摘要：

目的 总结阿尔茨海默病自主神经功能障碍特点及其与认知功能障碍的相关性。方法 纳入2020年7月至2021年6月上海市金山区众仁老年护理医院收治的160例阿尔茨海默病患者，根据简易智能状态检查量表（MMSE）评分分为轻度组（评分>15，63例）和重度组（评分≤ 15，97例）。采用MMSE量表中文版和蒙特利尔认知评价基础量表（MoCA-B）评估认知功能，帕金森病预后量表-自主神经功能部分（SCOPA-AUT）评估自主神经功能，并测量卧位和直立位收缩压和舒张压。Spearman秩相关分析探讨自主神经功能与认知功能的相关性。结果 与轻度组相比，重度组患者MMSE总评分及其亚项评分（均P=0.000）、MoCA-B总评分及其亚项评分（均P=0.000）均降低，而SCOPA-AUT总评分（P=0.000）及其消化系统（P=0.000）、泌尿系统（P=0.000）和体温（P=0.001）分评分均升高。直立性低血压发生率为32.22%（29/90）。Spearman秩相关分析结果显示，SCOPA-AUT总评分（r_s=-2.980，P=0.000；r_s=-3.580，P=0.000）及其消化系统（r_s=-2.730，P=0.000；r_s=-3.160，P=0.000）、泌尿系统（r_s=-3.000，P=0.000；r_s=-3.240，P=0.000）和体温（r_s=-0.244，P=0.005；r_s=-3.270，P=0.000）分评分均与MMSE和MoCA-B总评分呈负相关。结论 阿尔茨海默病患者自主神经功能障碍与认知功能障碍呈正相关，主要体现在消化系统、泌尿系统和体温等子领域，而直立性低血压发生率较低。

关键词: 阿尔茨海默病, 自主神经通路, 认知障碍, 神经心理学测验

Abstract:

Objective To investigate the autonomic nervous dysfunction in patients with Alzheimer's disease (AD) and its relationship with cognitive function. Methods A total of 160 AD patients were enrolled in Shanghai Jinshan Zhongren Aged Care Hospital from July 2020 to June 2021. Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment-Basic (MoCA-B) and Scale for Outcomes in Parkinson's Disease-Autonomic (SCOPA-AUT) were used to assess the cognitive and autonomic nervous function of AD patients, and the occurrence of orthostatic hypotension (OH) in AD were evaluated with the lying and standing blood pressure testing. Spearman rank correlation analysis was used to analyze the correlation between autonomic nervous function and cognitive function. Results Compared with the mild AD group, the scores of MMSE, MoCA -B and their subitems were lower (P=0.000, for all), and SCOPA-AUT score (P=0.000) and its subitem of digestive system (P=0.000), urinary system (P=0.000) and body temperature (P=0.001) were increased in the severe AD group. The incidence of OH was 32.22% (29/90). Spearman rank correlation analysis showed that the SCOPA-AUT sore (r_s=-2.980, P=0.000; r_s=-3.580, P=0.000) and its subitem of digestive system (r_s=-2.730, P=0.000; r_s=-3.160, P=0.000), urinary system (r_s=-3.000, P=0.000; r_s=-3.240, P=0.000) and body temperature (r_s=-0.244, P=0.005; r_s=-3.270, P=0.000) were negatively correlated with MMSE and MoCA-B scores. Conclusions The autonomic nervous dysfunction and its subitem of digestive system, urinary system and body temperature were significant correlated with the cognitive impairment in AD patients. However, there is a lower incidence of OH in AD.

Key words: Alzheimer disease, Autonomic pathways, Cognition disorders, Neuropsychological tests