早發(fā)性帕金森病與晚發(fā)性帕金森病神經(jīng)心理學障礙的臨床特征比較及相關(guān)性分析
發(fā)布時間：2018-09-13 11:15
【摘要】：目的:探討早發(fā)性帕金森病(EOPD)與晚發(fā)性帕金森病(LOPD)患者合并抑郁的相關(guān)情況;探討EOPD與LOPD合并輕度認知功能障礙(MCI)的發(fā)病率、影響因素以及相關(guān)認知損害亞領(lǐng)域之間的差異。方法:本研究納入從2016年4月至2017年3月符合標準的在我院就診的原發(fā)性帕金森病患者共92例,其中EOPD患者38例,LOPD患者54例。收集患者詳細相關(guān)信息并采用Hoehn-Yahr分級、統(tǒng)一帕金森病評定量表第三部分(UPDRS-III)評分、漢密爾頓抑郁量表(HAMD)、簡易精神狀態(tài)量表(MMSE)和蒙特利爾認知評估量表(MoCA)分別評估患者的運動、抑郁和總體認知情況,同時配合Stroop色詞測驗、Rey聽覺學習測驗(RAVLT)、畫鐘測驗、波士頓命名測驗-30版本(BNT-30)和連線測驗(TMT)評估患者的注意、記憶、執(zhí)行、語言及視空間能力等5大認知亞領(lǐng)域情況,比較EOPD患者和LOPD患者的抑郁和認知功能障礙等神經(jīng)心理學障礙,同時分析兩組患者合并輕度認知功能障礙的相關(guān)影響因素。結(jié)果:(1)根據(jù)HAMD評測結(jié)果,38例EOPD患者中23例患者合并抑郁,占57.89%,15例患者無抑郁癥狀,占42.11%;54例LOPD患者中26例患者合并抑郁,占48.15%,28例患者無抑郁癥狀,占51.85%,兩者之間差異無統(tǒng)計學意義(P=0.241);(2)EOPD和LOPD合并抑郁患者HAMD評分分值分別為19.74±1.91和18.77±1.18,差異有統(tǒng)計學意義(P=0.035);(3)根據(jù)MMSE和MOCA評估結(jié)果,9例EOPD患者合并MCI,占23.68%,29例患者無認知障礙,占76.32%;25例LOPD患者合并認知功能障礙,占46.30%,29例患者無認知障礙,占53.70%,差異有統(tǒng)計學意義(P=0.027);(4)EOPD和LOPD患者的MoCA評分分別為26.39±2.30和24.48±2.81,差異有統(tǒng)計學意義(P=0.001);(5)EOPD和LOPD合并MCI患者RAVLT評分結(jié)果如下:即刻記憶總分分別為46.42±11.33和37.57±12.30,差異有統(tǒng)計學意義(P=0.046);延遲回憶得分分別為5.18±1.56和4.13±1.17,差異有統(tǒng)計學意義(P=0.032);(6)EOPD和LOPD合并MCI患者Stroop色詞評分結(jié)果:A部分得分分別為44.78±1.72和43.17±2.15,差異無統(tǒng)計學差異(P=0.055),B部分得分分別為44.78±1.39和40.22±2.89,差異有統(tǒng)計學意義(P0.001),C部分得分分別為37.89±1.90和34.17±1.47差異有統(tǒng)計學意義(P0.001);(7)EOPD和LOPD合并MCI患者TMT結(jié)果:TMT-A部分得分分別為70.78±4.32分和77.78±4.43分,差異有統(tǒng)計學差異(P0.001),TMT-B部分得分分別為159.22±2.22分和175.21±2.62分,差異有統(tǒng)計學差異(P0.001);(8)EOPD和LOPD合并MCI患者其他認知評估結(jié)果如下:畫鐘測驗得分分別為6.89±0.78分和5.48±1.24分,BNT-30得分分別為27.00±1.22分和25.91±1.04分,差異有統(tǒng)計學差異(P值分別為0.004和0.017);(9)EOPD和LOPD患者一般資料比較:兩組患者發(fā)病年齡(45.53±2.27)歲和(57.28±3.32)歲,差異有統(tǒng)計學意義(P0.001),性別、病程、Hoehn-Yahr分級、工作性質(zhì)和UPDRS-III之間無統(tǒng)計學差異(P0.05);(10)EOPD組患者MoCA評分與工作性質(zhì)呈正相關(guān)(r=-0.465,P=0.003),與HAMD評分呈負相關(guān)(r=0.390,P=0.015),與發(fā)病年齡、病程、目前年齡、性別、Hoehn-Yahr分級、UPDRS-III評分無明顯相關(guān)性(P0.05);LOPD組患者MoCA評分與病程(r=-0.446,P=0.001)、目前年齡(r=-0.404,P=0.002)、Hoehn-Yahr分級(r=-0.430,P=0.001)級UPDRS-III評分(r=-0.361,P=0.007)呈負相關(guān),與發(fā)病年齡、性別、工作性質(zhì)、HAMD評分之間無明顯相關(guān)性(P0.05)。結(jié)論:(1)本研究結(jié)果表明,初中以上學歷的EOPD患者較LOPD患者抑郁癥狀嚴重,但其合并抑郁的發(fā)病率未見明顯差異;(2)初中以上學歷的EOPD患者較LOPD患者合并MCI發(fā)病率低;(3)EOPD合并MCI患者認知障礙表現(xiàn)為延遲回憶、注意力和視空間能力,LOPD合并MCI患者5個認知障礙領(lǐng)域均受損害;(4)EOPD患者認知功能與其工作性質(zhì)明顯有關(guān),體力勞動的EOPD患者認知功能較腦力勞動的EOPD患者差;EOPD患者的認知功能與其抑郁癥狀呈負相關(guān);LOPD患者認知功能與病程、目前年齡、運動障礙呈負相關(guān)。
[Abstract]:Objective: To investigate the association between early-onset Parkinson's disease (EOPD) and late-onset Parkinson's disease (LOPD) with depression, the incidence of EOPD and LOPD with mild cognitive impairment (MCI), the influencing factors and the differences in related cognitive impairment subfields. A total of 92 patients with primary Parkinson's disease were enrolled in our hospital, including 38 patients with EOPD and 54 patients with LOPD. Detailed information was collected and classified by Hoehn-Yahr, UPDRS-III, HAMD, MMSE and Montreal Cognitive Assessment Scale. (MoCA) assessed the patients'movement, depression, and general cognitive status, together with the Stroop Color Word Test, Rey Auditory Learning Test (RAVLT), Clock Drawing Test, Boston Naming Test-30 (BNT-30) and Wired Test (TMT) assessed the patients' attention, memory, execution, language and visual spatial ability in five cognitive sub-fields, and compared the patients with EOPD. Results: (1) According to the results of HAMD, 23 of 38 patients with EOPD had depression, accounting for 57.89%, 15 patients had no depressive symptoms, accounting for 42.11%; 26 of 54 patients with LOPD had depression. And depression, accounting for 48.15%, 28 patients without depressive symptoms, accounting for 51.85%, there was no significant difference between the two (P = 0.241); (2) EOPD and LOPD with depression in patients with HAMD scores were 19.74 + 1.91 and 18.77 + 1.18, respectively, the difference was statistically significant (P = 0.035); (3) According to the MMSE and MOCA evaluation results, 9 patients with EOPD with MCI, accounting for 23.68%, 29 patients with depression. There was no cognitive impairment, accounting for 76.32%; 25 patients with LOPD complicated with cognitive impairment, accounting for 46.30%, 29 patients without cognitive impairment, accounting for 53.70%, the difference was statistically significant (P = 0.027); (4) MoCA scores of EOPD and LOPD patients were 26.39 (+ 2.30) and 24.48 (+ 2.81), respectively, with significant difference (P = 0.001); (5) RAVLT scores of EOPD and LOPD combined with MCI patients such as The total score of immediate memory was 46.42 [11.33] and 37.57 [12.30], and the difference was statistically significant (P = 0.046); the delayed memory score was 5.18 [1.56] and 4.13 [1.17], respectively, with significant difference (P = 0.032); (6) The Stroop color word score of EOPD and LOPD patients with MCI was 44.78 [1.72] and 43.17 [2.15], respectively. The difference (P = 0.055), the scores of part B were 44.78 (+ 1.39) and 40.22 (+ 2.89) respectively, the difference was statistically significant (P 0.001), the scores of part C were 37.89 (+ 1.90) and 34.17 (+ 1.47) (P 0.001); (7) The TMT scores of EOPD and LOPD patients with MCI were 70.78 (+ 4.32) and 77.78 (+ 4.43), respectively. The scores of TMT-B were 159.22 (+ 2.22) and 175.21 (+ 2.62) respectively, and the differences were statistically significant (P 0.001); (8) Other cognitive assessment results of EOPD and LOPD patients with MCI were as follows: Clock drawing test scores were 6.89 (+ 0.78) and 5.48 (+ 1.24), BNT-30 scores were 27.00 (+ 1.22) and 25.91 (+ 1.04), respectively (P The values were 0.004 and 0.017, respectively; (9) The general data of EOPD and LOPD patients were compared: the age of onset of EOPD and LOPD patients were 45.53 (+ 2.27) and 57.28 (+ 3.32) years, with significant differences (P 0.001), gender, course of disease, Hoehn-Yahr classification, work nature and UPDRS-III were not statistically different (P 0.05); (10) MoCA score and work nature of EOPD patients were positively correlated. (r = - 0.465, P = 0.003), nenegatively correlated with HAMDscore (r = - 0.390, P = 0.390, P = 0.015), but not significantly correlated with onsage, course, current age, current age, gender, Hoehn-Yahrgrade, UPDRS-III score (P 0.05); MoCAscore and course of disease (r = - 0.446, P = 0.446, P = 0.001), current age (r = - 0.404, P = 0.002), Hoehn-Yar (Hoehn =-Hohn-Yahr = - 0.430-Yahr, UPDRS-0.430.430, UPDRS-III score; UPDRS-III score in LOPD