吡贝地尔联合艾司西酞普兰对帕金森病病人运动功能及认知功能的影响

目的探讨吡贝地尔联合艾司西酞普兰对帕金森病病人运动功能及认知功能的影响。方法选取2014年1月—2016年1月在我院接受治疗的124例帕金森病病人作为研究对象,将其随机分为对照组和观察组,每组62例。对照组给予吡贝地尔治疗,观察组在对照组基础上联合小剂量艾司西酞普兰治疗。分析两组治疗前后统一帕金森综合评分量表(UPDRS)、39项帕金森病调查表(PDQ-39)、韦氏记忆量表(WMS)以及简易智能量表(MMSE)、残图命名(DPN)、词语流畅性测验量表(VFT)、画钟测验(CDT)得分情况。结果两组治疗后,UPDRS总评分和PDQ-39评分均明显降低,差异有统计学意义(P0.05),且观察组UPDRS总评分和PDQ-39评分显著高于对照组(P0.05);治疗后,两组UPDRSⅢ和UPDRSⅣ评分与治疗前相比显著降低(P0.05),且观察组UPDRSⅢ和UPDRSⅣ评分明显高于对照组(P0.05);两组治疗后长时记忆、短时记忆、即时记忆、总量表分和记忆商的韦氏记忆量表评分显著高于治疗前(P0.05),观察组治疗后各指标评分均明显高于对照组(P0.05);治疗后,两组病人MMSE、DPN、VFT和CDT评分数值显著高于治疗前(P0.05),且观察组治疗后DPN、VFT和CDT评分数值明显高于对照组(P0.05)。结论吡贝地尔联合艾司西酞普兰治疗帕金森病病人,可明显改善临床整体症状,对病人认知功能和运动功能改善效果较为理想。     

吡贝地尔联合多巴丝肼治疗帕金森病的临床疗效及安全性分析

目的分析吡贝地尔联合多巴丝肼治疗帕金森病的临床疗效及安全性。方法选取鹤壁市中医院神经内科2012年2月—2014年2月收治的帕金森病患者145例,采用随机数字表法将患者分为对照组72例和观察组73例。对照组患者给予多巴丝肼治疗,观察组患者给予吡贝地尔联合多巴丝肼治疗,均治疗12周。采用改良Webester量表评定临床疗效,记录治疗前和治疗12周后帕金森综合评分量表(UPDRS)评分及治疗期间药物相关不良反应发生情况。结果观察组临床疗效优于对照组(P0.05)。治疗前两组患者UPDRS评分比较,差异无统计学意义(P0.05);治疗后观察组患者UPDRS评分低于对照组(P0.01)。治疗期间,对照组患者不良反应发生率为5.6%,观察组为4.1%,差异无统计学意义(P0.05)。结论吡贝地尔联合多巴丝肼治疗帕金森病疗效确切,能有效改善患者临床症状,且安全性较高。     

吡贝地尔联合美多巴口服及心理干预治疗帕金森病的效果观察

目的观察吡贝地尔联合美多巴及心理干预治疗帕金森病（PD）的疗效和安全性。方法将84例PD患者随机分为治疗组及对照组各42例,两组均口服吡贝地尔缓释片50mg/次、1～3次/d,在此基础上治疗组联合美多巴及心理干预治疗,疗程均为12周。采用改良Webester量表评定临床疗效,同时行PD统一评分量表（UP-DRS）评分、观察不良反应发生情况。结果治疗组临床疗效总有效率显著高于对照组;两组治疗后改良Webester评分及UPDRS评分均较治疗前明显降低,尤以治疗组为著（P均〈0．05）;两组治疗前后肝肾功能均无异常,不良反应发生率无显著差异。结论吡贝地尔联合美多巴及心理干预治疗PD效果确切,且不良反应较小。     

