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目的：探讨帕金森病（PD）伴轻度认知功能障碍（PD-MCI）的相关因素及临床特征，找出帕金森病伴轻度认知功能障碍的预测因子。方法：参照运动障碍协会工作组推荐的帕金森病伴轻度认知功能障碍的诊断标准，用蒙特利尔认知功能评估量表（MoC A）及帕金森病统一评定量表（Ⅰ～Ⅲ）对81 例PD患者进行评估。结果：81 例PD患者中47 例为轻度认知功能障碍，占58 %，23 例无认知功能障碍，占28 %；14 %PD-MCI病人病程小于5年。PD-MCI组与帕金森病不伴有认知功能障碍（PD-NCI）组在文化程度、H&Y 分期、每日左旋多巴等效剂量（LEDD）上差异有统计学意义（P＜0.05）；视空间/ 执行功能、延迟记忆、注意力、语言、抽象能力认知域差异有统计学意义（P＜0.05）；UPDRSⅢ、姿势不稳步态障碍（PIGD）差异有统计学意义（P＜0.05）；MoCA评分与年龄（r = -0.31，P＜0.05）、H&Y 分期（r = -0.44，P＜0.05）、UPDRS-Ⅲ分数（r=-0.32，P＜0.05）、UPDRS-Ⅱ（r= -0.35，P＜0.05）、UPDRS-Ⅰ （r = -0.40，P＜0.05）、迟缓（r = -0.38，P＜0.05）、PIGD 呈负相关（r=-0.31，P＜0.05），与教育程度呈正相关（r=0.30，P＜0.05）。纳入 MoCA 评分为因变量，年龄、教育程度、H&Y 分期、UPDRS-Ⅲ分数、UPDRS-Ⅱ分数、UPDRS-Ⅰ分数为自变量行多元线性回归分析，年龄（beta-coefficients -0.06，P＜0.05）和H&Y 分期（beta-coefficients -0.80，P＜0.05）为帕金森病伴轻度认知功能障碍的预测因子；为观察UPDRSⅢ中亚项评分对认知功能的独立影响，单独纳入迟缓和PIGD评分为自变量，结果迟缓为帕金森病伴轻度认知功能障碍的预测因子（betacoefficients -0.12，P＜0.05）。结论：MCI是PD 患者中发生率较高的一种非运动症状，以视空间/ 执行功能、延迟记忆、注意力、语言功能障碍为主。患者的认知功能和年龄、教育程度、疾病严重程度、运动障碍密切相关，特别是迟缓与姿势不稳/ 步态障碍。年龄、H&Y 分期、迟缓为PD-MCI的预测因子。

英文摘要:

Objective:To investigate the correlated factors and predictors of mild cognitive impairment in patients with Parkinson's disease and its clinical characters.Methods:According to the diagnostic criteria of Movement Disorder Society Task Force for Mild Cognitive Impairment in Parkinson's Disease, 81 PD patients were evaluated by Montreal Cognitive Assessment (MoCA),and Unified Parkinson's Disease Rating Scale (Ⅰ-Ⅲ).Results:In 81 PD patients, 47 cases (58 %) were with mild cognitive impairment PD-MCI and 23 cases (28 %) were with no cognitive impairment(PD-NCI). Patients (14 %) with mild impaired cognition had a disease duration of less than 5 years. There was significant difference between PD-MCI and PD-NCI group in education (P＜0.05), H&Y stage (P＜0.05), the L-dopa equivalent daily dose (LEDD)(P＜0.05); the score in PD-MCI group was significantly lower in visuospatial and executive functioning(P＜0.05), delayed recall (P＜0.05), attention(P＜0.05), language (P＜0.05) and abstract (P＜0.05) subdomains compared with that of PD-NCI group. The difference of UPDRSⅢ and postural instability and gait difficulty (PIGD) were statistically significant in two groups (P＜0.05). MoCA score of PD-MCI group was negatively correlated with age (r = -0.31, P＜0.05), H&Y stage (r=-0.44, P＜0.05), UPDRS-Ⅲ (r=-0.32, P＜0.05), UPDRS-Ⅱ(r=-0.35, P＜0.05), UPDRS-Ⅰ(r = -0.40, P＜0.05), bradykinesia(r=-0.38, P＜0.05) and PIGD (r=-0.31, P＜0.05), and MoCA score of PD-MCI group was positively correlated with education (r=0.30, P＜0.05). Including MoCA score as the dependent variable, and age, H&Y stage, education, UPDRS-Ⅲ, UPDRS-Ⅱ, UPDRS-Ⅰas the independent variables, PD-MCI was predicted by age (beta coefficients -0.06, P＜0.05) and H&Y stage (beta-coefficients -0.80, P＜0.05). Furthermore, multiple regressions with UPDRS subscale scores were conducted to examine their unique contributions to cognitive function. When including bradykinesia and PIGD subscale scores, only bradykinesia predicted PD-MCI(beta-coefficients -0.12, P＜0.05).Conclusion:Mild cognition impairment is one of the common non-motor symptom with highly prevalence in PD, which is mainly characterized by the dramatic impairments in the cognitive domains of visuospatial and executive functioning, delayed recall, attention, language. Poorer cognitive performance is associated with increasing disease severity, age, movement disorder and education, especially in bradykinesia and PIGD. Mild cognitive impairment may be predicted by age, H&Y and bradykinesia.

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