Related Study Of The Prediction Effect Of Plasma STREM2 Levels In Parkinson’s Disease With Cognitive Impairment

Background:Parkinson’s cognitive impairment(PDCI)is one of the most common clinical non-motor symptoms,It is commonly divided into Mild cognitive impairment in Parkinson’s disease(PD-MCI)and dementia in Parkinson’s disease(PDD)two categories.Studies have shown that the prevalence of dementia in the PD population is about 30%.Even in newly diagnosed patients,the number of patients with dementia is twice that of healthy elderly people.The final incidence of PDD reaches more than 80%,and the average time to develop dementia after PD diagnosis is about 10 years.With the study of PDD,which has found that PD patients have mild cognitive impairment for a long time before developing dementia,the research shows that the incidence of PD-MCI in newly diagnosed PD patients is close to 1 / 3.Often people with PD have no or little decline,then a turning point and then a faster decline.In one study of patients with PD at an early stage,more than 20% of patients with MCI returned to normal cognition within a year.Triggering receptor expressed on myeloid cells 2 TREM2 belongs to the immunoglobulin family,which is a type of receptor located on the cell surface,selectively and highly expressed in the central nervous system on microglia,regulating phagocytosis,cytokine production,cell proliferation,and cell survival.Microglia play an important role in neurodegeneration related to aging.Overexpression of TREM2 contributes to maintaining the dynamic balance of microglia and is able to inhibit sustained activation of microglia,promote phagocytosis and clear apoptotic neurons to protect nerve cells from damage to the inflammatory response.TREM2 is subjected to proteolytic cleavage and is released into the extracellular space as a soluble variant(sTREM2).Soluble variation(sTREM2)is released into the extracellular space.STREM2 can be detected in cerebrospinal fluid,Plasma and serum.Objective:At present,PD-MCI diagnosis is mainly neuropsychological evaluation,which is highly subjective and also susceptible to the fluctuations of patients’ life status.In this experiment,we explored the predictive ability of sTREM2 in plasma to predict cognitive decline in PD patients.Provide provide objective indicators for the diagnosis of diagnosis and cognitive decline of PD-MCI.Methods:A total of 67 PD patients admitted to hospital from November 2021 to December 2021 were selected according to inclusion and exclusion criteria,including 39 males and 28 females.There were 22 healthy controls and 22 healthy controls,including 13 males and 9 females.According to the diagnostic criteria of PD,PD-MCI and PDD,PD patients and healthy people were divided into four groups,namely,healthy control group(n = 22)and PDCN group(n = 18),PD-MCIgroup(n = 32)and PDD group(n = 17).Common clinical data of PD patients were collected: Age,sex,course of disease,education level,Hoehn-Yahr)(HY)classification,frozen gait,HAMD score,HAMA score,MODs-UPDRS PART II score,Mods-UPDRS PART III score.The scores of each group on the Montreal Cognitive Assessment(Mo CA)and mini-Mental State Examination(MMSE)were assessed and sorted out.Venous blood of each PD patient was collected and the plasma level of sTREM2 was determined by ELISA.Statistical analysis was performed to compare the differences in general clinical data,cognitive loss and plasma sTREM2 levels among the groups.Results:1.Comparison of clinical data between PD without dementia group and PD with dementia group Among the 50 patients with PD without dementia,31 patients(62.0%)were male and 19 patients(38.0%)were female;among the 17 patients with PD with dementia,8 patients(47.1%)were male and 9patients(52.9%)were female;there was no statistical significance in gender between the two groups(P=0.281>0.05).The age and disease course of patients in the two groups were not normally distributed.The age of patients without PD and dementia was 62.0(54.0,69.0)years old,and that of patients with PD and dementia was 68(65.0,70.0)years old.The difference in age between the two groups was statistically significant(P=0.014<0.05).In the PD group without dementia,the course of disease was 3.0(2.0-4.0)years.In the PD group with dementia,the course of disease was 5.0(3.0-7.0)years,and the difference in the course of disease between the two groups was statistically significant(P=0.003<0.05).The difference analysis showed that there were statistically significant differences between the two groups in age,course of disease,education level,HY grade,frozen gait and HAMD score(P<0.05).There were no significant differences in gender,HAMA score,MOSS-UPDRS PART II score and MOSs-UPDRS PART III score(P=0.288>0.05).The