Analysis Of The Relationship Between Cognitive Function And Uric Acid Levels And Brain Volume In Parkinson’s Disease

Background:Parkinson’s disease(PD)is one of the most common neurodegenerative diseases,causing a huge social burden.In addition to motor symptoms such as resting tremor,bradykinesia,hypertonia,and postural balance abnormalities.PD patients often experience non-motor symptoms including cognitive impairment,depression,anxiety,and autonomic dysfunction,which have a negative impact on quality of life.According to epidemiological researchs,cognitive impairment associated with Parkinson’s disease(PD)is not unusual in PD patients,and when PD patients advance to Parkinson’s disease dementia(PDD),Studies on cognitive impairment in PD are comparatively scarce as compared to Alzheimer’s disease(AD).In order to offer early identification,diagnosis,and therapy for PD patients who acquire cognitive impairment,it is crucial to investigate the risk factors that lead to cognitive impairment in PD.UA is a chemical that the body uses as an antioxidant and which may also have neuroprotective properties.It is hypothesized that it might have a protective impact on the cognitive function of people with Alzheimer’s disease.The majority of research have indicated that PD patients have lower blood UA levels,and that lower blood UA levels correlate with the severity of motor symptoms and with poorer cognitive performance.However,it has also been shown that high blood UA may have neurotoxic effects.The sequential link between PD and blood UA levels has also been said to be ambiguous.Therefore,the existing findings on a national and worldwide level on the connection between UA and cognitive performance are ambiguous.MRI can measure brain volume,which is a valid clinical sign.Patients with PD experience similar brain atrophy as their disease worsens.Previous research has demonstrated the link between brain shrinkage and non-motor PD symptoms,and post-mortem brain autopsy investigations in PDD patients have demonstrated the link between PDD and limbic and cortical Lewy bodies.Less research has been done on the connection between brain volume and cognitive performance in PD,and it is unclear how this association relates to blood UA levels.Objective:The link between cognitive function,UA,and brain volume in PD is the main topic of this essay.(1)To look at the connection between cognitive status and PD patients’ brain atrophy.(2)To investigate the connection between PD’s cognitive decline and brain shrinkage and high blood UA levels.(3)To use the PPMI database(Parkinson’s Progression Markers Initiative,PPMI)to investigate the connection between high blood UA levels and the transition of PD patients with normal cognition to PD patients with impaired cognition.Method:Fifty PD and fifty non-PD patients diagnosed in the Department of Neurology of the Second Hospital of Guangzhou Medical University from June 2022 to March2023 in the study.Patients with PD who scored below 26 on the Montreal Cognitive Assessment(MoCA)scale were placed in the group of people with cognitive impairment,while those who scored above 26 were placed in the control group.The high UA group included males with blood UA levels over 416umol/L and women with levels above 356umol/L,whereas the remaining individuals belonged to the normal UA group.Indicators of biochemistry,demographics,and personal history were noted.and Neuropsychological examinations and evaluations of everyday behavioral skills were carried out by neurologists and nurses with specialized training.Using the visual score of brain atrophy,skilled neurologists assessed the extent of brain atrophy.To investigate the influencing factors of cognitive decline in PD patients,multiple linear regression was used to examine the relationship between blood UA and cognitive decline.Pearson correlation and Spearman correlation were also used to investigate the correlation between UA,MoCA score,and visual score of brain atrophy.Patients were divided into the four groups—high UA group with cognitive impairment,normal UA group with cognitive impairment,high UA group without cognitive impairment and normal UA group without cognitive impairment.We also investigated whether there was an interaction between UA,brain atrophy,and cognitive status.The PPMI database was also used to look at the link between UA and cognitive status in PD.362 patients with PD and 149 healthy controls were included in the 3-year follow-up data.For men PD patients whose UA >416umol/L and female whose UA >356umol/Lwere considered as high blood UA group.The KM survival analysis and Cox regression model were used to investigate the effect of hyperuric acid on the conversion of cognitively normal patients to cognitive impairment in a3-years follow-up.Results:(1)Significant differences of blood UA,Montreal cognitive assessment scale(MMSE)and MoCA were observed between PD and non-PD groups(P< 0.05).(2)Comparing the PD high UA group and the normal UA group,the conclusion showed the differences in blood triglyceride,MMSE and MoCA scores in the high blood UA group were statistically significant(P< 0.05).(3)Using Spearman correlation analysis,MoCA score correlated with patients in the hyperemic UA group(r= 0.384,P= 0.006),hippocampus(r=-.500,P<0.05),temporal lobe(r=-0.415,P= 0.004),and total brain atrophy score(r=-0.425,P= 0.003).A linear regression was performed between the hyperemic UA group and MoCA score,and there was a positive correlation after adjusting for age,gender,and education level(B= 3.675,P= 0.027).The correlation between high blood UA level and blood UA and total hippocampal,cingulate,temporal,frontal,parietal,and brain atrophy scores was not statistically significant(P> 0.05).There was no significant difference of the hippocampus,cingulate gyrus,temporal lobe,frontal lobe,parietal lobe,and total brain atrophy scores among the four groups: high UA group with cognitive impairment,normal UA group with cognitive impairment,high UA group without cognitive impairment,and normal UA group without cognitive impairment(P> 0.05).(4)There was no statistically significant differences of the hippocampal,cingulate,temporal,frontal,parietal,and total brain atrophy scores between the PD patients with and without cognitive impairment(P> 0.05),and there was no correlation between two group using binary logistic regression analysis(P> 0.05).(5)There was no increased conversion of PD with normal cognition to PD with cognitive impairment in PD patients with hyperuric acid using KM survival analysis(P> 0.05),and hyperuric acid was not associated with the risk of conversion to cognitive impairment using the Cox equal proportional risk model(P> 0.05).Conclusion:(1)There is a positive correlation between high UA level and MoCA score in PD patients.High blood UA level has no significant protective effect on the conversion of normal cognition to cognitive impairment in PD patients in a 3-year follow-up.(2)MoCA scores in PD patients have a negative correlation with visual scores of hippocampal,temporal lobe and total visual scores.