伴快速眼球运动睡眠行为障碍的帕金森病患者临床特征

目的 评价快速眼球运动睡眠行为障碍(RBD)在帕金森病(PD)患者中的患病率以及伴发RBD的PD患者临床特征.方法 2007年连续入组124例PD患者,采用非运动症状问卷(NMSquest)第25项问答结果调查PD患者中RBD患病率;将入选患者分为RBD组(78例)和非RBD组(13例),采用统一PD评分量表(UPDRS)、Hoehn-Yahr(H-Y)分级比较2组运动症状严重程度和运动并发症发生情况;选用NMSquest量表比较2组非运动症状发生情况,选用MMSE、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、帕金森病睡眠量表(PDSS)和Epworth嗜睡量表(ESS)比较2组认知功能、焦虑和抑郁、夜间睡眠障碍和日间思睡程度.结果 (1)RBD的患病率为62.9%(78/124);(2)RBD组患者的病程[(3.8±2.8)年]显著短于非RBD组[(5.0±2.5)年,t=-1.972,P=0.048],但在性别、年龄、起病年龄、发病类型、左旋多巴等效剂量(LDE)和用药种类上2组差异没有统计学意义;(3)在运动症状中RBD与非RBD组在H-Y分级、UPDRS-Ⅱ、Ⅲ、Ⅳ评分以及运动并发症发生率方面差异无统计学意义;(4)在非运动症状中胃肠道功能、自主神经系统功能、精神和睡眠活动等方面的不良症状在RBD组的发生率显著高于非RBD组,但是认知、焦虑和抑郁、夜间睡眠障碍和日间思睡的严重程度在2组间差异没有统计学意义.结论 RBD在PD患者中的患病率较高,伴发RBD的PD患者病程较短且非运动系统受累更加广泛.     

帕金森病睡眠障碍影响因素分析

目的评价帕金森病(PD)患者睡眠障碍(SD)的发生率,分析PD睡眠障碍的特点及相关影响因素。方法根据中华医学会神经病学分会运动障碍及PD学组制订的帕金森病诊断标准,选择连续就诊和住院治疗的131例PD患者,采用PD睡眠障碍量表(PDSS)评价睡眠障碍并分为睡眠障碍(SD)组和非睡眠障碍(NSD)组,两组均行统一PD量表UPDRS-Ⅲ、Hoehn-Yahr(H-Y)分期、改良Webster评分、简易精神状态检查量表(MMSE)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、爱泼沃斯思睡量表(ESS)、不宁腿综合征严重程度评定量表(RLSRS)及日常生活能力量表(ADL)评价和分析。两组中男性患者均行前列腺彩超检查,以排除前列腺增生排尿障碍对睡眠障碍的影响。结果 131例PD患者中有96例存在睡眠障碍(PDSS-1<6)。经逐步线性回归分析发现共有改良Webster评分、ADL评分、左旋多巴具体剂量、MMSE、吡贝地尔具体剂量、RLSRS、H-Y分期、ESS、PDSS-7、HAMD、UPDRS-Ⅲ及HAMA等12项因素引入回归方程,性别、年龄、病程及受教育程度均被回归分析逐步剔除。两组中男性患者前列腺彩超检查形态差异无显著性。结论PD患者睡眠障碍的发生率为73.3%。PD睡眠障碍的影响因素依次为抑郁、运动症状评分、病情分期、整体症状评分、日常生活能力、认知水平、吡贝地尔具体剂量、左旋多巴具体剂量、焦虑、不宁腿综合征(RLS)、幻觉及日间思睡。与性别、年龄、病程和受教育程度无关。     

