A Case-control Study On Risk Factors Of Cognitive Impairment In Parkinson’s Disease

Background: Cognitive impairment in Parkinson’s disease(PD)is a common disease that endangers people’s lives.Due to the lack of effective clinical cures,the patients’ prognosis is poor.Therefore,it is particularly important to early identify the influencing factors of cognitive impairment in PD and its relationship with prognosis,so as to provide positive reference for early control of cognitive impairment in PD and improvement of prognosis.Objective: This study was designed to provide theoretical reference for diagnosis and treatment evaluation of patients with PD through exploring the correlation between uric acid,homocysteine and cognitive impairment in patients with PD.Methods: patients with PD(PD group)diagnosed and treated in the hospital from March 2019 to September 2020,and healthy individuals(healthy control group)receiving physical examination in the same hospital during the same period were enrolled as study subjects.According to the Montreal Cognitive Assessment(Mo CA)score,patients with PD were divided into cognitive impairment group and noncognitive impairment group.The plasma Hcy and uric acid were detected by high performance liquid chromatography.The baseline data,uric acid and homocysteine of PD group and the healthy control group were compared.Cognitive impairment of patients with PD were analyzed.Logistic analysis was performed to screen the risk factors for cognitive impairment in patients with PD,and a prediction model was established and verified.In addition,the correlation between the Montreal cognitive function scale score and uric acid,homocysteine in Parkinson’s disease patients with cognitive impairment was analyzed.Results: The uric acid level in PD group was significantly lower than that in the healthy control group,and the Hcy level was significantly higher than that in the healthy control group(P<0.05).Of 61 patients in PD group,52.46%(32/61)developed cognitive impairment and 47.54%(29/61)did not have cognitive impairment.The proportions of patients ≥ 60 years,nature of work(manual work),course of disease ≥ 6years,H-Y classification ≥ grade 3,UPDRS-III ≥ 27 points,and Hcy in the cognitive impairment group were significantly higher than those in the non-cognitive impairment group,while the uric acid levels were significantly lower than those in the non cognitive impairment group(P<0.05).Logistic analysis indicated that age,nature of work,course of disease,H-Y classification,UPDRS-III score,uric acid,and Hcy were influencing factors of cognitive impairment in patients with PD(P<0.05).The sensitivity,specificity and the area under curve of the prediction model constructed based on the above influencing factors for predicting cognitive impairment in patients with PD were89.52%,80.94% and 0.895,respectively.The coincidence rate of the predictive value of the model with the actual value was 93.75%(30/32).The score of Montreal cognitive impairment scale was positively correlated with uric acid level in Parkinson’s disease with cognitive impairment group(P < 0.05);It was negatively correlated with the level of homocysteine(P < 0.05).Conclusion: There are many factors affecting cognitive impairment in patients with PD.It is necessary to pay more attention to PD patients with advanced age,engaged in physical work,long course of disease,severe condition and severe motor symptoms.It is also necessary to actively monitor changes in serum uric acid and Hcy levels of such patients.Early assessment of the risk of cognitive impairment in patients with PD is of positive significance,which has positive significance for early assessment of the risk of cognitive dysfunction in PD patients.