本文選題：帕金森病 + 認(rèn)知功能��； 參考：《天津醫(yī)科大學(xué)》2014年碩士論文

【摘要】：第一部分帕金森病患者認(rèn)知損害特征的研究 目的首先通過(guò)對(duì)76例不同分期帕金森病(Parkinson's disease,PD)患者以及健康對(duì)照者認(rèn)知功能的評(píng)估,從神經(jīng)心理學(xué)方面分析PD患者合并認(rèn)知損害的特點(diǎn)；另外對(duì)初次診斷為帕金森病的患者在服用左旋多巴前后分別實(shí)施認(rèn)知功能評(píng)估,探討左旋多巴對(duì)早期帕金森病患者認(rèn)知功能的影響。 對(duì)象和方法收集我院神經(jīng)內(nèi)科門診PD患者76例,其中初次診斷為PD的患者28例,正常對(duì)照組32例。采用神經(jīng)心理測(cè)試評(píng)估其執(zhí)行功能、注意力、記憶力、視空間功能、信息處理速度、語(yǔ)言流暢性等特定領(lǐng)域的單項(xiàng)認(rèn)知功能及患者的總體認(rèn)知功能。采用的認(rèn)知評(píng)定量表包括簡(jiǎn)易精神狀態(tài)量表(MMSE)、蒙特利爾認(rèn)知評(píng)估量表(MoCA)、言語(yǔ)流暢性測(cè)驗(yàn)(VFT)、威斯康星卡片分類測(cè)驗(yàn)(WCST)、Benton線方向判斷、定步調(diào)聽覺連續(xù)加法測(cè)驗(yàn)(PASAT)、數(shù)字符號(hào)編碼測(cè)驗(yàn)(DSCT)、加利福尼亞語(yǔ)言學(xué)習(xí)測(cè)試(CVLT)。同時(shí)收集PD患者的基本資料,包括年齡、性別、教育程度和Hoehn-Yahr分期。采用Hoehn-Yahr分期對(duì)PD疾病的嚴(yán)重程度進(jìn)行評(píng)估,其中2.5期為疾病早期,≥2.5期為疾病晚期。對(duì)初次診斷為PD的患者在服用左旋多巴前及服藥3個(gè)月后分別實(shí)施上述神經(jīng)心理測(cè)試組的評(píng)估。 結(jié)果與對(duì)照組相比,早期組PD患者的WCST-64正確應(yīng)答數(shù)減少、持續(xù)錯(cuò)誤數(shù)增多,DSCT、PASAT得分均降低,差異有統(tǒng)計(jì)學(xué)意義(P0.05)；晚期組PD患者除WCST-64正確應(yīng)答數(shù)、完成分類數(shù)減少、持續(xù)錯(cuò)誤數(shù)增多,DSCT、 PASAT得分降低外,CVLT短時(shí)回憶和延遲回憶以及動(dòng)物命名得分亦降低,同時(shí)MMSE、MoCA評(píng)分下降,差異有統(tǒng)計(jì)學(xué)意義(P0.05)；晚期組PD患者與早期組PD患者相比,DSCT、PASAT得分降低,CVLT短時(shí)回憶和延遲回憶的詞語(yǔ)數(shù)減少,言語(yǔ)流暢性測(cè)驗(yàn)的動(dòng)物命名和漢語(yǔ)詞語(yǔ)列舉得分均降低,MoCA評(píng)分下降,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。入組PD患者服用左旋多巴前后認(rèn)知功能變化的比較發(fā)現(xiàn),患者的WCST-64正確應(yīng)答數(shù)增多,持續(xù)錯(cuò)誤數(shù)減少,DSCT、 PASAT得分升高,差異有統(tǒng)計(jì)學(xué)意義(P0.05),總體認(rèn)知功能MoCA評(píng)分雖有升高,但無(wú)統(tǒng)計(jì)學(xué)意義(P=0.174)。 結(jié)論早期PD患者的認(rèn)知功能受損主要表現(xiàn)在執(zhí)行功能、注意力、信息處理速度方面；而晚期PD患者可存在廣泛的認(rèn)知功能損害,包括執(zhí)行功能、信息處理速度、注意力、記憶力、語(yǔ)言流暢性均有受損,因此患者的總體認(rèn)知功能評(píng)分差于正常對(duì)照者；左旋多巴對(duì)早期PD患者的部分認(rèn)知功能有所改善,主要表現(xiàn)在患者的執(zhí)行功能、信息處理速度、注意力有所好轉(zhuǎn)。不同分期PD患者的認(rèn)知損害表現(xiàn)不同,選擇敏感的、恰當(dāng)?shù)脑u(píng)定量表可早期并準(zhǔn)確發(fā)現(xiàn)PD患者的認(rèn)知功能障礙,并且針對(duì)認(rèn)知損害領(lǐng)域的不同,進(jìn)行相應(yīng)的社會(huì)心理治療和認(rèn)知障礙的康復(fù)治療,可能會(huì)延遲或阻止癡呆的發(fā)生。 第二部分影響帕金森病患者生活質(zhì)量因素的分析 目的通過(guò)對(duì)PD患者運(yùn)動(dòng)癥狀、非運(yùn)動(dòng)癥狀以及其它相關(guān)因素的量化評(píng)估,探討影響帕金森病患者生活質(zhì)量的主要因素。 對(duì)象和方法采用帕金森病生活質(zhì)量問(wèn)卷(PDQ-39)、帕金森病統(tǒng)一評(píng)定量表(UPDRS)、Hoehn-Yahr分期、漢密爾頓抑郁量表(HAMD)、漢密爾頓焦慮量表(HAMA)、帕金森睡眠量表(PDSS)、蒙特利爾認(rèn)知評(píng)估量表(MoCA)以及簡(jiǎn)明疼痛評(píng)估量表(BPI)對(duì)76例帕金森病患者的生活質(zhì)量、日常生活能力、運(yùn)動(dòng)功能、疾病嚴(yán)重程度、抑郁情緒、睡眠、認(rèn)知功能和帕金森病相關(guān)疼痛等指標(biāo)進(jìn)行評(píng)估,同時(shí)記錄患者的年齡和病程等基本資料,比較分析上述指標(biāo)與帕金森病患者生活質(zhì)量的相關(guān)性。 結(jié)果一元相關(guān)分析顯示：UPDRS-Ⅱ、UPDRS-Ⅲ、PDSS、BPI、MoCA、 HAMD、HAMA、病程均與與PDQ-39SI呈顯著相關(guān)性(P0.01),逐步回歸分析顯示：影響患者生活質(zhì)量的主要因素依次是UPDRS-Ⅱ、 HAMD、BPI、MoCA、 PDSS(標(biāo)準(zhǔn)回歸系數(shù)依次是0.370、0.296、0.268、-0.213、-0.190). 結(jié)論UPDRS-Ⅱ、HAMD、BPI、MoCA、PDSS與PD患者PDQ-39SI有著顯著的影響�；颊叩娜粘；顒�(dòng)受限、抑郁、疼痛、認(rèn)知狀況、睡眠障礙是影響帕金森病患者生活質(zhì)量的重要因素。除運(yùn)動(dòng)癥狀外,還應(yīng)重視PD患者的上述非運(yùn)動(dòng)癥狀并采取合適的干預(yù)和治療措施,改善患者的生活質(zhì)量。
[Abstract]:A study on cognitive impairment in patients with Parkinson ' s disease in the first part

