帕金森病患者睡眠障碍相关因素分析及其对生活质量的影响

目的探讨帕金森病(PD)患者伴发睡眠障碍(SD)的特点、影响因素、与运动症状(MS)及非运动症状(NMS)的相关性及其对患者生活质量的影响。方法收集2010年4月至2011年11月就诊于北京天坛医院神经内科的132例PD患者的人口学资料,采用匹兹堡睡眠指数量表(PSQI)、爱泼沃斯瞌睡量表(ESS)评估患者睡眠状况,完成相关MS、NMS及生活质量量表的评定。结果 (1)132例PD患者中86例(65.2%)伴发SD(PSQI评分≥5分),为SD组,PSQI平均分为(9.7±3.9)分;46例(34.8%)不伴发SD(PSQI评分<5分),为NSD组;同时完成ESS量表评定的114例患者中,15例(13.2%)有白天困倦(ESS评分≥10分),ESS平均分为(13.5±3.2)分,99例(86.8%)无白天困倦(ESS评分<10分)。(2)PD患者PSQI量表前三位因子及评测结果分别为白天功能紊乱(1.6±1.0)分,睡眠紊乱(1.3±0.5)分,主观睡眠质量(1.3±0.8)分。(3)SD组和NSD组除受教育水平(P=0.032)外,性别、年龄、起病年龄、病程、起病侧别及临床类型均无显著差异(P>0.05)。(4)SD组和NSD组除了统一帕金森病量表(UPDRS)Ⅲ评分外(P=0.007),H-Y分期、改良Webster评分、剂末现象个数、UPDRSⅣ评分均无显著差异(P>0.05)。(5)SD组NMS个数、运动症状期后NMS个数明显多于NSD组(P=0.000),而运动症状期前NMS无显著差异(P>0.05);SD组眩晕、噩梦、入睡困难、白天思睡、性生活障碍、性冷淡、焦虑、抑郁、淡漠、注意力下降、疼痛及梦游的发生率明显高于NSD组(P<0.05);SD组UPDRSⅠ、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、ESS、自主神经症状量表(SCOPA-AUT)、疲劳量表(FS-14)、疲劳严重度量表(FSS)及不宁腿综合征严重程度评定量表(RLSRS)评分均明显高于NSD组(P<0.05)。(6)SD组UPDRSⅡ、日常生活能力量表(ADL)评分明显高于NSD组(P<0.05);SD组39项帕金森病生活质量问卷(PDQL-39)量表评分明显低于NSD组(P<0.05)。(7)相关分析发现,焦虑、抑郁与PSQ     

Cannabidiol (CBD) Consideration in Parkinson Disease

Parkinson disease (PD) is a progressive neurodegenerative disorder characterized by the decrease in dopaminergic neurons in the brain leading to motor and nonmotor symptoms. With the increased availability of cannabidiol in the United States and interest in the PD community for PD-related symptom management in complementary to pharmacologic treatment, this review provides nurse practitioners with useful information on existing studies and regulatory considerations on the implication of cannabidiol in PD.     

Comorbidity and Functional Mobility in Persons with Parkinson Disease

Objectives

To report the frequency, severity, and types of comorbidities in people with Parkinson disease (PD) using a validated self-report comorbidity screening tool, and to determine the relationship between comorbidity and functional mobility.

Design

A secondary analysis and cross-sectional observational study design.

Setting

University hospital; outpatient balance disorders laboratory.

Participants

Persons with mild to moderate idiopathic PD (N=76).

Intervention

Not applicable.

Main Outcome Measures

The Cumulative Illness Rating Scale-Geriatric (CIRS-G) and a comprehensive mobility assessment including gait (distance walked in 3min), balance (mini-Balance Evaluation Systems Test), and physical function (Physical Performance Test).

Results

All participants reported comorbidities in addition to their diagnosed PD. The average ± SD number of comorbidities was 6.96±2.0 (range, 2–11), and the total CIRS-G score ± SD was 12.7±4.8. The most commonly reported organ systems with comorbidity were eyes and ears (89%), psychiatric (68%), musculoskeletal (64%), lower gastrointestinal (62%), respiratory (60.5%), upper gastrointestinal (59.2%), and genitourinary (53.9%). The total CIRS-G score was significantly related to functional mobility: gait (r=−.53, P=.0001), balance (r=−.43, P=.0003), and physical performance (r=−.36, P=.0041). Of the original 14 organ systems measured, there were 7 systems that, when combined, best predicted gait performance, 6 systems combined that best predicted balance performance, and 4 systems combined that predicted functional performance.

Conclusions

This study reports a high frequency of multiple medical system comorbidity in people with mild to moderate PD. Furthermore, comorbidity scores were associated with mobility disability: gait, balance, and physical function. Early intervention is important to delay mobility disability in PD, and we recommend that people with PD found to have comorbidities should be screened for balance and gait deficits.     

