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目的 :比较正常颅压性脑积水(NPH)患者与帕金森病(PD)患者的轻度认知损害程度和特点,分析2种疾病神经心理学评估的鉴别诊断意义。方法:采用病例对照研究,NPH患者与PD患者进行性别、年龄、受教育年限匹配,分为NPH组(n=18)和PD组(n=18),分别采用改良Hoehn&Yahr(H-Y)分级及简易精神状态检查(MMSE)、Rey听觉词语测验(RAVLT)、韦氏数字广度测验(DST)、画钟试验(CDT)进行运动障碍和认知功能评估,2组比较采用Fisher确切概率法、t检验或Wilcoxon秩和检验分析。结果:NPH组病程[(1.75±0.26)年]较PD组病程[(5.66±4.29)年]短[95%可信区间(CI):-5.97~-1.85),P=0.000 5],但NPH组的改良H-Y分期得分较PD组高(95%CI:0.549~1.56,P=0.000 6)。NPH组的MMSE量表总分较PD组低(95%CI:-2.18~-0.60,P=0.003 1)。NPH组RAVLT评价的即刻回忆、短时延迟回忆、长时延迟回忆皆比PD组得分低(95%CI:-13.31~-0.69,P=0.031 0;95%CI:-4.70~-0.74,P=0.008 5;95%CI:-6.05~-2.17,P=0.000 1)。NPH组的数字顺背广度和逆背广度均较PD组得分低(95%CI:-2.83~-0.17,P=0.028 2;95%CI:-1.45~-0.11,P=0.024 7)。NPH组的CDT得分较PD组低(95%CI:-1.33~-0.33,P=0.001 8)。结论 :非痴呆的NPH和PD患者以步态异常为主要临床表现时可伴不同程度认知功能损害,但前者认知功能损害领域更广、程度更严重。采用MMSE、RAVLT、DST、CDT对2组不典型的病例进行全面认知功能评估,有一定诊断参考价值。
Objective: To compare the degree and characteristics of mild cognitive impairment in patients with normal intracranial pressure hydrocephalus (NPH) and Parkinson’s disease (PD), and to analyze the differential diagnostic significance of neuropsychological assessment of the two diseases. Methods: A case-control study was conducted. NPH patients and PD patients were matched for gender, age and education years. The patients were divided into NPH group (n = 18) and PD group (n = 18) MMSE, RAVLT, DST and CDT were used to assess dyskinesia and cognitive function. Fisher exact test, t-test Or Wilcoxon rank sum test analysis. Results: The duration of NPH group was shorter than that of PD group (95% confidence interval (CI): -5.97 to -1.85, P = 0.0005) compared with PD group [(1.75 ± 0.26) years) The improved HY stage in NPH group was higher than that in PD group (95% CI: 0.549-1.56, P = 0.0006). The total score of MMSE in NPH group was lower than that in PD group (95% CI: -2.18-0.60, P = 0.0031). The immediate recall, short-term delayed recall and long-term delayed recall in RAVLT assessment of NPH group were all lower than those in PD group (95% CI: -13.31 ~ -0.69, P = 0.031 0; 95% CI: -4.70 ~ -0.74, P = 0.008 5; 95% CI: -6.05 to -2.17, P = 0.000 1). The NPH group had a lower breadth and a reverse breadth than the PD group (95% CI: -2.83-0.17, P = 0.0282; 95% CI: -1.45-0.11, P = 0.0247). The CDT score of NPH group was lower than that of PD group (95% CI: -1.33-0.33, P = 0.001 8). CONCLUSION: Non-demented patients with NPH and PD may have cognitive impairment with different levels of cognitive impairment with gait abnormalities as the main clinical manifestations. However, the former has a more extensive and severe cognitive impairment. Using MMSE, RAVLT, DST, CDT on 2 groups of atypical cases comprehensive cognitive function assessment, a certain diagnostic reference value.