Objective To analyze the cognitive impairment of Parkinson ' s disease ( PD ) and healthy controls in 76 patients with different stages of Parkinson ' s disease ( PD ) .
In addition , the cognitive function of patients with Parkinson ' s disease was assessed by cognitive function before and after administration of L - dopa , and the effect of L - dopa on cognitive function in patients with early Parkinson ' s disease was discussed .

Object and method were used to collect 76 cases of PD patients in Department of Internal Medicine Department of our hospital . Among them , 28 patients were diagnosed as PD and 32 in normal control group . The basic data of PD patients were assessed by using neuropsychological test . The cognitive assessment scale was included in the mental state scale ( MMSE ) , the Montreal Cognitive Assessment Scale ( MoCA ) , the fixed tone auditory continuous addition test ( VFT ) , the Wisconsin Card Sorting Test ( DSCT ) , the California Language Learning Test ( CVLT ) .

Results Compared with the control group , the number of correct responses of WCST - 64 in early group PD patients decreased , the number of persistent errors increased , the scores of DSCT and PASAT decreased , and the difference was statistically significant ( P0.05 ) .
In the late group , the number of patients with PD was decreased , the number of persistent errors increased , the DSCT and PASAT scores decreased , while the scores of MMSE and MoCA decreased , and the difference was statistically significant ( P0.05 ) .
Compared with early PD patients , the scores of DSCT , PASAT score decreased , the number of short - term memory and delayed recall of CVLT decreased , the scores of verbal fluency test decreased and the scores of Chinese words decreased , and MoCA score decreased , and the difference was statistically significant ( P0.05 ) .

Conclusion The impairment of cognitive function in early PD patients is mainly manifested in the aspects of executive function , attention and information processing speed .
Patients with advanced PD can have extensive cognitive impairment , including executive function , information processing speed , attention , memory and language fluency , so the overall cognitive function score of patients is worse than that of normal controls ;
Left - handed dopa has improved some cognitive functions in PD patients , mainly in the patient ' s performance , information processing speed and attention . The cognitive impairment of PD patients with different stages is different , and the sensitive and appropriate scales can be used to identify the cognitive impairment of PD patients .

Analysis of the factors influencing the quality of life in patients with Parkinson ' s disease

Objective To explore the main factors influencing the quality of life of PD patients by quantitative assessment of the symptoms , non - movement symptoms and other related factors of PD patients .

Objective To evaluate the quality of life , daily life , motor function , severity of disease , depression , sleep , cognitive function and related pain in 76 patients with Parkinson ' s disease by using PD Q - 39 , Parkinson ' s Disease Unified Rating Scale ( UPDRS ) , Hoehn - Yahr stage , Hamilton Depression Scale , Hamilton Anxiety Scale ( HAMA ) , Parkinson ' s Sleep Scale ( PDSS ) , Montreal Cognitive Assessment Scale ( MoCA ) , and Simple Pain Assessment Scale .

Results A meta - correlation analysis showed that UPDRS - 鈪，

本文編號(hào)：1929837