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Paolo Barone MD Angelo Antonini MD Carlo Colosimo MD Roberto Marconi MD Letterio Morgante MD Tania P. Avarello MD Eugenio Bottacchi MD Antonino Cannas MD Gabriella Ceravolo MD Roberto Ceravolo MD Giulio Cicarelli MD Roberto M. Gaglio MD Rosa M. Giglia MD Francesco Iemolo MD Michela Manfredi MD Giuseppe Meco MD Alessandra Nicoletti MD Massimo Pederzoli MD Alfredo Petrone MD Antonio Pisani MD Francesco E. Pontieri MD Rocco Quatrale MD Silvia Ramat MD Rosanna Scala MD Giuseppe Volpe MD Salvatore Zappulla MD Anna Rita Bentivoglio MD Fabrizio Stocchi MD Giorgio Trianni MD Paolo Del Dotto MD 《Movement disorders》2009,24(11):1641-1649
We performed a multicenter survey using a semistructured interview in 1,072 consecutive patients with Parkinson's disease (PD) enrolled during 12 months in 55 Italian centers to assess the prevalence of nonmotor symptoms (NMSs), their association with cognitive impairment, and the impact on patients' quality of life (QoL). We found that 98.6% of patients with PD reported the presence of NMSs. The most common were as follows: fatigue (58%), anxiety (56%), leg pain (38%), insomnia (37%), urgency and nocturia (35%), drooling of saliva and difficulties in maintaining concentration (31%). The mean number of NMS per patient was 7.8 (range, 0–32). NMS in the psychiatric domain were the most frequent (67%). Frequency of NMS increased along with the disease duration and severity. Patients with cognitive impairment reported more frequently apathy, attention/memory deficit, and psychiatric symptoms. Apathy was the symptom associated with worse PDQ‐39 score but also presence of fatigue, attention/memory, and psychiatric symptoms had a negative impact on QoL. These findings further support a key role for NMS in the clinical frame of PD and the need to address them specifically in clinical trials using dedicated scales. © 2009 Movement Disorder Society 相似文献
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目的探讨帕金森病(PD)患者及不同亚群生活质量(QOL)的影响因素,分析非运动症状(NMS)的具体影响。方法用统一PD评定量表第Ⅲ、Ⅴ部分(UPDRS-Ⅲ、H-Y分级)评定185名原发性PD患者的运动症状,用PDNMS筛查问卷(NMSQ)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、PD睡眠量表(PDSS)和蒙特利尔认知测验(MOCA)评定NMS,用36条简化医疗结局调查问卷(SF-36)评价QOL。采用逐步多元线性回归分析探讨PD患者QOL的影响因素和NMS的具体作用。结果 PD患者SF-36各维度分值均较健康同龄老人下降。相关分析显示,SF-36总分与H-Y分级、UPDRSⅢ、HAMA、HAMD及NMSQ分值成负相关,与PDSS评分成正相关,与HAMD的6个因子(除日夜变化)和NMSQ的9个症状群(除性功能)均显著负相关。回归分析显示,UPDRSⅢ和强直分能解释SF-36总分变化的21.6%,加入各NMS量表分值后,NMSQ能单独解释SF-36总分变化的21.5%;引入HAMD和NMSQ的细项后,绝望感、泌尿道症状、认知损害、体质量减轻、和阻滞症状能解释SF-36总分变化的35.8%;≤65岁、66岁~75岁和>75岁患者的QOL影响因素不同。结论 NMS中的绝望感、泌尿道症状、认知、体质量减轻、阻滞症状以及运动障碍中的强直型对QOL的影响较大,且导致不同年龄段患者QOL下降的因素不同。故需重视上述NMS的诊治,以改善PD患者QOL。 相似文献
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Gordon W. Duncan MBChB MRCP Tien K. Khoo PhD MRCP Alison J. Yarnall MBBS MRCP John T. O'Brien DM FRCPsych Shirley Y. Coleman PhD David J. Brooks MD FRCP Roger A. Barker PhD MRCP David J. Burn MD FRCP 《Movement disorders》2014,29(2):195-202
Nonmotor symptoms (NMS) are common in patients with established Parkinson's disease (PD) and have a major impact upon quality of life. We investigated the significance of NMS in relation to health‐related quality of life (HRQoL) in patients with newly diagnosed PD. Patients and healthy controls were recruited as part of the Incidence of Cognitive Impairment in Cohorts with Longitudinal Evaluation in Parkinson's Disease Study. Prevalence of NMS was determined with the Non‐Motor Symptom Questionnaire. HRQoL was recorded with the 39‐item Parkinson's Disease Quality of Life Questionnaire (PDQ‐39). Further assessments included measures of motor disability, depression, sleep, and cognition. One hundred and fifty‐eight patients with newly diagnosed PD and 99 controls participated in this cross‐sectional study. Patients reported greater numbers of NMS than controls (mean 8.3 ± 4.3 versus 2.8 ± 2.5 symptoms; P < 0.001). Patients reported lowest HRQoL in the domains assessing bodily discomfort, mobility, and activities of daily living. Motor and nonmotor symptoms impacted negatively upon HRQoL scores. Patients with the