帕金森病伴发焦虑与运动症状及非运动症状关系的研究

目的 探讨帕金森病(PD)患者伴发焦虑与运动症状及非运动症状(NMS)的关系.方法 对124例PD患者应用汉密尔顿焦虑量表(HAMA)进行评测,分为焦虑组和非焦虑组,并完成相关运动症状及NMS量表评测.结果 (1)124例PD患者焦虑发生率为33.87%,焦虑和抑郁共病率为31.45%;(2)两组患者运动症状及运动并发症相关量表评测结果分别为:Hoehn-Yahr分期:2.48.±0.80 vs.2.04±0.78;UPDRS-Ⅲ (运动):30.68 ±9.91 vs 24.70±12.25;"开-关"现象发生率:35.71%vs.17.07%,两组间具有统计学差异(PO.05);(3)焦虑组患者出现NMS个数为(14.57±3.83)个,非焦虑组患者为(1 0.03.±5.25)个,两组间均有统计学差异(P<0.05);(4)焦虑组抑郁、性生活障碍、不宁腿综合征、淡漠、白天思睡、入睡困难、眩晕、疼痛、噩梦以及体位性头晕等NMS发生率高于非焦虑组,两组均有统计学差异(P<0.05);(5)焦虑组和非焦虑组患者NMS相关量表评测结果分别为:UPDRS-I(精神、行为和情绪):4.74±1.93vs.2.93±1.84;HAMD:19.41±6.97 vs.9.82±5.83:PSQI:19.48±6.36 vs.12.37±6.47;ESS:6.69±5.62 vs.3.56±3.34;SCOPA-AUT:43.48±7.75 vs 36.76±7.33;RLSRS:21.77±6.51 vs.17.29±7.27,两组间具有统计学差异(P0.05);(6)焦虑组和非焦虑组患者UPDRS-Ⅱ(日常生活活动)以及PDQL评分结果分别为:15.29±5.85 vs.12.22±5.39、128.62±20.51 vs.149.30±20.13,具有统计学差异(P<0.05).结论 焦虑是PD常见的NMS之一,与运动障碍的程度以及运动并发症相关;PD伴发焦虑患者NMS的发生率高,个数多,精神、行为、情绪、睡眠、自主神经障碍突出,严重影响患者的日常生活活动能力,使生活质量明显下降.     

综合心理护理对帕金森病患者的影响

目的研究综合心理护理对帕金森病患者的影响。方法将2007年9月～2009年10月在我院住院的帕金森病54例随机分为常规心理护理组和综合心理护理组,每组27例。采用汉密尔顿抑郁量表(HAMD)、诺丁汉健康问卷(NHP)和生活满意度Z量表(LSIZ)对两组护理前和护理后6个月进行抑郁状况和生活质量分析。结果两组护理前HAMD评分及各生活质量评分比较差异均无统计学意义(P>0.05)。心理护理后综合心理护理组HAMD评分明显低于常规心理护理组(P<0.05);综合心理护理组抑郁症状改善总有效率高于常规心理护理组(P<0.05);护理后两组精力、情绪反应、睡眠、躯体活动、亲属关系和社交生活评分明显低于护理前(P<0.05),综合心理护理组上述指标和常规心理护理组相比差异有统计学意义(P<0.05)。结论综合心理护理可有效改善帕金森病患者的抑郁状况和生活质量。     

Insomnia: An Underrecognized Nonmotor Symptom in Parkinson Disease

Insomnia is a highly prevalent nonmotor symptom among patients with Parkinson disease (PD) and significantly impacts their quality of life. It is typically an underdiagnosed and untreated symptom of PD. Accurate assessment, ruling out other potential etiologies, and a combination of nonpharmacologic and pharmacologic interventions are important strategies in the management of insomnia in patients with PD. The goal of treatment is to improve sleep duration, sleep quality, and overall quality of life. Nurse practitioners play an integral role in the recognition, assessment, and management of insomnia in PD.     

经颅超声对我国帕金森病患者的诊断价值:Meta分析

目的 采用Meta分析的方法,评价我国经颅超声（TCS）对帕金森病（PD）患者的诊断价值。方法 检索建库至2017年11月间PubMed、Cochrone图书馆、CNKI和中国生物医学文献数据库中有关TCS诊断国人PD的文献,以诊断性试验准确性评价工具（QUADAS）评价纳入文献的质量,并采用Meta-disc 1.4软件进行数据分析,计算我国TCS诊断PD患者的汇总敏感度、特异度、阳性似然比、阴性似然比和诊断比值比,并绘制汇总受试者工作特征（SROC）曲线。结果 共纳入15篇文献,中文12篇,英文3篇,我国TCS诊断PD的敏感度范围为0.62~0.93,特异度范围为0.50~0.94。纳入研究存在异质性,采用随机效应模型进行分析。我国TCS诊断的汇总敏感度、特异度、阳性似然比、阴性似然比和诊断比值比及其95% CI分别为0.78（0.76,0.81）、0.85（0.83,0.88）、5.46（4.01,7.44）、0.22（0.17,0.29）和27.15（16.96,43.46）,SROC曲线下面积为0.904 9,Q指数为0.836 5。结论 在我国,TCS诊断PD具有一定价值,可作为辅助检查手段。     

