和首发症状类型的PD患者在不同认知域的MoCA因子分的差异均无统计学意义(均P >0.05).非条件多因素Logistic回归分析显示PD病程、H-Y分级及HAMD评分是认知障碍发生的主要影响因素.PSG监测显示伴认知障碍的PD患者的睡眠效率(57%±21%比66%±17%)显著降低、非快速眼动睡眠l期(NREMSl)比例(37%±21%比27%±13%)显著增高、非快速眼动睡眠2期(NREMS2)比例(40%±17%比46%±13%)及快速眼动睡眠期(REMS)比例(39%±28%比54%±36%)显著下降,差异均有统计学意义(均P<0.05).结论 PD患者中认知障碍的发生率较高,伴认知障碍的PD患者的疾病严重程度更重,部分非运动症状更常见.疾病严重程度及抑郁对认知功能有显著的影响,同时认知功能损害对PD患者的睡眠产生一定的影响,主要表现为睡眠效率的下降和睡眠结构的严重紊乱.

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abstracts:

Objective To analyze the clinical characteristics,correlation factors and clinical heterogeneities in Parkinson's disease (PD) patients with cognitive impairment and identify whether cognitive impairment could influence the aspect of sleep.Methods A total of 130 PD outpatients and inpatients of sleep center at our hospital were eligible for participation.According to Montreal cognitive assessment (MoCA),they were divided into cognitive normal group (MoCA ≥26) (n =51) and cognitive impairment group (MoCA < 26) (n =79).Their clinical characteristics were mainly evaluated by unified Parkinson's disease rating scale (UPDRS),Hoehn-Yahr(H-Y) stage,Hamilton depression scale (HAMD-24 item) and Epworth sleepiness scale (ESS).And all of them underwent video-polysomnography (PSG).Results The proportion of cognitive impairment (MoCA < 26) was 60.76%.Compared to those without cognitive impairment,the PD patients with cognitive impairment had significantly higher score of HAMD (10±7 vs 7 ± 4),increased incidence of hallucinations (40.50% vs 19.60%) and REM behavior disorders (RBD) (63.29% vs 39.21%),significantly higher H-Y stage [2.5 (2.0-3.0) vs 2.0 (2.0-2.5)],United Kingdom Parkinson Disease Society (UPDRS) part Ⅲ (22 ± 10 vs 19 ± 10) and levodopaequivalent daily dose(LED) (511 ± 302vs 380 ± 272) (all P < 0.05).However,no significant differences existed in the subscores of MOCA between PD patients with different sides of onset and motor subtypes of onset (all P > 0.05).Non-conditional Logistic regression analysis showed that PD duration,score of HAMD and H-Y stage were the major influencing factors of cognition.On PSG,significantly decreased sleep efficiency (57% ±21% vs 66% ± 17%),higher percentage of non-REM sleep stage 1 (NREMS1)(37% ±21% vs 27% ± 13%),lower percentage of NREMS2 (40% ± 17% vs 46% ± 13%) and REM sleep (39% ± 28% vs 54% ± 36%) were found for PD patients with cognitive impairment (all P < 0.05).Conclusion The PD patients with cognitive impairment have more severe disease and partial nonmotor symptoms.And the severity of disease and depression is closely associated with cognitive impairment.Cognitive impairment may also affect sleep to cause decreased sleep efficiency and severe sleep structure disorder.

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