帕金森病非运动症状的临床研究

目的 探讨PD患者非运动症状的临床表现及其发生率.方法 随机收集未经治疗的PD患者48例,在口服美多巴治疗前及治疗后6个月分别进行PD统一评定量表运动部分、非运动症状筛查量表、抑郁量表、认知功能量表、匹兹堡睡眠质量指数、便秘问卷测定.结果 主要的非运动症状发生率便秘94%、睡眠障碍63%、抑郁33%、认知功能障碍25%.治疗前各量表评分:PD评定量表(运动检查)33.93±19.82,非运动症状筛查量表异常率100%,抑郁量表5.18±4.45,蒙特利尔认知评估量表26.54±3.85,匹兹堡睡眠质量指数6.83±5.10,便秘45例;治疗6个月后各量表评分:PD评定量表(运动检查)11.14±9.43,非运动症状筛查量表异常率仍为100%,抑郁量表5.18±4.31,蒙特利尔认知评估量表26.65±3.64,匹兹堡睡眠质量指数6.97±4.81,便秘45例.在运动症状出现之前即有便秘8例、睡眠障碍6例,认知功能障碍均发生在Hoehn-Yahr分期Ⅲ期以上患者.结论 PD非运动症状表现多样,部分症状发生率较高,也可是其主要症状,也可先于运动症状出现.认知功能障碍发生于PD晚期.抗帕金森病治疗只能改善PD患者运动症状,不能改善非运动症状.     

帕金森病非运动症状相关性的研究

目的 探讨帕金森病(PD)患者非运动症状(NMS)中抑郁、自主神经功能、认知功能、嗅觉、快速动眼睡眠障碍评分之间及其与运动症状的相关性.方法 采用PD综合评分量表(UPDRSⅢ)对44例原发性PD患者的运动症状进行评估;同时采用简易智力状况检查量表(MMSE)、17项汉密尔顿抑郁量表(HAMD-17)、PD自主神经功能量表(SCOPA-AUT)、睡眠障碍(RBD)量表和史尼芬16项嗅觉筛查量表(SS-16)对患者的NMS进行评分,与12例对照组比较,统计NMS之间及其与UPDRSⅢ之间的相关性.结果 PD组患者嗅觉障碍、抑郁程度、自主神经功能、快速动眼睡眠障碍均较对照组严重(P＜0.01),而MMSE的评分比较差异则无统计学意义(P=0.804).此外,在PD组中,HAMD-17评分(r=0.447,P=0.004)、SCOPA-AUT评分(r=0.360,P =0.023)与UPDRSⅢ呈明显正相关;而在NMS之间SCOPA-AUT与RBD评分呈正相关(r =0.331,P =0.035);HAMD-17与MMSE评分呈明显负相关(r=-0.460,P=0.003,);与SCOPA-AUT呈正相关(r=0.394,P=0.011).结论 NMS已经成为影响PD患者生活质量的重要因素.NMS常伴随发生,其中抑郁、自主神经功能紊乱程度与运动症状的严重程度密切相关;自主神经功能紊乱与睡眠障碍的发生有一定相关性;PD患者抑郁的程度与其认知障碍和自主神经功能紊乱程度一致.     

帕金森病非运动症状的诊疗进展

帕金森病(PD)是一种中老年人常见的神经系统变性疾病,以黑质多巴胺能神经元变性缺失和路易小体形成为主要病理特征。主要临床表现为运动迟缓、肌强直、静止性震颤和姿势步态异常等〔1〕。近年来,PD的非运动症状(NMS)已引起人     

帕金森病非运动症状治疗国际指南解读和比较

欧洲神经病协会联盟在2011年推出了《欧洲神经病治疗手册》。该指南依据最新循证医学证据进一步提出了晚期帕金森病治疗方法,为晚期帕金森病的治疗提供了更多选择。指南涉及运动系统症状治疗及非运动系统症状治疗,尤其对以往认识比较欠缺的非运动系统症状的治疗进行了详细的阐述,并对神经精神症状、睡眠障碍、自主神经功能障碍、胃肠道功能障碍及感觉异常等症状一一提出了相关建议。     

