【摘要】 目的 :比较正常颅压性脑积水(NPH)患者与帕金森病(PD)患者的轻度认知损害程度和特点,分析2种疾病神经心理学评估的鉴别诊断意义。方法:采用病例对照研究,NPH患者与PD患者进行性别、年龄、受教育年限匹配,分为NPH组(n=18)和PD组(n=18),分别采用改良Hoehn&Yahr(H-Y)分级及简易精神状态检查(MMSE)、Rey听觉词语测验(RAVLT)、韦氏数字广度测验(DST)、画钟试验(CDT)进行运动障碍和认知功能评估,2组比较采用Fisher确切概率法、t检验或Wilcoxon秩和检验分析。结果:NPH组病程[(1.75±0.26)年]较PD组病程[(5.66±4.29)年]短[95%可信区间(CI):-5.97~-1.85),P=0.000 5],但NPH组的改良H-Y分期得分较PD组高(95%CI:0.549~1.56,P=0.000 6)。NPH组的MMSE量表总分较PD组低(95%CI:-2.18~-0.60,P=0.003 1)。NPH组RAVLT评价的即刻回忆、短时延迟回忆、长时延迟回忆皆比PD组得分低(95%CI:-13.31~-0.69,P=0.031 0;95%CI:-4.70~-0.74,P=0.008 5;95%CI:-6.05~-2.17,P=0.000 1)。NPH组的数字顺背广度和逆背广度均较PD组得分低(95%CI:-2.83~-0.17,P=0.028 2;95%CI:-1.45~-0.11,P=0.024 7)。NPH组的CDT得分较PD组低(95%CI:-1.33~-0.33,P=0.001 8)。结论 :非痴呆的NPH和PD患者以步态异常为主要临床表现时可伴不同程度认知功能损害,但前者认知功能损害领域更广、程度更严重。采用MMSE、RAVLT、DST、CDT对2组不典型的病例进行全面认知功能评估,有一定诊断参考价值。更多还原

【Abstract】 Objective By comparative analysis of severity and characteristics of cognitive impairment in patients with normal pressure hydrocephalus(NPH)and Parkinson’s disease(PD) to determine the value of neuropsychological assessment for the differential diagnosis of the two diseases. Methods In this case-control study, 18 patients with NPH and 18 gender, age and years of education matched patients with PD were enrolled. Information about medical related data was obtained. The motor symptoms using modified Hoehn &Yahr(H&Y) scale was assessed. Cognitive functions were evaluated using mini-mental state examination(MMSE), Rey auditory and verbal learning test(RAVLT), digital span test(DST) and clock drawing test(CDT). Data of the two groups of patients were compared by Fisher exact test, t test or Wilcoxon rank sum test. Results Patients with NPH were of shorter duration [(1.75±0.26) years vs(5.66±4.29) years][95%confidence interval(CI):-5.97—-1.85, P =0.000 5], but modified H&Y stages were significantly more severe(95% CI:0.549—1.56, P=0.000 6) for patients with NPH. The MMSE scores(95%CI:-2.18—-0.60, P=0.003 1), immediate memory(95%CI:-13.31 —-0.69, P=0.031 0), short-delayed memory(95%CI:-4.70 —-0.74, P=0.008 5) and long-delayed memory of RAVLT(95%CI:-6.05 —-2.17, P=0.000 1), the back(95%CI:-2.83 —-0.17, P=0.028 2) and reverse(95%CI:-1.45—-0.11, P=0.024 7) DST, and CDT scores were significantly worse in patients with NPH than in patients with PD. Conclusions Non-dementia NPH and PD patients with gait disorders as the main clinical manifestations could be associated with different degree of cognitive impairment,but the former was more severe. Of the two groups of atypical cases, using MMSE, RAVLT, DST and CDT to conduct a comprehensive evaluation of cognitive impairment had a reference value for their diagnosis.更多还原