抑郁障碍对帕金森病患者生活质量的影响

分别采用抑郁自评量表和36条简明健康状况调查表评价100例原发性帕金森病患者的抑郁障碍和生活质量,结果显示,除生理职能差异无统计学意义外(P0.05),生理功能(P=0.001)、情感(P=0.000)、社会功能(P=0.007)、躯体疼痛(P=0.000)、精力(P=0.000)、精神健康(P=0.000)、一般健康(P=0.004)和总评分(P=0.000)差异均有统计学意义。提示抑郁障碍可以降低帕金森病患者的生活质量。     

嗓音障碍对早中期帕金森病患者生活质量的影响

目的 探讨嗓音障碍对早中期帕金森病（PD）患者生活质量的影响。方法 纳入 2020 年 4 月至 2021 年 8 月在首都医科大学附属北京康复医院帕金森病医学中心住院的 86 例早中期 PD 患者作 为PD组,选取2021年12月至2022年2月从社会招募的47名健康人作为对照组,收集受试者的一般资料。 采用 Hoehn & Yahr（H&Y）分期确定 PD 患者的临床分级,采用国际运动障碍学会统一帕金森病评定量表 第Ⅲ部分（MDS-UPDRS-Ⅲ）对 PD 患者的运动症状进行评估,采用 39 项帕金森病调查问卷（PDQ-39）、老年 抑郁量表（GDS）、汉密尔顿焦虑量表（HAMA）、蒙特利尔认知评估量表（MoCA）、吞咽障碍问卷（SDQ）、嗓音 障碍指数（VHI-10）对受试者的生活质量、抑郁、焦虑、认知功能、吞咽功能、嗓音状态进行评估。采用协 方差分析比较两组 VHI-10、PDQ-39 得分。采用 Spearman 相关分析早中期 PD 患者嗓音障碍和生活质量 的相关因素。采用多重线性回归分析早中期PD患者生活质量的影响因素。结果 协方差分析结果显示, PD 组 VHI-10、PDQ-39 得分高于对照组［8.0（4.0,11.3）分比 0（0,0）分、23.4（15.4,29.0）分比 0（0,3.0）分］, 差异有统计学意义（P＜0.01）。男性PD患者的PDQ-39得分低于女性患者［21.2（14.7,26.2）分比［26.3（18.6, 31.4）分］,差异有统计学意义（Z=-2.41,P＜ 0.05）。Spearman 相关分析显示,PD 患者的 VHI-10 得分 与年龄、HAMA 得分、GDS 得分、SDQ 得分呈正相关（r=0.25、0.31、0.42、0.64;P＜ 0.05）;PDQ-39 得分与 H&Y 分期、UPDRS-Ⅲ得分、GDS 得分、HAMA 得分、SDQ 得分、VHI-10 得分呈正相关（r=0.22、0.24、0.54、 0.37、0.33、0.47;P＜ 0.05）。多重线性回归分析显示,GDS 得分、VHI-10 得分及性别是早中期 PD 患者生 活质量的影响因素（P＜ 0.01）。结论 早中期 PD 患者存在嗓音障碍问题,且嗓音障碍会降低早中期 PD 患者的生活质量。     

帕金森病合并不宁腿综合征的相关因素分析

目的研究帕金森病(Parkinson's disease,PD)患者合并不宁腿综合征(restless leg syndrome,RLS)的特点,进一步探讨PD患者易合并RLS的相关因素。方法选取门诊诊断为PD的102例患者,根据是否合并RLS将入选病例分为不伴RLS的PD组和伴RLS的PD组,分别比较两组的一般状况、病史、临床表现、严重程度评分以及治疗等临床资料,进行单因素统计分析。结果102例PD患者中有28例合并有RLS,发生率为27·5%。其中有1例为诊断PD之前即存在RLS,其余均在出现PD症状后才出现RLS症状。两组在HAMD评分上有统计学差异(P0.05),而在一般状况,主要症状,左旋多巴的治疗以及蒙特利尔,UPDRS评分等方面均未见统计学差异(P0.05)。PD患者中RLS的发生与抑郁情绪有着较密切的关系,另外发现PD发病年龄与RLS的严重程度呈负相关。PD患者的发病年龄越小,RLS的程度越严重。结论PD患者抑郁状态时合并RLS的可能性较大。PD合并RLS患者,PD的发病年龄越小,RLS程度越严重。     

