帕金森病抑郁及其对认知、平衡功能和生活质量的影响

doi:10.3969/j.issn.1006-9771.2026.02.006

摘要/Abstract

摘要：

目的探讨抑郁状态对住院帕金森病患者认知功能、睡眠质量、平衡功能和生活质量的影响。

方法收集2023年1月至2025年5月四川省八一康复中心55例住院帕金森病患者，依据汉密尔顿抑郁量表(HAMD)评分分为抑郁组(n = 39)和非抑郁组(n = 16)。抑郁组再根据蒙特利尔认知评估量表(MoCA)评分，分为轻度认知功能障碍组(n = 13)和中重度认知功能障碍组(n = 26)。采用匹兹堡睡眠质量指数(PSQI)、Berg平衡量表(BBS)、改良Rivermead移动指数(MRMI)和健康调查简表(SF-36)评估各维度功能。

结果抑郁组PSQI评分显著高于非抑郁组(β = -0.341, P < 0.001)，SF-36躯体健康相关维度(躯体功能、躯体角色、总体健康)和心理健康相关维度(生命活力、社会功能)评分均低于非抑郁组(β > 0.279, P < 0.05)。HAMD评分与PSQI评分和SF-36大多数维度评分相关(|r| > 0.329, P < 0.05)。中重度认知障碍组BBS评分明显低于轻度认知障碍组(F = 9.224, P = 0.004)。

结论抑郁与帕金森病患者睡眠、平衡功能和生活质量等多方面损害密切相关。

关键词: 帕金森病, 抑郁, 认知障碍, 平衡, 生活质量

Abstract:

Objective To explore the impact of depressive state on cognitive function, sleep quality, balance function and quality of life in hospitalized Parkinson's disease patients.

Methods A total of 55 inpatients with Parkinson's disease were recruited from Sichuan Bayi Rehabilitation Center between January, 2023 and May, 2025. Based on the scores of Hamilton Depression Scale (HAMD), they were divided into depressive group (n = 39) and non-depressive group (n = 16). The depressive group was further subdivided into mild cognitive impairment (MCI) subgroup (n = 13) and moderate-to-severe cognitive impairment subgroup (n = 26) according to the scores of Montreal Cognitive Assessment (MoCA). The Pittsburgh Sleep Quality Index (PSQI), Berg Balance Scale (BBS), modified Rivermead Mobility Index (MRMI), and 36-Item Short Form Survey (SF-36) were used to evaluate functional performance across various dimensions.

Results The PSQI score was higher in the depressive group than in the non-depressive group (β = -0.341, P < 0.001), while the scores for physical component summary-related dimensions (physical function, role physical and general health) and mental component summary-related dimensions (vitality and social function) of SF-36 were lower (β > 0.279, P < 0.05). The HAMD score of the depressive group was correlated with PSQI scores and most SF-36 dimension scores (|r| > 0.329, P < 0.05). The BBS score was lower in the moderate-to-severe cognitive impairment subgroup than in the mild cognitive impairment subgroup (F = 9.224, P = 0.004).

Conclusion Depression is closely associated with impairment in sleep, balance function and quality of life in Parkinson's disease patients.

Key words: Parkinson's disease, depression, cognition, balance, quality of life

中图分类号:

R742.5

张力引. 帕金森病抑郁及其对认知、平衡功能和生活质量的影响[J]. 《中国康复理论与实践》, 2026, 32(2): 174-180.

ZHANG Liyin. Depression in Parkinson's disease and its association with cognition, balance and quality of life[J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(2): 174-180.