美多芭加用吡贝地尔治疗帕金森病的临床疗效观察

目的评定美多芭与吡贝地尔联合应用治疗帕金森病的临床疗效。方法56例帕金森病病人随机分为两组,单用美多芭组(28例)和美多芭加用吡贝地尔组(28例),临床疗效采用改良Webester量表进行治疗前后评定,同时测定出现运动并发症(运动症状波动及异动症)的时间。结果临床总有效率单用美多芭组为71.43%,美多芭加用吡贝地尔组为85.71%,美多芭加用吡贝地尔组总有效率明显高于单用美多芭组(P<0.05)。单用美多芭组出现运动并发症的时间是4.02年±1.96年,美多芭加用吡贝地尔组为5.01年±2.03年,两组出现运动并发症的时间经统计学分析,差异无统计学意义(P>0.05)。结论单用美多芭和美多芭加用吡贝地尔治疗帕金森病均有效,而且美多芭加用吡贝地尔比单用美多芭治疗帕金森病有效率更高。     

止颤汤治疗帕金森病合并抑郁状态的疗效观察

目的观察止颤汤治疗帕金森病合并抑郁状态的疗效。方法两组病人基础用药均为治疗帕金森病的西药,治疗组在基础治疗上加用止颤汤治疗。观察并比较3个月后两组汉密尔顿抑郁量表评分和统一帕金森病评定量表(UPDRS)评分。结果治疗组治疗前后汉密尔顿抑郁量表评分和UPDRS总分差异有统计学意义(P0.05),UPDRS各部分评分有改善,但差异无统计学意义(P0.05)。结论止颤汤对改善帕金森病症状以及帕金森病合并抑郁状态有一定的治疗作用。     

止颤汤治疗帕金森病的临床疗效观察

目的观察止颤汤对帕金森病病人的临床治疗效果。方法60例帕金森病病人分成中药止颤汤治疗组(中药组)与西药培高利特(协良行)治疗组(西药组)。两组病人药物治疗3个月后,采用帕金森病统一评分量表(UPDRS)中的运动检查量表计分,比较治疗前后评分下降程度,评估其治疗效果。结果中药组治疗后UPDRS评分下降4.55分,西药组下降4.49分,两组治疗后UPDRS均较治疗前明显降低,差异有统计学意义(P<0.01),且中药组总有效率为83.33%,优于西药组的53.33%(P<0.05)。观察中无明显不良反应。结论中药止颤汤治疗帕金森病有较确切的临床疗效。     

普拉克索联合美多巴治疗晚期帕金森病的临床疗效观察

目的观察普拉克索联合美多巴治疗晚期帕金森病(PD)的临床疗效。方法选取2013年5月—2014年5月黄河三门峡医院收治的晚期PD患者86例,随机分为试验组和对照组各43例,分别给予普拉克索联合美多巴和吡贝地尔联合美多巴治疗,比较两组患者临床疗效,治疗前和治疗后4周、8周、12周帕金森评分量表Ⅲ(UPDRSⅢ)评分和汉密尔顿抑郁量表(HAMD)评分,记录治疗期间不良反应情况。结果试验组患者临床疗效优于对照组(P0.05)。两组患者治疗前、治疗后4周UPDRSⅢ评分、HAMD评分比较,差异均无统计学意义(P0.05);试验组患者治疗后8周、12周UPDRSⅢ评分、HAMD评分均低于对照组(P0.05);两组患者头晕、恶心呕吐、嗜睡、便秘、开关现象、精神症状发生率比较,差异无统计学意义(P0.05)。结论普拉克索联合美多巴联合治疗晚期PD临床疗效确切,可有效改善患者运动障碍症状和抑郁症状,且不良反应轻,可作为治疗晚期PD的优选方案。     

普拉克索联合美多巴治疗老年中晚期帕金森病的临床研究

目的评估普拉克索联合美多巴治疗老年中晚期帕金森病（PD）的疗效及安全性。方法入选86例患者,随机分为吡贝地尔组43例,普拉克索组43例,疗程均为12周;并于治疗4、8、12周后观察统一帕金森病评定量表（UPDRS）Ⅱ、Ⅲ、Ⅳ评分;记录治疗12周主要疗效及不良反应。结果普拉克索组第4、8、12周UP-DRSⅡ、Ⅲ、Ⅳ评分与基线评分比较有统计学差异（P〈0.05或P〈0.01）;普拉克索组及吡贝地尔组第4、8、12周UPDRSⅡ、Ⅲ、Ⅳ评分相对基线变化的平均值,2组间差异均无统计学意义（P〉0.05）;第12周普拉克索组与吡贝地尔组相比,治疗疗效减退、开关现象、异动症的总有效率均有统计学差异（P〈0.05）;2组不良反应发生率无统计学差异（P〉0.05）。结论普拉克索治疗中晚期老年PD患者安全有效。     