帕金森病合并不宁腿综合征26例临床分析

目的探讨帕金森病（Parkinson’s disease,PD）患者合并不宁腿综合征（restless leg syndrome,RLS）的临床特点,且进一步研究PD患者合并RLS的相关因素。方法选取确诊的119例PD患者,根据是否合并RLS分为伴RLS组和单纯PD组,分别比较2组的一般状况、病史、临床表现、严重程度、合并症、治疗情况等临床资料。结果 119例PD患者中26例合并RLS,发生率为20.8%,且RLS均出现在PD症状后。2组在UPDRS、HAMD、HAMA、PSQI上有统计学差异（P〈0.05）,而在一般状况、主要症状、左旋多巴治疗等方面均未见统计学差异（P〉0.05）。另外,发现左旋多巴的日剂量与RLS严重度之间存在正相关关系,即服用左旋多巴剂量越大,RLS程度越重。结论 RLS可能是PD病程中出现的一种并发症。PD运动症状较严重、并发症较多时合并RLS的可能性相对较大,随着多巴胺能药物剂量的加大,RLS的病情可能加重。     

影响帕金森病患者生活质量因素的研究

目的　研究影响帕金森病 (PD)患者生活质量的因素。方法　对 6 3例PD患者进行神经系统检查并作统一PD评定量表 (UPDRS)评分 ,H Y分级和Hamilton抑郁评分 ,以日常生活活动量表 (ADL)、PD 39项问题 (PDQ 39)、生活满意度量表 (LISB)问卷调查等评价患者生活质量 ,并进行统计学分析。结果　PD患者生活质量下降 ,与病程和病情严重程度显著相关 (P <0 0 5～ 0 .0 1) ,与抑郁评分呈负相关 (r=- 0 5 0 7,P <0 0 5 ) ,未发现与运动综合征存在相关性。结论　病情、病程、抑郁是生活质量的重要影响因素     

帕金森病伴精神障碍对患者生活质量的影响

目的探讨帕金森病伴有精神障碍(PDPsy)患者的生活质量。方法采用配对病例对照试验,收集2013年7月至2014年7月来本院诊治的PDPsy70例(PDPsy组),按照年龄性别匹配后选出对照组仅患帕金森病(PD)的70例(PD组)。比较两组患者的H-Y等级、睡眠、抑郁、焦虑、认知、生活质量。结果PD组患者的病情严重程度要低于PDPsy组患者的病情(χ2=10.88,P0.01)。PDPsy组的患者病程要比PD组的患者长(χ~2=17.46,P0.01)。PDPsy组的患者失眠以及日间思睡情况比PD组重(ESS:t=2.13,P=0.04;RBD:χ2=5.83,P=0.02)。两组患者焦虑情况差异无统计学意义(t=0.74,P=0.67)。PDPsy组抑郁状况要较仅有帕金森病患者严重(t=2.41,P=0.02)。两组患者在认知方面差异无统计学意义(t=0.58,P=0.99)。PDPsy组的患者的生活自理能力较PD组的患者要低(t=3.84,P=0.01)。结论帕金森病伴精神障碍的患者抑郁与睡眠、生活质量较差,需要照顾者以及医护人员更多关注。     

协同护理对帕金森病患者生活质量的影响

目的探讨协同护理对帕金森病患者生活质量的影响。方法将2013-06—2013-08我院40例住院帕金森病患者随机分为干预组（20例）和对照组（20例）,干预组接受知识和技能的指导、康复训练指导、社会支持、心理护理等护理干预措施。对照组接受常规的治疗和复查项目。以SF-36量表评估干预前和干预2个月后帕金森病患者的生活质量。结果干预2个月后,干预组的生活质量明显高于对照组,差异有统计学意义（P〈0.05）。结论协同护理干预措施能有效改善和提高帕金森病患者的生活质量。     

