帕金森病并发淡漠的危险因素研究

doi:10.3969/j.issn.1006-9771.2021.06.014

《中国康复理论与实践》 ›› 2021, Vol. 27 ›› Issue (6): 719-723.doi: 10.3969/j.issn.1006-9771.2021.06.014

帕金森病并发淡漠的危险因素研究

柳欣¹,尹志科¹,冯涛^1,³,邓永梅¹,赵越颖¹,董可¹,王春雪^2,⁴(),马惠姿^1,⁴()

^1.首都医科大学附属北京天坛医院，神经病学中心运动障碍性疾病科，北京市 100070
^2.首都医科大学附属北京天坛医院，神经精神医学与临床心理科，北京市 100070
^3.北京脑重大疾病研究院帕金森病研究所，北京市 100070
^4.国家神经系统疾病临床医学研究中心，北京市 100070

收稿日期:2020-07-21 修回日期:2021-05-11 出版日期:2021-06-25 发布日期:2021-06-21
通讯作者: 王春雪,马惠姿 E-mail:snowsen@126.com;mahuizi1127@126.com
作者简介:柳欣(1981-)，女，汉族，北京市人，主管护师，主要研究方向：帕金森病及运动障碍性疾病。
基金资助:
1. "十三五"国家重点研发计划项目(2016YFC1306501);北京市属医院科研培育计划项目(PX2020020);首都医科大学附属北京天坛医院青年科研基金项目(2018-YQN-33)

Risk Factors of Apathy in Parkinson's Disease

Xin LIU¹,Zhi-ke YIN¹,Tao FENG^1,³,Yong-mei DENG¹,Yue-ying ZHAO¹,Ke DONG¹,Chun-xue WANG^2,⁴(),Hui-zi MA^1,⁴()

^1.Department of Movement Disorders, Center for Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
^2.Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
^3.Parkinson's Disease Center, Beijing Institute for Brain Disorder, Beijing 100070, China
^4.China National Clinical Research Center for Neurological Disease, Beijing 100070, China

Received:2020-07-21 Revised:2021-05-11 Published:2021-06-25 Online:2021-06-21
Contact: Chun-xue WANG,Hui-zi MA E-mail:snowsen@126.com;mahuizi1127@126.com
Supported by:
National Key R & D Program of China(2016YFC1306501);Beijing Municipal Hospital Scientific Research and Cultivation Project(PX2020020);Youth Research Fund of Beijing Tiantan Hospital, Capital Medical University(2018-YQN-33)

摘要/Abstract

摘要： 目的

分析帕金森病患者淡漠的发生率及危险因素。

方法

回顾性收集2017年11月至2019年10月入住本院的帕金森病患者254例，根据Starkstein情感淡漠评定量表(SAS)分为淡漠组和非淡漠组，对两组人口学资料、运动症状、非运动症状及运动并发症等临床资料进行比较，并采用Logistic回归分析研究帕金森病并发淡漠的危险因素。

结果

254例帕金森病患者中124例(48.8%)并发淡漠。淡漠组年龄、发病年龄、国际运动障碍协会统一帕金森病评定量表第3部分(MDS-UPDRSⅢ)评分、汉密尔顿抑郁量表(HAMD)评分、汉密尔顿焦虑量表(HAMA)评分、匹兹堡睡眠质量指数(PSQI)评分均高于非淡漠组(t > 2.291, P < 0.05)；而蒙特利尔认知评估量表(MoCA)评分和简易精神状态检查(MMSE)评分低于非淡漠组(t > 22.424, P < 0.001)。两组间性别、受教育时间、体质量指数(BMI)、病程、H-Y分期、剂末现象、异动症、开关现象、快速动眼期睡眠行为障碍筛查量表(RBDSQ)评分、Epworth嗜睡量表(ESS)评分无显著性差异(P > 0.05)。Logistic回归分析显示，起病年龄、MoCA和HAMD评分与帕金森病并发淡漠密切相关(P < 0.05)。

结论

帕金森病并发淡漠与起病年龄大、抑郁、认知障碍相关。

关键词: 帕金森病, 淡漠, 抑郁, 认知障碍

Abstract: Objective

To study the prevalence and related factors of apathy in patients with Parkinson's disease (PD)．

Methods

From November, 2017 to December, 2019, 254 PD patients in our hospital were included. According to Starkstein Apathy Scale (SAS), they were divided into apathy group and non-apathy group. Clinical data such as demographic data, motor symptoms, non-motor symptoms and motor complications were collected for comparison between two groups. Logistic regression analysis was performed to investigate the risk factors of apathy in PD.

