MoCA量表在评估帕金森病患者认知功能中的应用

目的 采用蒙特利尔认知评估量表(MoCA)分析帕金森病(PD)患者的认知功能损害的特点,并探讨MoCA在评估PD认知功能方面的应用价值.方法 采用MoCA对35例PD患者进行认知功能评估,并进行各认知域的分析.结果 (1)本组研究对象的MoCA评分为20.51±5.767,其中7例患者MoCA≤26分,占20.0%;(2)PD患者各认知域障碍的发生率不一致,依次为语言(34例,97.1%)、延迟记忆(32例,91.4%)、视空间与执行能力(30例,85.7%)、抽象思维(27例,77.1%)、注意(23例,68.6%)、命名(13例,37.1%)和定向力(12例,34.3%):(3)MoCA的各认知域与总分的相关系数都大于0.50,P＜0.01.结论 (1)MoCA是评估PD患者认知功能的高效快捷的工具;(2)PD患者常见的认知功能损害包括语言、延迟记忆、视空间与执行能力、抽象思维和注意,而命名和定向力相对损害较轻.     

蒙特利尔认知评估量表和简易精神状态量表在帕金森病轻度认知功能障碍筛查中的应用

目的探讨蒙特利尔认知评估量表(MOCA)和简易精神状态量表(MMSE)在帕金森病轻度认知功能障碍(PDMCI)筛查中的应用。方法采用随机抽样方法,应用MOCA和MMSE对75例诊断为PDMCI患者、帕金森病认知功能正常(PDN)患者180例和健康患者145例进行评估,比较二者筛查PDMCI的敏感性和特异性。结果在文盲组MMSE的敏感性为93.10%,特异性为100%,而MOCA的敏感性仅为0%,特异性为92.72%;在小学组MMSE的敏感性为87.50%,特异性为100%,而MOCA的敏感性为41.67%,特异性为79.17%;在初中及以上学历组MMSE的敏感性为27.27%,特异性为100%,MOCA的敏感性为90.91%,特异性为85.71%。结论 MOCA适合初中及以上学历的PDMCI筛查工具,MMSE适合初中以下学历PDMCI筛查工具。     

蒙特利尔认知评估量表在癫认知功能障碍患者中的应用价值

目的分析蒙特利尔认知评估(MoCA)量表筛查癫患者认知功能障碍的应用价值。方法使用简明精神状态检查(MMSE)量表筛查出认知功能正常的120例癫患者,再行MoCA量表评分。依据MoCA量表评分结果将120例癫患者分为①认知功能正常(NC)组:MoCA量表评分≥26分;②认知功能损害(CI)组:MoCA量表评分<26分。比较两组癫患者MoCA量表各项分数的差异及认知功能改变的特点,应用单因素及多元Logistic回归分析认知功能损害的影响因素。结果①120例患者中50例(41.7%)MoCA量表评分<26分;②CI组MoCA量表各条目得分均低于NC组,差异有统计学意义(P<0.05);③Logistic回归分析结果显示,受教育年限是认知功能损害的影响因素(OR=1.34,95%C1:1.05~1.70,P<0.05)。结论 MMSE正常癫患者中仍存在相当比例MoCA量表评分异常的患者。建议使用MoCA量表测试癫患者的认知功能水平。     

非痴呆非抑郁帕金森病患者额叶认知功能变化的研究靠

目的探讨帕金森病(PD)患者认知功能变化的特点,以及额叶认知测试对PD患者认知障碍评价的意义.方法采用对额叶认知障碍比较敏感的神经心理方法词语流畅性、连线测验、Stroop字色干扰测验对31例非痴呆非抑郁PD患者和25名年龄、性别、受教育程度相匹配的正常对照进行测试.结果非痴呆非抑郁PD患者与对照组比较额叶认知功能评分较差(词语流畅性P＜0.05、连线试验P＜0.01、Stroop字色干扰测试P＜0.01).结论非痴呆非抑郁的PD患者额叶认知功能显著降低,其机制可能与额叶-纹状体多巴胺环路中递质紊乱有关.     