吡贝地尔缓释片联合多巴丝肼、甘精胰岛素治疗老年糖尿病合并帕金森患者的疗效评价

选取2018年3月～2020年1月老年糖尿病合并帕金森患者98例,随机平分为对照组采用多巴丝肼+甘精胰岛素治疗,观察组采用吡贝地尔缓释片+多巴丝肼+甘精胰岛素治疗.结果观察组总有效率87. 76％高于对照组71.43％(P＜0.05);治疗后两组帕金森病评定量表(UPDRS)评分、均较治疗前改善,且观察组低于对照组(P...     

胞磷胆碱治疗帕金森病合并认知功能障碍的疗效观察

目的观察胞磷胆碱治疗帕金森病合并认知功能障碍的临床疗效。方法选取2014年12月—2016年2月在我院神经内科收治的帕金森病合并认知功能障碍病人113例,分为对照组(53例)和观察组(60例),对照组行常规治疗并口服盐酸多奈哌齐片,观察组在对照组的基础上加用胞磷胆碱,治疗3个月后,比较两组统一帕金森病定量表(UPDRS)评分、蒙特利尔认知评估量表(MoCA)评分、简易精神状态量表(MMSE)评分以及临床疗效。结果两组治疗后UPDRS评分均较治疗前显著降低(P0.05),且观察组治疗后UPDRS总分显著低于对照组(P0.05)。观察组治疗后MoCA评分及MMSE评分显著高于治疗前以及对照组治疗后(P0.05)。对照组总有效率81.13%,观察组总有效率91.67%,观察组总有效率显著高于对照组(P0.05)。结论胞磷胆碱能有效改善帕金森病人脑神经功能,能显著改善病人认知功能,提高临床疗效。     

苍白球腹后部毁损术治疗帕金森病的长期疗效分析

目的探讨苍白球腹后内侧部毁损术（PVP）治疗帕金森病（PD）的长期疗效.方法 79例原发性PD病人,随机分为两组,58例接受PVP（手术组）,21例接受常规药物治疗（未手术组）,记录手术组术前与术后半年、1年、2年、3年、4年UPDRS评分情况,未手术组就诊时、就诊后半年、1年、2年、3年、4年UPDRS评分情况.结果 PVP术前、术后短期、长期UPDRS评分比较有统计学意义（P〈0.001）;长期随访观察显示,手术组PDRS评分增长速度较未手术组慢（P〈0.05）.结论 PVP能使PD症状得到明显的缓解和消除,其短期疗效显著,长期疗效逐年降低,PVP能在一定程度上延缓PD病情的发展.     

99Tcm-TRODAT-1 SPECT脑显像在评价苍白球腹后部毁损术治疗帕金森病长期疗效中的价值

目的探讨^99Tc^m —TRODAT-1SPECT脑显像在评价苍白球腹后部毁损术（PVP）治疗帕金森病（PD）疗效中的应用价值。方法对13例单侧PVP手术治疗病人、31例内科治疗PD病人和10名健康人（健康对照组），行脑^99Tc^m-TRODAT-1SPECT断层显像，利用感兴趣区技术测定纹状体与小脑部位DAT比值。结果健康对照组双侧纹状体摄取差异无统计学意义，内科治疗组PD病人及单侧PVP手术治疗PD病人双侧纹状体与小脑部位DAT比值（ST／CB）分别较健康对照组明显降低（P〈0．05），症状对侧较症状同侧钉／CB DAT比值明显降低（P〈0．05），内科治疗组PD病人同PVP手术治疗PD病人双侧ST／CB差异无统计学意义（P〉0．05），但UPDRS评分前者高于后者（P〈0．05）。结论^99Tc—TRODAT-1SPECT脑显像结合UPDRS评分，有助于客观评价PVP手术治疗PD的疗效，加深对PVP手术原理的理解和认识，同时为评价其他PD术式的疗效，提供新的思路和方法。     

