心理护理干预对帕金森病抑郁症患者抑郁症状的影响

目的探讨心理护理干预对帕金森病（PD）抑郁症患者抑郁症状的影响。方法对88例PD伴抑郁患者进行测评并随机分为对照组（44例）和实验组（44例）,对照组给予常规神经内科护理;实验组在常规护理基础上同时给予心理干预,采用汉密尔顿抑郁量表（HAMD）对PD患者入院时及治疗后6周进行评分。结果帕金森病伴抑郁患者心理干预后,试验组患者抑郁症状明显减轻,HAMD评分下降,与干预前比较差异有统计学意义（P〈0.05）。结论心理护理干预可有效地改善患者的抑郁症状,延缓帕金森病患者的进展速度,促进其身心健康。     

氯氮平治疗帕金森病精神障碍的疗效观察

目的探讨氯氮平治疗帕金森病(PD)并发精神障碍的临床疗效及不良反应。方法收集PD并发精神障碍的患者56例,随机分为氯氮平组30例,喹硫平组26例。在优化抗帕金森病药物治疗基础上分别加用氯氮平或喹硫平,观察4周。治疗前后采用UPDRS评定运动功能;采用简明精神病评定量表(BPRS)和临床总体印象严重程度量表(CGI-S)评定精神症状;采用异常不自主运动量表评定异动症。结果 2组精神症状改善程度同基线比较均差异有统计学意义(P0.001),各时间点比较无显著差异。UPDRS评分,氯氮平组治疗前后运动功能评分差异无统计学意义,喹硫平组治疗前后运动功能评分有统计学差异(P0.05)。2组治疗前后异动症评分有显著差异(P0.05)。结论氯氮平对治疗PD并发精神障碍患者的疗效肯定、安全,不加重运动障碍,且能显著改善患者异动症。喹硫平对PD并发精神障碍的患者疗效肯定,但可加重患者运动障碍,且对异动症无效。     

DBS对帕金森病病人精神症状及认知功能的影响

目的 探讨丘脑底核（STN）-深部脑刺激术（DBS）对帕金森病（PD）病人精神症状及认知功能的影响。方法 回顾性分析2016年1月至2019年1月STN-DBS治疗的65例PD的临床资料。术前、术后1年，采用第三版统一帕金森病评分量表（UPDRS-Ⅲ）评估PD开关期运动症状；采用H-Y分期评估病情严重度；采用日常生活能力量表（ADL）评估日常生活能力；采用汉密尔顿焦虑量表（HAMA）评估焦虑情况；采用汉密尔顿抑郁量表（HAMD）评估抑郁情况；采用帕金森睡眠量表（PDSS）评估睡眠障碍情况；采用蒙特利尔认知评估量表（MoCA）和简易智力状态检查量表（MMSE）评估认知功能；采用帕金森患者生活质量问卷（PDQ39）测评生活质量。结果 术后1年，UPDRS-Ⅲ评分、H-Y分期、ADL评分、HAMA评分、HAMD评分、PDQ39评分、MoCA评分及MMSE评分均明显改善（P<0.05）。结论 STN-DBS能够显著改善PD病人运动症状、精神症状、认知功能及生活质量。     

重复经颅磁刺激治疗帕金森病后抑郁的疗效观察

目的观察重复经颅磁刺激(rTMS)对帕金森病(PD)后抑郁的临床疗效。方法将我院收治的68例PD后抑郁的患者随机分为2组,对照组给予常规抗PD治疗药物,治疗组在对照组治疗基础上联合rTMS治疗,采用汉密尔顿抑郁量表(HAMD)及统一帕金森病评定量表(UPDRS)对治疗前后2组患者抑郁状态及生活、运动功能进行对比。记录治疗组患者rTMS治疗的不良反应。结果治疗组治疗前后HAMD及UPDRS评分显著降低;治疗组HAMD评分较对照组显著降低(P<0.05);治疗组不良反应轻微。结论 rTMS治疗PD后抑郁安全有效,值得临床推广。     

