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。     

进行性核上性麻痹患者生活质量相关分析

目的探讨进行性核上性麻痹患者生活质量的相关因素。方法连续纳入2012年1月至2019年12月共218例进行性核上性麻痹患者,采集其社会人口学和临床资料,采用39项帕金森病调查表(PDQ-39)评估生活质量,进行性核上性麻痹评价量表(PSPRS)评估运动症状和非运动症状,非运动症状量表(NMSS)评估非运动症状,汉密尔顿抑郁量表24项(HAMD-24)、汉密尔顿焦虑量表(HAMA)和里尔淡漠评定量表(LARS)评估情绪,额叶功能评价量表(FAB)评估额叶功能,蒙特利尔认知评价量表(MoCA)评估认知功能。对PDQ-39评分与社会人口学和各项量表评分行相关分析以及线性数量关系的验证。结果相关分析显示,PDQ-39评分与病程(r=0.301,P=0.000)、查尔森合并症指数(CCI)评分(r=0.147,P=0.031)、左旋多巴日等效剂量(r=0.225,P=0.001)、PSPRS评分(r=0.551,P=0.000)、NMSS评分(r=0.484,P=0.000)、HAMD-24评分(r=0.515,P=0.000)、HAMA评分(r=0.439,P=0.000)和LARS评分(r=0.476,P=0.000)呈正相关,而与FAB评分(r=-0.325,P=0.000)和MoCA评分(r=-0.355,P=0.000)呈负相关。多因素线性逐步回归分析显示,女性(P=0.021)、病程(P=0.026)、左旋多巴日等效剂量(P=0.008),以及PSPRS评分(P=0.000)、NMSS评分(P=0.002)、HAMD-24评分(P=0.004)和LARS评分(P=0.000)均与PDQ-39评分存在线性回归关系。结论女性、长病程、高左旋多巴日等效剂量以及严重的运动症状和非运动症状均与进行性核上性麻痹患者生活质量存在线性回归关系,应引起临床医师的高度重视。     

帕金森病患者血浆肿瘤坏死因子-α和白介素-6与非运动症状的相关性分析

目的探讨帕金森病(PD)患者血浆TNF-α和IL-6水平与非运动症状的相关性。方法采用ELISA法测定41例原发性PD患者(PD组)和37名健康对照者(正常对照组)血浆TNF-α和IL-6的水平。采用Hoehn-Yahr分期(H-Y分期)、统一PD评定量表第Ⅱ部分(UPDRSⅡ)、统一PD评定量表第Ⅲ部分(UPDRSⅢ)、非运动症状量表(NMSS)评价PD患者关期时的运动和非运动症状。结果与正常对照组比较,PD组TNF-α和IL-6水平显著降低(均P0.05)。PD组TNF-α水平与H-Y分期、UPDRSⅡ、UPDRSⅢ和NMSS评分无相关性(r=0.093,P=0.562;r=-0.024,P=0.882;r=0.131,P=0.415;r=-0.109,P=0.499)。PD组IL-6水平与H-Y分期、UPDRSⅡ、NMSS评分呈显著负相关(r=-0.411,P=0.008;r=-0.321,P=0.041;r=-0.324,P=0.039),与UPDRSⅢ评分无相关性(r=-0.126,P=0.431)。结论 PD患者可能存在免疫功能异常,且免疫炎症机制的异常可能参与PD非运动症状的致病过程。     