帕金森病认知功能损害

帕金森病（Parkinson’s disease,PD）认知功能损害近年来受到人们的关注,PD认知损害严重影响患者的日常生活能力,早期诊断和干预PD认知损害将有助于延缓PD痴呆的发生。本文就PD认知功能损害的发生率、诊断标准及治疗等方面进行简要综述。     

非痴呆非抑郁帕金森病患者额叶认知功能变化的研究

目的　探讨帕金森病 (PD)患者认知功能变化的特点 ,以及额叶认知测试对PD患者认知障碍评价的意义。方法　采用对额叶认知障碍比较敏感的神经心理方法 :词语流畅性、连线测验、Stroop字色干扰测验对 3 1例非痴呆非抑郁PD患者和 2 5名年龄、性别、受教育程度相匹配的正常对照进行测试。结果　非痴呆非抑郁PD患者与对照组比较额叶认知功能评分较差 (词语流畅性P <0 0 5、连线试验P <0 0 1、Stroop字色干扰测试P <0 0 1)。结论　非痴呆非抑郁的PD患者额叶认知功能显著降低 ,其机制可能与额叶 纹状体多巴胺环路中递质紊乱有关。     

影响帕金森病患者认知功能的独立危险因素分析

目的 分析影响帕金森病患者认知功能的独立危险因素.方法 回顾性分析南通大学第二附属医院75例帕金森病患者的临床资料,分别采用帕金森病统一评价量表(UPDRS)、蒙特利尔认知评估(MoCA)量表、匹兹堡睡眠质量指数(PSQI)、蒙哥马利抑郁评定量表(MADRS)、Hoehn-Yahr分期进行评估.采用单因素分析和多因素L...     

并存非运动症状的帕金森病患者轻度认知功能障碍发生情况及危险因素分析

目的探讨并存非运动症状的帕金森病(PD)患者轻度认知功能障碍(MCI)发生情况及危险因素分析。方法选取2012年3月至2015年9月本院收治的并存非运动症状的PD患者86例,其中男性45例,女性41例,将MoCA评分<26分的44例患者纳入PD-MCI组,MoCA≥26分的42例患者则纳入PD-NC组(认知功能正常),由3名以上神经科培训的专业人员分别对两组患者进行UPDRS评价、H-Y分级评价、NMSQ评价、MoCA评价,根据各量表的评价结果分析探讨PD患者发生MCI的危险因素。结果 PD-MCI组与PD-NC相比,认知功能方面在视空间技能(t=6.391,P<0.01)、执行功能(t=6.048,P<0.01)、抽象思维(t=6.762,P<0.01)、记忆(t=-4.247,P<0.01)这几项差异有统计学意义;非运动症状方面在兴趣丧失(χ2=5.957,P=0.015)、焦虑抑郁(χ~2=4.643,P=0.031)、睡梦中肢体活动(χ~2=4.43,P=0.035)的发生率存在统计学差异(P<0.05);统计分析得出PD患者发生MCI的主要因素为兴趣丧失和睡梦中肢体活动。结论早期未治疗的PD患者的认知功能障碍的发生与兴趣丧失以及梦境中肢体活动存在一定的联系。     

血管性认知功能损害脑CT灌注成像与认知功能的关系

目的探讨血管性认知功能损害患者脑CT灌注成像特征,分析其与认知功能的相关性。方法 2016-06—2018-06在焦作市第二人民医院住院诊治的缺血性脑卒中患者112例进行蒙特利尔认知评估量表(MoCA)测验,依据测试结果分为认知功能正常者46例和不正常者66例,认知功能不正常者进一步分为血管性非痴呆认知功能损害(vascular cognitive impairmentno-dementia,V-CIND)组48例和血管性痴呆(VaD)组18例,分析各组患者脑CT灌注成像特征,以及与认知功能的相关性。结果本次入组112例脑卒中患者VCI发生率为58.93%。脑血容量(CBV)及脑血流量(CBF)指标3组间比较差异有意义(P0.05);CBV和CBF与MoCA评分呈正相关(P0.05),与连线测验完成时间呈负相关(P0.05)。结论认知障碍患者均存在不同程度的脑血流灌注降低,且随着认知功能进展血流灌注进一步下降,脑计算机断层灌注成像可早期识别VCI,为临床诊治提供依据。     

