帕金森病嗅觉障碍研究进展

帕金森病（Parkinsondisease,PD）的主要临床特征为运动症状,但近年来其非运动性症状日益收到重视。嗅觉功能障碍是PD主要的非运动症状之一。据统计,90％的PD患者运动症状出现前表现有不同程度嗅觉功能减退或完全性嗅觉丧失。     

帕金森病嗅觉障碍研究进展

帕金森病以静止性震颤、行动迟缓、肌张力增高为主要运动症状,同时伴有嗅觉减退、便秘、认知障碍、RBD、精神症状、焦虑、抑郁、淡漠、自主神经功能障碍等多种非运动症状。嗅觉障碍是帕金森病常见的非运动症状之一,可早于运动症状数年出现。因此,筛查嗅觉障碍可能有助于早期发现并诊断帕金森病。本文就帕金森病嗅觉障碍的病理生理、危险因素、与其他症状的关系、检查方法及治疗等方面的研究进展做一综述。     

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。     

吸烟对帕金森病患者嗅觉障碍的影响

目的探讨吸烟对帕金森病(PD)患者嗅觉障碍的影响。方法根据吸烟情况将167例PD患者(PD组)及100例正常人(正常对照组)分为吸烟亚组及不吸烟亚组。采用TT嗅觉测试液对入组者进行嗅素识别阈值测定。结果与正常对照组比较,PD组MMSE评分及蒙特利尔认知评估(Mo CA)评分显著降低(均P0.05),两组年龄、吸烟史及男性比率未见明显差异(均P0.05)。PD组嗅素识别阈显著高于正常对照组(t=6.785,P=0.000)。与PD吸烟亚组比较,不吸烟亚组嗅素识别阈显著升高(t=-3.000,P=0.003)。正常人吸烟亚组较不吸烟亚组嗅素识别阈值减低,但无统计学意义(t=0.784,P=0.435)。PD吸烟者嗅觉阈值与吸烟年限、吸烟总量无相关(r=-0.104,P=0.441;r=-0.156,P=0.246)。结论吸烟可能对PD患者嗅觉有保护作用,并且与吸烟年限、吸烟总量无关。     

帕金森病的嗅觉障碍

嗅觉障碍可以是帕金森病(PD)早期而常见的症状.既往研究[1]表明,约70%～100%的PD患者有嗅觉障碍,其发生机制目前还存在争议,相关临床研究的结论也不一致.     

伴或不伴快动眼睡眠行为障碍的帕金森病临床特点比较

目的 比较伴或不伴快动眼睡眠行为障碍的帕金森病(PD-RBD⁺;PD-RBD^-)在临床特征上的差异。方法 收集在陕西省人民医院就诊的PD患者,通过多导睡眠监测技术(PSG)将其划分为PD-RBD⁺组和PD-RBD^-组,收集人口学资料,完成临床资料收集及相关神经心理量表测评,统计两组患者病情严重程度、运动及非运动症状特点,并进行统计分析。结果 共纳入PD患者59例,其中PDRBD+组25例,PD-RBD^-组34例。PD-RBD⁺组比PD-RBD^-组男性更多,强直为主型占比多,UPDRS第Ⅲ部分分数更高,冻结和体位性低血压发生率高。结论 总体而言,PD-RBD⁺组症状较PD-RBD^-组更重。     

帕金森病嗅觉减退与非运动症状的相关性研究进展

<正>帕金森病(Parkinson’s disease,PD)是仅次于阿尔茨海默病的第二常见的全球神经退行性疾病,其病理机制是黑质多巴胺能神经元受损,存活神经元中含有α-突触核蛋白(Alpha-synuclein,α-syn)的包涵体(路易小体)受损。PD患病率随着年龄的增长而增加,60岁以上人群中有1%的人患有PD^[1]。根据2015年颁布的运动障碍学会标准,早期PD可分为3个阶段:临床前PD(神经退行性变开始时没有明显的症状或体征)     