帕金森病两种常见睡眠障碍关联性研究

研究背景阻塞性睡眠呼吸暂停低通气综合征(OSAHS)和快速眼动睡眠期行为障碍(RBD)是帕金森病(PD)两种常见睡眠障碍,本研究探讨帕金森病合并两种睡眠障碍的临床特点和睡眠参数变化,以及二者之间相互作用机制。方法采用统一帕金森病评价量表(UPDRS)、简易智能状态检查量表(MMSE)和蒙特利尔认知评价量表(MoCA)中文版、Epworth嗜睡量表(ESS)和匹兹堡睡眠质量指数(PSQI)、非运动症状问卷(NMSQuest)、帕金森病预后量表-自主神经功能部分(SCOPA-AUT)、39项帕金森病调查表(PDQ-39)和Hoehn-Yahr分期评价190例帕金森病患者运动症状、非运动症状(认知功能、睡眠质量、自主神经功能等)和病情严重程度,并行多导睡眠图监测记录睡眠参数。结果共73例合并阻塞性睡眠呼吸暂停低通气综合征患者,其中22例同时发生快速眼动睡眠期行为障碍(PD+OSAHS+RBD组),51例不发生快速眼动睡眠期行为障碍(PD+OSAHS-RBD组)。PD+OSAHS+RBD组患者UPDRSⅠ评分(P=0.015)、UPDRSⅡ评分(P=0.023)、ESS评分(P=0.002)、PSQI评分(P=0.048)、NMSQuest评分(P=0.001)和SCOPA-AUT评分(P=0.026),以及平均动脉血氧饱和度(P=0.029)、最低动脉血氧饱和度(P=0.001)、快速眼动睡眠期最低动脉血氧饱和度(P=0.000)、快速眼动睡眠期紧张性(P=0.000)和时相性(P=0.000)下颏肌电活动均高于PD+OSAHS-RBD组,而MoCA评分低于PD+OSAHS-RBD组(P=0.013)。相关分析显示,呼吸暂停低通气指数和氧减指数与NMSQuest(r_s=0.252,P=0.032;r_s=0.229,P=0.010)、SCOPA-AUT(r_s=0.322,P=0.005;r_s=0.247,P=0.037)和PDQ-39(r_s=0.340,P=0.004;r_s=0.269,P=0.023)评分呈正相关关系。结论帕金森病同时合并阻塞性睡眠呼吸暂停低通气综合征和快速眼动睡眠期行为障碍的患者认知功能障碍、日间嗜睡程度、自主神经功能障碍等非运动症状更加严重。尽管发生快速眼动睡眠期行为障碍的患者夜间动脉血氧饱和度较高,但并不能显著改善帕金森病合并阻塞性睡眠呼吸暂停低通气综合征患者总体缺氧症状。     

帕金森病疲劳症状特点及其与其他症状的相关分析

目的探讨帕金森病患者疲劳症状特点及其与其他症状的相关性。方法共100例原发性帕金森病患者,根据疲劳严重程度评分(FSS)分为疲劳组(FSS评分4分,58例)和非疲劳组(FSS评分≤4分,42例),采用统一帕金森病评价量表第三部分(UPDRSⅢ)、修订的Hoehn-Yahr分期和改良Webster症状评分评价运动症状;非运动症状量表(NMSS)、简易智能状态检查量表(MMSE)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、Epworth嗜睡量表(ESS)和匹兹堡睡眠质量指数(PSQI)评价非运动症状;统一帕金森病评价量表第二部分(UPDRSⅡ)评价日常生活活动能力和39项帕金森病调查表(PDQ-39)评价生活质量。结果 100例帕金森病患者中58例存在疲劳症状,发生率58%。帕金森病疲劳组白天打盹(χ~2=16.256,P=0.000)、疲劳(χ~2=84.639,P=0.000)、缺乏兴趣(χ~2=10.705,P=0.001)、主动性下降(χ~2=9.350,P=0.002)、情绪低落(χ~2=9.350,P=0.002)、焦虑和(或)惊恐情绪(χ~2=4.625,P=0.032)、情感平淡(χ~2=22.032,P=0.000)、快感缺失(χ~2=18.247,P=0.000)、记忆力减退(χ~2=4.366,P=0.037)、尿急(χ~2=5.774,P=0.016)、尿频(χ~2=5.774,P=0.016)、性生活困难(χ~2=3.877,P=0.049)、嗅觉或味觉减退(χ~2=5.360,P=0.021)发生率,以及UPDRSⅢ评分(t=6.374,P=0.000)、修订的Hoehn-Yahr分期(Z=-3.345,P=0.001)和改良Webster症状评分(t=6.819,P=0.000),NMSS(t=2.923,P=0.011)、HAMD(Z=-2.451,P=0.014)、HAMA(t=5.417,P=0.000)和ESS(Z=-2.116,P=0.034)评分,UPDRSⅡ(Z=-3.115,P=0.002)和PDQ-39(Z=-2.696,P=0.007)评分均高于非疲劳组且差异有统计学意义。Spearman秩相关分析显示,FSS评分与改良Webster症状评分(rs=0.622,P=0.000)、NMSS评分(rs=0.611,P=0.000)呈高度正相关,与病程(rs=0.582,P=0.000)、UPDRSⅢ评分(rs=0.573,P=0.000)、修订的Hoehn-Yahr分期(rs=0.542,P=0.000)、HAMD评分(rs=0.505,P=0.000)、HAMA评分(rs=0.477,P=0.000)、ESS评分(rs=0.474,P=0.000)、PSQI评分(rs=0.410,P=0.000)、UPDRSⅡ评分(rs=0.559,P=0.000)和PDQ-39评分(rs=0.578,P=0.000)呈中度正相关,而与MMSE评分呈低度负相关(rs=-0.258,P=0.000)。结论帕金森病患者疲劳症状发生率较高,且与其他症状之间存在相关性,严重影响生活质量。     

