武冬冬;李淑华;苏闻;蔡晓杰;金丽莹;金莹;崔艺耀;赵鸿;陈海波;

• 1:北京医院神经内科

摘要(Abstract)：

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,并分析各神经精神症状间的相互关系及影响因素。方法应用简明精神病量表(BPRS)调查209例PD患者的20项神经精神症状发生率和分布情况,并分析各神经精神症状间的相关性以及与临床特征包括年龄、受教育时间、病程、认知水平、运动功能、抑郁、焦虑、睡眠、生活质量、左旋多巴等效剂量等的相关性。结果 PD神经精神症状发生率较高的前3位分别为动作迟缓(84.21%)、关心身体健康(66.51%)和焦虑(54.55%),发生率较低的症状为不合作、定向障碍和自知力障碍(均为5.26%)。BPRS的5个分量表即焦虑抑郁、缺乏活力、思维障碍、激活性和敌对猜疑两两之间均具有相关性(均P<0.01),其中思维障碍与敌对猜疑(r=0.477)、缺乏活力与思维障碍(r=0.441)、缺乏活力与敌对猜疑(r=0.429)之间呈中度相关。BPRS总分与受教育时间、帕金森病睡眠量表(PDSS)评分和简易精神状态检查量表(MMSE)评分呈负相关,与年龄、统一帕金森病评定量表(UPDRS)第3部分评分、修订Hoehn-Yahr(H-Y)分期、汉密尔顿抑郁量表(HAMD)评分、汉密尔顿焦虑量表(HAMA)评分、帕金森病生活质量问卷(PDQ-39)评分呈正相关(均P<0.05),与病程和左旋多巴等效剂量无相关性(均P>0.05)。BPRS高分组(>35分)PD与BPRS低分组(≤35分)PD患者在年龄、起病年龄、UPDRSⅢ、PDQ-39、HAMA、HAMD和MMSE评分间比较存在统计学差异(均P<0.05)。逐步多元线性回归分析结果示HAMA和MMSE评分对BPRS总分影响最大(r2分别为0.196和0.270)。结论 PD患者的神经精神症状发生率高且具多样性。MMSE评分越低,PD患者精神症状越严重。

关键词(KeyWords)： 帕金森病;简明精神病状态评定量表;神经精神症状

Abstract:

Keywords:

基金项目(Foundation): 首都卫生发展科研专项项目(首发2011-4011-01)

作者(Author): 武冬冬;李淑华;苏闻;蔡晓杰;金丽莹;金莹;崔艺耀;赵鸿;陈海波;

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参考文献(References)：

• [1]Ravina B,Marder K,Fernandez HH,et al.Diagnostic criteria for psychosis in Parkinson’s disease:report of an NINDS,NIMH work group[J].Mov Disord,2007,22(8):1061-1068.
• [2]Minguez-Castellanos A,Escamilla-Sevilla F,Katati MJ,et al.Different patterns of medication change after subthalamic or pallidal stimulation for Parkinson’s disease:target related effect or selection bias?[J].J Neurol Neurosurg Psychiatry,2005,76(1):34-39.
• [3]Lieberman A.Are dementia and depression in Parkinson’s disease related?[J].J Neurol Sci,2006,248(1-2):138-142.
• [4]Richard IH.Anxiety disorders in Parkinson’s disease[J].Adv Neurol,2005,96:42-55.
• [5]Diederich NJ,Goetz CG,Stebbins GT.Repeated visual hallucinations in Parkinson’s disease as disturbed external/internal perceptions:focused review and a new integrative model[J].Mov Disord,2005,20(2):130-140.
• [6]Isella V,Melzi P,Grimaldi M,et al.Clinical,neuropsychological,and morphometric correlates of apathy in Parkinson’s disease[J].Mov Disord,2002,17(2):366-371.
• [7]Shulman LM,Taback RL,Bean J,et a1.Comorbidity of the non-motor symptoms of Parkinson’s disease[J].Mov Disord,2001,16(3):507-510.
• [8]Aarsland D,Karlsen K.Neuropsychiatric aspects of Parkinson’s disease[J].Curr Psychiatry Rep,1999,1(1):61-68.
• [9]Fenelon G,Mahieux F,Huon R,et a1.Hallucinations in Parkinson’s disease:prevalence,phenomenology and risk factors[J].Brain,2000,123(Pt 4):733-745.
• [10]Holroyd S,Currie L,Wooten GF.Prospective study of hallucinations and delusions in Parkinson’s disease[J].J Neurol Neurosurg Psychiatry,2001,70(6):734-738.
• [11]de Maindreville AD,Fenelon G,Mahieux F.Hallucinations in Parkinson’s disease:a follow-up study[J].Mov Disord,2005,20(2):212-217.
• [12]Bugalho P,da Silva JA,Cargaleiro I,et al.Psychiatric symptoms screening in the early stages of Parkinson’s disease[J].J Neurol,2012,259(1):124-131.