嗅覺減退覺知力的缺失與輕度認知障礙帕金森病患者的關系
發(fā)布時間：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,病程進展緩慢,多見于中老年人。臨床主要表現(xiàn)為靜止性震顫、運動遲緩、姿勢步態(tài)異常等癥狀。隨著對PD研究的不斷進展和深入,越來越多的學者發(fā)現(xiàn)除了其經(jīng)典的運動癥狀外,自主神經(jīng)功能紊亂、感覺障礙、睡眠異常、認知功能改變等非運動癥狀也為其重要的臨床表現(xiàn)。其非運動癥狀之間可能存在著某些關聯(lián)。嗅覺障礙和認知障礙在臨床表現(xiàn)較為常見,二者不僅加重了PD患者其他的臨床癥狀,而且還能導致PD患者生活質量嚴重下降,還增加PD的死亡率和病死率。目前關于嗅覺障礙和認知障礙的發(fā)病機制及在PD患者中兩者之間的聯(lián)系尚不明確。有研究報道,認知障礙PD患者有時并沒有認知到他們的嗅覺功能障礙。因此,嗅覺減退覺知力的缺失可能與PD患者的認知障礙有關。近年來,Hely等在多年對PD患者隨訪研究中指出,PD患者出現(xiàn)認知障礙的比例高達40%,認知障礙對患者日常生活的影響比較顯著,是決定患者生活質量的關鍵因素之一。有研究表明,伴有認知障礙的PD患者其嗅覺障礙、抑郁、幻覺等癥狀更為常見。嗅覺障礙作為非運動癥狀之一,與認知功能存在一定的聯(lián)系。從神經(jīng)解剖學上分析,嗅腦包括額、顳葉皮質等與認知功能相關的一些神經(jīng)結構。在人類的認知行為中,嗅腦也起著重要的作用,嗅腦部分功能的反映為可表現(xiàn)為嗅覺功能。當嗅腦發(fā)生病理變化時,嗅覺障礙與認知障礙可能同時發(fā)生。本研究旨探討嗅覺減退覺知力的程度和非癡呆PD患者的認知狀況之間的關系,通過評估PD患者的嗅覺功能和認知功能,進一步探討了存在輕度認知障礙的PD患者嗅覺功能之間的關系,為更深入了解PD非運動癥狀之間的聯(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,按簡易智能精神狀態(tài)檢查量表(MMSE)和蒙特利爾認知評估量表(Mo CA)評分對所有參與者的認知狀況進行篩查和評估。選用OE嗅覺測試法(Open Essence)和嗅覺自行評估法來評估嗅覺障礙程度。嗅覺自我評測問卷評分和OE評分的百分比來評估嗅覺缺失覺知力的程度。采用Hoehn-Yahr分級量表(Hoehn-Yahr,HY分期)和統(tǒng)一帕金森病評定量表運動檢查部分(Unified Parkinson's Disease Rating Scale motor part,UPDRS PartⅢ)評定PD患者的病情嚴重程度。統(tǒng)計所有參與者的各種量表評分,并進行統(tǒng)計分析。結果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統(tǒng)計學意義(P=0.32)。然而,PD-MCI組和PD-CN組之間的年齡差異具有統(tǒng)計學意義(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.在嗅覺測試中,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)計學意義(p0.05)。PD-MCI組、PD-CN組和HC組間的OE評測三組間的單向方差分析差異具有統(tǒng)計學意義(p0.001)。12個PD-MCI患者中有7個患者(58.3%)表現(xiàn)出嗅覺功能障礙,20個PD-CN患者中有5個患者表現(xiàn)出嗅覺功能障礙(20.0%)。根據(jù)Scheffe事后檢驗,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組的嗅覺自我評測得分明顯較低(p0.001)。3.在嗅覺減退覺知力評測中,PD-MCI組、PD-CN組和HC組間的嗅覺減退覺知力單向方差分析差異具有統(tǒng)計學意義(p0.001)。Scheffe事后檢驗表明,PD-MCI組得分明顯高于PD-CN組(p0.001)。PD-CN組和HC組之間的差異無統(tǒng)計學意義(P=0.36)。結論PD患者出現(xiàn)的嗅覺減退和認知力損害兩種非運動癥狀之間存在著相關性,額葉功能障礙與嗅覺功能障礙可能存在一定的關聯(lián),嗅覺減退的程度可預測PD患者早期癡呆的轉歸,為臨床早發(fā)現(xiàn),早診斷,更好的管理輕度認知障礙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.
【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R742.5
本文編號：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.
【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R742.5
【相似文獻】
相關期刊論文 前10條
1 綠水;硒鉬銅鋅何處尋?[J];健身科學;2004年03期
2 趙繼元;;這些疾病可引起嗅覺減退[J];醫(yī)藥與保健;2008年03期
3 邢光前;;嚴重嗅覺減退如何治療[J];求醫(yī)問藥;2010年10期
4 郝愛慶;張顯貴;;鼻和鼻竇內翻性乳頭狀瘤[J];黑龍江醫(yī)學;1990年01期
5 葉傳基;;鋅:被忽視的營養(yǎng)劑[J];國外醫(yī)學.耳鼻咽喉科學分冊;1990年06期
6 ;嗅覺減退與變應性鼻炎[J];國外醫(yī)學.耳鼻咽喉科學分冊;1994年02期
7 鐘大可;李應昆;鐘蘭;;中醫(yī)綜合治療嗅覺減退1例[J];按摩與導引;2008年02期
8 尹世杰,朱莉;Refsum綜合征1例[J];安徽醫(yī)科大學學報;1988年02期
9 王璐;;放療時,飲食注意啥?[J];抗癌之窗;2012年04期
10 張祖貽,何家聲;頭痛、嘔吐、意識障礙[J];江蘇醫(yī)藥;1983年04期
相關會議論文 前1條
1 馬振亞;劉安麗;田豐;馬賽;尚力強;楊曉春;;鼻內窺鏡加柯——陸氏手術治療鼻內翻性乳頭狀瘤[A];第四屆全國中西醫(yī)結合耳鼻咽喉科學術會論文匯編[C];2003年
相關重要報紙文章 前4條
1 趙繼元;嗅覺減退 也可能是病鬧的[N];家庭醫(yī)生報;2008年
2 趙繼元;聞不出味可能與疾病有關[N];農(nóng)村醫(yī)藥報（漢）;2008年
3 湘雅二醫(yī)院 曾益慈;嗅覺喪失后能恢復嗎？[N];大眾衛(wèi)生報;2002年
4 張春暉 孫靜 張濤;鼻部病變不可小視[N];健康報;2006年
相關博士學位論文 前1條
1 馮娟;慢性鼻—鼻竇炎術后復發(fā)相關因素探討及心理學特征與手術療效分析[D];新疆醫(yī)科大學;2016年
相關碩士學位論文 前2條
1 劉永磊;嗅覺減退覺知力的缺失與輕度認知障礙帕金森病患者的關系[D];鄭州大學;2016年
2 衛(wèi)來;慢性鼻—鼻竇炎患者精神心理紊亂及手術療效分析[D];大連醫(yī)科大學;2014年
，本文編號：2187033
本文鏈接：http://sikaile.net/yixuelunwen/shenjingyixue/2187033.html
最近更新
教材專著
