嗅覺(jué)減退覺(jué)知力的缺失與輕度認(rèn)知障礙帕金森病患者的關(guān)系
發(fā)布時(shí)間：2018-08-16 20:01
【摘要】：背景與目的帕金森病(Parkinson's disease,PD)是一種神經(jīng)系統(tǒng)變性疾病,病程進(jìn)展緩慢,多見(jiàn)于中老年人。臨床主要表現(xiàn)為靜止性震顫、運(yùn)動(dòng)遲緩、姿勢(shì)步態(tài)異常等癥狀。隨著對(duì)PD研究的不斷進(jìn)展和深入,越來(lái)越多的學(xué)者發(fā)現(xiàn)除了其經(jīng)典的運(yùn)動(dòng)癥狀外,自主神經(jīng)功能紊亂、感覺(jué)障礙、睡眠異常、認(rèn)知功能改變等非運(yùn)動(dòng)癥狀也為其重要的臨床表現(xiàn)。其非運(yùn)動(dòng)癥狀之間可能存在著某些關(guān)聯(lián)。嗅覺(jué)障礙和認(rèn)知障礙在臨床表現(xiàn)較為常見(jiàn),二者不僅加重了PD患者其他的臨床癥狀,而且還能導(dǎo)致PD患者生活質(zhì)量嚴(yán)重下降,還增加PD的死亡率和病死率。目前關(guān)于嗅覺(jué)障礙和認(rèn)知障礙的發(fā)病機(jī)制及在PD患者中兩者之間的聯(lián)系尚不明確。有研究報(bào)道,認(rèn)知障礙PD患者有時(shí)并沒(méi)有認(rèn)知到他們的嗅覺(jué)功能障礙。因此,嗅覺(jué)減退覺(jué)知力的缺失可能與PD患者的認(rèn)知障礙有關(guān)。近年來(lái),Hely等在多年對(duì)PD患者隨訪研究中指出,PD患者出現(xiàn)認(rèn)知障礙的比例高達(dá)40%,認(rèn)知障礙對(duì)患者日常生活的影響比較顯著,是決定患者生活質(zhì)量的關(guān)鍵因素之一。有研究表明,伴有認(rèn)知障礙的PD患者其嗅覺(jué)障礙、抑郁、幻覺(jué)等癥狀更為常見(jiàn)。嗅覺(jué)障礙作為非運(yùn)動(dòng)癥狀之一,與認(rèn)知功能存在一定的聯(lián)系。從神經(jīng)解剖學(xué)上分析,嗅腦包括額、顳葉皮質(zhì)等與認(rèn)知功能相關(guān)的一些神經(jīng)結(jié)構(gòu)。在人類的認(rèn)知行為中,嗅腦也起著重要的作用,嗅腦部分功能的反映為可表現(xiàn)為嗅覺(jué)功能。當(dāng)嗅腦發(fā)生病理變化時(shí),嗅覺(jué)障礙與認(rèn)知障礙可能同時(shí)發(fā)生。本研究旨探討嗅覺(jué)減退覺(jué)知力的程度和非癡呆PD患者的認(rèn)知狀況之間的關(guān)系,通過(guò)評(píng)估PD患者的嗅覺(jué)功能和認(rèn)知功能,進(jìn)一步探討了存在輕度認(rèn)知障礙的PD患者嗅覺(jué)功能之間的關(guān)系,為更深入了解PD非運(yùn)動(dòng)癥狀之間的聯(lián)系提供了可能,為臨床醫(yī)師早發(fā)現(xiàn),早診斷,更好的管理輕度認(rèn)知障礙PD患者提供了參考和依據(jù)。方法共納入32例原發(fā)性PD患者及24例性別、年齡、受教育程度與病例組相匹配的健康志愿者。采集多有參與者一般信息,按簡(jiǎn)易智能精神狀態(tài)檢查量表(MMSE)和蒙特利爾認(rèn)知評(píng)估量表(Mo CA)評(píng)分對(duì)所有參與者的認(rèn)知狀況進(jìn)行篩查和評(píng)估。選用OE嗅覺(jué)測(cè)試法(Open Essence)和嗅覺(jué)自行評(píng)估法來(lái)評(píng)估嗅覺(jué)障礙程度。嗅覺(jué)自我評(píng)測(cè)問(wèn)卷評(píng)分和OE評(píng)分的百分比來(lái)評(píng)估嗅覺(jué)缺失覺(jué)知力的程度。采用Hoehn-Yahr分級(jí)量表(Hoehn-Yahr,HY分期)和統(tǒng)一帕金森病評(píng)定量表運(yùn)動(dòng)檢查部分(Unified Parkinson's Disease Rating Scale motor part,UPDRS PartⅢ)評(píng)定PD患者的病情嚴(yán)重程度。統(tǒng)計(jì)所有參與者的各種量表評(píng)分,并進(jìn)行統(tǒng)計(jì)分析。結(jié)果1.在32例PD患者中,20例PD-CN患者(62.5%)和12例PD-MCI患者(37.5%)。PD-MCI組、PD-CN組和HC組在性別、受教育年限間的差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.32)。然而,PD-MCI組和PD-CN組之間的年齡差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。PD-MCI組的Mo CA得分明顯低于PD-CN組(P0.001)或HC組(P0.001)。2.在嗅覺(jué)測(cè)試中,PD-MCI組、PD-CN組和HC組三組間的單向方差分析差異具有統(tǒng)計(jì)學(xué)意義(p0.05)。PD-MCI組、PD-CN組和HC組間的OE評(píng)測(cè)三組間的單向方差分析差異具有統(tǒng)計(jì)學(xué)意義(p0.001)。12個(gè)PD-MCI患者中有7個(gè)患者(58.3%)表現(xiàn)出嗅覺(jué)功能障礙,20個(gè)PD-CN患者中有5個(gè)患者表現(xiàn)出嗅覺(jué)功能障礙(20.0%)。根據(jù)Scheffe事后檢驗(yàn),PD-MCI組和PD-CN組得分明顯低于HC組(p0.001和p0.001)。此外,與PD-CN組相比(表1),PD-MCI組的嗅覺(jué)自我評(píng)測(cè)得分明顯較低(p0.001)。3.在嗅覺(jué)減退覺(jué)知力評(píng)測(cè)中,PD-MCI組、PD-CN組和HC組間的嗅覺(jué)減退覺(jué)知力單向方差分析差異具有統(tǒng)計(jì)學(xué)意義(p0.001)。Scheffe事后檢驗(yàn)表明,PD-MCI組得分明顯高于PD-CN組(p0.001)。PD-CN組和HC組之間的差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.36)。結(jié)論P(yáng)D患者出現(xiàn)的嗅覺(jué)減退和認(rèn)知力損害兩種非運(yùn)動(dòng)癥狀之間存在著相關(guān)性,額葉功能障礙與嗅覺(jué)功能障礙可能存在一定的關(guān)聯(lián),嗅覺(jué)減退的程度可預(yù)測(cè)PD患者早期癡呆的轉(zhuǎn)歸,為臨床早發(fā)現(xiàn),早診斷,更好的管理輕度認(rèn)知障礙PD患者提供了參考。
[Abstract]:BACKGROUND & OBJECTIVE Parkinson's disease (PD) is a degenerative disease of the nervous system. The disease progresses slowly, mostly in middle-aged and elderly people. In addition to symptoms, non-motor symptoms such as autonomic nervous dysfunction, sensory disturbance, sleep disorders, cognitive changes are also important clinical manifestations. There may be some association between non-motor symptoms. It leads to a serious decline in the quality of life in PD patients and increases the mortality and mortality of PD. The pathogenesis of olfactory and cognitive impairment and the relationship between them are still unclear in PD patients. Deletion may be related to cognitive impairment in PD patients. In recent years, Hely et al. pointed out that 40% of PD patients have cognitive impairment. Cognitive impairment has a significant impact