帕金森病患者快速眼球运动睡眠行为障碍临床特征及相关因素

目的分析伴快速眼球运动睡眠行为障碍(REM sleep behavior disorder,RBD)帕金森病(Parkinson’s disease,PD)患者的临床特征,探讨RBD的相关因素。方法连续入组PD患者63例,根据REM睡眠行为异常问卷-香港版(RBDQ-HK)分为PD+RBD组(n=28)和PD-RBD组(n=35)。采用统一帕金森病评定量表(UPDRS)、HoehnYahr(H-Y)分级比较两组运动症状严重程度;采用非运动症状问卷(NMS±quest)比较非运动症状发生情况;采用蒙特利尔认知评估(MOCA)、贝克焦虑量表(BAI)、贝克抑郁量表(BDI)、Epworth嗜睡评分量表(ESS)比较认知、焦虑、抑郁和日间思睡等情况。结果 PD患者中RBD发生率为44.4%(28/63),PD+RBD组病程显著长于PD-RBD组(χ~2=12.733,P=0.002),年龄更大(t=-2.292,P=0.025),H-Y分级更高(χ~2=7.014,P=0.008),但在性别、发病年龄、起病类型、左旋多巴等效剂量上两组差异无统计学意义;在运动症状方面,PD+RBD组UPDRSⅡ、Ⅲ评分更高(t=-2.734,P=0.008;U=3.329,P=0.001);在非运动症状方面,PD+RBD组胃肠道功能及睡眠障碍、精神相关症状等方面发生率均显著高于PD-RBD组(P0.05),焦虑及抑郁在PD+RBD组中更常见(χ~2=3.958,P=0.047;χ~2=10.338,P=0.001),但在认知功能、日间思睡上两组差异无统计学意义。此外,便秘(OR=7.257)、长病程(OR=5.389)、高UPDRSⅢ评分(OR=1.060)与PD患者RBD相关。结论病程更长、年龄更大、运动症状及非运动症状受累更严重的PD患者易伴发RBD。便秘、长病程、高UPDRSⅢ评分可能是RBD的危险因素。     

帕金森病患者睡眠障碍临床分析

目的分析帕金森病(PD)患者睡眠障碍发生情况及可能影响因素。方法采用统一帕金森病评定量表(UPDKS)、Hoehn-Yahr分级表、汉密尔顿抑郁量表、改良Webster评分、匹兹堡睡眠质量指数(PQSI)、爱泼沃斯思睡量表(ESS)及简明精神状态量表(MMSE)对PD患者病情及睡眠情况进行评定,并与对照组进行对照分析。结果62例PD患者中53例(85.5%)有睡眠障碍,其中失眠46例(86.8%),异态睡眠39例(73.6%),白天睡眠障碍36例(69.2%),与对照组对比均有显著差异(P<0.05)。结论PD患者睡眠障碍较为常见,主要表现为失眠、异态睡眠、日间嗜睡、睡眠发作等,其程度与抑郁、病情严重度及多巴胺能药物剂量等有关。     

广东省乡镇青少年学生白日过度思睡状况及相关因素

目的了解广东乡镇地区11～18岁青少年学生白日过度思睡(Excessive Daytime Sleepiness,EDS)的发生情况及探讨其影响因素。方法整群抽取广东省龙门县5所中学的5003名学生,采用一般情况调查表、爱泼沃斯嗜睡量表(Epworth Sleepiness Scale,ESS)、失眠严重指数量表(Insomnia Severity Index,ISI)、贝克抑郁量表(Beck Depression Inventory,BDI)和焦虑自评量表(Self-rating Anxiety Scale,SAS)等进行问卷调查。结果青少年学生EDS(ESS10)发生率为11.1%(95%CI:10.2%～12.0%),男性高于女性(12.0%vs.10.1%,P0.05),并且在年龄、是否吸烟、身体状况、学习压力、学习兴趣、是否午睡及不同睡眠时间方面EDS的发生率存在明显差异(P0.01);EDS组的BDI、SAS和ISI总分均高于非EDS组(P0.01)。Logistic回归分析结果显示男性(OR=1.25,95%CI:1.03～1.52)、习惯性午睡(OR=1.35,95%CI:1.11～1.64)、吸烟(OR=2.02,95%CI:1.23～3.33)、学习压力大(OR=1.28,95%CI:1.07～1.54)、学习兴趣低(OR=1.38,95%CI:1.10～1.73)、有慢性疾病(OR=1.69,95%CI:1.22～2.34)、失眠(OR=3.37,95%CI:2.60～4.37)、焦虑(OR=1.95,95%CI:1.57～2.42)、抑郁(OR=1.65,95%CI:1.30～2.09)情绪是EDS的危险因素。结论广东乡镇青少年学生EDS发生率较高,男性、习惯性午睡、抽烟、学习压力大、学习兴趣低、有慢性疾病、失眠及焦虑抑郁情绪是EDS的危险因素,提示伴有EDS的青少年情绪状况和睡眠质量较差。     

