周涌涛,赵俊武,李渊,冯焕焕,但小娟,张辉,陈彪

• 1:首都医科大学宣武医院
• 2:威海市立医院
• 3:潍坊市人民医院

摘要(Abstract)：

目的 探讨帕金森病（PD）认知损害的临床特点及危险因素对冻结步态（FOG）的影响。方法 纳入2015-05-26—2022-01-08在首都医科大学宣武医院神经内科住院确诊为PD、完成认知评估的808例患者，收集其临床资料，包括ADL评分、H-Y分级、UPDRS-Ⅲ评分、MMSE评分及有无冻结步态等，并进行分析。结果 PD认知损害的发生率30.07%，与病程<5 a相比，病程>10 a增加1.78倍认知损害发生风险。与年龄≤49岁相比，年龄>49岁增加4.04倍认知损害发生风险（P<0.05）。认知损害与ADL和UPDRS-Ⅲ评分显著相关（分别为r=0.43、-0.25,P<0.05），认知损害增加1.75倍FOG发生风险（P<0.05），其与便秘在FOG发病中具有协同作用，二者可增加2.95倍FOG发生风险（P<0.05）。结论 年龄>49岁与病程>10 a是PD认知损害的独立危险因素，认知功能与ADL相互影响，是引起ADL下降的独立因素，并增加1.75倍FOG发生风险。认知损害与便秘在FOG发病中具有协同作用，使FOG发生的风险增加2.95倍。

关键词(KeyWords)： 帕金森病;认知损害;冻结步态;日常生活能力;便秘;临床特点;危险因素

Abstract:

Keywords:

基金项目(Foundation): 国家自然基金面上项目(编号:30970926);; 首都医科大学基础-临床课题(编号:14JL19)

