摘要：

帕金森病认知功能障碍起病隐匿，是帕金森病常见非运动症状，包括帕金森病轻度认知损害和帕金森病痴呆，尤以执行功能障碍突出，亦可见视空间能力、记忆力和言语功能等认知域损害。主要危险因素包括男性、高龄、低受教育程度、严重运动症状、基线认知功能较差和白天过度嗜睡。主要病理改变是脑组织路易小体形成，也可见阿尔茨海默病样病理改变。脑脊液总α-突触核蛋白和β-淀粉样蛋白1 ~ 42 水平降低作为生物学标志物的价值尚存争议。相关基因研究较少且无法获得肯定结论。PET 显像发现多巴胺能通路和乙酰胆碱能通路均参与帕金森病认知功能障碍的发生；MRI 研究发现皮质及皮质下结构萎缩与帕金森病认知功能障碍有关。嗅觉障碍可能是帕金森病认知功能障碍的预测因素之一。帕金森病痴呆与路易体痴呆具有共同的生物学特性，二者鉴别诊断困难。胆碱酯酶抑制剂和美金刚有助于改善临床症状，应注意个体化治疗。认知行为疗法具有潜在临床价值，尚待更多研究。

关键词: 帕金森病, 认知障碍, 综述

Abstract:

Parkinson's disease cognitive impairment (PD-CI) is one of the major non-motor symtoms (NMS) of PD, including Parkinson's disease with mild cognitive impairment (PD - MCI) and Parkinson's disease dementia (PDD). Executive dysfunction is relatively prominent, but other cognitive domains as visuospatial ability, memory and language can also be affected. Main risk factors for PD-CI include male gender, advanced age, low education, severe motor symptoms, low baseline cognitive function and excessive daytime sleepiness (EDS). Lewy bodies are main pathological changes, and Alzheimer's disease (AD) related pathological changes can also be seen. The application value of decreased α?synuclein (α-Syn) and β-amyloid 1-42 (Aβ1-42) levels in cerebrospinal fluid (CSF) as biomarkers remains controversial. There are few related research and no defined pathogenic genes currently. Both dopaminergic pathway and acetylcholinergic pathway are involved in the occurrence of PD - CI as demonstrated in PET studies. Cortical and subcortical atrophy are associated with PD - CI as observed in MRI studies. Olfactory dysfunction may be one of the predictors of cognitive impairment. PDD and dementia with Lewy bodies (DLB) share common biological characteristics, therefore the differential diagnosis sometimes is difficult. Cholinesterase inhibitors (ChEIs) and memantine help to improve clinical symptoms, but treatment decision should be made with individualization. Cognitive behavioral treatment (CBT) has potential clinical value and should be investigated by more studies.

Key words: Parkinson disease, Cognition disorders, Review