白日嗜睡和睡眠质量对宫颈癌患者手术后焦虑、抑郁的影响

目的 探讨白日嗜睡和睡眠质量对宫颈癌患者手术后焦虑抑郁的影响。方法 选取2018年1月～2019年6月于我院接受治疗的86例宫颈癌患者为研究对象,使用爱泼沃斯嗜睡量表(ESS)和匹兹堡睡眠质量指数(PSQI)评估患者的白日嗜睡严重程度和睡眠质量水平,比较不同白日嗜睡严重程度和睡眠质量水平患者的焦虑(HAMA)、抑郁(HAMD)水平,并使用Pearson法分析ESS评分和PSQI与HAMA和HAMD评分的相关性。结果 ESS评分为0～6分患者HAMA评分为8.26±3.44分,HAMD评分为15.71±4.08分,ESS评分为7～16分患者HAMA评分为17.02±4.33分,HAMD评分为26.24±5.11分,ESS评分为17～24分患者HAMA评分为25.28±4.08分,HAMD评分为34.29±5.25分,三组之间存在统计学差异(P0.05);PSQI评分为0～7分患者HAMA评分为7.37±3.18分,HAMD评分为14.21±3.49分,PSQI评分为8～14分患者HAMA评分为15.37±4.21分,HAMD评分为24.21±3.55分,PSQI评分为15～21分患者HAMA评分为23.29±4.04分,HAMD评分为32.74±4.27分,三组之间存在统计学差异(P0.05);Pearson法分析结果显示,ESS和PSQI与HAMA和HAMD相关系数r分别为0.544、0.369、0.507、0.488。结论 白日嗜睡和睡眠质量与宫颈癌患者手术后焦虑抑郁密切相关,白日嗜睡程度越严重、睡眠质量越差,患者的焦虑、抑郁水平越严重。     

帕金森病伴发睡眠障碍的临床特点、相关因素及视频多导睡眠图的变化

目的探讨帕金森病(PD)患者伴发睡眠障碍(SD)的临床特点、相关因素、视频多导睡眠图(v-PSG)变化及其对患者生活质量的影响。方法收集2014-06—2016-06就诊于北京天坛医院老年病科的94例PD患者,记录患者的人口学资料。采用匹茨堡睡眠质量指数量表(PSQI)评估患者的睡眠状况,根据评测结果将患者分为PD伴发SD组(PSQI≥5分,PD-SD组)及未伴发SD组(PSQI5分,PD-NSD组)。对PD患者进行统一帕金森病评分量表第三部分(UPDRS-Ⅲ)、蒙特利尔认知评估量表(MoCA)、简易精神状态检查量表(MMSE)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、爱泼沃斯思睡量表(ESS)、疲劳严重度量表(FSS)、UPDRSⅡ量表、日常生活能力量表(ADL)、39项PD生活质量问卷(PDQL-39)及PSQI评分检测,比较两组患者运动症状、非运动症状、生活质量以及睡眠质量等变化。结果 (1)94例PD患者中57例(60.64%)存在SD。(2)PD-SD组和PD-NSD组在性别构成、年龄、起病年龄、受教育水平及病程方面比较均无统计学差异(P0.05)。(3)PSQI量表评分结果显示,PD-SD组睡眠质量、睡眠潜伏期、睡眠时间、睡眠效率、SD、使用睡眠药及日间功能障碍评分均较PD-NSD组高(均P0.01)。(4)PD-SD组患者UPDRSⅠ评分、FSS评分、HAMD评分、HAMA评分和ESS评分、UPDRSⅡ评分、ADL评分、PDQL-39评分明显高于PD-NSD组(P0.05或P0.01)。(5)32例PD患者行v-PSG监测,与PD-NSD组比较,PD-SD组总睡眠时间减少(P0.05),睡眠效率及最低血氧饱和度降低(均P0.05)。结论 PD患者SD的发生率较高;PD-SD患者SD更严重,整体睡眠质量更差;SD明显影响PD患者其他非运动症状。     

