Investigation On Clinical Characteristics Of Cognitive Impairment In Parkinson’s Disease And Early Warning Of Imaging

PART I Clinical characteristics and related factors of cognitive impairment in Parkinson’s diseaseObjective:To investigate the clinical characteristics and related factors of cognitive impairment in Parkinson’s disease.Methods:125 PD patients who visited the department of Neurology at Xinhua hospital affiliated to Shanghai Jiao Tong University from August 2015 to December 2017 were recruited and divided into PD with normal cognition(PD-NC)and PD with cognitive impairment(PD-CI),PD-CI were also divided into two groups:PD with mild cognitive impairment(PD-MCI)and PD with dementia(PDD).The patients were collected for the general information and evaluated by Unified Parkinson’s Disease Rating Scale-motor score(UPDRS-Ⅲ),Hoehn-Yahr staging(H-Y staging),the Montreal Cognitive Assessment(Moca)and the Hamilton Anxiety and Depression Scales.Results:(1)Scoring rates of each cognitive domain of Moca in PD-NC、PD-MCI and PDD groups were as followed:Visuo-spatial and executive function:(4.60±0.614),(3.25±1.056)and(1.21±1.298),naming:(2.96±0.204),(2.85±0.427)and(2.11±0.95),attention:(5.98±0.146),(4.88±0.966)and(4.13±1.695),language:(2.87±0.337),(2.35±0.802)and(1.24±1.173),ion:(1.83±0.481),(1.40±0.778)and(0.61±0.755),delayed memory:(3.74±0.966),(2.00±1.485)and(0.42±0.642),orientation:(5.98±0.146),(5.80-0.564)and(5.24±1.384).In each cognitive domain of Moca PDD group was significantly lower than that of PD-MCI group and PD-NC group,and PD-MCI group were significantly lower than PD-NC group.(2)There was no significant difference in sex ratio,onset age,type of dyskinesia,HAMA scores between PD-CI and PD-NC group.Compare to PD-NC group,PD-CI group in age(67.54±9.179 vs 63.80±8.027),the duration(6.10±6.337 vs 4.19±3.360),UPDRS-Ⅲ(25.42±13.341 vs 18.68±8.726),H-Y staging(2.30±0.723 vs 1.83±0.628),and HAMD score(12.64±12.12 vs 7.06±6.47)were significantly higher than those of PD-NC group.Interestingly,the level of education(10.42±4.335 vs 12.75±2.945)in PD-CI group was significantly lower than that of PD-NC group.Multivariable Logistic regression analysis showed that age(OR=1.057,95%confidence interval:1.005-1.112,p=0.032),level of education(OR=0.819,95%confidence interval:0.724-0.927,p=0.002),H-Y staging(OR=2.600,95%confidence interval:1.037-6.515,p=0.042)and HAMD score(OR=1.051,95%confidence interval:1.000-1.104,p=0.048)is associated with cognitive impairment in Parkinson’s disease.Conclusions:The cognitive impairment of PD is manifested as multiple cognitive domain impair.Age,level of education,motor dysfunction and depression are risk factors for PD cognitive dysfunction.PART Ⅱ Investigation on FDG PET imaging in early warning of cognitive impairment in Parkinson’s diseaseObjective:To explore whether FDG PET imaging can provide early warning signal for cognitive impairment in Parkinson’s diseaseMethods:27 PD patients with normal cognition who visited the department of Neurology at Xinhua hospital affiliated to Shanghai Jiao Tong University from August 2015 to November 2015 were recruited and underwent 18F-FDG PET CT at study entry.The patients were collected for the general information and evaluated by Unified Parkinson’s Disease Rating Scale-motor score(UPDRS-Ⅲ),Hoehn-Yahr staging(H-Y staging)and the Montreal Cognitive Assessment(Moca)at entry and half-yearly,for a follow-up period of total two years.The NC did not undergo follow-up assessments.Based on the results of Moca,at the end of the 2-year follow-up patients were classified into PD with normal cognition(PD-NC2),PD with mild cognitive impairment(PD-MCI)and PD with dementia(PDD).Using the SPM to analyze the characteristics of the metabolism in different cognitive level in PD patients.Results:(1)At the end of 2-year follow-up,2 patients lost,l patient developed into PDD,14 patients developed into PD-MCI,10 patients remain PD-NC(PD-NC2).(2)At entry,there was no significant difference in age,sex ratio,level of education,Moca scores,the duration,onset age,UPDRS-Ⅲ,H-Y staging between PD-MCI and PD-NC2 group.(3)There was significant metabolic reduction in local frontal、parietal、occipital lobes in PD-MCI group at baseline,before diagnosis of MCI,compared with NC.PD-NC2 had reduced cerebral metabolism in the local occipital lobe at baseline,compared with NC.Compared to PD-NC2,PD-MCI had significant metabolic reduction in parietal lobe,and the degree of hypometabolism of occipital lobe was further deepened.Conclusions:Decreased metabolism in the parietal and frontal lobes of 18F-FDG PET imaging may serve as an early warning signal for PD-MCI and may provide ultra-early diagnostic value for PD-MCI.