帕金森病患者主观性认知减退的临床研究

目的探讨伴有主观性认知减退(SCD)的帕金森病(PD)患者(PD-SCD~+)和不伴有SCD的PD患者(PD-SCD~-)各领域的认知功能是否有差异。方法将40例PD患者按照是否有SCD主诉分为PD-SCD~+(n=22)和PD-SCD~-(n=18)两组。用相关测试评价患者各个领域的认知功能(包括注意力、执行功能、语言功能、记忆力功能、视空间功能),比较两组之间各领域的认知测试分数的差异。结果(1)PD-SCD~+与PD-SCD~-两组患者的临床基线资料(P0.05);(2)PD-SCD~+与PD-SCD~-两组在记忆力(即刻与延迟回忆2,P=0.0477)上的差异有统计学意义;在注意力(数字广度试验,P=0.7697;100连续减7,P=0.8696)、执行功能(连线试验,P=1.0000)、语言功能(语言流畅性,P=0.3596;命名和复述,P=0.9140)、记忆力(即刻与延迟回忆1:P=1.0000;定向:P=0.7686)、视空间功能(画钟试验,P=1.0000;五边形交叉,P=0.5597)的差异无统计学意义。结论 PD-SCD~+与PD-SCD~-两组患者的临床基线资料没有差异。PD-SCD~+组的记忆力(即刻与延迟回忆2)较PD-SCD~-组差。     

Cognitive function in HIV-seropositive Nigerians without AIDS

Studies of cognitive function in individuals with HIV infection who remain relatively asymptomatic have shown widely variable estimates of impairment in different races and countries. Limited data exist on the impact of early asymptomatic HIV infection on cognition in developing nations, and indeed none from Nigeria. Hence, this cross-sectional study sets out to determine whether there are differences between Nigerian asymptomatic HIV-seropositive and HIV-seronegative subjects, and whether such differences: if any, could be explained by the degree of immunosuppression (i.e. CD4 cell count). A selected population of 60 heterosexual asymptomatic treatment-naive HIV-positive subjects were administered the Community Screening Instrument for Dementia (CSI-D) to assess language, memory, registration, attention and calculation, recall, praxis and orientation. HIV positives differed from individually matched control subjects in certain measures of language expression, registration, attention and calculation, orientation to time, motor response and total CSI-D scores. The CD4 cell count of the HIV-seropositive subjects had no significant correlation with the cognitive test scores.     

Cognitive test scores in community-based older adults with and without dementia

In an epidemiological survey of a rural, largely blue-collar, community, 1,363 randomly selected adults, aged 65 years, were administered a cognitive screening battery (including in part the CERAD neuropsychological tests): Mini-Mental State Examination; Word List Learning, Recall, and Recognition; Story, Immediate and Delayed Recall; Boston Naming Test; Verbal Fluency; Temporal Orientation; Constructional Praxis; Draw a Clock; and Trailmaking. Cognitively impaired subjects and cognitively intact controls underwent independent standardized diagnostic assessments and were rated on Clinical Dementia Rating (CDR) scale. Overall, subjects at higher CDR levels (more severe dementia) had worse scores on all tests; showing that standard neuropsychological tests are valid for characterizing the cognitive impairments seen in dementia, even in community settings. However, non-demented scores on the CERAD tests in this community-based sample were lower than reported from CERAD's pooled healthy controls from Alzheimer's Disease Centers (ADCs) nationwide. Thus, 'normal' scores from specialty dementia clinics, where there may be a selection bias, may differ from normative scores from rural and/or less-educated populations. Patients from such populations may be functionally intact despite low test scores. Community-based studies are required to complement specialty clinic-based studies of dementia and cognitive functioning.     