青少年失眠状况和睡眠质量及二者相关性分析

目的调查青少年失眠状况和睡眠质量及二者之间的相关性。方法对技工学校学生统一发放4733份调查问卷,最终获得有效问卷3342份,记录社会人口学资料,包括性别、年龄、身高、体重、健康状况、户籍、是否为独生子女、父母受教育程度、家庭收入、学习压力、吸烟和饮酒等,以及睡眠和情绪相关量表评分,包括失眠严重指数(ISI)中文版、匹兹堡睡眠质量指数(PSQI)、Epworth嗜睡量表(ESS)、焦虑自评量表(SAS)和Beck抑郁量表(BDI)。结果 3342名青少年中存在失眠997例(29.83%)、日间嗜睡568例(17.00%)、焦虑243例(7.27%)和抑郁1287例(38.51%)。根据ISI中文版评分分为非失眠组(2345名)和失眠组(997例),失眠组女性(P=0.000)、健康状况不良(P=0.000)、非独生子女(P=0.006)、有学习压力(P=0.000)和吸烟(P=0.027)比例,以及ISI中文版评分(P=0.000)、ESS评分(P=0.000)、SAS评分(P=0.000)和BDI评分(P=0.000)均高于非失眠组。Pearson相关分析显示,ISI中文版评分和PSQI评分均与ESS评分(r=0.361,P=0.000;r=0.064,P=0.000)、SAS评分(r=0.326,P=0.000;r=0.069,P=0.000)和BDI评分(r=0.529,P=0.000;r=0.067,P=0.000)呈正相关,且ISI中文版评分的上述相关性(r=0.300～0.600)高于PSQI评分(r0.100)。进一步偏相关分析显示,ISI中文版评分与PSQI评分呈负相关(r=-0.056,P=0.001)。结论失眠组女性更多、健康状况更差、非独生子女更多、学习压力更大、吸烟比例更高,以及日间嗜睡、焦虑和抑郁更严重。与PSQI量表相比,ISI量表中文版与日间嗜睡、焦虑和抑郁的关系更紧密,可能更适用于筛查和评价青少年失眠状况。     

帕金森病患者健康相关生活质量的影响因素研究

目的探讨影响帕金森病(PD)患者健康相关生活质量(HRQoL)的主要因素。方法选用39项PD问卷(PDQ-39)、PD统一评定量表(UPDRS)和相关非运动症状评定量表对99例PD患者进行调查,分析影响HRQoL的主要因素。结果相关分析显示,PDQ-39综合指数(PDQ-39SI)与病程、每日左旋多巴剂量、UPDRSⅡ、Ⅲ、Ⅳ评分、Hoehn-Yahr分期、17项汉密尔顿抑郁量表(HRSD-17)、汉密尔顿焦虑量表(HAMA)和爱泼沃斯嗜睡量表(ESS)评分呈正相关(r为0.42～0.80,P均小于0.01),与简易精神状态量表(MMSE)、帕金森病睡眠量表(PDSS)评分呈负相关(r为-0.47、-0.68,P均小于0.01),与PD分型呈正相关(r=0.23,P<0.05)。进一步的多元回归结果表明:UPDRSⅡ、HAMD-17、ESS评分是影响PDQ-39SI的主要因素,3因素相加对HRQoL的影响起决定作用的72.1%。结论非运动症状对PD患者HRQoL有着显著的影响,应重视对抑郁和日间过度嗜睡等非运动症状的治疗。     

帕金森病患者轻度认知功能损害

目的 探讨帕金森病(PD)患者伴轻度认知功能损害(MCI)即PD-MCI的特征及其相关因素.方法 采用多种量表[MMSE、Hoehn-Yahr分期、Webster评分、PD统一评分量表-运动(UPDRS-motor)及剑桥老年认知检查量表中文版(CAMCOG-C)]评估PD患者的病情严重程度、运动和认知功能;应用Petersen改良标准诊断PD-MCI.结果 89例PD患者中,认知正常(PDCOGNL)56例(63%),PD-MCI 20例(22%),PD痴呆(PDD)13例(15%).PD-MCI组较PDCOGNL组在定向、语言、记忆、注意、执行、思维、知觉等方面均存在明显损害,两组年龄和起病年龄差异无统计学意义,受教育程度差异有统计学意义(PD-MCI:4.4±4.3,PDCOGNL:7.1±4.9;q=3.270,P<0.05);PD-MCI组的年龄、起病年龄及受教育程度较PDD组差异均无统计学意义;而PDD组较PDCOGNL组在年龄、起病年龄、受教育程度等方面差异均有统计学意义(q=-4.913、-4.997、4.740,均P<0.01);3组间病程差异无统计学意义.Hoehn-Yahr分期、Webster评分及UPDRS-motor评分与PD认知功能均存在负相关.结论 PD-MCI是PD认知正常与PDD之间的过渡状态,存在多个区域的认知损害;高龄、起病年龄迟、受教育程度低可能是PD认知损害的危险因素;疾病严重程度及运动功能与PD认知功能存在着负相关.     