中国帕金森病患者不宁腿综合征患病率的meta分析

目的为了研究不宁腿综合征(RLS)在中国帕金森病(PD)患者中的患病率,以及其与一般人群中RLS患病率的比较。方法通过在万方医学网、中国知网(CNKI)、维普网、Pubmed和Web of Science数据库中检索关于中国PD患者RLS的患病率相关的横断面研究和病例﹣对照研究。经过筛选后的文献采用Stata 12.0来分析RLS在中国PD患者中的患病率。结果总共纳入了34项研究,其中按照诊断标准可分为IRLSSG组(n=7)、NMS问卷组(n=16)、PDSS组(n=4)以及自定标准的其他组(n=7)。meta分析结果提示,总的RLS患病率为33%;IRLSSG组RLS的患病率为23%;NMS问卷组的患病率为44%;PDSS组为13%;其他组为28%。RLS在PD组的患病率明显高于一般人群(OR=4.65,95%CI:2.39~9.03,P0.001)。结论 RLS在中国PD人群中的患病率为33%;依据不同的诊断标准得出的患病率有所差异。NMS问卷作为RLS的初筛具有一定作用,而对于PD中RLS患者的诊断则推荐采用IRLSSG。此外,中国PD人群中的RLS患病率要明显高于一般人群。     

帕金森病或帕金森综合征合并不宁腿综合征18例临床分析

目的 研究帕金森病(PD)或帕金森综合征(PDS)合并不宁腿综合征的临床特点及治疗.方法 对18例PD或PDS合并不宁腿综合征患者的临床资料进行回顾性分析.结果 本组患者均有PD症状及双腿难以描述的不适感,且伴有不同程度的睡眠障碍.本组患者起始均予以一般治疗(下肢按摩、活动),并增加多巴胺剂量或调整多巴胺服药次数,结果 11例患者临床症明显改善;其余7例在此基础上加用多巴胺受体激动剂及抗癫癎药物等治疗,5例患者症状有所改善;另2例加用苯二氮(艹)/(卓)类及肌松剂症状有缓解,但2周左右后作用消失.结论 PD或PDS合并不宁腿综合征的临床特点为同时具有PD样症状及双腿难以描述的不适感,并有不同程度的睡眠障碍.多巴胺及多巴胺受体激动剂、抗癫癎药物等治疗有效.     

The influence of fatigue on health-related quality of life in patients with Parkinson's disease

OBJECTIVE: To examine the correlation between fatigue and health-related quality of life (HRQL) in patients with Parkinson's disease (PD). PATIENTS AND METHODS: Sixty-six patients with idiopathic PD. The patients did not have a depressive mood disorder or cognitive impairment. Fatigue was measured by the Fatigue Severity Scale (FSS). HRQL was measured by the Parkinson's Disease Questionnaire (PDQ-39) and the Short-Form 36 (SF-36). RESULTS: Thirty-three (50%) of the patients had significant fatigue. Patients with fatigue had a more advanced disease than those without fatigue, measured by the UPDRS scale, including a higher Hoehn and Yahr stage and lower Schwab and England score. Patients with fatigue reported more distress in the dimensions of emotional well-being and mobility (PDQ-39) and also had a significantly higher PDQ summary index. On the SF-36 patients with fatigue reported more problems in the areas of physical functioning, role limitation (physical), social functioning and vitality. Correlations between the FSS and the HRQL scales were highest for the summary index of PDQ-39 and in the dimensions of ADL, mobility and emotional well-being (PDQ-39) and physical functioning, role limitation (physical), social functioning, general health and vitality (SF-36). CONCLUSIONS: PD has a substantial negative impact on HRQL. We found a strong correlation between fatigue and high distress scores on HRQL scales in a population of patients with PD who were not depressed or demented. The diversity of symptoms and high prevalence of non-motor features, including fatigue, is important to take into account in our efforts to optimize treatment and care for this patient group.     