首次确诊帕金森病患者情绪和认知功能障碍的关系

目的观察研究首次确诊帕金森痛患者情绪和认知功能障碍之间的关系。方法60例首次确诊帕金森病（PD）患者,采用简易智能状态检查量表（MMSE）和词ir-流畅性测验评定患者的认知功能;采用汉密尔顿抑郁量表（HAMD）和汉密尔顿焦虑量表（HAMA）评定患者的情绪障碍。采用统一帕金森病评分量表（UPDRS）和改良Hoehn—Yahr分级评定患者的帕金森病严重程度。结果（1）60例首次确诊PD患者改良H0ehn～Yahr分级显示：I级11例,Ⅱ级32例,Ⅲ级16例,Ⅳ级1例。其中具有抑郁障碍患者28例,占46．7％;具有焦虑障碍患者20例,占33．3％,20例焦虑障碍PD患者都具有抑郁障碍。（2）60例首次确诊PD患者中,具有认知功能障碍患者23例,占38．3％;MMSE评分和词汇流畅性测验评分均与病程呈负相关,差异具有统计学意义（r分别为-0．42,-0．46;P〈0．05）。（3）60例首次确诊PD患者HAMD评分和MMSE评分及词汇流畅性测验评分呈负相关,差异具有统计学意义（r分别为-0．69,-0．76;P〈0．01）。PD患者HAMA评分和MMSE评分及词汇流畅性测验评分亦呈负相关,差异具有统计学意义（r分别为～0．60,-0．68;P〈0．01）。结论首次确诊PD患者多为轻、中度患者,早期即表现情绪障碍和认知功能障碍,且两者具有高度相关性。     

微电极引导的苍白球鼠损术对帕金森病患者认知功能的近期影响

目的：了解微电极引导的腹侧苍白球毁损术（PVP）对帕金森病（PD）患者认知功能的影响,方法：对接受PVP治疗的20例PD患者手术前后进行认知功能检查,临床记忆量表、线方向判断测验、言主流畅性及简明精神状态量表检查。结果：左侧PVP患者术后临床记忆量表联想学习分测验成绩较术前显著减退（P＜0．05）,其余记忆分测验、记忆商以及其他认知检查手术前后无显著改变（P＞0．05）;右侧PVP患者术后较术前各项检查成绩无明显改变（P＞0．05）,手术后运动功能较术前显著改善（P＜0．05）。结论左侧苍白球参与了语言记忆,PVP对所检查的认知功能影响轻微。     

重复经颅磁刺激对帕金森病患者双眼竞争平均切换时间的影响

目的 探讨对帕金森病病患者辅助运动区进行重复经颅磁刺激（rTMS）的感知觉变化。 方法 回顾性连续纳入2018 年4—10 月于安徽医科大学第一附属医院神经内科门诊就诊的12 例帕金 森病患者（6 例男性，6 例女性），采用rTMS 的持续性θ爆发式磁刺激序列，在导航下对辅助运动区进行 连续14 d 的rTMS 治疗，治疗前后分别测定患者未服药状态下的双眼竞争平均切换时间，并采用汉密尔 顿焦虑量表（HAMA）、汉密尔顿抑郁量表17 项（HAMD-17）、统一帕金森病评定量表中第Ⅲ部分运动症 状评定量表（UPDRS Ⅲ）进行评定。结果 受试者治疗前UPDRS Ⅲ评分为（29.25±12.02）分，治疗后评 分为（24.00±11.63）分明显低于治疗前，差异有统计学意义（t=2.644，P ＜ 0.05）。受试者治疗前HAMA、 HAMD-17 评分分别为（9.08±3.09）、（9.75±3.52）分，治疗后分别为（8.50±3.29）、（8.75±3.22）分，治疗前 后评分差异均无统计学意义（t值分别为1.074、1.225，均P＞ 0.05）。治疗前后受试者双眼竞争平均切换 时间为（5.50±1.47）、（4.06±1.21）s，治疗后的双眼竞争平均切换时间较治疗前明显缩短，差异有统计学 意义（t=3.743，P ＜ 0.05）。结论 rTMS 干预帕金森病患者辅助运动区可加快帕金森病患者双眼竞争的 切换，提高其感知觉水平。     