Excessive daytime somnolence in Japanese patients with Parkinson''s disease

To investigate the prevalence and severity of excessive daytime somnolence (EDS) in Japanese patients with Parkinson's disease (PD) and to examine the main cause of EDS. Fifty-three Japanese patients with PD (PDs: 32 females and 21 males) and 17 controls (10 females and seven males) were evaluated using the Epworth Sleepiness Scale (ESS). The severity of the disease was evaluated by Unified Parkinson's disease Rating Scale (UPDRS), and information about quality and quantity of medications was collected. The correlations amongst EDS and age, severity of PD, duration of illness and medications were analyzed. The mean ESS score was significantly higher in advanced PDs than in controls, and correlated with the UPDRS score (r(s) = 0.743, P < 0.0001). Age, duration of illness and the dose of levodopa weakly correlated with ESS score. The intake of dopamine agonists did not affect the severity of EDS. The mean ESS score in PDs was lower than that reported in PD in European and American studies. EDS in Japanese patients with PD was milder compared with Caucasian patients, which might be due to the lower doses of the medications used in Japan. The results suggest that EDS in PD is mainly because of neuropathological changes of the disease itself.     

Association of daytime sleepiness with nigrostriatal dopaminergic degeneration in early Parkinson's disease

Abstract Introduction Many patients with Parkinson's disease (PD) report daytime sleepiness. Its etiology, however, is still not fully understood. The aim of this study was to examine if the amount of nigrostriatal dopaminergic degeneration is associated with subjective daytime sleepiness in patients with PD. Patients and methods We investigated 21 patients with PD clinically and by means of [¹²³I] FP-CIT-SPECT (DaTSCAN^R). Each patient filled in the Epworth sleepiness scale (ESS), the Parkinson's Disease Sleep Scale (PDSS), and the self-rating depression scale according to Zung (SDS) to assess sleepiness, sleep quality, and depressive symptoms. Results The mean specific dopamine transporter binding in the 21 PD patients (60.8 ± 10.4 years, nine females, median Hoehn and Yahr stage 2.0) was decreased. Nine patients were in Hoehn and Yahr stage 1 (58.7 ± 6.6 years, four females; ESS score 7.4 ± 4.5; PDSS score 105.1 ± 30.9), the other 12 patients were in Hoehn and Yahr stage 2 (62.4 ± 12.6 years, five females; ESS score 6.7 ± 4.7, PDSS score 97.1 ± 25.6). Age, gender, ESS, and PDSS scores were not significantly different in both groups. However, ESS scores showed an inverse correlation with mean DAT binding in the striatum (r = -0.627, p = 0.03), the caudate nucleus (r = -0.708, p = 0.01), and the putamen (r = -0.599, p = 0.04) in patients with Hoehn and Yahr stage 2. There was no correlation of the ESS score with age, disease duration, UPDRS motor score, PDSS score, or depression score. Conclusion Subjective daytime sleepiness seems to be associated with dopaminergic nigrostriatal degeneration in early PD.     

Increased daytime sleepiness in Parkinson's disease: a questionnaire survey.

We evaluated the frequency and severity of excessive daytime sleepiness in an outpatient population with Parkinson's disease in comparison to age-matched controls and examined its relationship with antiparkinsonian drug therapy and sleep history. Increased daytime sleepiness and involuntary sleep episodes have been described in Parkinson's disease, but the etiology is not completely understood. The Epworth Sleepiness Scale (ESS), a validated questionnaire for daytime sleepiness, was prospectively administered to 99 consecutive outpatients with Parkinson's disease and 44 age-matched controls. In addition, a short sleep-screening questionnaire was used. The ESS revealed significantly increased daytime sleepiness in PD patients compared to controls (7.5 +/- 4.6 vs. 5.8 +/- 3.0, P = 0.013). The ESS score was abnormally high (10 or more) in 33 % of PD patients and 11.4% of controls (P = 0.001). ESS was not different between PD patients on levodopa monotherapy and those on levodopa and dopamine agonists, or between patients taking ergoline or non-ergoline dopamine agonists. In PD patients and in controls, sleepiness was significantly associated with reported heavy snoring. Increased daytime sleepiness is more frequent in patients with PD than in elderly controls. Similar to controls, increased daytime sleepiness in PD patients is correlated with heavy snoring.     

