血管性帕金森综合征与帕金森病认知功能的比较

doi:10.3969/j.issn.1673-5765.2022.04.003

摘要/Abstract

摘要：

目的比较血管性帕金森综合征（vascular parkinsonism，VaP）和帕金森病（Parkinson's disease，PD）患者的认知功能特点。

方法回顾性纳入2018年1月-2020年12月于华北理工大学附属医院首次就诊的VaP患者和PD患者。采用MMSE和MoCA量表评估PD患者和VaP患者的认知功能状态，统一帕金森病评定量表第3部分（unified Parkinson's disease rating scale Ⅲ，UPDRS Ⅲ）评定患者的运动功能。比较2组临床资料和上述量表评分的差异。以MoCA＜26分为认知障碍的标准，比较VaP合并认知障碍（VaP with cognition impairment，VPCI）亚组与PD合并认知障碍（PD with cognition impairment，PDCI）亚组间上述指标的差异。

结果共纳入VaP组19例，PD组22例患者。VaP组高血压（78.9% vs . 40.9%，P =0.014）、糖尿病（52.6% vs. 22.7%，P =0.047）及脑白质病变（84.2% vs. 36.4%，P =0.002）的发生率高于PD组，而PD 组的高同型半胱氨酸血症发生率高于VaP组（72.7% vs. 36.8%，P =0.021）；VaP组的认知障碍发生率高于PD组（78.9% vs. 45.5%，P =0.028），MMSE（中位数：24.0分 vs. 29.0分，P＜0.001）、MoCA（中位数：17.0分 vs. 26.0分，P =0.002）和UPDRS Ⅲ（中位数：18.0分 vs. 33.5分，P＜0.001）评分低于PD组。 VPCI患者的MMSE（中位数：23.0分 vs. 27.0分，P =0.002）、MoCA（中位数：17.0分 vs. 22.0分，P =0.041）和UPDRSⅢ（中位数：18.0分 vs. 37.0分，P =0.004）评分均低于PDCI患者。

结论与PD患者相比，VaP患者中合并认知功能障碍的比例更高，而且VaP患者的认知功能障碍较PD患者严重。

文章导读： 对VaP和PD患者认知功能和运动功能症状进行区分在临床上非常重要，本文总结了两者的区别，显示VaP患者的认知功能下降发生率和严重程度均较PD患者严重，提示临床应更重视对此类患者的认知干预。

关键词: 血管性帕金森综合征; 帕金森病; 认知功能

Abstract: Objective To compare the cognitive function between the patients with vascular parkinsonism (VaP) and Parkinson's disease (PD). Methods PD patients and VaP patients who were firstly admitted in North China University of Science and Technology Affiliated Hospital from January 2018 to December 2020 were enrolled in the retrospective study. MMSE and MoCA were used to evaluate the patients’ cognitive function, and the unified Parkinson's disease rating scale part Ⅲ (UPDRS Ⅲ) was used to evaluate the motor function. The scores of MMSE, MoCA, UPDRS Ⅲ and baseline characteristics between PD patients and VaP patients were compared. Cognitive impairment was defined as MoCA<26. The differences in the above scores between VaP patients with cognition impairment (VPCI) and PD patients with cognition impairment (PDCI) were compared. Results A total of 19 VaP patients and 22 PD patients were enrolled in this study. VaP patients had higher incidence of hypertension (78.9% vs . 40.9%, P =0.014), diabetes (52.6% vs . 22.7%, P =0.047) and leukodystrophy (84.2% vs . 36.4%, P =0.002) than PD patients, while PD patients had higher incidence of hyperhomocysteinemia than VaP patients (72.7% vs . 36.8%, P =0.021); VaP patients had higher incidence of cognitive impairment (78.9% vs . 45.5%, P =0.028) and lower scores of MMSE (24.0 vs . 29.0, P <0.001), MoCA (17.0 vs . 26.0, P =0.002) and UPDRS Ⅲ (18.0 vs . 33.5, P <0.001) than PD patients. VPCI patients had lower scores of MMSE (23.0 vs . 27.0, P =0.002), MoCA (17.0 vs . 22.0, P =0.041) and UPDRS Ⅲ (18.0 vs . 37.0, P =0.004) than PDCI patients. Conclusions VaP patients had higher incidence of cognition impairment and more severer cognition impairment than PD patients.