on daily life and is one of the key factors to determine the quality of life of PD patients with cognitive impairment. Olfactory dysfunction, depression, hallucinations and other symptoms are more common. As one of the non-motor symptoms, olfactory dysfunction is associated with cognitive function. Neuroanatomically, the olfactory brain includes some neural structures related to cognitive function, such as frontal and temporal cortex. The purpose of this study was to explore the relationship between the degree of olfactory hypoesthesia and the cognitive status of non-dementia PD patients, and to further explore the existence of olfactory and cognitive impairment in PD patients by assessing their olfactory and cognitive functions. The relationship between olfactory function in patients with mild cognitive impairment and non-motor symptoms of PD provides a possibility for further understanding the relationship between PD and non-motor symptoms, and provides a reference and basis for clinicians to early discover, early diagnose and better manage patients with mild cognitive impairment. Healthy volunteers matched with the case group were screened and assessed with the Simple Mental State Examination Scale (MMSE) and Montreal Cognitive Assessment Scale (MOCA). OE olfaction test (Open Essence) and olfactory self-assessment were used to assess olfactory impairment. The degree of impairment was assessed by the percentages of olfactory self-assessment questionnaire score and OE score. The severity of PD was assessed by Hoehn-Yahr scale (HY stage) and Unified Parkinson's Disease Rating Scale motor part (UPDRS Part III). Results 1. Among 32 PD patients, 20 (62.5%) had PD-CN and 12 (37.5%) had PD-MCI. There was no significant difference in gender and length of education between PD-MCI, PD-CN and HC groups (P = 0.32). The score of MOCA in PD-MCI group was significantly lower than that in PD-CN group (P 0.001) or HC group (P 0.001). 2. In olfactory test, there was significant difference in one-way ANOVA among PD-MCI group, PD-CN group and HC group (P 0.05). There was significant difference in one-way ANOVA among PD-MCI group, PD-CN group and HC group (P 0.05). 7 out of 12 PD-MCI patients (58.3%) showed olfactory dysfunction, and 5 out of 20 PD-CN patients showed olfactory dysfunction (20.0%). According to Scheffe's post-mortem test, the scores of PD-MCI and PD-CN groups were significantly lower than those of HC group (p0.001 and p0.001). In addition, compared with PD-CN group (Table 1), the olfactory self-assessment of PD-MCI group was distinct. Significantly lower (p0.001). 3. In the evaluation of olfactory hypoesthesia, the difference of one-way ANOVA between PD-MCI group, PD-CN group and HC group was statistically significant (p0.001). Scheffe postmortem test showed that the score of PD-MCI group was significantly higher than that of PD-CN group (p0.001). There was no significant difference between PD-CN group and HC group (P = 0.36). There is a correlation between olfactory impairment and cognitive impairment. Frontal lobe dysfunction may be associated with olfactory impairment. The degree of olfactory impairment can predict the prognosis of early dementia in PD patients. It provides a basis for early detection, early diagnosis and better management of patients with mild cognitive impairment. Reference resources.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R742.5
本文編號(hào)：2187033