帕金森病患者血清脂联素水平与运动症状及非运动症状的相关性

目的 探讨帕金森病(PD)患者血清脂联素水平与运动症状以及非运动症状的相关性.方法 选取94例PD患者以及90名健康对照者,利用ELISA法检测PD患者及健康对照者血清脂联素水平,并记录PD患者的年龄、多巴丝肼片剂量,并对所有PD患者行帕金森病评价量表第三部分评分(UPDRSⅢ)、Hoehn-Yahr分期、ADL、Webster、疲劳严重度量表(FSS)、匹茨堡睡眠质量指数(PSQI)、自主神经功能量表(SCOPA-AUT)、汉密尔顿抑郁量表(HAMD)评估.结果 PD患者血清脂联素水平为(8.2士2.6)mg/L,明显低于健康对照组的(17.5±7.1)mg/L,且差异有统计学意义(t=-4.12,P＜0.01).脂联素水平与PD患者的UPDRSⅢ评分、H-Y分期、Webster评分、ADL评分及PSQI评分均呈负相关(r分别为-0.71,-0.82,-0.77,-0.64,-0.69;P＜ 0.05).结论 PD患者血清脂联素水平降低,且与PD患者的运动症状及非运动症状均有关.     

帕金森病与疲劳

目的探讨异质性帕金森病(Parkinson’s disease,PD)患者出现疲劳的临床特征及疲劳与运动及非运动症状的关联,明确症状的归属,以期寻找缓解症状的治疗方法。方法连续收集2014-04-2016-06就诊于广州市第一人民医院神经科运动障碍疾病门诊及住院的144例PD患者的病历资料,按帕金森病异质分组原则分组,全部患者采用疲劳严重程度(fatigue severity scale,FSS)和疲劳量表(fatigue scale,FS-14)评价疲劳,同时完成PD运动症状(motor symptoms,MS)、非运动症状(nomotor symptoms,NMS)、日常生活能力及质量相关的量表分析。结果 144例PD患者中,有疲劳症状60例(41.47%),疲劳组中早期PD且无其他NMS症状10例。异质性帕金森病不同组别比较显示强直为主型、女性及中晚期PD患者发生疲劳机会增加。单因素分析示,PD患者年龄、病程、H-Y分级、运动症状评分(UPDRS评分Ⅲ(R)、UPDRS评分Ⅲ总分)及UPDRSⅣ部分得分疲劳组得分均高于非疲劳组;非运动症状评分(NMSS)提示,疲劳组患者的NMS出现程度及频率均较非疲劳组严重,差异有统计学意义(P0.05);疲劳组精神情绪总体状况(UPDRSⅠ)、抑郁(HAMD)、焦虑(HAMA)、白天嗜睡(ESS)均明显高于非疲劳组;MMSE评分证实2组患者智能正常,差异无统计学意义(P0.05),但疲劳组较非疲劳组MMSE得分有下降趋势;疲劳组日常生活动能力(UPDRSⅡ)和生活质量PDQ39评分均显著高于非疲劳组,英格兰日常生活能力量表Schwab显著低于非疲劳组,差异均有统计学意义(P0.05)。多重线性回归分析,NMSS程度、焦虑、抑郁评分与疲劳显著相关。结论 PD患者疲劳的发生率高;异质性帕金森病发生疲劳几率不同;单因素分析疲劳组PD患者病程更长,运动症状及病情更严重,NMS更多、更重,生活质量更差;NMSS的程度、焦虑、抑郁是导致疲劳的主要原因;部分疲劳组患者的疲劳发生与MS及NMS无关,提示疲劳可能是PD病程中的独立的非运动症状之一。     

