早期与中晚期帕金森病非运动症状的比较以及对生活质量的影响
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摘要
目的比较早期与中晚期帕金森病(PD)非运动症状(NMS)及其对生活质量的影响。方法采用非运动并发症30题问卷(PDNMS)以及39项帕金森病生活调查表(PDQ39)评价82例早期PD患者(早期组)及69例中晚期PD患者(中晚期组)的NMS及健康相关生活质量。结果早期组及中晚期组患者的便秘、兴趣缺乏、幻觉、错觉、嗅觉减退、吞咽困难、排便不尽感、夜尿、跌倒、日间思睡、失眠及多汗发生率差异有统计学意义(P <0. 05～0. 01)。早期及中晚期PD患者PDNMS总分与PDQ39总分及各维度评分呈正相关(P <0. 05～0. 01)。早期PD患者PDNMS的注意力下降、兴趣缺乏以及抑郁与PDQ39总分具有相关性(r=0. 420,r=0. 366,r=0. 364;均P <0. 01);中晚期PD患者PDNMS的兴趣缺乏、日间思睡及流涎与PDQ39总分具有相关性(r=0. 396,r=0. 380,r=0. 371;均P <0. 01)。结论注意力下降、兴趣缺乏及抑郁对早期PD患者生活质量影响较大,而兴趣缺乏、日间思睡及流涎对中晚期PD患者生活质量影响较大。
Objective To compare the characteristics of non-motor symptoms( NMS) and the effects on healthrelated quality of life( HRQOL) of patients with Parkinson's disease( PD) between early and middle and late stages.Methods NMS was assessed by non-motor Symptoms Questionnaire for PD( PDNMS) and HRQOL by the 39-item PD questionnaire( PDQ-39) for eighty two early PD patients( early group) and sixty nine middle and late PD patients( middle and late group). Results There were significant difference in the incidence of constipation,loss of interest,hallucinations,delusions,hyposmia,dysphagia,incomplete bowel emptying,night urination,falling,daytime sleepiness,insomnia and sweating between early group and middle and late group( P < 0. 05-0. 01). The PDNMS was positively correlated with PDQ-39 and each dimension of PDQ-39 in early group and middle and late group( P < 0. 05-0. 01). Attention decline,lack of interest and depression of PDNMS were correlated with PDQ39 in early group( r = 0. 420,r = 0. 366,r = 0. 364; all P < 0. 01). Lack of interest,daytime sleepiness and salivation of PDNMS were correlated with PDQ39 in middle and late group( r = 0. 396,r = 0. 380,r = 0. 371; all P < 0. 01).Conclusions Attention decline,lack of interest and depression have impact on HRQOL with early phase PD patients. Lack of interest,daytime sleepiness and salivation have impact on HRQOL with middle and advanced phase PD patients.
Objective To compare the characteristics of non-motor symptoms( NMS) and the effects on healthrelated quality of life( HRQOL) of patients with Parkinson's disease( PD) between early and middle and late stages.Methods NMS was assessed by non-motor Symptoms Questionnaire for PD( PDNMS) and HRQOL by the 39-item PD questionnaire( PDQ-39) for eighty two early PD patients( early group) and sixty nine middle and late PD patients( middle and late group). Results There were significant difference in the incidence of constipation,loss of interest,hallucinations,delusions,hyposmia,dysphagia,incomplete bowel emptying,night urination,falling,daytime sleepiness,insomnia and sweating between early group and middle and late group( P < 0. 05-0. 01). The PDNMS was positively correlated with PDQ-39 and each dimension of PDQ-39 in early group and middle and late group( P < 0. 05-0. 01). Attention decline,lack of interest and depression of PDNMS were correlated with PDQ39 in early group( r = 0. 420,r = 0. 366,r = 0. 364; all P < 0. 01). Lack of interest,daytime sleepiness and salivation of PDNMS were correlated with PDQ39 in middle and late group( r = 0. 396,r = 0. 380,r = 0. 371; all P < 0. 01).Conclusions Attention decline,lack of interest and depression have impact on HRQOL with early phase PD patients. Lack of interest,daytime sleepiness and salivation have impact on HRQOL with middle and advanced phase PD patients.
