快速眼动睡眠行为障碍对帕金森病患者认知功能的影响

王振 宁连才 刘宝珠 匡祖颖 陈炳光 曹香燚 温友禄 徐海燕 陈修琼 彭章瑞

【摘要】目的 分析快速眼動睡眠行为障碍（RBD）与帕金森病（PD）的相关性以明确RBD对PD患者认知功能的影响。方法 回顾性分析123例PD患者的临床资料，根据是否伴有RBD将患者分为PD+RBD组（67例）和PD-RBD组（56例），比较2组各项资料的差异。采用Spearman秩相关分析检验多导睡眠监测睡眠参数与神经心理学相关指标的关系。结果 PD+RBD组病程长于PD-RBD组，总睡眠时间短于PD-RBD组，R期周期性腿动指数高于PD-RBD组（P均 < 0.05）。PD+RBD组蒙特利尔认知评估量表（MoCA）总分低于PD-RBD组，差异主要表现在执行能力、延迟记忆、注意力及抽象能力方面（P均 < 0.05）。PD+RBD组Stroop色词测验完成时间和错误数长/多于PD-RBD组（P均 < 0.05）。PD患者总睡眠时间和睡眠效率与MoCA总分、执行能力及注意力呈正相关，而与Stroop色词测验完成时间及错误数呈负相关（P均 < 0.05）。结论 RBD可能是PD患者认知功能障碍特别是执行功能障碍的重要危险因素。

【关键词】帕金森病;快速眼动睡眠行为障碍;认知功能障碍

Effect of REM sleep behavior disorder on cognitive function in Parkinson’s disease Wang Zhen，

Ning Liancai， Liu Baozhu， Kuang Zuying， Chen Bingguang， Cao Xiangyi，Wen Youlu， Xu Haiyan， Chen

Xiuqiong， Peng Zhangrui. Department of Psychological Behavior， Guangdong 999 Brain Hospital， Guangzhou

510510， China

Corresponding author， Ning Liancai， E-mail： wzc333999@163.com

【Abstract】Objective To analyze the correlation between rapid eye movement sleep disorder （RBD） and Parkinson’s disease （PD）， aiming to evaluate the effect of RBD on the cognitive function of PD patients. Methods Clinical data of 123 PD patients were retrospectively analyzed.  All patients were divided into the PD+RBD group （n = 67） and PD-RBD group （n = 56）. All parameters were statistically compared between two groups. The correlation between sleep parameters of polysomnography and neuropsychological parameters was assessed by Spearman correlation analysis. Results In the PD+RBD group， the course of disease was longer， the total sleep time was shorter and the  periodic limb movement index （PLMI） was higher than those in the PD-RBD group （all P < 0.05）. The total score of Montreal Cognitive Assessment Scale （MoCA） in the PD+RBD group was lower compared with that in the PD-RBD group， mainly in the domains of executive function， delayed recall， attention and abstraction （all P < 0.05）. In the PD+RBD group， the completion time and number of errors in Stroop color-word test were longer and more than those in the PD-RBD group （both P < 0.05）. The total sleep time and sleep efficiency of PD patients were positively correlated with the MoCA total score， executive function and attention， whereas negatively correlated with the completion time and number of errors of Stroop color-word test （all P < 0.05）. Conclusion RBD is probably a critical risk factor for cognitive dysfunction， especially the executive dysfunction， in PD patients.

【Key words】Parkinson’s disease; Rapid eye movement sleep behavior disorder;

Cognitive dysfunction

帕金森病（PD）是常见的进行性神经退行性疾病之一，与神经系统α-突触核蛋白聚集有关，临床表现主要分为运动和非运动症状。快速眼动睡眠行为障碍（RBD）是PD的非运动症状之一，能够检测出运动前期PD，提示不良预后[1]。有研究表明，RBD与PD患者的认知功能障碍之间存在关联，伴有RBD的PD（PD+RBD）患者比不伴有RBD的PD（PD-RBD）患者认知功能障碍更严重，但也有少量研究表明RBD对某些靶向认知领域没有影响[2-3]。因此，RBD对PD患者认知功能的影响值得进一步研究。本研究组比较了PD+RBD患者與PD-RBD患者客观睡眠参数及神经心理学相关指标的差异，进一步分析了两者的相关性，以明确RBD对PD患者认知功能的影响。……