difference analysis showed that there were statistically significant differences between the two groups in age,course of disease,education level,HY stage,frozen gait and HAMD score.In order to further screen the risk factors of PD with dementia,binary Logistic regression stepwise screening was adopted due to the interaction between various factors.First,qualitative data were assigned values(see Table 2),and then Logistic regression analysis was conducted with age,course of disease,education level,HY stage,frozen gait and HAMD score as independent variables with dementia as dependent variables.The results showed that old age,long course of disease and high HY stage were risk factors for PD with dementia(P < 0.05),frozen gait and HAMD score were not risk factors for PD with dementia(P>0.05),education level was not protective factors for PD with dementia(P>0.05).2.Comparison of clinical data between PDCN group and PD-MCI group Among the 18 patients in the PDCN group,14 patients(62.0%)were male and 4 patients(38.0%)were female;among the 32 patients in the PD-MCI group,17 patients(53.1%)were male and 15 patients(46.9%)were female;there was no statistically significant difference in gender between the two groups(P=0.085>0.05).The age and disease course of patients in the two groups were not normally distributed.The age of patients in the PDCN group was 61.0(50.0,69.0)years old,and that of patients in the PD-MCI group was 63.5(55.0,70.0)years old.There was no significant difference in age between the two groups(P=0.288>0.05).The course of disease was 3.5(2.0-6.0)years,and 3.0(1.5-4.0)years in the PD-MCI group,and there was no significant difference in the course of disease between the two groups(P=0.495>0.05).Statistical analysis showed that there was a statistically significant difference in HY grading between the two groups(P<0.05).There was no significant difference in age,gender,course of disease,education level,frozen gait,HAMD score,HAMA score,MODs-UPDRS PART II score and MODs-UPDRS PART III score(P>0.05).3.Comparison of cognitive loss between PDCN group and PD-MCI group After analyzing PDCN group and PD-MCI group,there were statistically significant differences in visual space and executive ability,naming,attention,language,abstract thinking,delayed recall and other cognitive fields in Mo CA scale(P<0.05),but no statistically significant differences in directivity(P>0.05).In MMSE,there were statistically significant differences in language field(P<0.05),while there were no statistically significant differences in orientation,memory,computation and attention,recall and other cognitive fields(P>0.05).4.Comparison of cognitive loss between PDCN group and PDD group After analyzing PDCN group and PDD group,there were statistical differences in visual space and executive ability,naming,attention,language,abstract thinking,delayed recall,orientation and other cognitive fields in Mo CA scale(P<0.05).In MMSE,there were statistical differences in language orientation,memory,computation,attention,recall and other cognitive areas(P<0.05).5.Comparison of plasma sTREM2 levels in each group sTREM2 was low in healthy controls,increased in the PDCN group,peaked in the PD-MCI group,and began to decline in the PDD group.There was significant difference in plasma sTREM2 level among the four groups(P<0.05),and there was significant difference in plasma sTREM2 level between the healthy control group and the PDCN group and the PD-MCI group(P<0.05/6=0.0083),but no significant difference between the healthy control group and the PDD group(P>0.05/6=0.0083).PDCN group was significantly different from PD-MCI group and PDD group(P<0.05/6=0.0083).There was significant difference between PD-MCI group and PDD group(P<0.05/6=0.0083).When sTREM2 was set at the boundary value of 181.89ng/L,the yuden index reached its maximum,with a maximum sensitivity of71.9% and a specificity of 83.3%(P<0.05).Conclusion:1.There were differences in age,course of disease,education level,HY stage,frozen gait and HAMD score between patients with Parkinson’s disease and dementia and those without dementia.Age,course of disease and HY stage were the risk factors of Parkinson’s disease and dementia after risk factor selection.There was little difference in early clinical data of PDCI2.Mo CA sensitivity was better than MMSE in PD-MCI stage.In the early stage of cognitive impairment,spatial and executive ability,delayed recall,attention and language ability were impaired,and orientation and instantaneous memory were well preserved.3.STREM2 reaches its peak at PD-MCI stage,which is different from normal subjects,PDCN patients and PDD patients.STREM2 has high sensitivity and specificity in predicting Parkinson’s disease with cognitive impairment.