帕金森病患者认知功能障碍的神经精神症状分析

Analysis of neuropsychological symptoms in Parkinson's disease patients with cognitive impairment

摘要:

目的  研究了解帕金森病（PD）患者认知功能障碍的神经精神症状特征，为本病的防治提供科学依据。方法  选取330例帕金森病例，将病例分为3组，应用汉密尔顿抑郁量表、淡漠量表、简版老年抑郁量表和神经精神问卷（NPI）等进行评定，应用Excel 2007和SPSS 17.0统计软件进行数据处理及统计学分析。结果  330例病例中有128例无认知功能障碍（PD-NC），96例存在轻度认知功能障碍（PD-MCI），有106例存在痴呆（PD-D）。PD-NC组、PD-MCI和PD-D组受教育程度比较差异有统计学意义（P <0.01），Logistic多因素回归校正其他混杂因素后，发现受教育程度高是PD认知功能障碍的独立保护因子（P =0.003），而发病年龄高、病程长、淡漠及NPI分值高是PD认知功能障碍的独立危险因素（P <0.05）。各组间抑郁和淡漠症状逐级递增，存在显著差异的神经精神症状是心境恶劣和情感淡漠，核心精神症状在PD认知功能障碍中常见，PD-NC组占9.38%、PD-MCI组占11.46%、PD-D组占46.22%。结论  受教育程度在PD认知功能障碍中充当保护因素，与既往研究一致。异常精神行为症状在非痴呆PD患者和PD-D中均非常常见，随着PD认知功能障碍加重，精神行为异常更为多见，以睡眠障碍、夜间行为异常、幻觉、焦虑多见，而欣快和脱抑制相对少见。

Abstract:

Objective To study the neuropsychological symptoms of Parkinson's disease (PD) patients with cognitive impairment so as to provide scientific basis for prevention and treatment of Parkinson's disease. Methods Totally 330 patients were followed up. The patients were divided into three groups. The Hamilton Depression Rating Scale, the Apathy Evaluation Scale, the simple version of the Geriatric Depression Scale and the Neuropsychiatric Inventory (NPI) were evaluated. All analyses were computed using Statistical Package for Social Sciences (SPSS) version 17.0 and Excel version 2007 statistical software. Results Among the 330 cases, 128 patients did not have cognitive impairment (PD-NC), 96 cases of patients had mild cognitive impairment (PD-MCI), and 106 cases had dementia (PD-D). The PD-NC, PD-MCI and PD-D groups had significant differences in education degree (P < 0.01). After adjusting for other confounding factors, multivariate logistic regression revealed high education level was the independent protective factor for cognitive impairment in PD (P = 0.003); while the age of onset, long course of disease, indifference and high NPI scores were the independent risk factors for cognitive impairment in PD (P < 0.05). Depression and indifference symptoms gradually increased from the PD-NC group, PD-MCI group to PD-D group. The significantly different neuropsychiatric symptoms were dysthymia and apathy. The core spirit symptoms were common in cognitive impairment in PD, which accounted for 9.38% in the PD-NC group, 11.46% in the PD-MCI group and 46.22% in the PD-D group. Conclusions Education serves as a protective factor for cognitive impairment in PD, which is consistent with previous studies. Abnormal behavioral and psychological symptoms in non-demented PD patients and PD-D are very common. With the aggravation of cognitive impairment in PD, mental and behavioral abnormalities are more common, which mainly include sleep disorders and abnormalities of nocturnal behavior, hallucinations, anxiety; but euphoria and disinhibition are relatively rare.