group MoCAscore and course (r = - In the meantime, it is necessary to study the relationship between the two. There was no significant correlation between the scores of HAMD and age of onset (P 0.05). Conclusion: (1) EOPD patients with junior high school education or above had more severe depressive symptoms than LOPD patients, but there was no significant difference in the incidence of depression between them; (2) EOPD patients with junior high school education or above had more severe depressive symptoms than LOPD patients. The incidence of MCI was low in EOPD patients. (3) The cognitive impairment in EOPD patients with MCI was delayed memory, attention and visual spatial ability, and impaired in all five cognitive impairment areas in LOPD patients with MCI. (4) The cognitive function of EOPD patients was significantly related to the nature of their work. Cognitive function was negatively correlated with depressive symptoms, and cognitive function was negatively correlated with course of disease, current age and dyskinesia in LOPD patients.
【學位授予單位】：南昌大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R742.5
本文編號：2241016
[Abstract]:Objective: To investigate the association between early-onset Parkinson's disease (EOPD) and late-onset Parkinson's disease (LOPD) with depression, the incidence of EOPD and LOPD with mild cognitive impairment (MCI), the influencing factors and the differences in related cognitive impairment subfields. A total of 92 patients with primary Parkinson's disease were enrolled in our hospital, including 38 patients with EOPD and 54 patients with LOPD. Detailed information was collected and classified by Hoehn-Yahr, UPDRS-III, HAMD, MMSE and Montreal Cognitive Assessment Scale. (MoCA) assessed the patients'movement, depression, and general cognitive status, together with the Stroop Color Word Test, Rey Auditory Learning Test (RAVLT), Clock Drawing Test, Boston Naming Test-30 (BNT-30) and Wired Test (TMT) assessed the patients' attention, memory, execution, language and visual spatial ability in five cognitive sub-fields, and compared the patients with EOPD. Results: (1) According to the results of HAMD, 23 of 38 patients with EOPD had depression, accounting for 57.89%, 15 patients had no depressive symptoms, accounting for 42.11%; 26 of 54 patients with LOPD had depression. And depression, accounting for 48.15%, 28 patients without depressive symptoms, accounting for 51.85%, there was no significant difference between the two (P = 0.241); (2) EOPD and LOPD with depression in patients with HAMD scores were 19.74 + 1.91 and 18.77 + 1.18, respectively, the difference was statistically significant (P = 0.035); (3) According to the MMSE and MOCA evaluation results, 9 patients with EOPD with MCI, accounting for 23.68%, 29 patients with depression. There was no cognitive impairment, accounting for 76.32%; 25 patients with LOPD complicated with cognitive impairment, accounting for 46.30%, 29 patients without cognitive impairment, accounting for 53.70%, the difference was statistically significant (P = 0.027); (4) MoCA scores of EOPD and LOPD patients were 26.39 (+ 2.30) and 24.48 (+ 2.81), respectively, with significant difference (P = 0.001); (5) RAVLT scores of EOPD and LOPD combined with MCI