帕金森病患者自主神经功能障碍评估

目的：评估帕金森病（PD）患者中自主神经功能障碍症状发生比例、各症状分布的差异，及其与PD临床特点之间的关系。方法：应用SCOPA-AUT量表、统一帕金森病评分量表（UPDRS）、日常生活能力量表（ADL）、Hamilton抑郁量表和简易智能量表（MMSE）对116例原发性PD患者进行评估。结果：SCOPA-AUT总分和消化系统（GI）症状、排尿（UR）症状、体温调节（TH）症状、性功能（SX）症状评分均高于对照组，差异有极显著统计学意义（P=0．0001）。SCOPA-AUT总分与UPDRS评分、Hamilton抑郁量表评分呈正相关（P〈0．001），与生活质量ADL评分呈负相关（P〈0．001）。结论：自主神经功能障碍在PD早期就会出现，并随着疾病进展而加重，影响患者的生活质量。     

双侧丘脑底核电刺激对帕金森病患者生活质量影响的研究

目的对给予丘脑底核(STN)电刺激治疗的帕金森病(PD)患者进行生活质量评估,以评价治疗的有效性及不同因素对生活质量的影响。方法41例接受双侧STN深部电刺激(DBS)治疗的PD患者分别于术前及术后12个月应用统一帕金森病评定量表(UPDRS)、Hoehn和Yahr分期、Schwab和England日常生活活动量表、医院焦虑和抑郁量表(HADS)评价其临床情况;帕金森病生活质量问卷(PDQ-39)评价生活质量,并对统计结果进行配对t检验和Spearman相关性检验。结果UPDRS评分中日常生活活动、运动检查、并发症均有明显改善(P<0.001),而精神、行为和情绪无明显改善。HADS量表结果显示患者的焦虑及抑郁评分均有明显改善(P<0.001)。PDQ-39评分中运动、日常生活活动、情绪状态、身体不适、总评分等项均有明显改善(P<0.001),羞耻感也有改善(P<0.05)。相关性检验的结果提示与PDQ-39总评分变化程度成相关性的因素依次为:UPDRS运动检查“关”期(P<0.001), Schwab和England日常生活活动量表“关”期(P<0.001),UPDRS日常生活活动“关”期(P<0.01),HADS-抑郁(P< 0.05)。结论脑深部电刺激能明显改善PD患者的生活质量。     

丘脑底核脑深部电刺激治疗帕金森病合并抑郁障碍的长期疗效

目的研究丘脑底核（STN）脑深部电刺激（DBS）治疗帕金森病（PD）合并抑郁障碍的长期疗效并探讨其神经机制。方法对15例合并抑郁障碍的PD患者实施STN脑深部电极植入，术后3个月、6个月和12个月进行随访和临床评价。结果术后运动功能症状如肢体僵硬、震颤、运动迟缓和姿势平衡障碍改善良好，停药后PD分级量表运动评分显著下降（P〈0．01）。术后抑郁障碍症状如焦虑、绝望和激越症状改善良好，停药后汉密尔顿抑郁量表评分显著下降（P〈0．05）。结论STN-DBS能显著改善PD的抑郁障碍症状，STN在PD抑郁障碍神经机制中起重要作用。     

The assessment of depression in Parkinson's disease

Background:  Motor symptoms form the hallmark of Parkinson's Disease (PD), although features like depression are often present. Depression rating scales [e.g. Montgomery-Åsberg Depression Rating Scale (MADRS)] used in PD measure affective, cognitive and somatic symptoms. An important clinical question is which items of the MADRS are likely to be influenced by PD symptoms.
Methods:  Depression was assessed in 43 PD patients who scored below the cut-off of the MADRS and who differed widely in motor severity.
Results:  Parkinson's Disease patients scored relatively highest on Concentration difficulties, Reduced sleep and Inner tension. Reduced sleep, Lassitude and Suicidal thoughts were associated with motor severity and specifically with Bradykinesia, Rigidity and Axial impairment, however not with Tremor.
To avoid a possible influence on our results of coincidentally included PD patients with a depression, all associations between somatic MADRS items and motor severity were corrected for the influence of affective symptoms of depression. All associations remained significant.
Discussion:  In conclusion, the items Reduced sleep and Lassitude of the MADRS are likely to be influenced by motor symptoms. The high score on Concentration difficulties is suggested to be a reflection of cognitive dysfunction in PD. Thus, when assessing depression in PD, using a depression rating scale like the MADRS, adjusted cut-off scores are required.     

