帕金森病冻结步态与认知障碍的相关性研究
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摘要
目的:探讨帕金森病(PD)冻结步态与认知障碍的相关性。方法:收集2016年1月至2018年10月在天津市环湖医院临床确诊的帕金森病患者102例,根据新版冻结步态评分(New Freezing Of Gait Question,NFOGQ)将102例患者分为两组,冻结步态组(PD-FGD组)和非冻结步态组(PD-NFGD组),采用MMSE量表和MOCA量表对两组患者分别进行认知评估,采用帕金森病统一评价量表第3部分(UPDRSⅢ)中的冻结步态项评价冻结步态的分级,Hoehn-Yahr分级评价两组患者的运动性症状严重程度,另外采用NFOGQ量表对两组患者冻结步态进行评估,通过上述评估方法分析两组之间的认知评分差异,及102例患者的认知评分与冻结步态的相关性。结果:PD-FGD组(22例)H-Y分期评分明显高于PD-NFGD组(80例),差异有统计学意义(P<0.05)。PD-FGD组和PD-NFGD组患者MMSE评分和MOCA评分总分两组无统计学差异。PD-FGD组视空间和执行功能评分明显低于PD-NFGD组,差异有统计学意义(P<0.05)。PD-FGD组抽象思维评分明显低于PD-NFGD组,差异有统计学意义(P<0.05)。NFOGQ评分与MMSE评分(r=-0.182,p=0.067)无明显相关性,而与MoCA评分(r=-0.195,p=0.049)呈负相关,冻结步态分级与MMSE评分(r=-0.187,p=0.060)无明显相关性,而与MoCA评分(r=-0.204,p=0.039)呈负相关。结论:帕金森病患者的认知障碍和冻结步态严重程度呈正相关,帕金森伴冻结步态的患者在视空间、执行能力和抽象思维方面比帕金森不伴有冻结步态的患者更易受损。
Objective To explore the correlation between frozen gait and cognitive impairment in Parkinson's disease(PD). Methods 102 patients with Parkinson's disease who were clinically diagnosed at the Huanhu Hospital in Tianjin from January 2016 to October 2018 were enrolled. According to the New Freezing Of Gait Question(NFOGQ), 102 patients were divided into two groups(The frozen gait group(PD-FGD group) and the non-frozen gait group(PD-NFGD group)). PD-FGD group and the PD-NFGD were evaluated for cognitive assessment using the MMSE scale and the MOCA scale. The frozen gait items in the Parkinson's Disease Unified Assessment Scale Part 3(UPDRS Ⅲ) were evaluated for the grading of the frozen gait, and the Hoehn-Yahr grading was used to evaluate the severity of the motor symptoms in the two groups. In addition, the NFOGQ scale was used to evaluate the frozen gait of the two groups.The above assessment methods were used to analyze the differences in cognitive changes between the two groups and the correlation between cognition and frozen gait in 102 patients. Results H-Y staging score in FGD group(22 cases)was significantly higher than that in NFGD group(80 cases),and the difference was statistically significant(P<0.05). There were no significant differences in MMSE scores and MOCA scores between the PD-FGD group and the PD-NFGD group. The visual space and executive scores of the PD-FGD group is significantly lower than those of the PD-NFGD group, and the difference is statistically significant(P<0.05). The PD-FGD group has a significantly lower abstract score than the PD-NFGD group, and the difference is statistically significant(P<0.05). NFOGQ score is not significantly correlated with MMSE score(r=-0.182, p=0.067), but negatively correlated with MoCA score(r=-0.195, p=0.049). Freezing gait score is not significantly correlated with MMSE score(r=-0.187,p=0.060), but negatively correlated with MoCA score(r=-0.204, p=0.039).Conclusions There is a positive correlation between cognitive impairment and frozen gait severity in patients with PD. Patients with frozen gait is more vulnerable to impairment in executive ability and abstract thinking than those without frozen gait.