patients such as The total score of immediate memory was 46.42 [11.33] and 37.57 [12.30], and the difference was statistically significant (P = 0.046); the delayed memory score was 5.18 [1.56] and 4.13 [1.17], respectively, with significant difference (P = 0.032); (6) The Stroop color word score of EOPD and LOPD patients with MCI was 44.78 [1.72] and 43.17 [2.15], respectively. The difference (P = 0.055), the scores of part B were 44.78 (+ 1.39) and 40.22 (+ 2.89) respectively, the difference was statistically significant (P 0.001), the scores of part C were 37.89 (+ 1.90) and 34.17 (+ 1.47) (P 0.001); (7) The TMT scores of EOPD and LOPD patients with MCI were 70.78 (+ 4.32) and 77.78 (+ 4.43), respectively. The scores of TMT-B were 159.22 (+ 2.22) and 175.21 (+ 2.62) respectively, and the differences were statistically significant (P 0.001); (8) Other cognitive assessment results of EOPD and LOPD patients with MCI were as follows: Clock drawing test scores were 6.89 (+ 0.78) and 5.48 (+ 1.24), BNT-30 scores were 27.00 (+ 1.22) and 25.91 (+ 1.04), respectively (P The values were 0.004 and 0.017, respectively; (9) The general data of EOPD and LOPD patients were compared: the age of onset of EOPD and LOPD patients were 45.53 (+ 2.27) and 57.28 (+ 3.32) years, with significant differences (P 0.001), gender, course of disease, Hoehn-Yahr classification, work nature and UPDRS-III were not statistically different (P 0.05); (10) MoCA score and work nature of EOPD patients were positively correlated. (r = - 0.465, P = 0.003), nenegatively correlated with HAMDscore (r = - 0.390, P = 0.390, P = 0.015), but not significantly correlated with onsage, course, current age, current age, gender, Hoehn-Yahrgrade, UPDRS-III score (P 0.05); MoCAscore and course of disease (r = - 0.446, P = 0.446, P = 0.001), current age (r = - 0.404, P = 0.002), Hoehn-Yar (Hoehn =-Hohn-Yahr = - 0.430-Yahr, UPDRS-0.430.430, UPDRS-III score; UPDRS-III score in LOPD group MoCAscore and course (r = - In the meantime, it is necessary to study the relationship between the two. There was no significant correlation between the scores of HAMD and age of onset (P 0.05). Conclusion: (1) EOPD patients with junior high school education or above had more severe depressive symptoms than LOPD patients, but there was no significant difference in the incidence of depression between them; (2) EOPD patients with junior high school education or above had more severe depressive symptoms than LOPD patients. The incidence of MCI was low in EOPD patients. (3) The cognitive impairment in EOPD patients with MCI was delayed memory, attention and visual spatial ability, and impaired in all five cognitive impairment areas in LOPD patients with MCI. (4) The cognitive function of EOPD patients was significantly related to the nature of their work. Cognitive function was negatively correlated with depressive symptoms, and cognitive function was negatively correlated with course of disease, current age and dyskinesia in LOPD patients.
【學位授予單位】：南昌大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R742.5
【參考文獻】
相關(guān)期刊論文 前2條
1 李楠;徐心;;嗅覺障礙及其臨床檢測方法[J];中華臨床醫(yī)師雜志(電子版);2013年21期
2 陳生弟;陳海波;譚玉燕;;帕金森病癡呆的診斷與治療指南[J];中華神經(jīng)科雜志;2011年09期
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