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参考文献 43

[1]	FEIGIN V L, NICHOLS E, ALAM T, et al. Global, regional, and national burden of neurological disorders, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016[J]. Lancet Neurol, 2019, 18(5): 459-480. doi: S1474-4422(18)30499-X pmid: 30879893
[2]	RODRIGUEZ-BLAZQUEZ C, SCHRAG A, RIZOS A, et al. Prevalence of non-motor symptoms and non-motor fluctuations in Parkinson's disease using the MDS-NMS[J]. Mov Disord Clin Pract, 2020, 8(2): 231-239. doi: 10.1002/mdc3.v8.2
[3]	CHO J H, KIM J M, YANG H K, et al. Clinical perspectives of Parkinson's disease for ophthalmologists, otorhinolaryngologists, cardiologists, dentists, gastroenterologists, urologists, physiatrists, and psychiatrists[J]. J Korean Med Sci, 2020, 35(28): e230.
[4]	JANZ C, TIMPKA J, ROSQVIST K, et al. Non-motor symptom management: insights into adherence to treatment guidelines in Parkinson's disease patients[J]. J Parkinsons Dis, 2024, 14(2): 297-312.
[5]	OU R, HOU Y, WEI Q, et al. Longitudinal evolution of non-motor symptoms in early Parkinson's disease: a 3-year prospective cohort study[J]. NPJ Parkinsons Dis, 2021, 7(1): 58.
[6]	GUSTAFSSON A, HJALTE F, NORLIN J, et al. The association between non-motor symptoms and cost in Parkinson's disease[J]. J Neurol, 2025, 272(4): 297.
[7]	CONG S, XIANG C, ZHANG S, et al. Prevalence and clinical aspects of depression in Parkinson's disease: a systematic review and meta-analysis of 129 studies[J]. Neurosci Biobehav Rev, 2022, 141: 104749. doi: 10.1016/j.neubiorev.2022.104749
[8]	KWON K Y, PARK S, KIM R O, et al. Associations of cognitive dysfunction with motor and non-motor symptoms in patients with de novo Parkinson's disease[J]. Sci Rep, 2022, 12(1): 11461.
[9]	TIMMBLIN H, RAHMANI E, RYCZEK C A, et al. Physical inactivity links depressive symptoms and cognitive functioning among individuals with Parkinson's disease[J]. Neuropsychology, 2022, 36(6): 505-512. doi: 10.1037/neu0000837 pmid: 35737532
[10]	CHUQUILÍN-ARISTA F, ÁLVAREZ-AVELLÓN T, MENÉNDEZ-GONZÁLEZ M. Prevalence of depression and anxiety in Parkinson disease and impact on quality of life: a community-based study in Spain[J]. J Geriatr Psychiatry Neurol, 2020, 33(4): 207-213. doi: 10.1177/0891988719874130
[11]	SU W, LIU H, JIANG Y, et al. Correlation between depression and quality of life in patients with Parkinson's disease[J]. Clin Neurol Neurosurg, 2021, 202: 106523. doi: 10.1016/j.clineuro.2021.106523
[12]	金丽莹, 苏闻, 金莹, 等. 帕金森病抑郁及其对生活质量的影响[J]. 中华神经科杂志, 2018, 51(7): 510-514.
[13]	PALMERI R, LO BUONO V, BONANNO L, et al. Potential predictors of quality of life in Parkinson's disease: sleep and mood disorders[J]. J Clin Neurosci, 2019, 70: 113-117. doi: S0967-5868(19)31129-4 pmid: 31421992
[14]	CAMERUCCI E, LYONS K E, PAHWA R. Predicting depression in Parkinson's disease using commonly available PD questionnaires[J]. J Clin Med, 2024, 13(12): 2069. doi: 10.3390/jcm13072069