Effects of dyskinesias in Parkinson''s disease on quality of life and health-related costs: a prospective European study

The treatment of Parkinson's disease (PD) with l-DOPA leads to involuntary movements (dyskinesias). This 6-month observational study in three European countries in PD patients with various degrees of motor complications examined the effects of dyskinesias on the quality of life (QoL) of patients and health care costs. Retrospective and prospective health economic data were collected, and QoL of patients was measured using the Short Form-36 (SF-36) and the PD Quality of Life (PDQL) Scale. Regression analysis was used to estimate the adjusted effects of dyskinesias on QoL and costs, whilst accounting for the potentially confounding effects of disease progression, motor fluctuations and country. Increasing dyskinesia scores on either the Unified PD Rating Scale or the Goetz Dyskinesia Rating Scale were associated with significant reductions in QoL scores on the SF-36 and PDQL Scale. Increasing dyskinesia severity was also associated with increased depression scores on the Montgomery-Asberg Depression Rating Scale along with significant increases in health care costs. The effects of dyskinesia on QoL, depression and costs decreased but remained significant after adjustment for the confounding effects of disease progression and motor fluctuations. In conclusion, dyskinesias may adversely affect QoL and increase health care costs in patients with PD. Future studies should evaluate the potentially beneficial effects in terms of QoL and health care costs of strategies to delay the onset of, or the treatment of, dyskinesias.     

(123)I]beta-CIT SPECT imaging demonstrates reduced density of striatal dopamine transporters in Parkinson's disease and multiple system atrophy.

In vivo imaging of the dopamine transporter (DAT) with single photon emission computed tomography (SPECT) is a quantitative biomarker for Parkinson's disease (PD) onset and severity. This study has examined and compared the loss of striatal DAT in PD and multiple system atrophy (MSA) using [(123)I]beta-CIT SPECT imaging. One hundred and eighty-three patients (157 PD and 26 MSA) were studied. Clinical rating scales (Hoehn and Yahr stage and Unified Parkinson's Disease Rating Scale [UPDRS] scores) demonstrated that the MSA patients were more severely impaired than the PD patients. The striatal [(123)I]beta-CIT SPECT uptake was markedly reduced in both the PD and MSA groups. In addition, MSA patients showed more symmetric DAT loss compared with the PD patients, consistent with the more symmetric clinical motor dysfunction observed in MSA. While the loss of DAT was significantly reduced in all regions in both MSA and PD, comparison of the relative loss of the DAT did not significantly improve diagnostic accuracy in distinguishing between PD and MSA.     

Depression rating scales in Parkinson's disease: critique and recommendations.

