帕金森病患者神经精神症状的调查分析

目的 调查帕金森病(PD)患者的神经精神症状的发生、分布情况、相互关系以及对生活质量的影响.方法 应用统一帕金森病评分量表(UPDRS)的第Ⅲ部分及第Ⅳ部分中异动症及症状波动分值、简易智能量表(MMSE)、蒙特利尔认知功能评估(MOCA)、Hamilton焦虑量表、HamiGon抑郁量表、数字广度试验(DS)、帕金森病牛活质量量表(PDQ-39)等评分,对116例原发性PD患者的运动症状、神经精神症状及生活质量进行评估,采用Spearman等级相关及分层回归分析方法分析神经精神症状的发生因素,相互关系及对生活质量的影响.结果 神经精神症状具有较高的发病率,抑郁、焦虑、淡漠、注意力障碍及认知功能损害与UPDRSⅢ分值及H-Y分级有相关性,与病程没有相关性(P>0.05),幻觉与各因素均无相关性(均P>0.05).各神经精神症状间存在不同程度的相关性.根据分层回归结果,符神经精神症状对总体生活质量均有影响,其中,抑郁(△R2=19.1%,P<0.01)及淡漠(△R2=17.0%,P<0.01)对总体生活质量的影响最大.结论 神经精神症状在PD患者中很普遍,其对生活质量的影响不亚于运动症状,需要及时认识和干预.

Neuropsychiatric problems in patients with Parkinson's disease

Objective To survey the prevalence and distribution of neuropsychiatric problems in patients with Parkinson's disease(PD),and to investigate their effects on life quality and the interactions among different neuropsychiatric problems.Methods Unified Parkinson's disease rating Scale(UPDRS) part Ⅲ,dyskineisa and motor fluctuation subscale of UPDRS part Ⅳ,mini-mental state examination (MMSE),Montreal Cognitive Assessment(MoCA),Hamihon rate scale of depression(HRSD),Hamilton anxiety scale(HAMA),digit span(DS),and 39 item Parkinson'8 disease questionnaire(PDQ-39)were used to assess the motor symptoms and neuropsychiatric problems in 116 PD patients,66 males and 50 females,aged(67 4±9)(50-90),with the course of disease of 5±4 years(0.5-18 years).Spearman rank order correlation and hierarchical regressions of the major statistical procedures were employed.Results Various neuropsychiatric problems were found in the PD patients.The neuropsychiatric problems.such as depression.anxiety.apathy,attention deficit disorder,and cognitive deficits,were correlated with the UPDRS Ⅳ score and Hoehn-Yahr stage.but not correlated with the course of disease(all P>0.05).Hallucination was not correlated with any factors(all P>0.05).There were some correlations among different neuropsvrchiatric problems.Hierarchical regression revealed that different neuropsychiatric problems showed significant effects on the quality of life after controlling the motor symptoms.Depression(△R2=19.1%.P<0.01)and apathy(△R2=17.0%,P<0.01)exerted the most powerful influence in causing poor quality of life.Conclusion Neuropsychiatric problems are common a in PD patients Their effects on the poor quality of lire are no less than that of motor symptoms and should be recognized and treated well.