作者(Author): 周涌涛,赵俊武,李渊,冯焕焕,但小娟,张辉,陈彪

参考文献(References)：

• [1] GOZALEZ-LATAPI P,BAYRAM E,LITVAN I,et al. Cognitive Impairment in Parkinson’s Disease:Epidemiology, Clinical Profile,Protective and Risk Factors[J]. Behav Sci(Basel),2021,11(5):74.
• [2] WILLIS A W,SCHOOTMAN M,KUNG N,et al. Predictors of survival in patients with Parkinson disease[J]. Arch Neurol,2012,69:601-607.
• [3] TROPEA T F,HARTSTONE W,AMARI N,et al. Genetic and phenotypic characterization of Parkinson’s disease at the clinic-wide level[J]. NPJ Parkinsons Dis,2024,10(1):97.
• [4] OGBIMI E M,AKEMOKWE F M,OGUNRIN O. Frequency,pattern and predictors of cognitive impairments in patients with Parkinson’s disease using the Community Screening Instrument for Dementia[J]. Front Hum Neurosci,2023,17:1126526.
• [5] WANG S,LI T,ZHOU T,et al. Survival in patients with Parkinson’s disease:a ten-year follow-up study in northern China[J]. BMC Neurol,2022,22(1):367.
• [6] WINTER Y,VON CAMPENHAUSEN S,AREND M,et al.Health-related quality of life and its determinants in Parkinson’s disease:results of an Italian cohort study[J]. Parkinsonism Relat Disord,2011,17(4):265-269.
• [7] MONAGHAN A S,GORDON E,GRAHAM L,et al. Cognition and freezing of gait in Parkinson’s disease:A systematic review and meta-analysis[J]. Neurosci Biobehav Rev,2023,147:105068.
• [8] PAULY L,PAULY C,HANSEN M,et al. Retrograde procedural memory is impaired in people with Parkinson’s disease with freezing of gait[J]. Front Aging Neurosci,2024,15:1296323.
• [9] ZHANG Z X,ANDERSON D W,HUANG J B,et al. Prevalence of Parkinson’s disease and related disorders in the elderly population of greater Beijing,China[J]. Mov Disord,2003,18(7):764-772.
• [10]王俊，姜立刚.帕金森病患者医疗支出与疗效的研究进展[J].中国实用神经疾病杂志，2020,23(22):2020-2024.
• [11] COCKX H M,OOSTENVELD R,FLóREZ R Y A,et al. Freezing of gait in Parkinson’s disease is related to imbalanced stoppingrelated cortical activity[J]. Brain Commun,2024,6(5):fcae259.
• [12]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学组.中国帕金森病治疗指南（第四版）[J].中华神经科杂志，2020,53(12):14.
• [13] ZHOU Y,ZHAO J,HOU Y,et al. Dopaminergic pathway and primary visual cortex are involved in the freezing of gait in Parkinson’s disease:a PET-CT study[J]. Neuropsychiatr Dis Treat,2019,15:1905-1914.
• [14] MILLER K J,SUAREZ-IGLESIAS D,SEIJO-MARTINEZ M,et al. Physiotherapy for freezing of gait in Parkinson’s disease:a systematic review and meta-analysis[J]. Rev Neurol,2020,70(5):161-170.
• [15] QU Y,LI J,CHEN Y,et al. Freezing of gait is a risk factor for cognitive decline in Parkinson’s disease[J]. J Neurol,2023,270(1):466-476.
• [16] BERG D,POSTUMA R B,ADLER C H,et al. MDS research criteria for prodromal Parkinson’s disease[J]. Mov Disord,2015,30(12):1600-1611.
• [17] WANG H,LI H Y,GUO X,et al. Association of Posture Instability with Dopamine Drop of Nigrostriatal System and Hypometabolism of Cerebral Cortex in Parkinson’s Disease[J]. Curr Neurovasc Res,2021,18(2):244-253.
• [18]王丽娟，冯淑君，聂坤.中国帕金森病轻度认知障碍的诊断和治疗指南（2020版）[J].中国神经精神疾病杂志，2021,47(1):1-11.
• [19] EVANS J R,MASON S L,WILLIAMS-GRAY C H,et al. The natural history of treated Parkinson’s disease in an incident,community based cohort[J]. J Neurol Neurosurg Psychiatry,2011,82:1112-1118.
• [20] BARVAS E,MATTAVELLI G,ZAPPINI F,et al. Cognitive phenotypes in Parkinson’s disease:A latent profile analysis[J].Neuropsychology,2021,35(4):451-459.
• [21] VASCONCELLOS L F,PEREIRA J S. Parkinson’s disease dementia:Diagnostic criteria and risk factor review[J]. J Clin Exp Neuropsychol,2015,37(9):988-993.
• [22] NICOLETTI A,LUCA A,BASCHI R,et al. Vascular risk factors,white matter lesions and cognitive impairment in Parkinson’s disease:the PACOS longitudinal study[J]. J Neurol,2021,268(2):549-558.
• [23] PIERZCHLINSKA A,KWASNIAK-BUTOWSKA M,SLAWEK J,et al. Arterial Blood Pressure Variability and Other Vascular Factors Contribution to the Cognitive Decline in Parkinson’s Disease[J]. Molecules,2021,26(6):1523.
• [24] HOU M,HOU X,QIU Y,et al. Characteristics of Cognitive Impairment and Their Relationship With Total Cerebral Small Vascular Disease Score in Parkinson’s Disease[J]. Front Aging Neurosci,2022,14:884506.
• [25]王莎莎，魏森，许予明.脑小血管病患者中影像学标记物及整体负担与轻度帕金森样体征的关系[J].中国实用神经疾病杂志，2020,23(9):760-765.
• [26] KIM S,NA H K,SUN Y,et al. Regional Burden of Enlarged Perivascular Spaces and Cognition and Neuropsychiatric Symptoms in Drug-Naive Patients With Parkinson Disease[J].Neurology,2024,102(12):e209483.
• [27] MOLLENHAUER B,ZIMMERMANN J,SIXEL-DORING F,et al.Baseline predictors for progression 4 years after Parkinson’s disease diagnosis in the De Novo Parkinson Cohort(DeNoPa)[J]. Mov Disord,2019,34(1):67-77.
• [28] HALLIDAY G M,LEVERENZ J B,SCHNEIDER J S,et al. The neurobiological basis of cognitive impairment in Parkinson’s disease[J]. Mov Disord,2014,29(5):634-650.
• [29] ZHANG X,MOLSBERRY S A,SCHWARZSCHILD M A,et al.Association of Diet and Physical Activity With All-Cause Mortality Among Adults With Parkinson Disease[J]. JAMA Netw Open,2022,5(8):e2227738.
• [30] XU Q,PARK Y,HUANG X,et al. Physical activities and future risk of Parkinson disease[J]. Neurology,2010,75(4):341-348.
• [31] CAMARGO C H F,FERREIRA-PERUZZO S A,RIBAS D I R,et al. Imbalance and gait impairment in Parkinson’s disease:discussing postural instability and ataxia[J]. Neurol Sci,2024,45(4):1377-1388.
• [32] MONAGHAN A S,GORDON E,GRAHAM L,et al. Cognition and freezing of gait in Parkinson’s disease:A systematic review and meta-analysis[J]. Neurosci Biobehav Rev,2023,147:105068.
• [33] BIDGOOD R,ZUBELZU M,RUIZ-ORTEGA J A,et al. Automated procedure to detect subtle motor alterations in the balance beam test in a mouse model of early Parkinson’s disease[J]. Sci Rep,2024,14(1):862.
• [34]周涌涛.便秘对帕金森病冻结步态的影响[J].中国实用神经疾病杂志，2023,26(12):1453-1457.
• [35] ZHOU Y,SU Y,XU W,et al. Constipation Increases Disability and Decreases Dopamine Levels in the Nigrostriatal System through Gastric Inflammatory Factors in Parkinson’s Disease[J].Curr Neurovasc Res,2019,16(3):241-249.
• [36] RUTZ D G,BENNINGER D H. Physical Therapy for Freezing of Gait and Gait Impairments in Parkinson Disease:A Systematic Review[J]. PM R,2020,12(11):1140-1156.
• [37] POHL P,WRESSLE E,LUNDIN F,et al. Group-based music intervention in Parkinson’s disease-findings from a mixedmethods study[J]. Clin Rehabil,2020,34(4):533-544.
• [38] JOHANSSON H,FOLKERTS A K,HAMMARSTROM I,et al.Effects of motor-cognitive training on dual-task performance in people with Parkinson’s disease:a systematic review and meta-analysis[J]. J Neurol,2023,270(6):2890-2907.