[15]	中华医学会神经病学分会帕金森病及运动障碍学组, 中国医师协会神经内科医师分会帕金森病及运动障碍专业委员会. 中国帕金森病的诊断标准(2016版)[J]. 中华神经科杂志, 2016, 49(4): 268-271.
[16]	KOH M R E, CHUA C Y, NG S Y, et al. Poor sleep quality is associated with fatigue and depression in early Parkinson's disease: a longitudinal study in the PALS cohort[J]. Front Neurol, 2022, 13: 998103. doi: 10.3389/fneur.2022.998103
[17]	DORNAS F M, BISPO F M M, VIANA Y G, et al. Predictors of balance in individuals with Parkinson's disease: a cross-sectional study[J]. J Bodyw Mov Ther, 2023, 35: 64-68. doi: 10.1016/j.jbmt.2023.04.041 pmid: 37330804
[18]	WILCZYŃSKI J, PEDRYCZ A, ZIELIŃSKI E, et al. Postural stability in Parkinson's disease patients[J]. Acta Bioeng Biomech, 2017, 19(4): 135-141. pmid: 29507431
[19]	SEPPI K, CHAUDHURI K R, COELHO M, et al. Update on treatments for nonmotor symptoms of Parkinson's disease: an evidence-based medicine review[J]. Mov Disord, 2019, 34(2): 180-198. doi: 10.1002/mds.v34.2
[20]	MILYUKHINA I V. Pathogenesis, clinical features, and treatments of depression in Parkinson's disease[J]. Nevrol Neiropsikhiatr Psikhosomat, 2019, 11(4): 93-99.
[21]	DALLÉ E, MABANDLA M V. Early life stress, depression and Parkinson's disease: a new approach[J]. Mol Brain, 2018, 11(1): 18.
[22]	REYES-PÉREZ P, GARCÍA-MARÍN L M, AMAN A M, et al. Investigating the shared genetic etiology between Parkinson's disease and depression[J]. J Parkinsons Dis, 2024, 14(3): 483-493.
[23]	THOBOIS S, PRANGE S, SGAMBATO-FAURE V, et al. Imaging the etiology of apathy, anxiety, and depression in Parkinson's disease: implication for treatment[J]. Curr Neurol Neurosci Rep, 2017, 17(10): 76.
[24]	中华医学会神经病学分会帕金森病及运动障碍学组, 中国医师协会神经内科医师分会帕金森病及运动障碍学组. 中国帕金森病治疗指南(第四版)[J]. 中华神经科杂志, 2020, 53(12): 973-986.
[25]	ALNAJJAR A Z, ABOULMAGD M E, KRAYIM A, et al. Efficacy of cognitive behavioral therapy for anxiety and depression in Parkinson's disease patients: an updated systematic review and meta-analysis[J]. Neurol Sci, 2024, 45(7): 5277-5290. doi: 10.1007/s10072-024-07659-6
[26]	张星星, 周晨, 段宏为, 等. 认知行为疗法减轻帕金森病患者抑郁或焦虑的Meta分析[J]. 中国全科医学, 2019, 22(16): 2084-2090.
[27]	WANG M, ZHANG W, ZANG W. Repetitive transcranial magnetic stimulation improves cognition, depression, and walking ability in patients with Parkinson's disease: a meta-analysis[J]. BMC Neurol, 2024, 24(1): 490.
[28]	JIANG S, ZHAN C, HE P, et al. Neuronavigated repetitive transcranial magnetic stimulation improves depression, anxiety and motor symptoms in Parkinson's disease[J]. Heliyon, 2023, 9(8): e18364.
[29]	MAKKOS A, PÁL E, ASCHERMANN Z, et al. High-frequency repetitive transcranial magnetic stimulation can improve depression in Parkinson's disease: a randomized, double-blind, placebo-controlled study[J]. Neuropsychobiology, 2016, 73(3): 169-177. doi: 10.1159/000445296 pmid: 27093063
[30]	ZHANG W, DENG B, XIE F, et al. Efficacy of repetitive transcranial magnetic stimulation in Parkinson's disease: a systematic review and meta-analysis of randomised controlled trials[J]. EClinicalMedicine, 2022, 52: 101589. doi: 10.1016/j.eclinm.2022.101589
