帕金森病患者的血压变异性与认知功能的关系

The Relationship between Blood Pressure Variability and Cognitive Function in Parkinson’s Disease Patients

摘要: 目的：探讨帕金森病(Parkinson’s disease, PD)患者长期血压变异性与认知功能纵向变化的相关性。方法：从帕金森进展标志物倡议(Parkinson’s Progression Marker Initiative, PPMI)数据库中筛选2025年3月21日以前诊断为原发性PD的1444名患者为研究对象，收集其基线及随访12个月、24个月、36个月、48个月和60个月的数据资料，分析PD患者的血压资料，研究5年内血压变异性与基线临床认知评估量表结果的相关性及临床认知评估量表结果纵向变化的相关性。结果：基线数据线性回归分析发现，基线蒙特利尔认知评估量表(Montreal cognitive assessment, MoCA)评分与Supine SBP-CV (β = −4.351, P = 0.037)、Supine SBP-SD (β = −0.034, P = 0.034)均呈负相关，基线符号数字模型测试(symbol digit modality test, SDMT)评分与Supine DBP-SD (β = −0.194, P = 0.046)、Standing DBP-CV (β = −14.544, P = 0.042)、Supine SBP-SD (β = −0.131, P = 0.026)、Supine SBP-CV (β = −18.737, P = 0.016)呈负相关，基线字母数字序列测试(letter number sequencing, LNS)评分与血压变异性未见明显线性相关。通过线性混合效应模型分析发现，MoCA评分中Supine SBP-SD (β = −0.010, P = 0.020)、Supine SBP-CV (β = −1.147, P = 0.042)、Standing SBP-CV (β = −1.052, P = 0.045)、Standing DBP-CV (β = −1.082, P = 0.039)变化幅度越大，其MoCA评分随时间衰退更显著；LNS评分中Supine SBP-SD (β = −0.009, P = 0.013)、Supine SBP-CV (β = −1.080, P = 0.035)、Standing SBP-SD (β = −0.009, P = 0.018)、Standing SBP-CV (β = −1.177, P = 0.015)、Standing DBP-CV (β = −1.023, P = 0.031)、Standing DBP-SD (β = −0.013, P = 0.042)增加，其LNS评分下降越快；SDMT评分中Standing DBP-CV (β = −4.226, P = 0.011)和Standing SBP-CV (β = −4.304, P = 0.011)升高，其SDMT评分衰减越多。结论：对帕金森病患者来说，血压变异性与认知有关，无论是收缩压还是舒张压，波动程度越大，对其认知功能的损伤也越大。

Abstract: Objective: To explore the correlation between long-term blood pressure variability and longitudinal changes in cognitive function in patients with Parkinson’s disease (PD). Methods: A total of 1444 patients diagnosed with primary PD before March 21, 2025, were selected from the Parkinson’s Progression Marker Initiative (PPMI) database as the study subjects. Data were collected at baseline and follow-up visits at 12, 24, 36, 48, and 60 months to analyze the blood pressure profiles of PD patients and to investigate the correlation between blood pressure variability over 5 years and both baseline clinical cognitive assessment scale scores and their longitudinal changes. Results: Linear regression analysis of baseline data revealed that baseline Montreal Cognitive Assessment (MoCA) scores were negatively correlated with Supine SBP-CV (β = −4.351, P = 0.037) and Supine SBP-SD (β = −0.034, P = 0.034). Baseline Symbol Digit Modality Test (SDMT) scores were negatively correlated with Supine DBP-SD (β = −0.194, P = 0.046), Standing DBP-CV (β = −14.544, P = 0.042), Supine SBP-SD (β = −0.131, P = 0.026), and Supine SBP-CV (β = −18.737, P = 0.016). No significant linear correlation was found between baseline Letter Number Sequencing (LNS) scores and blood pressure variability. Linear mixed-effects model analysis showed that in MoCA scores, greater variability in Supine SBP-SD (β = −0.010, P = 0.020), Supine SBP-CV (β = −1.147, P = 0.042), Standing SBP-CV (β = −1.052, P = 0.045), and Standing DBP-CV (β = −1.082, P = 0.039) was associated with a more significant decline in MoCA scores over time. For LNS scores, increases in Supine SBP-SD (β = −0.009, P = 0.013), Supine SBP-CV (β = −1.080, P = 0.035), Standing SBP-SD (β = −0.009, P = 0.018), Standing SBP-CV (β = −1.177, P = 0.015), Standing DBP-CV (β = −1.023, P = 0.031), and Standing DBP-SD (β = −0.013, P = 0.042) were associated with a faster decline in LNS scores. For SDMT scores, increases in Standing DBP-CV (β = −4.226, P = 0.011) and Standing SBP-CV (β = −4.304, P = 0.011) were associated with greater decline in SDMT scores. Conclusion: For patients with Parkinson’s disease, blood pressure variability is associated with cognition. The greater the fluctuation of both systolic and diastolic blood pressure, the more impairment in cognitive function.