Factors affecting health-related quality of life amongst Asian patients with Parkinson's disease

Background and purpose:  This cross-sectional study was carried out to identify factors predicting health-related quality of life (HRQoL) amongst Asian patients with Parkinson's disease (PD).
Methods:  A total of 183 PD patients (mean age: 61 years, male: 68.9%) attending a tertiary neuroscience clinic in Singapore completed the English or Chinese version of the 8-item Parkinson's Disease Questionnaire (PDQ-8). Patients' socio-demographic characteristics and their clinical variables were analysed to identify factors influencing the PDQ-8 Summary Index and responses to its eight dimensions.
Results:  In the multiple linear regression model, the use of Chinese survey, higher motor score and longer duration of PD were associated with poorer overall HRQoL. The multiple logistic regression analyses showed that female patients and patients with higher Hoehn and Yahr stage were more probably to report worse emotional well-being; patients who completed Chinese survey reported more problems with mobility, cognition and stigma; patients with higher motor scores were more probably to report problems with activities of daily living; patients with longer duration of PD were more probably to report problems with mobility, social support, communication and stigma.
Conclusion:  Both socio-demographic factors and disease-specific variables influence HRQoL in PD patients; the effects of culture-related factors on HRQoL should not be overlooked when assessing HRQoL in multi-cultural settings.     

Gender differences in disability and health-related quality of life in patients with Parkinson's disease treated with stereotactic surgery

OBJECTIVES: To investigate eventual differences between women and men with Parkinson's disease (PD) before and after surgery, with respect to clinical status, disability and health-related quality of life (HRQoL). MATERIAL AND METHODS: Twenty-four men and 14 women with PD received a total of 46 surgical procedures (pallidotomy, thalamotomy and deep brain stimulation of the thalamus, pallidum or subthalamic nucleus). The impact of PD on disability and other aspects of HRQoL was analysed separately in men and women before and at a mean of 11 months after surgery, using the following assessment tools: The Unified Parkinson's Disease Rating Scale (UPDRS), the ADL Taxonomy, the Nottingham Health Profile, the Life Satisfaction Questionnaire and a Visual Analogue Scale. RESULTS: At surgery, women had a significantly longer duration of disease than men (mean: 15 vs. 10 years, P < 0.01). They had a higher stage on the Hoehn and Yahr scale and worse scores on UPDRS parts II (ADL) and IV (complications), as well as on the Schwab and England scale and on the ADL Taxonomy. Following surgery, both men and women showed improvement, but women experienced greater benefit than men in ADL, in emotions, and in social life. CONCLUSIONS: Perhaps women with PD should be offered surgery more often and earlier in the course of their disease.     

Impact of fatigue on quality of life in patients with Parkinson's disease

Background and purpose:  Fatigue is frequent and important in the lives of Parkinson's disease (PD) patients. It is multidimensional, with physical and mental aspects. The aim of our study was to explore the impact of fatigue on quality of life (QoL) for PD patients.
Methods:  The sample consisted of 175 PD patients from Eastern Slovakia (52% males, mean age 68.2 ± 9.2, mean disease duration 7.4 ± 6.7). The Multidimensional Fatigue Inventory (five dimensions), the Parkinson's Disease Quality of Life Questionnaire (eight dimensions) and the Unified Parkinson's Disease Rating Scale were used. Demographic data were obtained in a structured interview. Fisher's exact test, t -test, and multiple linear regression analysis were used.
Results:  Different aspects of fatigue selectively explained different domains of QoL – physical dimensions of fatigue were connected with Mobility and Activities of daily living; mental fatigue dimensions affected Cognition, Emotional well-being, Communication and Activities of daily living; general fatigue was related to Bodily discomfort. The explained variances varied from 5% (Social support) to 65% (Activities of daily living).
Conclusion:  Fatigue combined with worse functional status appears to be a significant contributor to poor quality of life. Its multidimensional construct can be used to develop strategies for improving specific aspects of fatigue to improve QoL for PD patients.     