减重平板训练对老年帕金森病患者姿势和平衡能力的改善作用

目的探讨减重平板训练对老年帕金森病（parkinson's disease, PD）患者姿势和平衡能力的改善作用。 方法选取2018年1月至2019年6月浙江医院收治的74例老年PD患者,其中采用常规药物联合传统物理训练进行康复治疗38例（对照组）,在对照组治疗基础上给予减重平板训练进行康复治疗36例（观察组）。采用统一帕金森病评分量表（unified rating scale for Parkinson's disease, UPDRS）Ⅲ评估步态和姿势异常;采用Berg平衡量表（Berg balance scale, BBS）评估平衡能力;采用功能独立性评定量表（functional independence measure, FIM）评估运动能力。比较分析两组患者治疗前后UPDRSⅢ、BBS、FIM评分的差异。组间及组内比较均采用t检验。 结果与治疗前比较,观察组和对照组治疗后UPDRSⅢ评分、BBS评分、FIM评分均明显增高（t=2.815、3.016、4.281,2.035、2.049、2.234;均P<0.05）。两组患者治疗前UPDRSⅢ评分、BBS评分、FIM评分的差异均无统计学意义（t=0.975、0.784、0.539,P>0.05）;观察组治疗后UPDRSⅢ评分、BBS评分、FIM评分均明显高于对照组（t=2.346、2.035、3.014,P<0.05）。 结论减重平板训练能有效改善老年帕金森病患者的姿势和平衡能力。     

Sleep attacks and Parkinson's disease treatment

Three patients with Parkinson's disease had so-called sleep attacks at the wheel while taking bromocryptine, lisuride pergolide, or piribedil. We believe that all dopamine agonists can induce sleep attacks.     

Effect of psychiatric and other nonmotor symptoms on disability in Parkinson's disease

OBJECTIVES: To examine the effect of depression and other nonmotor symptoms on functional ability in Parkinson's disease (PD). DESIGN: A cross-sectional study of a convenience sample of PD patients receiving specialty care. SETTING: The Parkinson's Disease Research, Education and Clinical Center at the Philadelphia Veterans Affairs Medical Center. PARTICIPANTS: One hundred fourteen community-dwelling patients with idiopathic PD. MEASUREMENTS: The Unified Parkinson's Disease Rating Scale (UPDRS); Hoehn and Yahr Stage; Mini-Mental State Examination; Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, depression module; probes for psychotic symptoms; Hamilton Depression Rating Scale; Geriatric Depression Scale-Short Form; Apathy Scale; and Epworth Sleepiness Scale. Disability was rated using the UPDRS activity of daily living (ADL) score and the Schwab and England ADL score. Multivariate analysis determined effect of depression and other nonmotor symptoms on disability. RESULTS: The presence of psychosis, depressive disorder, increasing depression severity, age, duration of PD, cognitive impairment, apathy, sleepiness, motor impairment, and percentage of time with dyskinesias were related to greater disability in bivariate analyses. Entering these factors into two multiple regression analyses, only the increasing severity of depression and worsening cognition were associated with greater disability using the UPDRS ADL score, accounting for 37% of the variance in disability (P<.001). These two factors plus increasing severity of PD accounted for 54% of the variance in disability using the Schwab and England ADL score (P<.001). CONCLUSION: Results support and extend previous findings that psychiatric and other nonmotor symptoms contribute significantly to disability in PD. Screening for nonmotor symptoms in PD is necessary to more fully explain functional limitations. Further study is required to determine whether identifying and treating these symptoms will improve function and quality of life.     

