不同运动亚型早期帕金森病的非运动症状研究

背景　帕金森病（PD）是一种常见的老年期神经退行性疾病，具有高发病率、高患病率和高致残率的特点，PD患者的临床表现多样，包括运动症状和非运动症状，根据不同运动症状可将PD分为不同亚型，不同运动分型PD患者在发病因素、病理生理过程等方面存在差异。然而，目前对于PD，尤其是早期PD的非运动症状研究较少。目的　通过比较不同运动亚型早期PD患者在认知功能、额叶功能、情绪和睡眠情况、自主神经功能等非运动症状方面的差别，探讨非运动症状与早期PD运动亚型之间的关系。方法　选取2017年1月-2020年3月浙江医院神经内科门诊和病房收治的116例早期PD患者为研究对象，采用运动障碍学会-统一帕金森病评估量表（MDS-UPDRS）将其分为震颤为主型（TD）组、姿势不稳/步态障碍型（PIGD）组及混合型（IT）组。比较三组早期PD患者一般临床资料、MDS-UPDRS、非运动症状量表（NMSS）、简易智力状态检查量表（MMSE）、额叶功能评定量表（FAB）、老年抑郁量表（GDS-30）、情感淡漠评定量表（MAES）、帕金森病睡眠量表（PDSS）、自主神经量表（SCOPA-AUT）的评估结果。结果　TD组、PIGD组、IT组分别为76例、32例、8例。三组患者非运动症状的出现频率和严重程度得分比较，差异有统计学意义（P<0.05）；三组患者的FAB、GDS-30、MAES、SCOPA-AUT得分比较，差异有统计学意义（P<0.05）。结论　PD的非运动症状是PD的常见症状，在PD早期就可以出现，PIGD型和IT型的非运动症状较TD型严重，对早期PD患者进行合理的运动分型有助于在临床诊疗中更有效地评估PD患者的病情和预后并制定更合理的治疗方案。

#br# Non-motor Symptoms in Early Parkinson's Disease with Three Different Motor Subtypes

Background　Parkinson's disease（PD） is a common neurodegenerative disease in the elderly with high incidence，prevalence and morbidity.Patients with PD have variable clinical presentations，including motor and non-motor symptoms.According to motor symptoms，PD can be divided into different subtypes，with subtype-specific pathogenic factors and pathophysiological processes.However，only a few studies have focused on non-motor symptoms of PD，especially early PD.Objective　To explore the relationship between non-motor symptoms and motor subtypes of early PD by analyzing non-motor symptoms such as cognitive function，frontal lobe function，mood and sleep status，and autonomic function by motor subtypes in early PD patients.Methods　One hundred and sixteen neurology outpatients and inpatients with early PD from Zhejiang Hospital were included between January 2017 to March 2020 and divided into tremor-dominant（TD），postural instability/gait disorder（PIGD），and mixed（IT） groups according to the Movement Disorder Society-Unified Parkinson's Disease Rating Scale.The clinical data，and Motor disorders society-the unified Parkinson's disease rating scale，measurement results of Non-Motor Symptom Scale，Mini-Mental State Examination，Frontal Assessment Battery，Geriatric Depression Scale，Apathy Evaluation Scale，Parkinson's Disease Sleep Scale and Scales for Outcomes in Parkinson's Disease-Autonomic were compared between the three groups.Results　There were 76 cases in TD group, 32 cases in PIGD group and 8 cases in IT group.There were significant differences in frequency and severity of non-motor symptoms among three groups（P<0.05）.The assessed frontal lobe function，depression，apathy and cardiovascular autonomic function of patients between the three groups showed significant differences（P<0.05）.Conclusion　Non-motor symptoms are common in PD，which can appear in the early stage.The non-motor symptoms of PIGD and IT subtypes are more severe than those of TD subtype.The precise motor classification of early PD may facilitate effective assessment of the patient's status and prognosis in clinical practice，as well as the formulation of an appropriate treatment regimen.