[31]	陈思, 刘杰, 李顺, 等. 虚拟现实技术对帕金森病患者平衡功能的影响[J]. 中国康复理论与实践, 2017, 23(9): 1091-1095. doi: 10.3969/j.issn.1006-9771.2017.09.021
	CHEN S, LIU J, LI S, et al. Effects of virtual reality rehabilitation on balance for patients with Parkinson's disease[J]. Chin J Rehabil Theory Pract, 2017, 23(9): 1091-1095.
[32]	GOETZ C G, CHOI D, GUO Y, et al. It is as it was: MDS-UPDRS Part III scores cannot be combined with other parts to give a valid sum[J]. Mov Disord, 2023, 38(2): 342-347. doi: 10.1002/mds.v38.2
[33]	MENG D, JIN Z, WANG Y, et al. Longitudinal cognitive changes in patients with early Parkinson's disease and neuropsychiatric symptoms[J]. CNS Neurosci Ther, 2023, 29(8): 2259-2266. doi: 10.1111/cns.14173 pmid: 36924300
[34]	HE Y, TIAN Y, HAN H, et al. The path linking disease severity and cognitive function with quality of life in Parkinson's disease: the mediating effect of activities of daily living and depression[J]. Health Qual Life Outcomes, 2021, 19(1): 92.
[35]	马惠姿, 房进平, 冯涛, 等. 帕金森病患者不同程度抑郁在汉密尔顿抑郁量表的结构差异[J]. 中国康复理论与实践, 2021, 27(7): 829-833. doi: 10.3969/j.issn.1006-9771.2021.07.015
	MA H Z, FANG J P, FENG T, et al. Structural differences of depression for patients with Parkinson's disease using Hamilton Depression Scale[J]. Chin J Rehabil Theory Pract, 2021, 27(7): 829-833.
[36]	SEUBERT-RAVELO A N, YÁÑEZ-TÉLLEZ M G, SALGADO-CEBALLOS H, et al. Mild cognitive impairment in patients with early-onset Parkinson's disease[J]. Dement Geriatr Cogn Disord, 2016, 42(1/2): 17-30. doi: 10.1159/000447533
[37]	AIELLO E N, D'IORIO A, SOLCA F, et al. Ecological validity of the Montreal Cognitive Assessment in non-demented Parkinson's disease patients[J]. Neurodegener Dis, 2022, 22(3/4): 159-163. doi: 10.1159/000532115
[38]	MARINUS J, ZHU K, MARRAS C, et al. Risk factors for non-motor symptoms in Parkinson's disease[J]. Lancet Neurol, 2018, 17(6): 559-568. doi: S1474-4422(18)30127-3 pmid: 29699914
[39]	TAN Y, LIU W, DU J, et al. Validation of revised Chinese Version of PD-CRS in Parkinson's disease patients[J]. Parkinsons Dis, 2020, 2020: 5289136.
[40]	YOGEV-SELIGMANN G, HAUSDORFF J M, GILADI N. The role of executive function and attention in gait[J]. Mov Disord, 2008, 23(3): 329-472. doi: 10.1002/mds.v23:3
[41]	MORRIS R, LORD S, BUNCE J, et al. Gait and cognition: mapping the global and discrete relationships in ageing and neurodegenerative disease[J]. Neurosci Biobehav Rev, 2016, 64: 326-345. doi: 10.1016/j.neubiorev.2016.02.012 pmid: 26915926
[42]	谢福, 唐干, 杨楠, 等. 帕金森病伴抑郁患者肠道菌群特征及其与心理因素相关性研究[J]. 中国神经精神疾病杂志, 2025, 51(5): 274-279.
[43]	SHEENA M K, JIMMY J, BURKHOUSE K L, et al. Anterior cingulate cortex activity during attentional control corresponds with rumination in depression and social anxiety[J]. Psychiatry Res Neuroimaging, 2021, 317: 111385. doi: 10.1016/j.pscychresns.2021.111385