新疆维汉两民族帕金森病患者运动症状及非运动症状的特点

目的探讨新疆维汉两民族帕金森病(PD)患者运动及非运动症状的严重程度。方法入选130例PD患者和80例健康人,通过完成临床症状评定量表评分(UPDRS)及HoehnYahn(H-Y)评分,非运动症状评分量表,比较维汉两民族PD患者运动及非运动症状的差异性。结果维汉两民族PD患者在病程,起病年龄,UPDRSⅠ,Ⅱ,Ⅲ部分及H-Y分级及首发症状方面对比差异无统计学意义。腹胀、睡眠障碍、便秘、疲乏和排尿困难是最常见的非运动症状主诉,其发生率在维汉两民族PD所占比率分别为:38.75%vs 38%;37.5%vs 60%;41.25%vs 38%;32.5%vs 24%;35%vs 62%。维汉两民族PD患者在便秘及疲乏方面比较差异有统计学意义(P0.05)。结论新疆维吾尔族PD患者在便秘及疲乏方面较汉族PD严重,而维汉两民族PD患者在其他运动症状及非运动症状方面比较无明显差异。     

重视帕金森病非运动症状

随着对帕金森病（PD）认识的加深,非运动症状已成为PD症状学的重要组成部分。PD患者嗅觉下降发生率高,并可用来鉴别PD与非典型性和继发性帕金森综合征;对PD患者消化道症状的研究发现,便秘患者PD发病风险增加5倍,且肠道神经中发现了α?突触核蛋白和Lewy体的沉积;精神症状如快速动眼期睡眠行为障碍（RBD）、抑郁、焦虑及幻觉妄想等显著降低了患者生活质量,且RBD转化为PD等神经变性疾病的概率显著增高。非运动症状有可能成为PD早期诊断的突破点,需给予更大关注,加强研究。     

帕金森病患者非运动症状的研究

目的 调查帕金森病(PD)非运动症状的发生和分布情况及其与PD严重程度、病程之间的关系.方法 应用统-PD评分量表(UPDRS)的第Ⅲ、V部分、PD非运动症状30问卷量表(the PD NMS questionnaire,NMSQuest)、日常生活能力量表(ADL)和简易智能量表(MMSE)评分,对81例原发性PD患者的运动症状和非运动症状进行了评估,并将结果与国外的相关研究结果进行比较.结果 非运动症状在PD病程各个时期均可出现,平均每个PD患者出现7项左右不同的非运动症状,以记忆力障碍、便秘和夜尿增多的发生率最高.并且非运动症状的发生与PD疾病的进展相关,与Hoehn and yahr(H-Y)分级呈正相关(rs=0.360,P<0.01),与UPDRSⅢ运动评分呈正相关(rs=0.336,P<0.01),且影响患者的生活质量,与ADL评分呈负相关(rs=-0.250,P<0.05);而与年龄、性别、病程、PD发病类型和左旋多巴.每日治疗量无相关性.(分别为rs=0.193、rs=-0.142、rs=-0.053、rs=0.017和rs=0.195,均为P>0.05) 结论非运动症状的发生在PD中很普遍,对生活质量的影响不比运动症状轻,需要全面认识和及时干预.     

帕金森病非运动症状的临床处理

帕金森病非运动症状日益受到重视,也成为帕金森病的研究热点。文章介绍了帕金森病相关非运动症状,包括感觉障碍、神经精神症状、睡眠障碍及自主神经功能障碍等,着重介绍其临床表现、评估方法及处理策略。     

帕金森病非运动症状患者的临床特征及影响因素

目的探讨帕金森病(PD)非运动症状(NMS)的临床特征及其影响因素。方法选择该院2009年6月至2012年6月收治的147例PD患者为观察组,并以同期健康体检者150例为对照组,采用NMS量表对两组的NMS情况进行采集,分析PD患者的NMS的临床特征及其影响因素。结果观察组NMS发生总数为1～25个,平均(12.4±5.8)个,显著高于对照组(P<0.01);观察组NMS发生率显著高于对照组,两组30项NMS发生率比较中,观察组有20项症状发生率显著高于对照组(P<0.01,P<0.05)。PD患者NMS发生总数与病程和病情严重度具有相关性(P<0.05),与性别、年龄、文化程度、职业性质、发病年龄及疾病分型不具有相关性(P>0.05)。结论 PD患者的NMS表现以自主神经功能减退最为显著,其NMS发生总数随患者病程及病情严重程度的增加而增加。     

帕金森病非运动症状的中西医治疗进展

随着对帕金森病认识的深入,帕金森病的非运动症状如神经精神症状、自主神经功能障碍、睡眠障碍等逐渐被临床医生所关注,如何有效控制帕金森病的非运动症状已被临床医生所重视,在西医常规治疗基础上,探求中医治疗方法提高疗效,成为很多临床医生的共识。本研究针对帕金森病的非运动症状中西医结合治疗作一综述,以期对治疗有所帮助。     

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.     