APOE and the risk of PD with or without dementia in a population-based study

OBJECTIVE: To study the association between APOE genotype and PD with or without dementia. METHODS: The study formed part of the Rotterdam Study, a prospective, population-based cohort study on the frequency, etiology, and prognosis of chronic diseases. The cohort examined for PD consisted of 6,969 independently living or institutionalized inhabitants from a suburb of Rotterdam, the Netherlands, aged 55 years or older. All participants were screened at baseline (1990 to 1993) and at follow-up (1993 to 1994) for symptoms of parkinsonism by study physicians; screen positives received a diagnostic workup by a neurologist. RESULTS: APOE genotyping was available for 107 PD patients (26 with and 81 without dementia) and 4,805 non-PD control subjects. The presence of at least one epsilon2 allele significantly increased the risk of PD (OR = 1.7; 95% CI, 1.0 to 2.8). When we looked separately for demented and nondemented PD patients as compared with nonparkinsonian controls, APOE did not appear to be associated with PD without dementia, but both the epsilon2 and the epsilon4 allele increased the risk of PD with dementia (OR = 5.6; 95% CI, 2.0 to 15.2 and OR = 3.6; 95% CI, 1.3 to 9.9). The risk of dementia for epsilon4 allele carriers was not significantly different for persons with or without PD. However, the epsilon2 allele strongly increased the risk of dementia in patients with PD (interaction p < 0.007). CONCLUSIONS: In the elderly the APOE-epsilon2 allele increases the risk of PD and, in particular, the risk of PD with dementia.     

Cognitive and motor function in patients with Parkinson's disease with and without depression

The objective of this study was to define risk factors for depression in patients with idiopathic Parkinson's disease (PD) and to evaluate the correlation of depression with cognitive function and the primary domains of parkinsonian motor dysfunction tremor, bradykinesia, rigidity, gait and balance impairment. The risk factors for depression in patients with PD remain controversial. Several investigators have demonstrated a significant association between cognitive dysfunction and depression, but motoric and disease variables can confound this evaluation and have shown an inconsistent relation to depression. A consecutive series of 88 patients with PD were examined using the motor subscale of the Unified Parkinson's Disease Rating Scale (UPDRSm), Hoehn-Yahr stage (HY), and Hamilton Rating Scale for Depression (HRSD). Major depression was diagnosed according to the criteria in the Diagnostic and Statistic Manual of Mental Disorders, 4th edition. Gender, age, handedness, PD duration, side of PD onset, motor fluctuations, UPDRSm total score, daily Levodopa dose, and Mini-Mental State Examination score (MMSE) were analyzed using multivariate and univariate logistic regression, Fisher's Exact test, and Pearson correlations. Major depression was diagnosed in 12 patients (7.3%). Low MMSE score, axial bradykinesia, gait and balance impairment were strongly significant predictors of depression. In conclusion, depression and physical function are important factors impairing the quality of life for patients with PD, and regular depression screening and treatment should focus on patients with PD who have cognitive impairment, high axial bradykinesia, gait and balance impairment.     

血管性痴呆大鼠认知功能及nNOS的表达

目的 探讨血管性痴呆(VD)大鼠认知功能、海马神经元结构及nNOS的表达.方法 采用双侧颈总动脉结扎法制备慢性前脑缺血动物模型,40只老龄大鼠随机分为假手术组(S)、模型组(M).应用水迷宫、透射电镜及免疫组化方法对2组大鼠学习记忆、神经元结构、nNOS表达进行观察.结果 与假手术组比较,大鼠水迷宫学习记忆能力在造模2个月后差异有统计学意义(P＜0.05),大鼠海马神经元在造模后变性水肿明显,大鼠海马及颞叶皮层nNOS在造模2个月后表达增加 (P＜0.05).结论 海马及颞叶皮层nNOS表达增加,神经元变性,可能导致血管性痴呆大鼠学习记忆障碍.     