引文
[1]李静,陈为安,张旭,等.早期与中晚期帕金森病患者非运动症状的比较研究[J].中国全科医学,2016,19(34):4201-4203.
[2]曹雯燕,徐耀.肠道菌群对帕金森病运动及非运动症状的影响及可能机制[J].临床神经病学杂志,2018,31(4):305-307.
[3]李淑华,陈海波.帕金森病非运动症状研究进展及临床意义[J].中华神经科杂志,2017,50(1):71-74.
[4]Martinez-Martin P,Rodriguez-Blazquez C,Kurtis MM,et al.The impact of non-motor symptoms on health-related quality of life of patients with Parkinson's disease[J].Mov Disord,2011,26(3):399-406.
[5]Valkovic P,Harsany J,Hanakova M,et al.Nonmotor symptoms in early-and advanced-stage Parkinson's disease patients on dopaminergic therapy:how do they correlate with quality of life?[J/OL].ISRN Neurol,2014,2014:587302[2014-03-04].https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3963114/.
[6]Hughes AJ,Daniel SE,Kilford L,et al.Accuracy of clinical diagnosis of idiopathic Parkinson's disease:a clinico-pathological study of 100 cases[J].J Neurol Neurosurg Psychiatry,1992,55(3):181-184.
[7]Chaudhuri KR,Martinez-Martin P,Schapira AH,et al.International multicenter pilot study of the first comprehensive self-completed nonmotor symptoms questionnaire for Parkinson's disease:the NMSQuest study[J].Mov Disord,2006,21(7):916-923.
[8]Shulman LM,Taback RL,Bean J,et al.Comorbidity of the nonmotor symptoms of Parkinson's disease[J].Mov Disord,2001,16(3):507-510.
[9]Kadastik-Eerme L,Muldmaa M,Lilles S,et al.Nonmotor Features in Parkinson's disease:what are the most important associated factors?[J].Parkinsons Dis,2016,2016:4370674[2016-02-08].https://www.hindawi.com/journals/pd/2016/4370674/.
[10]Khoo TK,Yarnall AJ,Duncan GW,et al.The spectrum of nonmotor symptoms in early Parkinson disease[J].Neurology,2013,80(3):276-281.
[11]Hershey LA,Peavy GM.Cognitive decline in Parkinson disease:How steep and crowded is the slope?[J].Neurology,2015,85(15):1268-1269.
[12]Reijnders JS,Ehrt U,Weber WE,et al.A systematic review of prevalence studies of depression in Parkinson's disease[J].Mov Disord,2008,23(2):183-189.
[13]Marsh L.Depression and Parkinson's disease:current knowledge[J].Curr Neurol Neurosci Rep,2013,13(12):409.
[14]孟莉,王彦永,李艳敏,等.帕金森病的非运动症状及其影响因素[J].临床神经病学杂志,2014,27(4):248-250.
[15]Palma JA,Kaufmann H.Autonomic disorders predicting Parkinson's disease[J].Parkinsonism Relat Disord,2014,20(Suppl 1):S94-98.
[16]李雪莲,陈先文,王尚培,等.帕金森病患者便秘临床特点及相关因素分析[J].中华神经科杂志,2016,49(4):282-287.
[17]Boesveldt S,Verbaan D,Knol DL,et al.A comparative study of odor identification and odor discrimination deficits in Parkinson's disease[J].Mov Disord,2008,23(14):1984-1990.
[18]Berendse HW,Roos DS,Raijmakers P,et al.Motor and non-motor correlates of olfactory dysfunction in Parkinson's disease[J].J Neurol Sci,2011,310(1-2):21-24.