帕金森病非运动症状的临床分析

目的通过对帕金森病患者非运动症状发生率进行分析,探讨非运动症状的临床特征。方法采用"帕金森病非运动症状筛查量表"对146例帕金森病患者的非运动症状发生率进行排序,并结合临床类型、Hoehn-Yahr分期等因素对非运动症状进行分析。结果帕金森病非运动症状的总发生率为98.6%,其中便秘的发生率最高为82.9%,其次为睡眠障碍(66.4%)、小便障碍(63.7%)、记忆困难(57.5%)、性生活障碍(50.7%)等。非运动症状发生率随Hoehn-Yahr分期的增加而增加,差异有统计学意义(P0.01)。结论自主神经功能障碍是帕金森病最常见的非运动症状。Hoehn-Yahr分期与非运动症状发生率明显相关。     

Therapy guided by symptoms for Parkinson's disease

Low-dose combinations of medications that work in slightly different ways constitute optimal management of Parkinson's disease. Surgical approaches are being perfected for patients who stop responding favorably to pharmacologic treatment.     

Initial symptoms of Parkinson's disease with elderly onset

BACKGROUND/OBJECTIVE: As the incidence of Parkinson's disease (PD) is related to aging, we consider it important to determine how the initial symptoms change with age in order to diagnose early elderly cases of PD accurately. METHODS: 84 patients (age at onset 70.7+/-9.0 years; mean +/-1 SD) were studied to see whether the initial symptoms change according to age. RESULTS: The prevalence of resting tremor was significantly lower in patients of advanced age (p = 0.041). In contrast, the incidence of postural and gait disorders increased significantly with aging (p = 0.032). The prevalences of rigidity and kinetic disorders, which are important clinical features of PD, were not influenced by aging. CONCLUSION: These findings suggest that the cause of PD is not related to the aging process itself, since the prevalences of all symptoms were not influenced by aging. Knowledge of the prevalence of the initial symptoms of PD may contribute to the accurate diagnosis in early and elderly cases.     

Parkinson's disease or Parkinson symptoms following seasonal influenza

Please cite this paper as: Toovey S et al. (2011) Parkinson’s disease or Parkinson symptoms following seasonal influenza. Influenza and Other Respiratory Viruses 5(5), 328–333. Background Influenza may cause neurological sequelae and has been associated with encephalitis lethargica, an entity displaying Parkinson’s disease (PD) signs and symptoms that followed the 1918 influenza pandemic. We studied the association between diagnosed influenza and idiopathic PD or Parkinson symptoms (PS) not followed by a firm PD diagnosis. Methods We used the UK‐based General Practice Research Database to perform a case–control analysis. We identified cases who developed an incident diagnosis of PD or PS between 1994 and March 2007, and we matched four controls on age, gender, general practice, calendar time, and history in the database to each case. We calculated odds ratios (OR) with 95% confidence intervals (CI) using conditional logistic regression to assess the relative risk of developing PD or PS in association with previous influenza diagnoses. Results We identified 3976 PD cases and 18 336 PS cases. The risk of developing PD was not associated with previous influenza infections. However, PS was associated with recent influenza (last infection 0–29 days: OR 3·03, 95% CI 1·94–4·74; 30–364 days: OR 1·36, 95% CI 1·14–1·63), number of influenza episodes (1 attack: OR 1·20, 95% CI 1·12–1·28; 2 attacks: OR 1·52, 95% CI 1·28–1·81; ≥3 attacks: OR 2·00, 95% CI 1·45–2·75), and severity of preceding influenza infections (≥1 severe attack: OR 1·45, 95% CI 1·25–1·68). Conclusions Influenza is associated with PD‐like symptoms such as tremor, particularly in the month after an infection, but not with an increased risk of developing idiopathic PD.     

