标题：帕金森综合征患者的认知、睡眠及精神行为的观察性研究

      作者：曾一君 1，杨兴东 2，张幼林 1，崔颖 1，刘欣 1，郑永真 1    1.北京丰台医院神经内科，北京 100071；2.北京海淀医院神经内科，北京 100082

      卷次： 2019年30卷6期

      【摘要】 目的 观察帕金森综合征(Parkinson's syndrome)的认知障碍、睡眠障碍及精神行为异常的特点以帮助患者改善日常生活能力。方法 选择2015年1月至2017年5月在北京丰台医院神经内科确诊为帕金森综合征的58例患者，使用简易精神状态评定表(MMSE)和蒙特利尔认知功能评估量表(MoCA)评估认知功能，并将患者分为认知障碍组和认知正常组，采用帕金森病睡眠量表(PDSS)、Epworth嗜睡量表(ESS)、失眠严重程度指数量表(ISI)评估患者的睡眠障碍状况，采用汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD)评估焦虑和抑郁功能。结果 认知障碍组和认知正常组各纳入29例，两组患者在性别、年龄、病程及受教育水平方面比较差异均无统计学意义 (P>0.05)；认知障碍组和认知正常组患者的MoCA评分 [(13.32±4.53)分 vs (15.75±6.16)分]和MMSE评分[(20.64±3.39)分 vs (24.63±4.21)分]比较，认知障碍组均低于认知正常组，差异均有统计学意义(P<0.05)，其中以视空间和执行功能[(2.54±0.76)分 vs (3.26±1.25)分]、注意力[(3.53±1.38)分 vs (4.27±0.36)分]、语言[(0.98±1.47)分 vs (1.04±0.75)分]、抽象思维[(0.39±0.52)分 vs (1.38±0.26)分]、延迟记忆[(1.45±0.47)分 vs (3.57±1.29)分]等方面明显；认知障碍组和认知正常组患者的HAMA [(10.77±5.62)分 vs (7.32±4.51)分]、HAMD [(11.95±4.82)分 vs (7.67±4.39)分]评分比较，差异均有统计学意义(P<0.05)。认知障碍组和认知正常组两组患者PDSS [(85.50±22.70)分 vs (89.50±25.00)分]、ESS [(6.88±1.57)分 vs (6.71±0.69)分]、ISI [(8.97±0.47)分 vs (7.24±0.32)分]评分比较，差异均无统计学意义(P>0.05)。结论 帕金森综合征患者的认知功能受损主要表现在视空间和执行功能、注意力、语言、抽象思维、记忆力等方面，且合并有认知障碍的帕金森综合征患者的睡眠质量更差以及焦虑、抑郁的风险更高。
      【关键词】 帕金森综合征；认知障碍；睡眠障碍；焦虑；抑郁
      【中图分类号】 R742.5 【文献标识码】 A 【文章编号】 1003—6350（2019）06—0703—04

An observational study of cognitive, sleep, and mental behavior in patients with Parkinson's syndrome.
ZENGYi-jun 1, YANG Xing-dong 2, ZHANG You-lin 1, CUI Ying 1, LIU Xin 1, ZHENG Yong-zhen 1. 1. Department of Neurology,Beijing Fengtai Hospital, Beijing 100071, CHINA; 2. Department of Neurology, Haidian Hospital, Beijing 100082, CHINA
【Abstract】 Objective To observe the characteristics of cognitive impairment, sleep disorders, and mental behav-ior abnormalities in patients with Parkinson's syndrome to help patients improve their daily living ability. Methods A to-tal of 58 patients diagnosed with Parkinson's syndrome in the Department of Neurology, Beijing Fengtai Hospital fromJanuary 2015 to May 2017, were assessed using the Mini Mental State Examination (MMSE) and the Montreal Cogni-tive Assessment Scale (MoCA), and they were divided into cognitive impairment group and normal cognitive group. Pa-tients were assessed with Parkinson's Disease Sleep Scale (PDSS), Epworth Sleepiness Scale (ESS), and Insomnia Sever-ity Index (ISI). The Hamilton Anxiety Scale (HAMA) and the Hamilton Depression Scale (HAMD) were used to assessanxiety and depression. Results There were 29 patients in the cognitive impairment group and the normal cognitivegroup. There was no significant difference in gender, age, disease duration, and education level between the two groups(P>0.05). The MoCA scores of the two groups were (13.32±4.53) vs (15.75±6.16), and the MMSE score was (20.64±3.39) vs (24.63±4.21), the scores in the cognitive impairment group were significantly lower than those in the normal cog-nitive group: especially in the visual space and executive function (2.54±0.76) vs (3.26±1.25), attention (3.53±1.38) vs(4.27±0.36), language (0.98±1.47) vs (1.04±0.75), abstract thinking (0.39±0.52) vs (1.38±0.26), and delayed memory(1.45±0.47) vs (3.57±1.29) (P<0.05). There were significant differences in the cognitive impairment group and the nor-mal cognitive group in the scores of HAMA and HAMD: HAMA (10.77±5.62) vs (7.32±4.51), HAMD (11.95±4.82) vs(7.67±4.39), P<0.05. There were no significant differences in the cognitive impairment group and the normal cognitivegroup in the scores of PDSS, ESS, ISI (P>0.05): PDSS (85.50±22.70) vs (89.50±25.00), ESS (6.88±1.57) vs (6.71±0.69),ISI (8.97±0.47) vs (7.24±0.32). Conclusion Impaired cognitive function in patients with Parkinson's syndrome is mainlyreflected in visual space and executive function, attention, language, abstract thinking, memory. Patients with Parkinson'ssyndrome with cognitive impairment have worse sleep quality and a higher risk of anxiety and depression.
      【Key words】 Parkinson's syndrome; Cognitive impairment; Sleep disorders; Anxiety; Depression