[19]Jost WH,Schrank B.Defecatory disorders in de novo Parkinsonians--colonic transit and electromyogram of the external anal sphincter[J].Wien Klin Wochenschr,1998,110(15):535-537.
[20]Gibson G,Mottram PG,Burn DJ,et al.Frequency,prevalence,incidence and risk factors associated with visual hallucinations in a sample of patients with Parkinson's disease:a longitudinal 4-year study[J].Int J Geriatr Psychiatry,2013,28(6):626-631.
[21]Goldman JG,Stebbins GT,Dinh V,et al.Visuoperceptive region atrophy independent of cognitive status in patients with Parkinson's disease with hallucinations[J].Brain,2014,137(Pt 3):849-859.
[22]Svetel M,Smiljkovic T,Pekmezovic T,et al.Hallucinations in Parkinson's disease:cross-sectional study[J].Acta Neurol Belg,2012,112(1):33-37.
[23]Forsaa EB,Larsen JP,Wentzel-Larsen T,et al.A 12-year population-based study of psychosis in Parkinson disease[J].Arch Neurol,2010,67(8):996-1001.
[24]赵鹏,朱红灿,朱晓临,等.帕金森病患者睡眠障碍的研究[J].临床神经病学杂志,2010,23(5):337-340.
[25]Chaudhuri KR,Healy DG,Schapira AH.Non-motor symptoms of Parkinson's disease:diagnosis and management[J].Lancet Neurol,2006,5(3):235-245.
[26]Bliwise DL,Trotti LM,Juncos JJ,et al.Daytime REM sleep in Parkinson's disease[J].Parkinsonism Relat Disord,2013,19(1):101-103.
[27]Sulzer D,Surmeier DJ.Neuronal vulnerability,pathogenesis,and Parkinson's disease[J].Mov Disord,2013,28(1):41-50.
[28]Factors impacting on quality of life in Parkinson's disease:results from an international survey[J].Mov Disord,2002,17(1):60-67.
[29]Santos-García D,de la Fuente-Fernández R.Impact of non-motor symptoms on health-related and perceived quality of life in Parkinson's disease[J].J Neurol Sci,2013,332(1):136-140.
[2]曹雯燕,徐耀.肠道菌群对帕金森病运动及非运动症状的影响及可能机制[J].临床神经病学杂志,2018,31(4):305-307.
[3]李淑华,陈海波.帕金森病非运动症状研究进展及临床意义[J].中华神经科杂志,2017,50(1):71-74.
[4]Martinez-Martin P,Rodriguez-Blazquez C,Kurtis MM,et al.The impact of non-motor symptoms on health-related quality of life of patients with Parkinson's disease[J].Mov Disord,2011,26(3):399-406.
[5]Valkovic P,Harsany J,Hanakova M,et al.Nonmotor symptoms in early-and advanced-stage Parkinson's disease patients on dopaminergic therapy:how do they correlate with quality of life?[J/OL].ISRN Neurol,2014,2014:587302[2014-03-04].https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3963114/.
[6]Hughes AJ,Daniel SE,Kilford L,et al.Accuracy of clinical diagnosis of idiopathic Parkinson's disease:a clinico-pathological study of 100 cases[J].J Neurol Neurosurg Psychiatry,1992,55(3):181-184.
[7]Chaudhuri KR,Martinez-Martin P,Schapira AH,et al.International multicenter pilot study of the first comprehensive self-completed nonmotor symptoms questionnaire for Parkinson's disease:the NMSQuest study[J].Mov Disord,2006,21(7):916-923.
[8]Shulman LM,Taback RL,Bean J,et al.Comorbidity of the nonmotor symptoms of Parkinson's disease[J].Mov Disord,2001,16(3):507-510.
[9]Kadastik-Eerme L,Muldmaa M,Lilles S,et al.Nonmotor Features in Parkinson's disease:what are the most important associated factors?[J].Parkinsons Dis,2016,2016:4370674[2016-02-08].https://www.hindawi.com/journals/pd/2016/4370674/.