postural instability and gait difficulty motor subtype reported worse HRQoL, compared with those with tremor‐dominant disease. Depression (P < 0.001), incomplete bowel emptying (P < 0.001), anxiety (P < 0.001), impaired concentration (P < 0.001), memory complaints (P < 0.001), and insomnia (P = 0.001) had the greatest negative impact upon HRQoL. NMS are common in patients with early PD and represent a significant cause of poorer health‐related quality of life. Cognitive, neuropsychiatric, and sleep disturbances are particularly associated with reduced well‐being. Screening and management of these symptoms should be prioritized at the time of diagnosis. © 2013 International Parkinson and Movement Disorder Society 相似文献
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The aim of this study was to investigate the prevalence of the different causes of falling in Parkinson's disease (PD) and to evaluate the influence of falls on patients' quality of life (QoL). We recruited 60 PD patients (31 with falls, 29 without falls). We found that falls were caused by: unstable posture (29.0%), freezing or festination (25.8%), sudden loss of postural reflexes (toppling falls) (25.8%), co-existing neurological disorders (6.5%), cardiological disorders (6.5%), and symptomatic orthostatic hypotension (3.2%). Duration of the disease was longer, its stage more advanced, daily levodopa dosage higher, and the proportion of patients with abnormalities in the EEG apparently greater in the group with falls. The presence of falls was found to be a factor contributing to a multidirectional negative impact on patients' QoL. QoL also depended on impairment of cognitive function, daily dosage of levodopa, disease duration, disease progression, and sex. The results of this study underline the need to diagnose the causes of falls in order to institute appropriate treatment and to improve patients' QoL. 相似文献
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Ohno Y 《CNS Neuroscience & Therapeutics》2011,17(1):58-65
5-HT(1A) receptors have long been implicated in the pathogenesis and treatment of anxiety and depressive disorders. Recently, several lines of studies have revealed new insights into the therapeutic role of 5-HT(1A) receptors in treating schizophrenia and Parkinson's disease. Specifically, 5-HT(1A) receptors seem to be a promising target for alleviating antipsychotic-induced extrapyramidal side effects (EPS) and cognitive/affective disorders in schizophrenia. In the treatment of patients with Parkinson's disease, 5-HT(1A) agonists are expected to improve not only affective symptoms (e.g., anxiety and depression), but also the core parkinsonian symptoms as well as antiparkinsonian agents-induced side effects (e.g., L-DOPA-induced dyskinesia). Here, the therapeutic mechanisms mediated by 5-HT(1A) receptors in schizophrenia and Parkinson's disease are reviewed. This evidence should encourage discovery of new 5-HT(1A) ligands, which can resolve the unmet clinical needs in the current therapy. 相似文献
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《Neurocirugía (Asturias, Spain)》2014,25(2):49-55
ObjectiveDeep brain stimulation (DBS) of the globus pallidus internus (GPi) is a promising therapeutic option for patients with medically refractory dystonia. We present the results after 1 year of DBS of the GPi in 4 patients with cervical dystonia.Materials and methodsFour patients with medically refractory cervical dystonia who underwent stereotactic pallidal DBS surgery between June 2010 and November 2011 were included in this retrospective study. Preoperative and postoperative evaluations at 3, 6 and 12 months after surgery were performed using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS).ResultsThe 4 patients experienced a sustained improvement, with a mean TWSTRS reduction of 74.25%, at 12 months follow-up. Disability improved by 80.5% (mean) at 1 year follow-up. No stimulation-related side effects were reported.ConclusionPallidal DBS is a valid and effective second-line treatment for patients with cervical focal dystonia. Our results support its use in patients with an insufficient response to medical treatment. 相似文献