组别	n	性别(男/女)/n	年龄/岁	病程/年	H-Y分期
抑郁组	39	20/19	69.10±8.26	8.00(4.00,13.60)	3.00(2.50,3.00)
非抑郁组	16	9/7	65.19±9.48	6.05(3.00,7.93)	2.75(1.50,3.00)
χ²/t/Z值		0.112	1.530	1.911	2.214
P值		0.737	0.132	0.056	0.027

变量	抑郁组(n = 39)	非抑郁组(n = 16)	β值	P值
MoCA	15.0(10.0, 21.0)	18.0(15.0, 21.0)	0.042	0.769
PSQI	14.0(10.0, 17.0)	9.0(7.0, 11.5)	-0.341	< 0.001
BBS	43.0(36.0, 48.0)	52.0(48.3, 52.8)	0.117	0.242
MRMI	36.0(29.0, 38.0)	39.0(37.5, 40.0)	0.086	0.210
PCS	34.0(24.0, 46.0)	68.0(53.5, 83.3)	0.445	0.001
躯体功能	40.0(20.0, 50.0)	67.5(55.0, 93.8)	0.376	0.028
躯体角色	0.0(0.0, 25.0)	87.5(0.0, 100.0)	0.551	0.035
躯体疼痛	62.0(44.0, 78.0)	89.0(68.3, 100.0)	0.249	0.067
总体健康	40.0(30.0, 50.0)	55.0(40.0, 73.8)	0.350	0.041
MCS	47.0(31.0, 70.0)	71.5(63.5, 77.0)	0.315	0.006
生命活力	50.0(45.0, 65.0)	80.0(71.3, 88.8)	0.387	< 0.001
社会功能	50.0(38.0, 50.0)	44.0(38.0, 63.0)	0.279	0.029
情感角色	0.0(0.0, 100.0)	100.0(33.0, 100.0)	0.032	0.808
心理健康	56.0(44.0, 76.0)	76.0(69.0, 84.0)	0.188	0.118

变量	偏相关系数(r)	P值
MoCA	-0.080	0.564
PSQI	0.692	< 0.001
BBS	-0.389	0.004
MRMI	-0.399	0.003
PCS	-0.595	< 0.001
躯体功能	-0.482	< 0.001
躯体角色	-0.329	0.015
躯体疼痛	-0.370	0.006
总体健康	-0.419	0.002
MCS	-0.554	< 0.001
生命活力	-0.701	< 0.001
社会功能	-0.216	0.117
情感角色	-0.394	0.003
心理健康	-0.478	< 0.001

变量	中重度认知功能障碍组(n = 26)	轻度认知功能障碍组(n = 13)	Z值	P值	调整后F值	调整后P值
PSQI	13.5(9.0, 16.3)	17.0(12.0, 17.5)	1.542	0.126	2.753	0.106
BBS	40.0(33.0, 46.3)	46.0(44.0, 51.5)	2.807	0.004	9.224	0.004
MRMI	34.5(26.8, 38.0)	38.0(34.0, 38.5)	2.022	0.043	3.884	0.056
PCS	33.5(22.5, 46.0)	36.0(27.0, 51.0)	0.790	0.435	0.418	0.522
躯体功能	35.0(10.0, 50.0)	45.0(32.5, 67.5)	1.795	0.076	2.876	0.099
躯体角色	0.0(0.0, 0.0)	0.0(0.0, 62.5)	1.772	0.168	2.876	0.099
躯体疼痛	54.0(44.0, 100.0)	67.0(38.5, 78.0)	-0.105	0.918	0.019	0.891
总体健康	40.0(30.0, 50.0)	40.0(12.5, 57.5)	-0.721	0.489	0.387	0.538
MCS	46.0(31.0, 71.5)	47.0(30.5, 69.0)	-0.194	0.848	0.133	0.718
生命活力	50.0(43.8, 65.0)	50.0(37.5, 72.5)	0.045	0.965	0.001	0.980
社会功能	50.0(38.0, 50.0)	50.0(37.5, 50.0)	0.429	0.713	0.141	0.709
情感角色	0.0(0.0, 100.0)	33.0(0.0, 100.0)	0.066	0.965	0.018	0.894
心理健康	56.0(44.0, 77.0)	56.0(38.0, 74.0)	-0.598	0.566	0.698	0.409