帕金森病患者健康相关生活质量的影响因素研究

目的探讨影响帕金森病(PD)患者健康相关生活质量(HRQoL)的主要因素。方法选用39项PD问卷(PDQ-39)、PD统一评定量表(UPDRS)和相关非运动症状评定量表对99例PD患者进行调查,分析影响HRQoL的主要因素。结果相关分析显示,PDQ-39综合指数(PDQ-39SI)与病程、每日左旋多巴剂量、UPDRSⅡ、Ⅲ、Ⅳ评分、Hoehn-Yahr分期、17项汉密尔顿抑郁量表(HRSD-17)、汉密尔顿焦虑量表(HAMA)和爱泼沃斯嗜睡量表(ESS)评分呈正相关(r为0.42～0.80,P均小于0.01),与简易精神状态量表(MMSE)、帕金森病睡眠量表(PDSS)评分呈负相关(r为-0.47、-0.68,P均小于0.01),与PD分型呈正相关(r=0.23,P<0.05)。进一步的多元回归结果表明:UPDRSⅡ、HAMD-17、ESS评分是影响PDQ-39SI的主要因素,3因素相加对HRQoL的影响起决定作用的72.1%。结论非运动症状对PD患者HRQoL有着显著的影响,应重视对抑郁和日间过度嗜睡等非运动症状的治疗。     

Nocturnal subcutaneous apomorphine infusion in Parkinson's disease and restless legs syndrome

OBJECTIVES: Nocturnal disabilities leading to fragmented sleep arising from parkinsonian off period related complications are common, under-reported and are difficult to treat. In this study, we evaluate the use of nocturnal continuous subcutaneous overnight apomorphine infusion in Parkinson's disease and restless legs syndrome. METHODS: Six parkinsonian patients and 2 patients with restless legs syndrome with nocturnal disabilities refractory to conventional oral therapy were assessed using a sleep diary while on standard treatment and during nocturnal apomorphine infusion. Three patients agreed to assessments during placebo infusion with normal saline. RESULTS: Apomorphine led to a dramatic reduction of nocturnal awakenings, nocturnal off periods, pain, dystonia and nocturia in parkinsonian patients. In patients with restless legs syndrome, apomorphine reduced nocturnal discomfort, reduced leg movements and improved pain and spasm scores significantly. Placebo infusion reproduced pain, nocturnal spasms and sleep disruption. CONCLUSION: This study suggests that overnight apomorphine infusion may be effective in overcoming refractory nocturnal disabilities in selected patients with Parkinson's disease and restless legs syndrome.     

The relationship of pain and health-related quality of life in Korean patients with Parkinson's disease

Background – Parkinson’s disease (PD) is a chronic progressive neurodegenerative disorder. Increasing attention has been focused on the pain and health‐related quality of life (HrQOL) in patients with PD. Objective – To evaluate the relationship between pain and the HrQOL in patients with PD. Methods – Eighty‐two patients with PD were included and classified into two groups according to the presence of pain. The Hoehn and Yahr scale, the Unified Parkinson’s Disease Rating Scale (UPDRS), the Modified Somatic Perception Questionnaire (MSPQ), the Zung Depression Inventory – Self‐rating Depression Scale (SDS), the Visual Analogue Scale and the Medical Outcomes Study 36‐Item Short Form Health Survey (SF‐36) were administered. The factors influencing the pain, HrQOL and parkinsonian manifestations were evaluated. Results – The PD with pain group had higher UPDRS part III scores, lower SF‐36 scores, higher SDS scores and higher MSPQ scores than the PD without pain group. The presence of pain, high Hoehn and Yahr stage, advanced age and somatic perception were the factors that had a negative effect on the physical component of the HrQOL. Depression and somatic perception were the most important predictive factors for the mental component of the HrQOL. Depression and poor parkinsonian motor abilities were the leading factors contributing to pain. Conclusion – Pain and depression were major detrimental factors affecting the physical and mental aspects of the HrQOL respectively. Therefore, the treatment of pain and depression can be important to improve the HrQOL.