Clinical Study Of Parkinson’s Disease With Mild Cognitive Impairpairment In Different Age Of Onset

Objective: investigating into clinical features,analysis of related factors and their impact on quality of life of Parkinson’s disease with mild cognitive impairment in different onset age,to provide effective basis for the early identification and clinical treatment of Parkinson’s disease with mild cognitive impairment.Methods:A total of 126 patients with non-dementia Parkinson’s disease(PD)were collected,who come from neurology medicine outpatient and/or hospitalization of Sichuan Provincial People’s Hospital from June 2016 to May 2017.Using Montreal cognitive assessment scale(Mo CA)to evaluate the cognitive function of PD patients,and the patients will be divided into two groups,one group is that PD with mild cognitive dysfunction(PD-MCI)(Mo CA < 24 points)and the other is PD with normal cognitive(PD-NC)(Mo CA ≥ 24 points),then the two groups were divided into three subgroups:early-onset(< 50 years),middle-onset(50 to 65 years)and late onset(> 65 years)according to the age of onset.Using Mini-mental state examinztion(MMSE),Mo CA,Auditory verbal learning test(AVLT)(huashan version),Digit span test(DST),Trail making test(TMT),Verbal fluency test(VFT)and Clock drawing test(CDT)(Sunderland version)to evaluate the overall cognitive function and individual cognitive function including memory,attention/working memory,executive function,language and visual spatial ability.Chooseing Unified parkinson’s disease rating scale the second and third part(UPDRS Ⅱ,UPDRS III),Hoehn-Yahr(H-Y),Activity of Daily Living Scale(ADL),Parkinson Disease Quality of Life Questionnaire(PDQ-39),Hamilton anxiety scale(HAMA),Hamilton depression scale(HMMD),The Epworth Sleeping Scale(ESS),and Rapid eye movement sleep behavior disorder screening questionnaire(RBDSQ)to evaluate motor function,quality of life,anxiety,depression and sleep quality for groups of patients.The data processing for general data and neuropsychological assessment results of PD patients was performed by SPSS 23 statistical software.Results:Of the 126 non-dementia PD patients,78 of them met PD-MCI,accounting for 61.9%,and 48 with PD-NC,accounting for 38.10%.The incidence(63.6%)of the middle-onset PD-MCI was higher than the early-onset PD-MCI(56.5%)and the late-onset PD-MCI(62.5%),but there was no statistical difference between them(χ2 = 0.360,P = 0.835).There were no significantly statistical differences in age,onset age,duration of disease,education time,and gender in the early-onset PD-MCI and early-onset PD-NC patients(P > 0.05).The education time in middle-onset and the late-onset PD-MCI were significantly shorter than PD-NC patients which have same onset age,The difference was statistical significant(the middle type:z = 3.508,P < 0.001;the late-onset:z = 2.130,P = 0.033).There was no statistical difference in age,onset age,duration and gender of the patients with middle and late onset PD-MCI campered PD-NC(P > 0.05).Compared with early-onset PD-NC group,the early-onset PD-MCI group overall cognitive function Mo CA score decreased(t = 7.516,P < 0.001),TMT-B of executive function tests(t = 2.237,P = 0.036)and draw the clock test(z = 2.462,P = 0.015)have lower scores,the difference was statistical significant;And MMSE score,TMT-A score,short-time free recall,delayed free recall,Repeat according to sequential and reverse order of attention /working and named for animals belonged to verbal fluency test score had no statistical difference(P > 0.05).Memory,attention/working memory,executive function,language,visual spatial ability were all impaired in the middle-onset PD-MCI group,and there was no statistical difference between subtypes(P > 0.05).Compared to the late onset PD-NC group,the late onset PD-MCI group overall cognitive which Mo CA(z = 5.785,P < 0.001),MMSE(z = 4.350,P < 0.001)score were decreased,short-time free recall number(t = 4.315,P < 0.001),delayed free recall(t = 3.569,P = 0.002),repeat sequentially(z = 3.215,P = 0.001),TMT-A(z = 4.063,P < 0.001),TMT-B(z = 2.191,P = 0.028)and clock drawing test(z = 3.507,P < 0.001)score were reduced,differences were statistical significant(P < 0.05),There was no statistical significant difference in the scores of repeat according to reverse order and named for animals(P > 0.05).Kruska-wallis test results showed that there were statistical significant differences in the number of delayed free recall(H = 6.326,P = 0.042)and TMT-A(H = 10.410,P = 0.005)score among the three PD-MCI subtypes(P < 0.05).Multiple comparison(Bonferroni method)results showed that the TMT-A score was difference between the late onset PD-MCI and early-onset PD-MCI(P = 0.005),the TMT-A score was difference between the middle type PD-MCI and early-onset PD-MCI(P = 0.023),there was no statistical difference in TMT-A score between the middle type and late onset PD-MCI group(P > 0.05),three groups of patients in Mo CA,MMSE,short-time free recall number,repeat according to sequential and reverse order,TMT-B,named for animals and clock drawing test score of have no statistical difference(P > 0.05).Spearman correlation analysis showed that Mo CA score of PD-MCI patients was positively correlated with education time(r = 0.466,P < 0.001),negatively correlated with UPDRSⅡ(r =-0.227,P = 0.045),PDQ-39(r =-0.255,P = 0.024),RBD(r =-0.275,P = 0.015),was no obviously correlated with age,course of diseases,onset age,H-Y stage,UPDRS III,ADL,Hamilton anxiety,Hamilton depression and ESS.The results of multiple linear regression analysis showed that education time was positively correlated with Mo CA score,and the Mo CA score increased by 0.358 points(95%CI:0.173 ~ 0.543)for each additional year of education time.The score of Mo CA was negatively correlated with RBD(95%CI :-3.332 ~-0.355,P = 0.016).Compared to PD-NC group of the same onset age,the scores on PDQ-39,UPDRS II,ADL of the early-onset and the middle-onset PD-MCI had no significant difference.The late onset PD-MCI group had a less scores on UPDRS II(t = 2.179,P = 0.029)and ADL(z = 2.483,P = 0.013)compared to the late onset PD-NC group,the difference was statistical significant,while their PDQ-39 score was no statistical difference(P > 0.05).Conclusion: There is significant morbidity of MCI in PD patients,and the occurrence of MCI may reduce the quality of life in the late-onset PD patients,but there is no significant correlation with age of onset.The characteristics of mild cognitive impairment in PD patients with different onset age groups are heterogeneity,however,the most common form of damage are the implementation of dysfunction and visual space dysfunction,Patients with a later age of onset were more likely to have executive dysfunction.Exposuring to shorter education and RBD is an independent risk factor for MCI in PD patients.