低频重复经颅磁刺激对不同亚型帕金森病运动症状的疗效观察

目的观察低频重复经颅磁刺激(repetitively transcranial magnetic stimulation,rTMS)对不同亚型帕金森病(Parkinsons disease,PD)运动症状的疗效。方法选择PD患者76例,依据主要运动症状类型分为震颤为主型26例(震颤组)、姿势异常步态障碍(postural instability-gait disorder,PIGD)为主型21例(PIGD组)和混合型29例(混合组)。3组在常规治疗基础上均给予rTMS治疗,治疗前后对所有患者进行统一PD评分量表第3部分(unified Parkinsons disease rating scale-third part,UPDRS-Ⅲ)评分,评估患者运动症状的改善情况。结果 PIGD组和混合组治疗后UPDRS-Ⅲ评分较治疗前明显下降[(23.25±5.82)分vs(27.81±6.16)分,(23.11±6.56)分vs(26.90±6.28)分,P<0.05]。震颤组治疗后UPDRS-Ⅲ评分较治疗前下降,但差异无统计学意义(P>0.05)。结论低频rTMS能够改善PIGD为主型与混合型PD的运动症状,而对震颤为主型PD的运动症状疗效不肯定。     

帕金森病患者非运动症状的发生状况及影响因素

目的 研究帕金森病(PD)非运动症状(non-motor symptoms,NMS)的各项发生率、发生数及可能影响因素.方法 对131例门诊确诊为PD的患者进行NMS问卷(NMSQuest)调查,研究各项发生率、总发生数的状况及其与各种可能因素间的关系.结果所有入组PD患者均有NMS,分布于PD的各个阶段,平均每例患者有11项NMS;各项发生率中以自主神经症状如夜尿、便秘等的发生率最高,入组年龄≥65岁患者组在嗅觉减退、吞咽困难和便秘等多项发生率上高于＜65岁组,强直-少动型患者在抑郁相关项目上发生率高于震颤型患者;NMS发生数与病程、患者入组年龄、统一帕金森病评定量表(UPDRS)总分和Hoehn-Yahr(H-Y)分级呈正相关.结论 NMS普遍存在于各期的PD患者,各项发生率随PD患者的临床特点不同而变化,NMS发生数与PD的疾病严重程度呈正相关,应提高对NMS诊断和合理治疗的重视.     

帕金森病睡眠障碍与非运动症状的相关性研究

目的探讨帕金森病(PD)患者睡眠障碍与非运动症状的相关性。方法 535例PD患者先用匹兹堡睡眠质量指数评测,并分为睡眠障碍组249例和非睡眠障碍组286例。分别用一般情况调查表、统一帕金森病评定量表(UPDRS)、Hoehn-Yahr分级、汉密尔顿抑郁量表(HMDS)、疲劳严重度量表和简易智能状态检查量表(MMSE)等对患者进行评分。结果睡眠障碍组较非睡眠障碍组更易出现便秘(67.5%vs 48.3%)、疲劳(79.1%vs 44.4%)、嗅觉减退(35.7%vs 23.8%)、排尿障碍(50.6%vs 11.5%)、头晕(45.4%vs 26.9%)等症状(P<0.01);睡眠障碍组各量表评分高于非睡眠障碍组[HMDS评分(16.96±10.57)分vs(9.77±7.55)分、UPDRS-Ⅰ(2.59±2.05)分vs(1.56±1.47)分、UPDRS-Ⅱ(11.27±5.81)分vs(8.63±4.51)分、UPDRS-Ⅲ(23.30±12.87)分vs(19.02±11.37)分、UPDRS总分(42.35±20.80)分vs(32.83±17.33)分,P<0.01]。2组患者Hoehn-Yahr分级、MMSE评分比较无显著差异,且其他非运动症状比较无显著性差异(P>0.05)。多元logistic回归分析显示,便秘、疲劳、抑郁、排尿障碍、头晕、UPDRS-Ⅲ是PD患者伴发睡眠障碍的危险因素(P<0.05,P<0.01)。结论睡眠障碍是PD患者常见的非运动症状,其与便秘、疲劳、抑郁、排尿障碍、头晕等非运动症状显著相关。