帕金森病患者情绪障碍研究

Study of emotional disorders in patients with Parkinson disease

目的了解帕金森病患者伴发的情绪障碍。方法采用汉密尔顿焦虑评价量表和抑郁评价量表对100例帕金森病患者和50例对照者进行情绪障碍研究;并根据简易智能状态检查量表、帕金森病统一评价量表(UPDRSⅢ)和改良Hoehn-Yahr分级,分别评价帕金森病患者的认知功能和运动障碍严重程度并进行病情分级。结果帕金森病组患者汉密尔顿焦虑评价量表评分[(14.45±8.30)分]和抑郁评价量表评分[(7.98±6.24)分]均高于对照组[(3.68±3.23)分、(2.76±3.32)分],差异均有统计学意义(P<0.01);其焦虑症状发生率为49%(49/100),高于对照组(2%),差异有统计学意义(P<0.01),但早期与中晚期患者之间差异无统计学意义(P>0.05)。帕金森病组患者抑郁症状发生率(12%)虽高于对照组(2%),但组间差异无统计学意义(P>0.05);中晚期患者抑郁症状发生率高于早期者(P<0.05)。帕金森病组焦虑症状主要表现为精神性焦虑及躯体性焦虑,抑郁症状则以焦虑躯体化、认知障碍、迟缓以及睡眠障碍为主;性别与肢体发病侧别对情绪障碍无明显影响,而汉密尔顿焦虑评价量表(r=0.199,P=0.049;r=0.295,P=0.005)和抑郁评价量表(r=0.196,P=0.050;r=0.274,P=0.009)情绪均与病程和UPDRSⅢ评分呈正相关。结论帕金森病患者以焦虑情绪为主要情绪障碍症状,表现为躯体性焦虑和精神性焦虑,于疾病早期即已出现;而抑郁症状多出现于疾病的中晚期,主要表现为焦虑躯体化、认知障碍、迟缓以及睡眠障碍。

Objective To investigate emotional disorders in Parkinson disease （PD） patients. Methods Hamilton Anxiety Rating Scale （HAMA） and Hamilton Depression Rating Scale （HAMD） were used to assess the emotional disorders of 100 PD patients and 50 controls. Mini-Mental State Examination （MMSE）, Unified Parkinson Disease Rating Scale （UPDRSHI） and modified Hoehn-Yahr grade were used to evaluate the cognitive function and the severity of dyskinesia in PD patients, and to grade the condition. Results The score of HAMA （14.45 ± 8.30） was significantly increased in PD patients than that in controls （3.68 ± 3.23） （P〈 0.01）. The score of HAMD （7.98 ± 6.24） was significantly increased in PD patients than that in controls （2.76 ± 3.32） （P〈 0.01）. The prevalence rate of anxiety in PD patients （49%） was significantly higher than that in controls （2%） （P〈 0.01）. Compared the prevalence rate of anxiety between early stage and middlelate stage of PD, no significant difference was found （P〉 0.05）. The prevalence rate of depression in PD patients （12%） was higher than that in controls （2%）, but the difference was not significant （P〉 0.05）. The prevalence rate of depression in middlelate stage of PD was significantly higher than that in early stage （P〈 0.05）. Psychiatric and somatic anxiety were the primary anxiety symptoms in PD patients, and depression was predominantly presented with somatization, cognitive disturbance, retardation and sleep disorders. No effect of gender or the side of affected limb was found on emotional disorders. The score of HAMA was positively correlated with duration of disease （r=0.199, P=0.049） and UPDRSⅢ score （r=0.295, P=0.005）. The score of HAMD was positively correlated with duration of disease （r= 0.196, P= 0.050） and UPDRSⅢ score （r= 0.274, P= 0.009）. Conclusion Psychiatric and somatic anxiety are the primary emotional disorders symptoms in PD patients, and presented in early stage. Depression symptom is mostly presented in middlelate stage of PD, and the predominant presentations are somatization, cognitive disturbance, retardation and sleep disorders.