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RA Lawson AJ Yarnall F Johnston GW Duncan TK Khoo D Collerton JP Taylor DJ Burn On behalf of the ICICLE‐PD study group 《International journal of geriatric psychiatry》2017,32(12):1362-1370
Background
The quality of life (QoL) of informal caregivers of people with Parkinson's disease (PD) (PwP) can be affected by the caring role. Because of cognitive symptoms and diminished activities of daily living, in addition to the management of motor symptoms, carers of PwP and cognitive impairment may experience increased levels of burden and poorer QoL compared with carers of PwP without cognitive impairment. This study aimed to investigate the impact of cognitive impairment in PD upon QoL of carers.Methods
Approximately 36 months after diagnosis, 66 dyadic couples of PwP and carers completed assessments. PwP completed a schedule of neuropsychological assessments and QoL measures; carers of PwP completed demographic questionnaires and assessments of QoL. Factor scores of attention, memory/executive function and global cognition, as derived by principal component analysis, were used to evaluate cognitive domains.Results
Hierarchical regression analysis found lower Montreal Cognitive Assessment was a significant independent predictor of poorer carer QoL, in addition to number of hours spent caregiving, carer depression and PD motor severity. Attentional deficits accounted for the largest proportion of variance of carer QoL. Carers of PwP and dementia (n = 9) had significantly poorer QoL scores compared with PwP and mild cognitive impairment (n = 18) or normal cognition (n = 39) carers (p < 0.01).Conclusions
Attentional deficits were the strongest predictor of carer QoL compared with other cognitive predictors. Carers for those with PD dementia reported the poorest QoL. Interventions such as respite or cognitive behavioural therapy to improve mood and self‐efficacy in carers may improve carer QoL. © 2016 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons, Ltd. 相似文献9.
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Á. Sánchez-Larsen J. García-García O. Ayo-Martín F. Hernández-Fernández I. Díaz-Maroto E. Fernández-Díaz M. Monteagudo T. Segura 《Neurología (Barcelona, Spain)》2018,33(6):369-377
Objectives
We aimed to determine whether the aetiology of ischaemic stroke has changed in recent years and, if so, to ascertain the possible reasons for these changes.Patients and methods
We analysed the epidemiological history and vascular risk factors of all patients diagnosed with ischaemic stroke at Complejo Hospitalario Universitario de Albacete (CHUA) from 2009 to 2014. Ischaemic stroke subtypes were established using the TOAST criteria. Our results were compared to data from the classic Stroke Data Bank (SDB); in addition, both series were compared to those of other hospital databases covering the period between the two.Results
We analysed 1664 patients (58% were men) with a mean age of 74 years. Stroke aetiology in both series (CHUA, SDB) was as follows: atherosclerosis (12%, 9%), small-vessel occlusion (13%, 25%), cardioembolism (32%, 19%), stroke of other determined aetiology (3%, 4%), and stroke of undetermined aetiology (40%, 44%). Sixty-three percent of the patients from the CHUA and 42% of the patients from the SDB were older than 70 years. Cardioembolic strokes were more prevalent in patients older than 70 years in both series. Untreated hypertension was more frequent in the SDB (SDB = 31% vs CHUA = 10%). The analysis of other databases shows that the prevalence of cardioembolic stroke is increasing worldwide.Conclusions
Our data show that the prevalence of lacunar strokes is decreasing worldwide whereas cardioembolic strokes are increasingly more frequent in both our hospital and other series compared to the SDB. These differences may be explained by population ageing and the improvements in management of hypertension and detection of cardioembolic arrhythmias in stroke units. 相似文献11.