Cognitive profiles in degenerative dementia without evidence of small vessel pathology and small vessel vascular dementia

Although a large number of studies have examined possible differences in cognitive performance between Alzheimer’s disease (AD) and vascular dementia (VaD), the data in the literature are conflicting. The aims of this study were to analyze the neuropsychological pattern of subjects affected by degenerative dementia without evidence of small vessel pathology (DD) and small vessel VaD subjects in the early stages and to investigate differences in the progression of cognitive impairment. Seventy-five patients with probable VaD and 75 patients with probable DD were included. All the subjects underwent a standard neuropsychological evaluation, including the following test: Visual Search, Attentional matrices, Story Recall, Raven’s Coloured Progressive Matrices, Phonological and Semantic Verbal Fluency, Token, and Copying Drawings. The severity of cognitive impairment was stratified according to the MMSE score. Fifteen subjects with probable DD and 10 subjects with probable VaD underwent a 12-month cognitive re-evaluation. No significant difference was found between DD and VaD subjects in any of the neuropsychological tests except Story Recall in the mild cognitive impairment (P < 0.001). The re-test value was significantly worse than the baseline value in the MMSE (P = 0.037), Corsi (P = 0.041), Story Recall (P = 0.032), Phonological Verbal Fluency (P = 0.02), and Copying Drawings (P = 0.043) in DD patients and in the Visual Search test (P = 0.036) in VaD subjects. These results suggest that a neuropsychological evaluation might help to differentiate degenerative dementia without evidence of small vessel pathology from small vessel VaD in the early stages of these diseases.     

Cognitive function of patients with nasopharyngeal carcinoma with and without temporal lobe radionecrosis

BACKGROUND: Radiotherapy is the primary treatment for nasopharyngeal carcinoma, and temporal lobe necrosis is observed in about 7% of patients after radiotherapy. Although some studies reported that these patients demonstrated cognitive impairment after radiotherapy, it is still unclear if the cognitive deficits are related to the radiation exposure or the radiation-induced necrosis. OBJECTIVE: To compare the cognitive function of patients with and without temporal lobe necrosis after radiotherapy for nasopharyngeal carcinoma. METHODS: A comprehensive neuropsychological battery was administered to 53 patients with nasopharyngeal carcinoma who had completed their radiotherapy at least 1 year previously. As evidenced by magnetic resonance imaging, 31 patients developed necrosis after treatment. Thirty-one age- and education-matched individuals were recruited as normal control subjects. RESULTS: Whereas the performance of patients without temporal lobe necrosis was similar to that of normal control subjects, patients with temporal lobe necrosis demonstrated significant impairment on tests of verbal (P<.001) and visual memory (range, P<.001 to P =.03), language (range, P<.001 to P =.01), motor ability (P =.02), planning (P =.02), cognitive ability (P =.007), and abstract thinking (range, P =.009 to P =.04). However, the performance of patients with necrosis on tests of general intelligence (range, P =.08 to P =.15), attention (range, P =.06 to P =.55), and visual abilities (range, P =.06 to P =.47) was not significantly different from that of normal control subjects and patients without necrosis. CONCLUSIONS: Radiotherapy for nasopharyngeal carcinoma seemed to have adverse but insignificant effects on the cognitive functions of the patients. However, for patients who developed temporal lobe necrosis after radiotherapy, memory, language, motor ability, and executive functions were significantly impaired, although their general intelligence remained relatively intact.     

Cognitive function in young Parkinsonian patients

We thank E. Stenager for his interest in our work and for the opportunity to comment on his questions; the numbers referred to here are his.