恩他卡朋双多巴治疗中晚期帕金森病疗效观察

目的观察对22例中晚期帕金森病(PD)患者采用恩他卡朋双多巴(LCE)治疗的效果。方法选择中晚期PD患者22例,先给予多巴丝肼片62.5 mg餐前1 h口服,3次/天,依据症状改善情况加量至125 mg餐前1 h口服,3次/天。待临床症状改善时,替换为LCE片口服,1片/次,2~3次/天,均在餐前1 h服用。分别于治疗前、治疗4周时,使用统一帕金森病评分(UPDRS)量表评价临床疗效及PD症状改善情况,用日常生活能力(ADL)量表评价PD患者的ADL,用PD生活质量问卷(PDQL-39)评价PD患者生活质量。结果22例中晚期PD患者治疗4周时的总有效率为100%(22/22)。治疗后UPDRS评分、ADL评分均低于治疗前(t分别为29.76、17.40,P均<0.01),治疗后PDQL-39评分高于治疗前(t=-12.06,P<0.01)。结论LCE可以显著改善PD中晚期患者的症状,提高ADL及生活质量。     

A Pilot Study of Respiration and Swallowing Integration in Parkinson’s Disease: “On” and “Off” Levodopa

Parkinson's disease is associated with both swallowing and respiratory dysfunction, increasing the risk of aspiration and pneumonia. Previous studies have shown improvements in measurements of swallowing and respiration with levodopa; however, the studies are small and some studies show conflicting reports. The aim of this study was to further investigate the effect of levodopa on respiration. Ten patients with Parkinson's disease were tested "On" and "Off" levodopa. Assessments included Unified Parkinson's Disease Rating Scale (UPDRS), coordination of swallowing and respiration, timed-test of swallowing, lung function testing, and, qualitative assessment of swallowing. There was a nonsignificant trend to lower volume per swallow when "On" levodopa, significant reduction in lung function when "On" levodopa, but no difference in coordination of swallowing and respiration or qualitative assessment of swallowing. There was a significant increase in motor examination score of the UPDRS when "Off" levodopa compared to "On." There may be a reduction in efficiency of swallowing with levodopa medication without any apparent increase in risk of aspiration. These pilot data suggest that further evaluation with larger numbers of participants is justified.     

通督推拿法辅助治疗帕金森病

目的观察通督推拿法辅助治疗帕金森病（PD）的效果。方法将63例PD患者随机分为观察组31例和对照组32例，两组均常规口服美多巴片，观察组在此基础上予通督推拿疗法。3个月后观察疗效及PD评定量表（UPDRS评分）中各项积分情况。结果观察组总有效率显著高于对照组，且治疗后精神、行为和情绪积分、日常活动积分、运动功能积分较对照组改善显著（P〈0．05）。结论通督推拿法辅助治疗PD可有效缓解病情发展，提高临床疗效。     

Predictors of nursing home placement in Parkinson's disease: a population-based, prospective study

OBJECTIVES: To examine the rate and predictors of nursing home placement in patients with Parkinson's disease. DESIGN: Four-year prospective study. SETTING: A population-based study in western Norway PARTICIPANTS: 178 community-dwelling subjects with Parkinson's disease. MEASUREMENTS: Main outcome measure was the time from baseline to nursing home admission. Baseline evaluation of motor symptoms (Unified Parkinson's Disease Rating Scale, UPDRS), cognition (clinical dementia interview, Gottfries, Brane & Steen dementia scale, and Mini-Mental State Examination), depression (clinical interview and the Montgomery & Asberg Depression Rating Scale), and psychotic symptoms (UPDRS Thought Disorder item) were performed. RESULTS: Forty-seven patients (26.4%) were admitted to a nursing home during the 4-year study period. Institutionalized patients were older, had more advanced Parkinson's disease with more severe motor symptoms and impairment of activities of daily living, were cognitively more impaired, were more often living alone, and had more hallucinations than those who continued to live at home. Duration of disease, levodopa dose, and gender distribution did not differ between the two groups. A Cox proportional hazards linear regression analysis showed that old age, functional impairment, dementia, and hallucinations were independent predictors of nursing home admission. CONCLUSIONS: Both motor and neuropsychiatric symptoms contributed to institutionalization, but the presence of hallucinations was the strongest predictor. This finding indicates it is possible that effective treatment of hallucinations may reduce the need for institutionalization in patients with Parkinson's disease.