摘要：

目的 探讨多系统萎缩和帕金森病患者执行功能障碍特点。方法 采用简易智能状态检查量表（MMSE）和蒙特利尔认知评价量表（MoCA），以及Stroop 色词测验（SCWT）、数字符号转换测验（DSST）/图形符号转换测验（GSST）、画钟测验（CDT）和连线测验（TMT）评价34 例多系统萎缩患者［以小脑共济失调为主要表现型（MSA-C 型）21 例、以帕金森病综合征为主要表现型（MSA-P 型）13 例］和18 例原发性帕金森病患者的整体认知功能和执行功能。结果 各组受试者MoCA 评分差异有统计学意义（P = 0.019），其中PD 组和MSA-C 型组患者评分低于对照组（P = 0.015，0.002）。各组受试者SCWT 测验各部分评分（P = 0.035，0.013，0.012，0.037）、DSST 评分（P = 0.000）、GSST 评分（P = 0.000）、TMT 评分（P = 0.035）差异均有统计学意义，其中，MSA-C 型组和MSA-P 型组患者SCWT-A（P = 0.004，0.045）、SCWT-B（P = 0.001，0.036）和SCWT-D（P = 0.023，0.010）评分均高于对照组，PD 组、MSA-C 型组和MSA-P 型组患者SCWT-C 评分（P = 0.005，0.014，0.003）、DSST 评分（P = 0.003，0.000，0.000）和GSST 评分（P = 0.001，0.000，0.000）均高于对照组，仅MSA-P 型组患者TMT 评分高于对照组（P = 0.006）。结论 多系统萎缩和帕金森病患者均存在不同程度的执行功能障碍，SCWT 和DSST/GSST 测验有助于评价此类患者的执行功能障碍。

关键词: 多系统萎缩, 帕金森病, 认知障碍, 神经心理学测验

Abstract:

Objective  To explore the characteristics of executive dysfunction of patients with multiple system atrophy (MSA) and Parkinson's disease (PD) by neuropsychological tests.  Methods  Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Stroop Color-Word Test (SCWT), Digital Symbol Substitution Test (DSST)/Graphic Symbol Substitution Test (GSST), Clock Drawing Test (CDT) and Trail Making Test (TMT) were used to assess the overall cognitive and executive function of 34 patients with MSA [21 with cerebellar-predominant (MSA-C) and 13 with parkinsonism-predominant (MSA-P)], 18 patients with primary PD and 14 normal controls.  Results  There was significant difference in MoCA score among different groups (P = 0.019). PD and MSA-C groups had lower MoCA score than that in normal control group (P = 0.015, 0.002). There were significant differences in each SCWT score (P = 0.035, 0.013, 0.012, 0.037), DSST (P = 0.000), GSST (P = 0.000) and TMT (P = 0.035) among different groups. Among them, MSA-C and MSA-P groups had significantly higher SCWT-A (P = 0.004, 0.045), SCWT-B (P = 0.001, 0.036) and SCWT-D scores (P = 0.023, 0.010) than those in normal control group. PD, MSA-C and MSA-P groups had significantly higher SCWT-C (P = 0.005, 0.014, 0.003), DSST (P = 0.003, 0.000, 0.000) and GSST scores (P = 0.001, 0.000, 0.000) than those in normal control group. MSA-P group had significantly higher TMT score than that in normal control group (P = 0.006).  Conclusions  Patients with MSA and PD may present executive dysfunction to different degrees. SCWT and DSST/GSST tests are useful in assessing executive dysfunction in those patients.

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