帕金森病性神经原性膀胱功能障碍

帕金森病(PD)是一种中老年人常见的缓慢进展性运动障碍疾病。35%～70%的PD患者会出现排尿症状,且常出现于疾病的后期。尿流动力学表现为逼尿肌的过度活动和反射性尿失禁。目前治疗主要有抗胆碱能药物和膀胱内灌注药物或肉毒素膀胱逼尿肌多点注射。其发生和治疗效果和多巴能神经元的损耗相关,但其机制仍需进一步阐明。     

从“柔肝熄风”理论分析抗颤止痉胶囊改善帕金森病运动症状的机制

柔肝熄风即滋阴养血柔肝而止痉熄风,治疗肝阴血虚动风证,是中医治风法之一。静止性震颤、肌僵直均为帕金森病患者肌张力改变的典型表现,临床上抗颤止痉胶囊在帕金森病运动症状改善中具有确切疗效。作者从柔肝熄风理论分析抗颤止痉胶囊中的理法方药,探讨论证抗颤止痉胶囊对帕金森病静止性震颤、肌僵直等症状的治疗作用机制。     

Changes in Walking Activity and Endurance Following Rehabilitation for People With Parkinson Disease

White DK, Wagenaar RC, Ellis TD, Tickle-Degnen L. Changes in walking activity and endurance following rehabilitation for people with Parkinson disease.

Objective

To investigate changes in walking activity and endurance after interdisciplinary rehabilitation in people with Parkinson disease (PD).

Design

Randomized controlled trial.

Setting

Clinic, home, and community.

Participants

Mild to moderate PD (Hoehn and Yahr stage 2-3).

Interventions

Three experimental conditions lasting 6 weeks in duration: (1) no active rehabilitation; (2) 3.0 hours of interdisciplinary rehabilitation a week; or (3) 4.5 hours of interdisciplinary rehabilitation a week. Participants had stable medication regimes during the study.

Main Outcome Measures

Walking activity was estimated with an activity monitor (AM) (time spent walking and number of 10-second walking periods) in the home and community settings over a 24-hour period. Walking endurance was measured in the clinic with the two-minute walk test (2MWT). Linear contrast analyses were applied to examine changes in walking activity and endurance after higher doses of rehabilitation, and 2-way analysis of variance models with interaction were applied to examine the effect of high and low baseline walking levels on changes.

Results

The 2MWT was completed by 108 people with PD (mean age, 66.53y; with PD, 6.59y), and AM data were used from 74 of these people (mean age, 66.7y; with PD, 5.8y). Improvement in AM measures and the 2MWT did not significantly change across increasing dosages of interdisciplinary rehabilitation. Higher doses of rehabilitation resulted in significant improvements in the 2MWT for subjects with low baseline walking endurance (P=.001), and in AM measures for subjects with high baseline walking activity (P<.02).

Conclusions

Interdisciplinary rehabilitation can improve walking activity and endurance depending on baseline walking levels.     

还原型谷胱甘肽治疗帕金森病

目的:探讨还原型谷胱甘肽(GSH)治疗帕金森病(PD)的价值。方法:38例原发性PD患者随机分为2 组,均予抗PD药物治疗,GSH组联合静脉注射还原型GSH600mg。治疗前后分别采用PD评分量表(UPDRS)进 行临床评价和血清总抗氧化能力(TRAP)、谷胱甘肽过氧化物酶(GSH Px)和脂质过氧化物含量(LPO)测定。结 果:与对照组比较,GSH组UPDRS评分无显著改善,而TRAP、GSH Px活性显著增高,LPO含量显著降低(P<0. 05),疗效持续时间>4个月。结论:GSH能够发挥辅助性治疗作用,提高机体抗氧化能力。     

帕金森病的护理进展

帕金森病是一种严重影响老年人生活的神经系统疾病,目前还不能根治本病。要提高生活质量,在采用药物治疗和手术治疗的同时,还依赖与多方面的护理和康复训练。     

Glucocerebrosidase mutations and the pathogenesis of Parkinson disease

Abstract

Parkinson disease (PD) is the second most common neurodegenerative disease after Alzheimer disease with a lifetime risk in the UK population of almost 5%. An association between PD and Gaucher disease (GD) derived from the observation that GD patients and their heterozygous carrier relatives were at increased risk of PD. GD is an autosomal recessive lysosomal storage disorder caused by homozygous mutations in the gene encoding glucocerebrosidase (GBA). Approximately 5%–10% of PD patients have GBA mutations, making these mutations numerically the most important genetic predisposing risk factor for the development of PD identified to date. GBA mutations result in a phenotype that is virtually indistinguishable clinically, pharmacologically, and pathologically from sporadic PD, except GBA mutations result in a slightly earlier age of onset and more frequent cognitive impairment among PD patients. The mechanisms by which GBA mutations result in PD are not yet understood. Both reduced glucocerebrosidase enzyme (GCase) activity with lysosomal dysfunction, and unfolded protein response (UPR) with endoplasmic reticulum-associated degradation (ERAD) and stress are considered contributory.