不同亚型帕金森病患者睡眠障碍临床特征及影响因素分析

目的探讨不同亚型帕金森病(PD)患者睡眠障碍的临床特征及影响因素。方法入选我院2012-02—2014-02收治的105例PD患者为观察对象,根据不同亚型分为A组(震颤为主)51例和B组(姿势异常-步态障碍为主)54例,采用帕金森病睡眠量表(PDSS)评价患者睡眠情况和临床特征,记录患者临床资料,采用多元素回归方程分析影响因素。结果 A组PDSS-1(夜间睡眠情况)、PDSS-2(入睡情况)、PDSS-3(睡眠维持)、PDSS-8(夜尿情况)、PDSS-12评分(肢体疼痛)和总分(整体睡眠质量)均显著高于B组,差异均具有统计学意义(均P0.05);与A组患者睡眠障碍相关的因素有H-Y评分和MMSE评分,与B组患者睡眠障碍相关的因素有左旋多巴日剂量、UPDRSⅢ总分和抑郁,差异均具有统计学意义(P0.05)。结论以姿势异常-步态障碍为主的PD患者整体睡眠质量较差,容易发生睡眠障碍,主要表现为夜间睡眠差,入睡困难,难以维持睡眠,夜尿多且夜间肢体痉挛疼痛,不同亚型患者睡眠障碍的影响因素也不同。     

伴与不伴快速眼动睡眠行为障碍帕金森病患者临床差异的meta分析

目的系统评价伴与不伴快速眼动睡眠行为障碍(RBD)帕金森病(PD)患者之间临床特征的差异。方法检索Pub Med、EMbase等外文数据库及中国生物医学数据库(CMB)、中国知识基础设施工程(CNKI)、维普中文科技期刊全文数据库(VIP)、万方数据库等中文数据库关于PD与RBD相关性分析的病例对照研究,检索时限从建库至2018年09月01日。对入选文献进行质量评价,并用Stata 12. 0软件进行Meta分析。结果共纳入了17项符合标准的病例对照研究,共计PD患者3006例,Meta分析结果显示:与不伴RBD的PD患者相比,伴RBD的PD患者年龄更大(SMD=0. 26; 95%CI0. 19～0. 34; P 0. 00 001)、病程更长(SMD=0. 29; 95%CI 0. 21～0. 37; P 0. 00 001)、Hoehn-Yahr分级更高(SMD=0. 22; 95%CI 0. 11～0. 33; P 0. 00 001)、UPDRS-III评分更高(SMD=0. 25; 95%CI 0. 15～0. 36; P 0. 00 001)、左旋多巴剂量更大(SMD=0. 17; 95%CI 0. 08～0. 26; P 0. 00 001),更易出现症状波动(OR=1. 65; 95%CI1. 34～2. 03; P0. 00 001)、异动症(OR=2. 24; 95%CI 1. 74～2. 88; P 0. 00 001),MMSE评分更低(SMD=-0. 23; 95%CI-0. 40～-0. 06; P=0. 008),幻觉(OR=3. 15; 95%CI 2. 06～4. 80; P 0. 00 001)更多见,而性别(OR=1. 15; 95%CI 0. 99～1. 35; P=0. 07)、发病年龄(SMD=0. 09; 95%CI-0. 01～0. 19; P=0. 08)组间差异不明显。结论 PD患者中RBD的发生与患者年龄、病程有关,且伴RBD的PD患者需要更高的左旋多巴剂量、更易出现运动并发症,非运动症状更明显,提示伴RBD的PD患者中枢神经系统变性程度更严重、损害范围更广泛。     

Reproductive factors and clinical features of Parkinson's disease

BackgroundLiterature suggests that sex steroid hormones may modify the risk for Parkinson's disease (PD). We investigated the potential effect of reproductive factors on the clinical features of idiopathic PD (IPD) patients.MethodsAll IPD female patients admitted to and evaluated at our Institute over a 12-month period were included in the present cross-sectional study. We investigated the effect of the following parameters by multivariate linear regression analysis: age at menarche, age at menopause, length of fertile life, duration of exposure to endogenous estrogens and cumulative length of pregnancies, use of contraceptives and hormonal replacement therapy.ResultsIn total, 579 patients were evaluated and 497 reported menopause before PD onset. In this population, age at PD onset was positively associated with age at menarche and at menopause, length of fertile life and duration of estrogen exposure. Moreover, UPDRS motor score was inversely associated with age at menopause, length of fertile life and duration of estrogen exposure. Increasing age at menarche was also associated with predominant resting tremor at PD onset. In models refitted on patients with early PD (disease duration <5 years; N = 226) all the associations found were confirmed. The relationship between surrogates of estrogen exposure and UPDRS motor score actually became more significant.ConclusionsOur observations support the concept that hormonal exposure of the nigro-striatal network during life may influence its susceptibility to degenerative stimuli in later life, but the association does not seem to be unique? unidirectional. In particular, increased severity of PD signs correlates with shorter duration of estrogen exposure. The underlying mechanisms need to be clarified.     

