初诊未治帕金森病淡漠及其相关因素研究

The clinical feature and correlative factors of apathy in drug-naive patients with Parkinson disease

目的研究初诊未治帕金森病(Parkinson disease,PD)患者淡漠的发生率及其相关因素。方法本研究为横断面研究,纳入川北医学院附属医院2016年5月到2020年5月临床确诊的初诊未治PD患者作为PD组。纳入同期100例健康体检者作为正常对照组。使用Lille淡漠量表(Lille apathy rating scale,LARS)评估初诊未治PD患者及正常对照组,LARS评分≥-21分为PD伴淡漠组及正常伴淡漠组,LARS评分<-21分归为PD不伴淡漠组及正常不伴淡漠组。使用非运动症状量表(non-motor symptoms scale,NMSS)全面评估PD患者各项非运动症状(nor-motor sysptoms,NMS)的发生率及严重程度;使用蒙特利尔认知功能评估量表(Montreal cognitive assessment,MoCA)评估PD患者的认知功能;使用贝克抑郁问卷(Beck depression inventory,BDI)及汉密尔顿焦虑量表(Hamilton anxiety rating scale,HARS)分别评估PD患者的抑郁及焦虑状况;使用PD生活质量问卷(39-item PD questionnaire,PDQ-39)评估PD患者的生活质量。结果共纳入PD组98例,其中PD伴淡漠组10例,PD不伴淡漠组88例;正常对照组100例,其中正常伴淡漠组5例,正常不伴淡漠组95例。PD组与正常对照组在性别、平均年龄、教育年限、LARS评分、吸烟、饮酒、高血压及糖尿病等人口学特征方面均无统计学差异(P>0.05)。PD伴淡漠组BDI得分(10.07±5.54 vs.5.30±4.71)、HARS得分(23.30±6.29 vs.11.46±6.86)、疲劳严重度量表(fatigue severity scale,FSS)得分(41.90±14.92 vs.28.81±14.71)、PDQ-39得分(59.10±28.22 vs.27.74±25.01)、帕金森病睡眠量表(Parkinson’s disease sleep scale,PDSS)得分(27.10±7.70 vs.16.22±0.70)和额叶行为量表(frontal behavior inventory,FBI)得分(15.20±5.45 vs.7.17±8.37)均高于PD不伴淡漠组(P<0.05)。PD伴淡漠组情绪/认知亚项及条目“缺乏动力、紧张、悲伤、淡漠和高兴不起来、注意/记忆亚项”及条目“注意力缺乏、胃肠道症状亚项”及条目“便秘、吞咽困难、泌尿系统症状亚项”及条目“尿频、夜尿增多和入睡困难、体质量改变”等的发生率高于PD不伴淡漠组。logistic分析发现HARS得分、胃肠道症状与PD淡漠有关。结论PD患者中常出现淡漠,合并焦虑和胃肠道症状的初诊未治PD易发生淡漠。

Objectives To survey the prevalence and correlative factors of apathy in drug-naive patients with Parkinson disease(PD).Methods Our cross-sectional study included clinical definite diagnosed PD patients from neurology department,Affiliated Hospital of North Sichuan Medical College from May 2016 to May 2020.One hundred normal controls were included as controls in the same period.The Lille Apathy Rating Scale(LARS)was used to evaluate apathy in drug-naive patients with PD and normal control group.LARS scores≥-21 were classified as PD with apathy group and normal with apathy group,LARS scores<-21 were classified as PD without apathy group and normal without apathy group.The Non-Motor Symptom Scale(NMSS)was used to access non-motor symptoms(NMS).Global cognitive function was evaluated using the Montreal Cognitive Assessment(MoCA).Depression and anxiety were evaluated using the Beck Depression Inventory(BDI)and the Hamilton Anxiety Rating Scale(HARS)separately.The Quality of life(QoL)of PD patients was evaluated using the 39-item PD Questionnaire(PDQ-39).Results A total of 98 PD patients were included in this study,10 in the PD with apathy and 88 in the PD without apathy.There were 100 normal controls including 5 with apathy and 95 without apathy.Further research found that there was no significant difference in demographic characteristics such as gender,average age,years of education,LARS score,smoking,drinking,hypertension and diabetes between the PD group and the normal control group(P>0.05).The scores of BDI,HARS,the Fatigue Severity Scale(FSS),PDQ-39,the Parkinson's Disease Sleep Scale(PDSS),the Frontal Behavior Inventory(FBI)were significantly higher in PD patients with apathy than in those without apathy.The prevalence of mood/apathy domain and the item"lack of motivation","feelings of nervousness","feelings of sadness","flat mood"and"difficulty experiencing pleasure",attention/memory domain and the item"concentration",gastrointestinal domain and the item"constipation"and"swallowing",urinary domain and the item"nocturia"and"frequent micturition","difficulty falling asleep"and"weight change"were significantly higher in PD patients with apathy than in those without apathy.The logistic regression indicated that higher HARS scores and gastrointestinal symptom in NMSS were associated with apathy in PD group.Conclusions Apathy was common in drug-naive PD patients and PD patients with anxiety and gastrointestinal symptom were prone to present with apathy.