A nationwide survey of excessive daytime sleepiness in Parkinson's disease in France

To determine the prevalence of excessive daytime sleepiness (EDS) and that of dozing and sudden onset of sleep episodes (SOS) while driving in ambulatory patients with Parkinson's disease (PD) in France, a national sample of private and public neurologists was asked to recruit the first 10 consecutive nondemented PD patients. Each patient completed a questionnaire including the Epworth Sleepiness Scale (ESS) and the likelihood of dozing off and experiencing SOS episodes behind the wheel. Clinical and demographic data were collected. One thousand six hundred and twenty‐five patients with PD were included in the survey. Twenty‐nine percent of the patients suffered from EDS (ESS score ≥10) but only 0.8% declared a high chance of dozing while driving and 0.5% reported totally unpredictable SOS episodes while driving. Risk factors for EDS were male gender, reduced activity of daily living, and a high daily levodopa equivalent dosage. Risk factors for SOS episodes while driving were an ESS score ≥10, male gender, and low Hoehn and Yahr staging. EDS is common in ambulatory patients with PD and is a major risk factor for dozing and for SOS episodes behind the wheel in patients who drive. © 2007 Movement Disorder Society     

Excessive daytime sleepiness in de novo and treated Parkinson's disease.

Excessive daytime sleepiness (EDS) in Parkinson's disease (PD) is due to either treatment-related factors or the disease itself. The study of this disturbing phenomenon in de novo parkinsonian patients may contribute to a better understanding of its pathophysiology. We conducted a case control study in which we compared 25 PD patients who had never been treated before with dopaminergic drugs (de novo PD), 50 PD patients being treated with dopaminergic drugs (treated PD), and 25 healthy control subjects, all of whom were matched for age and gender. EDS was measured by means of the Epworth Sleepiness Scale (ESS) and quality of sleep by means of the Pittsburgh Sleep Quality Index (PSQI). ESS and PSQI scores were not statistically different between de novo PD patients and controls, whereas they were significantly higher in treated PD. Differences in ESS score variability were best explained by the treatment effect, whereas there was no clear correlation between PSQI and any of the clinical variables considered.     

Modafinil for the treatment of excessive daytime sleepiness in Parkinson's disease: a case report

We report a 59 year old woman with levodopa responsive Parkinson's disease who developed excessive daytime sleepiness [Epworth Sleepiness Scale (ESS) score of 13]. Treatment with Modafinil 400 mg daily within two weeks produced a subjective improvement in her daytime sleepiness (ESS score after treatment is 8) with no significant change in her PD motor symptomotology.     

A study of excessive daytime sleepiness and its clinical significance in three groups of Parkinson's disease patients taking pramipexole, cabergoline and levodopa mono and combination therapy

Summary. Objective. To determine if therapy with an ergot and a non-ergot dopamine agonist and levodopa confers an increased risk of excessive daytime sleepiness and secondary "sleep attacks" in Parkinson's disease (PD). Methods. Comparative study of three clinical groups taking, pramipexole (Group 1, n = 19, 8 monotherapy), cabergoline (Group 2, n = 22, 10 monotherapy), and levodopa monotherapy (Group 3, n = 14). Clinical and demographic characteristics, occurrence of "sleep attacks", and assessment of daytime sleepiness [using the Epworth Sleepiness Scale (ESS)], recorded. Results. No patients reported "sleep attacks". Mean ESS scores: Group 1 (pramipexole) 8.0 ± 4.5 (range 0–16), Group 2 (cabergoline) 8.1 ± 3.9 (range 0–19), Group 3 (levodopa), 8.1 ± 5.5 (range 1–18). There was no significant difference between groups (p = 0.897). Scores of ≥16 indicating excessive daytime sleepiness (EDS) were evenly distributed throughout treatment groups, particularly in older patients with more advanced disease. Conclusions. Received March 31, 2000; accepted August 3, 2000     