Objective To explore the correlation between frozen gait and cognitive impairment in Parkinson's disease(PD). Methods 102 patients with Parkinson's disease who were clinically diagnosed at the Huanhu Hospital in Tianjin from January 2016 to October 2018 were enrolled. According to the New Freezing Of Gait Question(NFOGQ), 102 patients were divided into two groups(The frozen gait group(PD-FGD group) and the non-frozen gait group(PD-NFGD group)). PD-FGD group and the PD-NFGD were evaluated for cognitive assessment using the MMSE scale and the MOCA scale. The frozen gait items in the Parkinson's Disease Unified Assessment Scale Part 3(UPDRS Ⅲ) were evaluated for the grading of the frozen gait, and the Hoehn-Yahr grading was used to evaluate the severity of the motor symptoms in the two groups. In addition, the NFOGQ scale was used to evaluate the frozen gait of the two groups.The above assessment methods were used to analyze the differences in cognitive changes between the two groups and the correlation between cognition and frozen gait in 102 patients. Results H-Y staging score in FGD group(22 cases)was significantly higher than that in NFGD group(80 cases),and the difference was statistically significant(P<0.05). There were no significant differences in MMSE scores and MOCA scores between the PD-FGD group and the PD-NFGD group. The visual space and executive scores of the PD-FGD group is significantly lower than those of the PD-NFGD group, and the difference is statistically significant(P<0.05). The PD-FGD group has a significantly lower abstract score than the PD-NFGD group, and the difference is statistically significant(P<0.05). NFOGQ score is not significantly correlated with MMSE score(r=-0.182, p=0.067), but negatively correlated with MoCA score(r=-0.195, p=0.049). Freezing gait score is not significantly correlated with MMSE score(r=-0.187,p=0.060), but negatively correlated with MoCA score(r=-0.204, p=0.039).Conclusions There is a positive correlation between cognitive impairment and frozen gait severity in patients with PD. Patients with frozen gait is more vulnerable to impairment in executive ability and abstract thinking than those without frozen gait.
引文
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[11]Jha M,Jhunjhunwala K,Sankara BB,et al.Neuropsychological and imaging profile of patients with Parkinson’s disease and freezing of gait[J].Parkinsonism Related Disorders,2015,21(10):1184-1190.
[12]孙倩,王田,陈生弟等.帕金森病冻结步态患者的临床特征分析[J].中华神经科杂志,2015,48(7):575-579.
[13]Amboni M,Barone P,Picillo M,et al.A two-year followup study of executive dysfunctions in parkinsonian patients with freezing of gait at on-state[J].Mov Disord.2010;25(6):800-802.
[14]左丽君,扈杨,余舒扬等.帕金森病不同运动表型与认知障碍关系及其机制的研究[J].北京医学,2016,38(10):1003-1008.
[2]Verghese J,LeValley A,Hall CB,et a1.Epidemiology of gait disorders in community-residing older adults[J].JAm Geriatr Soc.2006,54(2):255-261.
[3]Aarsland D,Creese B,Politis M,et a1.Cognitive decline in Parkinson disease[J].Nat Rev Neurol.2017,13(4):217-231.
[4]David Gordon Lichter,Ralph Holmes,AnnHershey,et al.Importance of Balance-Gait Disorder as a risk fact or for cognitive impairment,dementia and related non-motor symptoms in Parkinson,s disease[J].Journal of Parkinson’s disease,2018,8(4):539-552.
[5]中华医学会神经病学分会帕金森病及运动障碍学组,中国医师协会神经内科医师分会帕金森病及运动障碍专业.中国帕金森病的诊断标准(2016版)[J].中华神经科杂志,2016,49(4):268-271.
[6]Goetz CG,Poewe W,Rascol O,et al.Movement disorder society task force report on the Hoehn and Yahr staging scale:status and recommendations[J].Mov Disord,2004,19(9):1020-1028.
[7]Alice Nieuwboer,Lynn Rochester,Talia Herman,et al Reliability of the new freezing of gait questionnaire:agreement between patients with Parkinson’s disease and their carers[J].Gait Posture,2009,30(4):459-463.
[8]Pasi M,Salvadori E,Poggesi A,et a1.White matter microstructural damage in small vessel disease is associated with Montreal cognitive assessment but not with mini mental state examination performances:vascular mild cognitive impairment Tuscany study[J].Stroke,2015,46(1):262-264.
[9]Muller ML,Albin RL,Kotagal V,et al.Thalamic cholinergic innervation and postural sensory integration function in Parkinson,s disease[J].Brain:a Journal of Neurology,2013,136(Pt11):3282-3289.
[10]Forsaa EB,Larsen JP,Wentzel-larsen T,et al.A 12-year population based study of freezing of gait in Parkinson’s Disease[J].Parkinsonism related Disorders,2015,21(3):254-258.
[11]Jha M,Jhunjhunwala K,Sankara BB,et al.Neuropsychological and imaging profile of patients with Parkinson’s disease and freezing of gait[J].Parkinsonism Related Disorders,2015,21(10):1184-1190.
[12]孙倩,王田,陈生弟等.帕金森病冻结步态患者的临床特征分析[J].中华神经科杂志,2015,48(7):575-579.
[13]Amboni M,Barone P,Picillo M,et al.A two-year followup study of executive dysfunctions in parkinsonian patients with freezing of gait at on-state[J].Mov Disord.2010;25(6):800-802.
[14]左丽君,扈杨,余舒扬等.帕金森病不同运动表型与认知障碍关系及其机制的研究[J].北京医学,2016,38(10):1003-1008.