[10]Khoo TK,Yarnall AJ,Duncan GW,et al.The spectrum of nonmotor symptoms in early Parkinson disease[J].Neurology,2013,80(3):276-281.
[11]Hershey LA,Peavy GM.Cognitive decline in Parkinson disease:How steep and crowded is the slope?[J].Neurology,2015,85(15):1268-1269.
[12]Reijnders JS,Ehrt U,Weber WE,et al.A systematic review of prevalence studies of depression in Parkinson's disease[J].Mov Disord,2008,23(2):183-189.
[13]Marsh L.Depression and Parkinson's disease:current knowledge[J].Curr Neurol Neurosci Rep,2013,13(12):409.
[14]孟莉,王彦永,李艳敏,等.帕金森病的非运动症状及其影响因素[J].临床神经病学杂志,2014,27(4):248-250.
[15]Palma JA,Kaufmann H.Autonomic disorders predicting Parkinson's disease[J].Parkinsonism Relat Disord,2014,20(Suppl 1):S94-98.
[16]李雪莲,陈先文,王尚培,等.帕金森病患者便秘临床特点及相关因素分析[J].中华神经科杂志,2016,49(4):282-287.
[17]Boesveldt S,Verbaan D,Knol DL,et al.A comparative study of odor identification and odor discrimination deficits in Parkinson's disease[J].Mov Disord,2008,23(14):1984-1990.
[18]Berendse HW,Roos DS,Raijmakers P,et al.Motor and non-motor correlates of olfactory dysfunction in Parkinson's disease[J].J Neurol Sci,2011,310(1-2):21-24.
[19]Jost WH,Schrank B.Defecatory disorders in de novo Parkinsonians--colonic transit and electromyogram of the external anal sphincter[J].Wien Klin Wochenschr,1998,110(15):535-537.
[20]Gibson G,Mottram PG,Burn DJ,et al.Frequency,prevalence,incidence and risk factors associated with visual hallucinations in a sample of patients with Parkinson's disease:a longitudinal 4-year study[J].Int J Geriatr Psychiatry,2013,28(6):626-631.
[21]Goldman JG,Stebbins GT,Dinh V,et al.Visuoperceptive region atrophy independent of cognitive status in patients with Parkinson's disease with hallucinations[J].Brain,2014,137(Pt 3):849-859.
[22]Svetel M,Smiljkovic T,Pekmezovic T,et al.Hallucinations in Parkinson's disease:cross-sectional study[J].Acta Neurol Belg,2012,112(1):33-37.
[23]Forsaa EB,Larsen JP,Wentzel-Larsen T,et al.A 12-year population-based study of psychosis in Parkinson disease[J].Arch Neurol,2010,67(8):996-1001.
[24]赵鹏,朱红灿,朱晓临,等.帕金森病患者睡眠障碍的研究[J].临床神经病学杂志,2010,23(5):337-340.
[25]Chaudhuri KR,Healy DG,Schapira AH.Non-motor symptoms of Parkinson's disease:diagnosis and management[J].Lancet Neurol,2006,5(3):235-245.
[26]Bliwise DL,Trotti LM,Juncos JJ,et al.Daytime REM sleep in Parkinson's disease[J].Parkinsonism Relat Disord,2013,19(1):101-103.
[27]Sulzer D,Surmeier DJ.Neuronal vulnerability,pathogenesis,and Parkinson's disease[J].Mov Disord,2013,28(1):41-50.
[28]Factors impacting on quality of life in Parkinson's disease:results from an international survey[J].Mov Disord,2002,17(1):60-67.
[29]Santos-García D,de la Fuente-Fernández R.Impact of non-motor symptoms on health-related and perceived quality of life in Parkinson's disease[J].J Neurol Sci,2013,332(1):136-140.