Fatigue and excessive daytime sleepiness in idiopathic Parkinson’s disease differently correlate with motor symptoms,depression and dopaminergic treatment

Background and purpose: A comprehensive study of both fatigue and excessive daytime sleepiness (EDS) in association with Parkinson’s disease (PD)‐related symptoms and treatment has not been performed yet. To assess the frequency and severity of fatigue and EDS in patients with idiopathic PD and to study their relation to motor and non‐motor symptoms and dopaminergic treatment. Methods: We prospectively assessed Fatigue Severity Scale (FSS) scores, Epworth Sleepiness Scale (ESS) scores, Beck Depression Inventory (BDI) scores, severity (Unified PD Rating Scale, UPDRS, part III; Hoehn & Yahr staging) and duration of the disease, and the current dopaminergic treatment in 88 consecutive patients with idiopathic PD. Results: Fatigue was found in 52 (59%), EDS in 42 (48%), and both complaints in 31 (35%) patients. Fatigued patients had higher UPDRS III scores (23.5 ± 11.1 vs. 18.6 ± 7.6, P = 0.03), higher Hoehn & Yahr staging (2.4 ± 0.9 vs. 2.1 ± 0.7, P = 0.03), and higher BDI scores (13.4 ± 7.1 vs. 9.1 ± 5.8, P = 0.004) than non‐fatigued patients. In contrast, UPDRS III, Hoehn & Yahr, and BDI scores did not differ between patients with or without EDS. However, the type of dopaminergic treatment (levodopa monotherapy versus combination of levodopa/dopamine agonists) was associated with significant differences in ESS (8.5 ± 5.2 vs. 10.8 ± 4.3, P = 0.04), but not FSS scores (4.1 ± 1.5 vs. 4.3 ± 1.5, P = 0.55). Disease duration correlated with ESS scores (r = 0.32, P = 0.003), but not with FSS scores (r = ?0.02, P = 0.82). Conclusions: In PD, there is a significant overlap of fatigue and EDS, but the two symptoms are differently correlated with the severity of motor symptoms, disease duration, depression, and dopaminergic treatment.     

Subjectively reported sleep quality and excessive daytime somnolence in Parkinson's disease with and without dementia, dementia with Lewy bodies and Alzheimer's disease

OBJECTIVE: We compared subjective sleep quality and excessive daytime somnolence (EDS) in controls, Parkinson's disease with (PDD) and without dementia (PD), dementia with Lewy bodies (DLB) and Alzheimer's disease (AD). We investigated whether sleep dysfunction and EDS associate with motor phenotype in PD, PDD and DLB. METHOD: Assessments included the Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI). RESULTS: EDS was more frequent in PD, DLB and PDD patients than in AD. PDD, PD and DLB patients also had worse sleep quality when compared with AD and controls. Baseline postural instability-gait difficulty (PIGD) motor phenotype in PDD was associated with a higher ESS score and frequency of EDS, but this association was lost at two years. PSQI scores did not differ between PIGD dominant and non-dominant PD, PDD and DLB patients. CONCLUSION: EDS and poor sleep quality are greater in PD, PDD and DLB, compared with AD. The dissociation of EDS and motor phenotype suggests their pathophysiology is anatomically and/or temporally distinct.     

帕金森病伴发认知功能障碍的相关因素分析

目的 探讨认知功能障碍在帕金森病中（Parkinson＇s disease,PD）的发生率及其影响因素.方法 对确诊的PD患者采用蒙特利尔认知评价量表（Montreal Cognitive Assessment MOCA中文版）、汉密尔顿抑郁量表（Hamilt depression scale,HAMD）及Webster功能评分量表进行评定分析PD伴发认知功能障碍的发生情况和相关影响因素.结果 PD伴发认知功能障碍者50例,认知功能障碍的发生率为76.9%,病程、文化程度、Webster评分、HAMD评分与帕金森病伴发认知功能障碍的发生均有统计学意义（P＜0.05）,年龄、性别、婚姻状况、经济情况与帕金森伴发认知功能障碍的发生均无统计学意义（P＞0.05）.回归分析发现病程和PD病情严重程度是PD患者伴发认知功能障碍的危险因素.结论 PD患者有较高认知功能障碍的发生率,PD伴发认知功能障碍的发生可能与PD患者的病程、文化程度、PD患者病情的严重程度及抑郁有关.