脑深部电刺激术对帕金森病患者非运动症状及生活质量的短期影响

目的研究脑深部电刺激术(DBS)对帕金森病(PD)患者非运动症状(NMS)及生活质量的短期影响。方法采用非运动症状量表(NMSS)、贝克抑郁量表第2版(BDI-Ⅱ)、中文版蒙特利尔认知评估量表(MoCA)、39项帕金森患者生活质量问卷(PDQ-39)评分对102例接受DBS治疗的PD患者进行评估。观察DBS治疗前及治疗后6个月患者NMS及生活质量的变化。结果与术前比较,患者术后NMSS认知维度评分无显著差异(P0.05),性功能、泌尿系统、胃肠道症状、知觉/幻觉、睡眠/疲劳、头晕/跌倒、抑郁/焦虑、其他评分及NMSS总分均显著降低(P0.05～0.01)。与术前相比,在BDI-Ⅱ评分及MoCA口语流畅度评分显著降低(P0.05～0.01)。与术前比较,术后PDQ-39认知力维度评分差异无统计学意义(P0.05),社会支持、躯体不适、交往、病耻感、日常活动能力、运动功能、情感维度评分和总分均显著减低(均P0.05)。结论 DBS短期内即可改善PD患者的抑郁、睡眠、泌尿系统症状、胃肠道症状等NMS及生活质量,对除口语流畅度以外的认知状态无明显影响。     

影响帕金森病运动亚型的相关因素分析

目的研究帕金森病步态和姿势异常亚型(Postural instability gait disorder,PIGD)与震颤亚型(Tremor dominant,TD)的临床表现差异以及影响帕金森病亚型的相关因素。方法收集2019年1月至2020年1月就诊于我院帕金森病专科门诊的69例帕金森病患者,分为PIGD组和TD组进行临床资料采集以及量表评估,量表包括Hoehn-Yahr量表(H-Y)、国际运动障碍学会统一帕金森病评定量表(MDS-UPDRS)、非运动症状评价量表(NMSS)、帕金森病睡眠量表(PDSS)、简明智力状态检查(MMSE)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、帕金森病生活质量评价量表(PDQ-39)。将收集的数据进行统计学分析。结果两组患者在发病年龄、病程、服用左旋多巴等效剂量、HAMA、HAMD、MMSE、PDSS、NMSS、PDQ-39评分的方面差异无统计学意义。在发病年龄、受教育程度、是否患有共病、UPDRS评分、H-Y分级、僵硬、运动迟缓、震颤、姿势和步态异常的方面差异有统计学意义。进行下一步相关性分析发现患者发病年龄、共病严重程度、H-Y分级、UPDRS评分、运动症状与PD亚型有相关性。结论帕金森病患者的发病年龄、共病严重程度、疾病严重程度、运动症状是影响PIGD亚型的相关因素。     

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。     

Validation of the Chinese Non-Motor Symptoms Scale for Parkinson's disease: Results from a Chinese pilot study

Objectives

To evaluate a Chinese version of the Non-Motor Symptoms Scale (NMSS) in Parkinson's disease (PD) as an instrument for measuring non-motor symptoms (NMSs) in Chinese patients with Parkinson's disease.