[Abstract]:BACKGROUND & OBJECTIVE Parkinson's disease (PD) is a degenerative disease of the nervous system. The disease progresses slowly, mostly in middle-aged and elderly people. In addition to symptoms, non-motor symptoms such as autonomic nervous dysfunction, sensory disturbance, sleep disorders, cognitive changes are also important clinical manifestations. There may be some association between non-motor symptoms. It leads to a serious decline in the quality of life in PD patients and increases the mortality and mortality of PD. The pathogenesis of olfactory and cognitive impairment and the relationship between them are still unclear in PD patients. Deletion may be related to cognitive impairment in PD patients. In recent years, Hely et al. pointed out that 40% of PD patients have cognitive impairment. Cognitive impairment has a significant impact on daily life and is one of the key factors to determine the quality of life of PD patients with cognitive impairment. Olfactory dysfunction, depression, hallucinations and other symptoms are more common. As one of the non-motor symptoms, olfactory dysfunction is associated with cognitive function. Neuroanatomically, the olfactory brain includes some neural structures related to cognitive function, such as frontal and temporal cortex. The purpose of this study was to explore the relationship between the degree of olfactory hypoesthesia and the cognitive status of non-dementia PD patients, and to further explore the existence of olfactory and cognitive impairment in PD patients by assessing their olfactory and cognitive functions. The relationship between olfactory function in patients with mild cognitive impairment and non-motor symptoms of PD provides a possibility for further understanding the relationship between PD and non-motor symptoms, and provides a reference and basis for clinicians to early discover, early diagnose and better manage patients with mild cognitive impairment. Healthy volunteers matched with the case group were screened and assessed with the Simple Mental State Examination Scale (MMSE) and Montreal Cognitive Assessment Scale (MOCA). OE olfaction test (Open Essence) and olfactory self-assessment were used to assess olfactory impairment. The degree of impairment was assessed by the percentages of olfactory self-assessment questionnaire score and OE score. The severity of PD was assessed by Hoehn-Yahr scale (HY stage) and Unified Parkinson's Disease Rating Scale motor part (UPDRS Part III). Results 1. Among 32 PD patients, 20 (62.5%) had PD-CN and 12 (37.5%) had PD-MCI. There was no significant difference in gender and length of education between PD-MCI, PD-CN and HC groups (P = 0.32). The score of MOCA in PD-MCI group was significantly lower than that in PD-CN group (P 0.001) or HC group (P 0.001). 2. In olfactory test, there was significant difference in one-way ANOVA among PD-MCI group, PD-CN group and HC group (P 0.05). There was significant difference in one-way ANOVA among PD-MCI group, PD-CN group and HC group (P 0.05). 7 out of 12 PD-MCI patients (58.3%) showed olfactory dysfunction, and 5 out of 20 PD-CN patients showed olfactory dysfunction (20.0%). According to Scheffe's post-mortem test, the scores of PD-MCI and PD-CN groups were significantly lower than those of HC group (p0.001 and p0.001). In addition, compared with PD-CN group (Table 1), the olfactory self-assessment of PD-MCI group was distinct. Significantly lower (p0.001). 3. In the evaluation of olfactory hypoesthesia, the difference of one-way ANOVA between PD-MCI group, PD-CN group and HC group was statistically significant (p0.001). Scheffe postmortem test showed that the score of PD-MCI group was significantly higher than that of PD-CN group (p0.001). There was no significant difference between PD-CN group and HC group (P = 0.36). There is a correlation between olfactory impairment and cognitive impairment. Frontal lobe dysfunction may be associated with olfactory impairment. The degree of olfactory impairment can predict the prognosis of early dementia in PD patients. It provides a basis for early detection, early diagnosis and better management of patients with mild cognitive impairment. Reference resources.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R742.5
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