Depression is a common comorbid condition in Parkinson's disease (PD) and a major contributor to poor quality of life and disability. However, depression can be difficult to assess in patients with PD due to overlapping symptoms and difficulties in the assessment of depression in cognitively impaired patients. As several rating scales have been used to assess depression in PD (dPD), the Movement Disorder Society commissioned a task force to assess their clinimetric properties and make clinical recommendations regarding their use. A systematic literature review was conducted to explore the use of depression scales in PD and determine which scales should be selected for this review. The scales reviewed were the Beck Depression Inventory (BDI), Hamilton Depression Scale (Ham-D), Hospital Anxiety and Depression Scale (HADS), Zung Self-Rating Depression Scale (SDS), Geriatric Depression Scale (GDS), Montgomery-Asberg Depression Rating Scale (MADRS), Unified Parkinson's Disease Rating Scale (UPDRS) Part I, Cornell Scale for the Assessment of Depression in Dementia (CSDD), and the Center for Epidemiologic Studies Depression Scale (CES-D). Seven clinical researchers with clinical and research experience in the assessment of dPD were assigned to review the scales using a structured format. The most appropriate scale is dependent on the clinical or research goal. However, observer-rated scales are preferred if the study or clinical situation permits. For screening purposes, the HAM-D, BDI, HADS, MADRS, and GDS are valid in dPD. The CES-D and CSDD are alternative instruments that need validation in dPD. For measurement of severity of depressive symptoms, the Ham-D, MADRS, BDI, and SDS scales are recommended. Further studies are needed to validate the CSDD, which could be particularly useful for the assessment of severity of dPD in patients with comorbid dementia. To account for overlapping motor and nonmotor symptoms of depression, adjusted instrument cutoff scores may be needed for dPD, and scales to assess severity of motor symptoms (e.g., UPDRS) should also be included to help adjust for confounding factors. The HADS and the GDS include limited motor symptom assessment and may, therefore, be most useful in rating depression severity across a range of PD severity; however, these scales appear insensitive in severe depression. The complex and time-consuming task of developing a new scale to measure depression specifically for patients with PD is currently not warranted.     

Parkinsonism in multiple system atrophy: natural history, severity (UPDRS-III), and disability assessment compared with Parkinson's disease.

We analyzed parkinsonian features in multiple system atrophy (MSA) compared with age- and disease duration-matched Parkinson's disease (PD) patients, and assessed the applicability of the Unified Parkinson's Disease Rating Scale (UPDRS) -III motor scale as a means of rating their severity. Cross-sectional analysis of parkinsonism was done using UPDRS-III, International Cerebellar Atatia Rating Scale, and disability scales (Hoehn and Yahr [H&A], Schwab and England, Katz and Lawton) in 50 unselected MSA patients and in 50 matched PD patients. At symptom onset, falls occurred 10 times more frequently in MSA, whereas limb tremor was 10 times more common in PD. At first visit (10.2 months), hemiparkinsonism and pill-rolling rest tremor were less common in MSA. Hypomimia, atypical rest, postural or action tremor, as well as postural instability were more frequent in MSA. At study examination (62.4 months), parkinsonian signs in MSA patients were more frequently symmetrical and associated with axial rigidity, antecollis and postural instability. A levodopa response of >50% was seen in <10% of MSA patients. Modified H&Y stages (3.2 +/- 1.3 vs. 2.2 +/- 0.78) and UPDRS-III scores (48.14 +/- 19.5 vs. 31.74 +/- 12.9) were significantly (P = 0.0001) higher in MSA. The internal consistency of the UPDRS-III was fair in MSA patients (Cronbach's alpha >0.90), and correlated well with marked dependency on the Schwab and England and Katz and Lawton scales. Factor structure analysis of UPDRS-III in MSA showed five clinically distinct subscores accounting for 74% of the variance, differing from PD by the dependency of the face-speech and limb bradykinesia items and independence of the postural-action tremor from the rest tremor items. There was a significant correlation (R(2) = 0.70, P = 0.001) between ICARS ataxia and UPDRS-III scores in MSA patients. Results confirm a distinct profile of parkinsonism in MSA and greater severity and disability compared with PD. It also indicates that the UPDRS-III provides a useful severity measure of parkinsonism in MSA, albeit contaminated by additional cerebellar dysfunction.     

Unawareness of dyskinesias in Parkinson's and Huntington's diseases

We performed a clinical study to evaluate the unawareness of dyskinesias in patients affected by Parkinson's disease (PD) and Huntington's disease (HD). Thirteen PD patients with levodopa-induced dyskinesias and 9 HD patients were enrolled. Patients were asked to evaluate the presence of dyskinesias while performing specific motor tasks. The Abnormal Involuntary Movement Scale (AIMS) and Goetz dyskinesia rating scale were administered to determine the severity of dyskinesias. The Unified Parkinson's disease rating scale (UPDRS) and Unified Huntington's Disease Rating Scale (UHDRS) were used in PD and HD patients, respectively. In PD we found a significant negative relationship between unawareness score at hand pronation-supination and AIMS score for upper limbs. In HD we found a significant positive relationship between total unawareness score and disease duration. In PD the unawareness seems to be inversely related with severity of dyskinesias, while in HD it is directly related to disease duration and severity.     