Methods

We conducted a psychometric analysis of the Chinese version of NMSS using a cross-sectional study of 126 patients with PD. The battery also included the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), the Mini-Mental State Examination (MMSE), the Geriatric Depression Scale (GDS), and the Hamilton Anxiety Scale (HAMA), and was conducted by neurologists.

Results

There were significant correlations between the NMSS and PSQI scores (rS = 0.63, P < 0.001), as well as the NMSS and ESS scores (rS = 0.38, P < 0.001). Furthermore, significant positive correlations between NMSS and GDS, NMSS and HAMA, and NMSS and disease duration were also observed. Importantly, the sleep/fatigue index of the NMSS significantly correlated with the PSQI and ESS findings, the mood/cognition index of the NMSS significantly correlated with the GDS and HAMA findings, and the attention/memory index of the NMSS significantly correlated with the MMSE findings.

Conclusion

The Chinese version of the NMSS can be considered a comprehensive, useful measure for NMS evaluation in Chinese PD patients.     

Prolonged-release melatonin in Parkinson's disease patients with a poor sleep quality: A randomized trial

BackgroundThe present study was a randomized, double-blind, placebo-controlled, multi-center trial to evaluate the efficacy and safety of prolonged-release melatonin (PRM) in Parkinson's disease (PD) patients with poor sleep quality.MethodsPD patients with a global Pittsburgh Sleep Quality Index (PSQI) score > 5 were included. Patients were assessed using the PSQI, a rapid eye movement sleep behavior disorder screening questionnaire, the Epworth Sleepiness Scale, Non-Motor Symptoms Scale (NMSS), Parkinson's Disease Quality of Life-39 (PDQ-39), and Unified Parkinson's Disease Rating Scale (UPDRS)-III at the beginning of the study and after 4 weeks of treatment with 2 mg of PRM. Partial correlation analysis was performed to investigate the relationship between PSQI score and the other scales.ResultsThirty-four PD patients with poor sleep quality were enrolled and divided into 2 groups based on medication; PRM (n = 16) and placebo (n = 18). Regarding efficacy, PSQI was significantly improved in the PRM group compared to the control group. Improvement in the NMSS and PDQ-39 summary index were observed in the PRM but not in the placebo group; UPDRS-III score was not significantly changed in either group. PSQI improvement correlated with improvement in NMSS score and PDQ-39 summary index. Regarding safety, all enrolled subjects did not complain of side effects due to PRM.ConclusionPRM is an effective and safe treatment option for subjective sleep quality in PD patients and beneficial effects on sleep quality are associated with improved non-motor symptoms and quality of life in PD patients.     

Sleep disorders in Chinese patients with Parkinson's disease: validation study of a Chinese version of Parkinson's disease sleep scale

To evaluate the Chinese version of the Parkinson's disease sleep scale (PDSS) as an instrument for measuring sleep disorders in Chinese patients with Parkinson's disease (PD). The objective of the present study was to carry out a metric analysis of a Chinese version of PDSS using a cross-sectional study of 126 patients with PD who participated in the study. Usual measures for PD patients including the Pittsburgh sleep quality index (PSQI), the Epworth sleepiness scale (ESS), the Geriatric Depression Scale (GDS), and the Hamilton Anxiety Scale (HAMA) were applied by neurologists. The intra-class correlation coefficient was 0.880, and test-retest reliability for total PDSS score was 0.914. The Mean total PDSS score was 118.38+/-26.07. There was a significant correlation between the PDSS and PSQI, between the PDSS and ESS, between the PDSS and GDS, between the PDSS and HAMA, between the PDSS and the disease durations, and between the PDSS and the LDE, respectively. The Chinese version of PDSS met some basic standards required for sleep disorders measures. It could lead to better understanding the sleep disorders of PD of China in future studies.     