Key words: Vascular Parkinsonism; Parkinson's disease; Cognitive function

石松鑫, 王大力, 李弘, 王星稳, 訾媛, 安雅臣, 张江. 血管性帕金森综合征与帕金森病认知功能的比较[J]. 中国卒中杂志, 2022, 17(04): 341-345.

SHI Songxin, WANG Dali, LI Hong, WANG Xingwen, ZI Yuan, AN Yachen, ZHANG Jiang. Comparison of Cognitive Function between Vascular Parkinsonism and Parkinson’s Disease[J]. Chinese Journal of Stroke, 2022, 17(04): 341-345.

参考文献

[1] CRITCHLEY M. Arteriosclerotic parkinsonism[J].Brain，1929，52（1）：23-83.
[2] GUPTA D，KURUVILLA A. Vascular parkinsonism：what makes it different[J]. Postgrad Med J，2011，87（1034）：829-836.
[3] 罗倩，彭思佳，王笑瑗，等. 血管性帕金森综合征的临床特征及神经影像学研究进展[J]. 中国卒中杂志，2021，16（9）：967-970.
[4] EL-TALLAWY H N，FARGHALY W M，SHEHATA
G A，et al. Prevalence of Parkinson's disease and other types of parkinsonism in Al Kharga district，Egypt[J/OL]. Neuropsychiatr Dis Treat，2013，9：1821-1826[2021-12-10]. https://doi.org/10.2147/ndt.s48318.
[5] GLASS P G，LEES A J，BACELLAR A，et al. The clinical features of pathologically confirmed vascular parkinsonism[J]. J Neurol Neurosurg Psychiatry，2012，83（10）：1027-1029.
[6] 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委员会. 中国血管性帕金森综合征诊断与治疗专家共识[J]. 中华神经科杂志，2017，50（5）：326-331.
[7] 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.
[8] SAVICA R，GROSSARDT B R，BOWER J H，et al. Incidence and pathology of synucleinopathies and tauopathyies related to parkinsonism[J]. JAMA Neurol，2013，70（7）：859-866.
[9] KALRA S，GROSSET D G，BENAMER H T. Differentiating vascular parkinsonism from idiopathic Parkinson's disease：a systematic review[J]. Mov Disord，2010，25（2）：149-156.
[10] 王丽娟，聂坤，张玉虎. 血管性帕金森综合征的诊治[J]. 中华神经科杂志，2021，54（8）：833-837.
[11] ST ENC BRADVICA I ，JANCULJAK D，BUTKOVIC-SOLDO S，et al. Cognitive dysfunction in idiopathic and vascular parkinsoni

[12] CHE MOHD NASSIR C M N，DAMODARAN T，YUSOF S R，et al. Aberrant neurogliovascular unit dynamics in cerebral small vessel disease：a rheological clue to vascular parkinsonism[J/OL].Pharmaceutics，2021，13（8）：1207[2021-12-10].https://doi.org/10.3390/pharmaceutics13081207.

[13] SALSONE M，CALIGIURI M E，VESCIO V，et al. Microstructural changes of normal-appearing white matter in vascular parkinsonism[J/OL]. Parkinsonism Relat Disord，2019，63：60-65[2021-12-10]. https://doi.org/10.1016/j.parkreldis.2019.02.046.
[14] NARASIMHAN M，SCHWARTZ R，HALLIDAY G. Parkinsonism and cerebrovascular disease[J/OL].J Neurol Sci，2021：120011[2021-12-10]. https://doi.org/10.1016/j.jns.2021.120011.
[15] MICELI V，RUSSELLI G，IANNOLO G，et al. Role of non-coding RNAs in age-related vascular cognitive impairment：an overview on diagnostic/prognostic value in vascular dementia and vascular parkinsonism[J/OL]. Mech Ageing Dev，2020，191：111332[2021-12-10]. https://doi.org/10.1016/j.mad.2020.111332.