帕金森病伴发抑郁及其相关因素的研究

Parkinson’s disease accompanied with depression and its associated factors

摘要:

目的 探讨帕金森病（PD）伴发抑郁的临床特点及其相关因素。方法 入选2013年10月至2015年2月在北京天坛医院神经内科及老年病科经诊断确诊为PD的患者（178例），评估抑郁情况后分为两组：抑郁组（107例）和非抑郁组（71例），对两组患者进行运动症状及运动并发症、非运动症状以及日常生活能力和生活质量的评测。结果 两组患者的受教育程度（P＜0.05）、病程（P＜0.05）、统一PD评定量表Ⅲ（UPDRS-Ⅲ；P＜0.001）、Hoehn-Yahr（P＜0.01）、UPDRS-Ⅳ（P＜0.001）、蒙特利尔认知评估量表（MoCA；P＜0.05）、疲劳评定量表?14项（FS-14；P＜0.001）、快速眼动睡眠期行为障碍筛查量表（RBDSQ；P＜0.01）、不宁腿综合征严重程度评定量表（RLSRS；P＜0.001）、UPDRS-Ⅱ（P＜0.001）、39项PD生活质量问卷（PDQL-39；P＜0.001）评分以及焦虑的发生率（P＜0.05）均存在显著性差异。Logistic回归分析显示，HAMA（OR＝1.282，P＜0.001）和UPDRS-Ⅱ（OR＝1.149，P＜0.05）量表的评分结果是PD伴发抑郁的危险因素。结论 与非抑郁组相比，PD伴发抑郁患者的运动症状及运动并发症的发生率更高；更易出现焦虑、认知障碍、睡眠障碍、疲劳及不安腿等多种非运动症状；焦虑和日常生活能力降低会增加PD伴发抑郁的风险；抑郁严重影响PD患者的生活质量。

Abstract:

Objective To investigate the clinical features and associated factors in Parkinson’s disease (PD) accompanied with depression. Methods All the 178 patients with identified PD admitted in the Department of Neurology and Department of Geriatrics of Beijing Tiantan Hospital from October 2013 to February 2015 were recruited in this study. According to the results of Hamilton Depression Scale-24 (HAMD-24), they were divided into depression group (n＝107) and non-depression group (n＝71). Both groups were evaluated by motor symptoms and complications, non-motor symptoms, activities of daily living and quality of life. Results Depression group had remarkable differences with non-depression group in education level (P＜0.05), disease duration (P＜0.05), score of unified Parkinson’s disease rating scale Ⅲ (UPDRS-Ⅲ, P＜0.001 ), Hoehn-Yahr (P＜0.01), score of UPDRS-Ⅳ (P＜0.001), score of Montreal cognitive assessment (MoCA, P＜0.05), result of 14 items fatigue scale (FS-14, P＜0.001), result of rapid eye movement sleep behavior disorder screening questionnaire (RBDSQ, P＜0.01), result of restless leg syndrome rating scale (RLSRS, P＜0.001), score of UPDRS-Ⅱ (P＜0.001), result of 39 items Parkinson’s disease quality of life questionnaire (PDQL-39, P＜0.001), and incidence of anxiety (P＜0.05). Logistic regression analysis showed that the scores of Hamilton anxiety Scale (HAMA, OR＝1.282, P＜0.001) and UPDRS-Ⅱ (OR＝1.149, P＜0.05) were the risk factors for PD with depression. Conclusion PD patients with depression have higher incidences of motor symptoms and complications than non-depression PD patients, and are prone to anxiety, cognitive impairment, sleep disorders, fatigue, restless legs and other non-motor symptoms. Anxiety and reduced activities of daily living increase the risk of PD with depression. Depression exerts serious impact on quality of life in PD patients.