Evaluation of an Arabic version of the non-motor symptoms scale in Parkinson’s disease

Non-motor symptoms (NMS) of Parkinson Disease (PD) are common and can cause severe disability. They are often under-recognized and remain untreated. Tools to evaluate these symptoms in Arabic-speaking patients are still lacking. The objective of this study was to evaluate an Arabic version of the non-motor symptoms scale (NMSS) of PD as an instrument for measuring NMS in Arabic-speaking patients. Sixty-two PD patients clustered around Hoehn & Yahr Stages 2–3 were evaluated by the Arabic version of NMSS. They also underwent a battery of standard psychometric assessment measures that included the scales for outcomes of Parkinson’s disease-autonomic (SCOPA-AUT), the Pittsburgh sleep quality index (PSQI), the Beck depression inventory, the geriatric depression scale (GDS), the mini-mental state examination (MMSE), the visual analogical scale for pain(VAS) and the neuro-psychiatric inventory (NPI). The metric properties of the NMSS were studied as well as its correlation with other standard tests evaluating NMS. The mean NMSS score was 82 ± 56 (skewness 0.88). There were highly significant correlations between the NMSS and the SCOPA-AUT as well as the NMSS and PSQI scores. Significant positive correlations between NMSS and GDS, BECK and VAS were also observed. The sleep/fatigue domain significantly correlated with the PSQI, the cardiovascular/urinary/sexual function/gastrointestinal domains significantly correlated with the SCOPA-AUT, the mood/cognition domain significantly correlated with the GDS and BECK findings. The mean Cronbach’s alpha coefficient was 0.87, showing a satisfactory internal consistency. The Arabic version of NMSS can be considered a comprehensive and reliable measure for non-motor symptoms in Arabic-speaking PD patients.     

The influence of fatigue on health-related quality of life in patients with Parkinson's disease

OBJECTIVE: To examine the correlation between fatigue and health-related quality of life (HRQL) in patients with Parkinson's disease (PD). PATIENTS AND METHODS: Sixty-six patients with idiopathic PD. The patients did not have a depressive mood disorder or cognitive impairment. Fatigue was measured by the Fatigue Severity Scale (FSS). HRQL was measured by the Parkinson's Disease Questionnaire (PDQ-39) and the Short-Form 36 (SF-36). RESULTS: Thirty-three (50%) of the patients had significant fatigue. Patients with fatigue had a more advanced disease than those without fatigue, measured by the UPDRS scale, including a higher Hoehn and Yahr stage and lower Schwab and England score. Patients with fatigue reported more distress in the dimensions of emotional well-being and mobility (PDQ-39) and also had a significantly higher PDQ summary index. On the SF-36 patients with fatigue reported more problems in the areas of physical functioning, role limitation (physical), social functioning and vitality. Correlations between the FSS and the HRQL scales were highest for the summary index of PDQ-39 and in the dimensions of ADL, mobility and emotional well-being (PDQ-39) and physical functioning, role limitation (physical), social functioning, general health and vitality (SF-36). CONCLUSIONS: PD has a substantial negative impact on HRQL. We found a strong correlation between fatigue and high distress scores on HRQL scales in a population of patients with PD who were not depressed or demented. The diversity of symptoms and high prevalence of non-motor features, including fatigue, is important to take into account in our efforts to optimize treatment and care for this patient group.     

Non-motor outcomes of subthalamic stimulation in Parkinson's disease depend on location of active contacts

Background

Subthalamic nucleus (STN) deep brain stimulation (DBS) improves quality of life (QoL), motor, and non-motor symptoms (NMS) in Parkinson's disease (PD). Few studies have investigated the influence of the location of neurostimulation on NMS.

Olfactory dysfunction and parasympathetic dysautonomia in Parkinson’s disease

Objective

Olfactory impairment occurs early in Parkinson’s disease (PD), as may dysautonomia. We investigated the relationship between olfaction and dysautonomia as well as other non-motor manifestations of PD.

Methods

Olfaction [University of Pennsylvania Smell Identification Test (UPSIT)], autonomic function in the pupillary (constriction and redilation velocity) and cardiac systems (resting low- and high-frequency heart rate variability (LF and HF HRV), positional changes in systolic blood pressure), neuropsychiatric function [Mini-mental Status Exam (MMSE)], Hamilton Depression Scale, activities of daily living [(ADLs), Schwab and England ADLs scale], quality of life [Short Form-36 health survey, PD Questionnaire 39 (PDQ-39)], and other non-motor symptoms [Non-motor Symptoms Scale (NMSS)] were simultaneously assessed in 33 participants (15 PD, 18 controls). Group comparisons, Spearman’s coefficients and non-parametric rank-based regression were employed to characterize relationships between olfaction and non-motor features.