Neuropsychological correlates of olfactory dysfunction in Parkinson's disease

Olfactory impairment is a common early non-motor manifestation in Parkinson's disease that has garnered interest as a clinical biomarker for early "pre-motor" diagnosis and prediction of associated clinical phenotypes. Whether olfactory impairment correlates well with motor symptoms is not yet clear, and recent interest has focused on the relationship between hyposmia and other non-motor symptoms. In this paper, we will review emerging evidence for a relationship between hyposmia and neuropsychiatric manifestations, discussing the potential pathophysiology together with challenges and opportunities for future research.     

吸烟与帕金森病嗅觉障碍

帕金森病是临床常见的神经变性病,根据临床症状可以分为运动症状和非运动症状,嗅觉障碍作为帕金森病最常见的非运动症状越来越受到重视。既往研究显示,尼古丁可能降低帕金森病发病风险,而有吸烟史的帕金森病患者嗅觉障碍轻微,因此吸烟可能通过嗅觉系统对帕金森病产生保护作用。吸烟对帕金森病患者嗅觉功能的影响可能有助于我们更全面地了解帕金森病发病过程。     

Motor and non-motor correlates of olfactory dysfunction in Parkinson's disease

Hyposmia is highly prevalent in the motor phase of Parkinson's disease (PD) and is an established pre-motor sign of PD that may precede the onset of motor symptoms by as long as 5 years. The data presented here are part of an ongoing study to determine the relationship of the olfactory deficit in PD with both motor and non-motor features of the disease. The study population so far includes 96 patients with a clinical diagnosis of PD (UK PD Society Brain Bank criteria; mean age 64.9 years; mean disease duration 4.8 years). Olfactory testing was performed using the 40-item UPSIT. We analyzed the relationship between UPSIT scores and measures of motor (disease duration, stage and severity) and non-motor (cognitive function, depression, anxiety and sleep) function. In 60 PD patients, [(123)I]FP-CIT SPECT scans were available to assess the relationship between UPSIT scores and striatal dopamine transporter (DAT) binding. Preliminary analyses revealed correlations of the olfactory deficit in PD with both motor and non-motor features, as well as with striatal DAT binding. These data suggest that the olfactory deficit in PD is not stationary by the time the motor phase is entered, but continues to progress over time. Hyposmia may therefore be useful as a marker of disease progression, at least in the early disease stages.     

特发性震颤与帕金森病患者嗅觉障碍的定量分析研究

目的检测特发性震颤(ET)与帕金森病(PD)患者的嗅觉功能,并探讨ET与PD的关系。方法应用中国科学院半导体研究所研制的五味嗅觉测试液检测30例ET、30例PD患者及30例健康对照组,从嗅觉察觉阈值和嗅觉识别阈值两个方面比较各组的差异。结果 PD组的嗅觉察觉阈值和嗅觉识别阈值均明显高于ET组和对照组(P<0.01),而ET组与对照组的嗅觉察觉阈值和嗅觉识别阈值差异无统计学意义(P>0.05)。结论帕金森病有明显的嗅觉功能障碍,而特发性震颤无明显的嗅觉功能障碍,ET与PD可能是两种不同性质的疾病。     

Parkinson's disease: clinical features, epidemiology and genetics

Genetic and epidemiological studies are critical to understanding the etiology of Parkinson's Disease (PD), and may lead to rational treatments for the disease. This article reviews the clinical features, epidemiology and genetics of PD, with emphasis on insights from recent genetic and epidemiological studies.     

Dystonia in Parkinson's disease: clinical and pharmacological features

We studied the features of dystonia in 9 patients with untreated idiopathic Parkinson's disease and in 56 patients on sustained treatment with L-dopa. Dystonia was seen as an initial symptom in patients with both early- and late-onset Parkinson's disease and included action dystonia of the limbs and cranial dystonia. Although the coexistence of parkinsonism and dystonia suggests a common pathophysiology, antiparkinsonian drugs did not consistently influence dystonic spasms. L-dopa-induced dystonia was seen as an off-period, biphasic, or peak-dose phenomenon. Each type showed a distinctive pattern of localization of dystonic spasms, possibly reflecting neurochemical aspects of basal ganglia somatotopy. Neuropharmacological studies performed in 12 patients suggest that off-period dystonia is genuinely induced by L-dopa and best relieved by antiparkinsonian agents.