摘要：

目的: 探讨老年帕金森病患者自主神经功能与认知功能之间的相关性。方法: 纳入2020年1月至2022年12月南京医科大学附属脑科医院诊断与治疗的130例老年帕金森病患者，采用Hoehn-Yahr分期进行疾病分期，统一帕金森病评价量表第三部分（UPDRSⅢ）评价运动障碍严重程度，帕金森病预后量表-自主神经功能部分（SCOPA-AUT）评价自主神经功能，简易智能状态检查量表（MMSE）和蒙特利尔认知评价量表（MoCA）评价整体认知功能，非运动症状量表（NMSS）评价总体非运动症状严重程度。结果: 共130例患者据是否伴发阿尔茨海默病分为伴阿尔茨海默病组（82例）和不伴阿尔茨海默病组（48例）。伴阿尔茨海默病组患者Hoehn-Yahr分期3 ~ 5级比例（χ² = 5.689，P = 0.017），UPDRSⅢ评分（t = 21.490，P = 0.000），SCOPA-AUT评分（t = 21.330，P = 0.000）及其体温调节障碍（χ² = 8.512，P = 0.004）、泌尿功能障碍（χ² = 17.270，P = 0.000）、胃肠功能障碍（χ² = 24.471，P = 0.000）、瞳孔调节障碍（χ² = 5.299，P = 0.021）、心血管功能障碍（χ² = 15.355，P = 0.000）比例，以及NMSS评分（t = 32.309，P = 0.000）均高于不伴阿尔茨海默病组，而MMSE（t = 4.730，P = 0.000）和MoCA（t = 6.840，P = 0.000）总评分及其各项分评分（均P = 0.000）均低于不伴阿尔茨海默病组。相关分析显示，伴阿尔茨海默病的帕金森病患者SCOPA-AUT评分与MMSE和MoCA总评分及其各项分评分呈负相关（均P = 0.000）。结论: 伴阿尔茨海默病的老年帕金森病患者自主神经功能障碍较严重，且其自主神经功能与认知功能密切相关。

关键词: 帕金森病, 阿尔茨海默病, 自主神经系统, 认知障碍

Abstract:

Objective: To analyze relationship between autonomic nervous function function in elderly patients with Parkinson's disease (PD). Methods: A total of 130 elderly patients with PD admitted to The Affiliated Brain Hospital of Nanjing Medical University from January 2020 to December 2022 were included. Hoehn-Yahr staging was used to evaluate stage of the disease, Unified Parkinson's Disease Rating Scale Ⅲ (UPDRS Ⅲ) was used to evaluate the severity of motor disorders, Scales for Outcomes in Parkinson's Disease-Autonomic (SCOPA-AUT) was used to evaluate autonomic nervous function, Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were used to evaluate cognitive function, Non-Μotor Symptoms Scale (NMSS) was used to evaluate the severity of non-motor symptoms. Results: According to whether the patients were accompanied by Alzheimer's disease (AD), they were divided into a group with AD (n = 82) and a group without AD (n = 48). The proportion of Hoehn-Yahr staging 3 to 5 (χ² = 5.689, P = 0.017), UPDRS Ⅲ score (t = 21.490, P = 0.000), SCOPA-AUT score (t = 21.330, P = 0.000), dysregulation of body temperature (χ² = 8.512, P = 0.004), urinary dysfunction (χ² = 17.270, P = 0.000), gastrointestinal dysfunction (χ² = 24.471, P = 0.000), dysregulation of pupil (χ² = 5. 299, P = 0.021), cardiovascular dysfunction (χ² = 15.355, P = 0.000) and NMSS score (t = 32.309, P = 0.000) in the group with AD were higher than those in the group without AD, the MMSE (t = 4.730, P = 0.000) and MoCA (t = 6.840, P = 0.000) total scores and subtype scores (P = 0.000, for all) in the group with AD were lower than those in the group without AD. Correlation analysis showed that the SCOPA-AUT score of PD patients with AD was negatively correlated with MMSE and MoCA total scores and subtype scores (P = 0.000, for all). Conclusions: The autonomic dysfunction of elderly PD patients with AD is more serious, and the autonomic nervous function is closely related to cognitive function.

Key words: Parkinson disease, Alzheimer disease, Autonomic nervous system, Cognition disorders