Results

Smell scores were lower in the PD group and correlated positively with pupil constriction velocity and HF HRV. Smell scores were correlated negatively with PDQ-39 and gastrointestinal items of the NMSS and positively with MMSE and Schwab and England ADLs. These correlated measures were not significant terms in regression models of smell scores in which age and PD diagnosis were significant and accounted for over half of the variability (R-squared 0.52–0.58).

Interpretation

This study suggests olfactory involvement occurs with parasympathetic dysautonomia in the pupillary and cardiovascular systems, involving both age-related and PD-related processes. Other non-motor features are concurrently involved, supporting the notion that aging and PD have widespread effects involving discrete portions of the autonomic and olfactory systems.     

Quantitation of non-motor symptoms in Parkinson's disease

Background:  Disabling non-motor symptoms (NMS) associated with Parkinson's disease (PD), such as dementia and loss of balance, do not respond well to levodopa therapy and can lead to eventual death in patients with the disease. In 2006, a multidisciplinary group of experts and patient representatives developed an NMS screening questionnaire (NMSQuest) and a unified Non-Motor Symptoms Scale (NMSS) to address the need for simple identification and comprehensive assessment of NMS in patients with PD.
Methods and Results:  An international pilot study of 96 healthy controls and 123 patients with various stages of treated and untreated PD was conducted to demonstrate that the NMSQuest is a feasible, valid, and accepted tool.
Conclusion:  The majority of patients and caregivers felt that the questionnaire was clear and relevant to their daily lives. Data from 242 PD patients with no dementia were analysed in a pilot study on the clinimetric validation of NMSS. Similar to the NMSQuest study, the NMSS study revealed a significant correlation between progression of PD and increasing NMS burden. These studies suggest that the NMSQuest accurately detects the NMS, and that the NMSS closely correlates with quality of life for PD patients.     

Association between fatigue and other motor and non-motor symptoms in Parkinson’s disease patients

Although fatigue is a common non-motor symptom in patients affected by Parkinson’s disease (PD), its association with motor and other non-motor symptoms is still largely unclear. We assessed fatigue in PD patients studying the possible association with motor and non-motor symptoms. Eighty-one PD patients were included in the study. The PD Fatigue Scale (PFS) and the Fatigue Severity Scale (FSS) scale were used to measure fatigue. Non-motor symptoms were assessed with the Non-Motor Symptoms Scale (NMSS). Motor impairment was assessed using the modified Hoehn and Yahr (HY) staging and the Unified PD Rating Scale (UPDRS) part-III and IV. Bivariate tests comparing all independent variables between patients with our without fatigue were used. Significant predictors of presence and severity of fatigue were determined with different models of logistic regression analyses. Fatigue severity was significantly higher in female patients. Bivariate test showed significant higher NMSS score in fatigued patients according to PFS (p < 0.00001) and FFS (p < 0.001), while HY was higher only in fatigued patients according to FSS (p < 0.022). Significant correlations between severity of fatigue and HY stage (p < 0.002) and UPDRS-III score (p < 0.001) were found, while, among specific non-motor symptoms, anhedonia presented with the most significant correlation (p < 0.003). Binary logistic regression confirmed NMSS as the main variable predicting presence of fatigue, while HY was significant as predicting variable only in the FSS model. Strongest non-motor symptoms predictors of severity were those included in Domain 3 (mood/anxiety) and Domain 2 (sleep disorders) of the NMSS. A significant increase in severity of fatigue related to the burden of non-motor symptoms (mainly affective and sleep disorders) was observed. Our findings indicate a moderate discrepancy in the ratings of the two fatigue scales, with PFS principally directed towards the burden of non-motor symptoms. Finally, the accurate individuation of the factors underlying fatigue, assessed with the systematic administration of holistic evaluation scales such as the NMSS, might improve current strategies used in the treatment of this disabling condition.