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ObjectivePatients with affective disorders are at high risk of suicide, especially during inpatient treatment and during the first year after discharge.MethodsA blinded case-control design was used. The study included a total national sample of patients with affective disorder admitted during the period from January 1, 1994 to December 31, 1995, who died because of suicide, either during admission or shortly after discharge.ResultsA history of suicide attempt was a significant risk factor (IRR 4.9; 95% CI 2.1–11.6). Loss of job during the year prior to the index admission was associated with an increase in suicide risk (IRR: 2.9; 95% CI 1.2–7.5). Clinical improvement during the index admission (IRR: 0.3; 95% CI 0.1–0.7), and treatment with antidepressant drugs at the censoring date (IRR: 0.3; 95% CI 0.1–0.7) were associated with a decrease in suicide risk.ConclusionImproved treatment may be a key factor in suicide prevention in patients during, and shortly after hospitalisation with affective disorders. Also, there is a need to be especially aware of suicide risk in patients with little or no improvement at discharge. 相似文献
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IntroductionParkinson's disease (PD) is characterized by a wide spectrum of non-motor symptoms that may impact negatively on the activities of the patient's daily life and reduce Health-related quality of life (HRQoL). The present study explored the impact of specific non-motor symptoms on the HRQoL in PD.MethodsEighty-four outpatients underwent the Montreal Cognitive Assessment (MoCA) assessing global functioning and several questionnaires to assess depression, apathy, impulse control disorders (ICD), anxiety, anhedonia and functional impact of cognitive impairment. The perceived QoL was assessed by Parkinson's Disease Questionnaire (PDQ-8).The PD sample was divided into patients with high and low HRQoL around the median of PDQ-8 and compared on clinical features, cognitive and neuropsychiatric variables. A linear regression analysis, in which the global functioning, apathy, depression, anxiety, anhedonia, ICD and the functional autonomy scores were entered as independent variables and PDQ-8 score as dependent variable, was applied.ResultsPatients with lower HRQoL were more depressed, apathetic, anxious and showed more severe reduction of functional autonomy and global functioning than patients with high HRQoL. The regression analysis revealed that higher level of anxiety, executive apathy and more reduced functional autonomy were significantly associated with higher score on PDQ-8.ConclusionsThe finding indicated that anxiety, apathy associated with impaired planning, attention and organization (i.e., executive apathy evaluated by the Dimensional Apathy Scale) and reduced functional autonomy contribute significantly to reduce the HRQoL in PD. Therefore, early identification and management of these neuropsychiatric symptoms should be relevant to preserve HRQoL in PD. 相似文献
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Levodopa is the most effective agent to alleviate motor dysfunction in Parkinson's disease but its long-term use is associated with the development of dyskinesias. Although the pathogenic processes behind the development of levodopa-induced dyskinesias are still being elucidated, it appears that chronic administration of this short-lived agent results in nonphysiologic pulsatile stimulation of striatal neurons and abnormal firing patterns in the basal ganglia. Dyskinesias have been associated with decreased quality of life, and a number of methodologies to evaluate severity of dyskinesias are now available. Strategies to avoid, reduce, or eliminate dyskinesias include providing more continuous dopaminergic stimulation, administering an antidyskinetic agent, and surgery. Several new compounds that may provide an antidyskinetic effect are also under investigation. 相似文献
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目的探讨水中运动训练对帕金森病患者运动功能、平衡功能和行走能力的康复作用。方法共40例原发性帕金森病患者随机接受常规陆上康复训练(陆上组,20例)和水中运动训练(水中组,20例),分别于训练前和训练8周时采用统一帕金森病评价量表第三部分(UPDRSⅢ)评价运动功能、Berg平衡量表(BBS)和起立-行计时走测验(TUGT)评价平衡功能、6分钟步行试验(6MWT)和10米步行试验(10MWT)评价行走能力。结果两组患者训练8周时UPDRSⅢ评分(P=0.000)和TUGT时间(P=0.000)低于训练前,BBS评分(P=0.000)、6MWT时间(P=0.000)和10MWT步速(P=0.000)高于训练前;训练8周时水中组患者UPDRSⅢ评分(P=0.037)和TUGT时间(P=0.013)低于陆上组,BBS评分高于陆上组(P=0.018)。结论常规陆上康复训练和水中运动训练均可以改善帕金森病患者运动功能、平衡功能和行走能力,特别是在运动功能和平衡功能方面水中运动训练效果优于常规陆上康复训练。 相似文献
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《Parkinsonism & related disorders》2014,20(3):274-279
ObjectiveExamine the correlates of Health Related Quality of Life (HRQL) in a large cohort of Parkinson's disease (PD) patients from National Parkinson Foundation (NPF) Centers of Excellence (COEs).BackgroundImproving outcomes for PD will depend upon uncovering disease features impacting HRQL to identify targets for intervention and variables for risk-adjustment models. Differences in HRQL outcomes between COEs could uncover modifiable aspects of care delivery.MethodsThis cross-sectional study examined the relative contribution of demographic, social, clinical and treatment features potentially related to HRQL, as measured by the PDQ-39, in 4601 consecutive subjects from 18 COEs. Stepwise linear regression was utilized to identify correlates of HRQL.ResultsThe variability in the PDQ-39 summary index score correlated with H&Y stage (R2 = 22%), Timed up and Go (TUG) (17%), disease duration (11%), comorbidities (8%), cognitive status (8%), antidepressant use (6%) and center at which a patient received care (5%). Stepwise regression reordered the importance of the variables, with the H&Y first and TUG and the center becoming equal and the second most important variables determining the PDQ-39 total score. All independent variables together accounted for 44% of the variability in HRQL.ConclusionsWe confirmed many but not all HRQL associations found in smaller studies. A novel observation was that the site of care was an important contributor to HRQL, suggesting that comparison of outcomes and processes among centers may identify best practices. 相似文献