The Characteristic Of Cognitive Impairment And Analysis Of Factors Influencing The Quality Of Life In76Patients With Parkinson’s Disease

-The characteristic of cognitive impairment in patients with Parkinson’s diseaseObjective:Firstly,to investigate the characteristics of cognitive impairment in terms of neuropsychology of Parkinson’s disease (PD)patients through the assessment of the cognitive function for PD patients of different stages and healthy controls;and then to explore the effect of levodopa on cognitive function in patients with early PD by the cognitive assessment before and after taking levodopa of the patients who were fist diagnosed with PD.Methods:76patients with PD (in which28cases were first diagnosed with PD)and32control subjects were enrolled in this study.Using neuropsychological tests to assess their cognitive function in specific areas such as executive function,attention,information processing speed,verbal fluency,visuospatial skills, memory and their overall cognitive function.A battery of neuropsychological tests comprise mini-mental state examination(MMSE), Montreal Cognitive Assessment(MoCA), verbal fluency test(VFT), Wiconsin Card Sorting test-64(WCST-64), judgment of line orientation test,Paced Auditory Seria Addition Test (PASAT),Digit Symbol Coding Test (DSCT),California Verbal Learning Test(CVLT)were used.We also collected basic information including age,gender,education and Hoehn-Yahr staging.Assessing the severity of PD motor symptoms by Hoehn-Yahr staging,which <2.5period for the early-stage disease,≥2.5period for advanced-stage disease. Implementing the above neuropsychological assessment for the initial diagnosis of PD patients before taking levodopa and after3months respectively.Results:Compared with the control group,patients with early PD group,the number of correct responses of WCST-64decreased and the sustained errors increased,scores of PAS AT, DSCT were lower,the difference was statistically significant (P<0.05); Patients with advanced PD group,in addition to the reducing correct responses and completed categories and the increasing sustained errors of WCST-64,scores of PASAT and DSCT declined,the words in short memory and delayed recall of CVLT and animal naming scores were also decreased,meanwhile MMSE,MoCA scores all declined,the difference was statistically significant (P<0.05);patients in advanced PD group compared with that in early PD group,scores of DSCT,PASAT were lower, the number of words in short-term memory and delayed recall of CVLT were reduced,scores of animal naming and Chinese words listing in VFT were lower,MoCA score decreased,the difference was statistically significant (P<0.05). Comparing the cognitive function of PD patents before and after taking levodopa, the correct answers of WCST-64increased and the number of sustained errors reduced after3months,scores of DSCT,WCST were also increased,the difference was statistically significant (P<0.05);The MoCA score which reflecting general cognitive function was increased,but not statistically significant(p=0.174).Conclusion:The cognitive impairment of patients with early PD is mainly reflected in executive function,attention and information processing speed;there is a wide range of cognitive impairment for patients with advanced PD,including that executive function,attention,information processing speed,memory and verbal fluency are all damaged,so the overall cognitive function in patients is worse than that in normal controls;The cognitive function of patients with early PD has improved partly after taking levodopa,mainly manifested that their executive function,attention and information processing speed have improved.The cognitive impairment in patients with different stages of PD behaves differently,the cognitive dysfunction in patients with PD can be found accurately and earlier by selecting sensitive and appropriate raring scales.At the same tine,we can provide relevant psychosocial and rehabilitation treatment for those patients with cognitive impairment in different domains,since this we may delay or prevent the occurrence of dementia.二Analysis of factors influencing the quality of life in patients with PDObjective:To explore tha main factors affecting the quality of life in patients with PD through the quantitative assessment of motor symptoms,nom-motor symptoms and other relevant factors in patients with PD.Methods:The quality of life,activities of daily living,motor function,disease severity, depression,sleep,cognitive function and pain associated with PD in76PD patients were evaluated by the Parkinson Disease Questionary-39(PDQ-39),Unified Parkinson disease rating scale(UPDRS),Hoehn-Yahr grade,Hamilton Depression Scale(HAMD), Hamilton Anxiety Scale(HAMA),Parkinson Disease Sleep Scale(PDSS),Montreal Cognitive Assessment(MoCA)and Brief Pain Inventory(BPI);and meanwhile recording some basic information such as age and disease duration.At last,we analyzed the relevance between the above factors and the the quality of life in patients with PD.Results:Bivariate analysis showed that PDQ-39summary index (PDQ-39SI) Positively correlated with the scores of UPDRS-Ⅱ、UPDRS-Ⅲ、PDSS、BPI、MoCA、 HAMD、HAMA and disease course(p<0.01).Multiple stepwise regression analysis showed that factors determing the PDQ-39SI of PD patients were the scores of UPDRS-Ⅱ,HAMD,BPI,MoCA and PDSS(the following standardized regression coefficients was0.370,0.296,0.268,-0.213,-0.190).Conclusion:The scores of UPDRS-Ⅱ,HAMD,BPI,MoCA and PDSS have significant influences on PDQ-39SI of patients with PD.The patients’daily activities,depression, pain,cognition and sleep are the most important factors which can influence the quality of life in PD patients.In addition to motor symptoms,we should also focus on those above non-motor symptoms of PD patients and take appropriate intervention and treatment measures to improve the quality of life for the patients.