Results

Among 254 PD patients, 124 (48.8%) cases were in apathy. Compared with non-apathy group, apathy group was older in age and age of onset, higher in the scores of Movement Disorder Society United Parkinson's Disease Rating Scale part III (MDS-UPDRS Ⅲ), Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA) and Pittsburgh Sleep Quality Index (PSQI) (t > 2.291, P < 0.05), and lower in the scores of Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) (t > 22.424, P < 0.001). There was no statistically significant difference in gender, time of education, body mass index (BMI), disease course, Hoehn-Yahr (H-Y) stage, wearing-off phenomenon, dyskinesia, on-and-off phenomenon, and the scores of Rapid Eye Movement Sleep Behavior Disorder Screening Questionnaire (RBDQ) and Epworth Sleeping Scale (ESS) between two groups (P > 0.05). Logistic regression analysis showed that the age of disease onset, MoCA and HAMD scores were correlated with apathy in patients with PD (P < 0.05).

Conclusion

The presence of apathy in PD may be associated with older age of disease onset, severity of depression and cognitive impairment.

Key words: Parkinson's disease, apathy, depression, cognition impairment

中图分类号:

R742.5

柳欣,尹志科,冯涛,邓永梅,赵越颖,董可,王春雪,马惠姿. 帕金森病并发淡漠的危险因素研究[J]. 《中国康复理论与实践》, 2021, 27(6): 719-723.

Xin LIU,Zhi-ke YIN,Tao FENG,Yong-mei DENG,Yue-ying ZHAO,Ke DONG,Chun-xue WANG,Hui-zi MA. Risk Factors of Apathy in Parkinson's Disease[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(6): 719-723.

图/表 4

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表4

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项目	非淡漠组 (n = 130)	淡漠组 (n = 124)	t/χ²/U值	P值
年龄(岁)	63(54.75,69.25)	65(62,71)	8.262	0.004
性别(男/女，n)	76/54	68/56	0.339	0.560
受教育时间(年)	9(6,12.25)	9(6,12)	0.727	0.395
BMI (kg/m²)	24.21±3.34	23.73±3.47	1.119	0.264
发病年龄(岁)	55.73±11.59	59.73±9.75	-2.983	0.003
病程(年)	5(2,8)	4.5(2,8)	0.159	0.690

项目	非淡漠组 (n = 130)	淡漠组 (n = 124)	t/χ²值	P值
MDS-UPDRS Ⅲ评分	37.6±15.9	43.6±18.0	-2.822	0.005
H-Y分期(早期/中晚期，n)	69/61	53/71	2.716	0.099
剂末现象(有/无，n)	37/93	46/78	2.151	0.142
异动症(有/无，n)	16/114	19/105	0.486	0.486
开关现象(有/无，n)	11/119	14/110	0.572	0.449

项目	非淡漠组 (n = 130)	淡漠组 (n = 124)	U值	P值
MoCA评分	23(18,26.25)	19(13,23)	28.466	< 0.001
MMSE评分	27(24,29)	25(20,27)	22.242	< 0.001
HAMD评分	8(4,13)	14(6.25,21)	21.586	< 0.001
HAMA评分	8(5,14)	13(8,19)	18.081	< 0.001
RBDSQ评分	3(1,6)	2(1,6)	0.219	0.640
PSQI评分	8.50±5.02	10.02±4.89	-2.291	0.023
ESS评分	4(2,7)	4(1,9)	0.992	0.320

自变量	β	SE	Wald	P值	Exp(B)	95%CI
起病年龄	0.030	0.014	4.411	0.036	1.030	1.002~1.059
女	-0.267	0.303	0.774	0.379	0.766	0.423~1.387
MDS-UPDRS Ⅲ评分	0.013	0.010	1.687	0.194	1.013	0.994~1.033
MoCA评分	-0.074	0.027	7.367	0.007	0.928	0.880~0.980
HAMD评分	0.042	0.019	5.177	0.023	1.043	1.006~1.082
PSQI评分	0.017	0.032	0.267	0.606	1.017	0.955~1.082

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帕金森病并发淡漠的危险因素研究

Risk Factors of Apathy in Parkinson's Disease

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