Behavioral Ratings of Executive Functioning Explain Instrumental Activities of Daily Living beyond Test Scores in Parkinson’s Disease

Objective: Executive dysfunction is common in Parkinson’s disease (PD), yet the relationship between executive functioning (EF) and instrumental activities of daily living (IADLs) is inconsistent. This inconsistency may be due to the limited relationship between EF test scores and behaviors. Rating scales provide a potential way to supplement test scores in predicting patient’s ability to complete IADLs by capturing a wide range of EF behaviors in their everyday environment. We hypothesized that informant-rated EF would provide incremental validity in predicting IADLs above and beyond EF test scores. Methods: Eighty-five patients were selected from a clinical neuropsychological database of PD patients evaluated for deep brain stimulation surgery at The Johns Hopkins Hospital between September 2006 and January 2015. Hierarchical regression was completed to determine the relationship between an EF behavioral rating scale (i.e., FrSBe), EF test scores, and IADLs. Results: The EF behavioral rating scale added incremental validity to neuropsychological test scores in predicting IADLs. Conclusions: Behavioral ratings of EF may provide additional information about how PD patients’ EF is influencing their everyday life.     

Rating scales for dystonia: a multicenter assessment.

The evaluation of dystonia requires a reliable rating scale. The widely used Fahn-Marsden Scale (F-M) has not been sufficiently tested across multiple centers and investigators. The Dystonia Study Group developed the Unified Dystonia Rating Scale (UDRS) and a Global Dystonia Rating Scale (GDS) to serve as instruments to assess dystonia severity. In this study, 25 dystonia experts evaluated the UDRS, F-M, and GDS for internal consistency and reliability. One hundred dystonia patients were videotaped using a standardized videotape protocol. Each examiner rated 20 patients using the UDRS, F-M, and GDS in random order. The examiner then assessed each scale for ease of use. Statistical analysis used Cronbach's alpha, intraclass correlation coefficients (ICC), generalized weighted kappa statistic, and Kendall's coefficient of concordance. The UDRS, F-M, and GDS showed excellent internal consistency (Cronbach's alpha 0.89-0.93) and good to excellent correlation among the raters (ICC range from 0.71-0.78). Inter-rater agreement was fair to excellent (Kendall's 0.54-0.87; kappa 0.37-0.91) being lowest for eyes, jaw, face, and larynx. The modifying ratings (Duration in the UDRS and Provoking Factor in the F-M) showed less agreement than the motor severity ratings. Among scales, the total scores correlated (Pearson's r, 0.977-0.983). Overall, 74% of raters found the GDS the easiest to apply. The GDS with its simplicity and ease of application may be the most useful dystonia rating scale.     

Validity of spiral analysis in early Parkinson's disease

Spiral analysis is an objective, easy to administer noninvasive test that has been proposed to measure motor dysfunction in Parkinson disease (PD). We compared overall Unified Parkinson Disease Rating Scale Part III scores to selected indices derived from spiral analysis in seventy‐four patients with early PD (mean duration of disease 2.4 ± 1.7 years, mean age 61.5 ± 9.7 years). Of the spiral indices, degree of severity, first order zero crossing, second order smoothness, and mean speed were best correlated with total motor Unified Parkinson's Disease Rating Scale (UPDRS) score (all P < 0.01), and these indices showed a gradient across worsening tertiles of UPDRS (P < 0.05). Spiral indices also correlated with UPDRS ratings for the worst side and worst arm scores as well. The domains of bradykinesia, rigidity, and action tremor were correlated with first order crossing, second order smoothness, and mean speed, where as rest tremor was most highly correlated with degree of severity. This suggests that the spiral analysis may supplement motor assessment in PD, although further analysis of spiral metrics, a larger sample and longitudinal data should be evaluated. © 2007 Movement Disorder Society