已治疗帕金森病患者的精神病性障碍特点及相关因素分析

摘要

目的 探讨帕金森病(PD)患者精神病性障碍的患病率及症状学特点,并分析其相关因素. 方法 应用简明精神病量表、神经精神问卷对82例PD患者和69例正常对照进行调查,分析PD患者起病年龄、抗PD药物种类和剂量、运动功能、Hoehn-Yahr分级、认知损害、抑郁、睡眠障碍等与PD精神病性障碍(PDPsy)的相关性. 结果 患者组PDPsy患病率为36.6％,对照组精神病性障碍患病率为2.9％,差异具有统计学意义(P＜0.0001).在具有PDPsy的30例患者中,错觉、错误的存在性感觉、幻觉、妄想的患病率分别为22.0％,14.6％、29.3％、7.3％.单因素分析显示,具有PDPsy患者的年龄(71.1±6.2)岁、服用的左旋多巴等效剂量(628.7±283.2)mg、帕金森病致残量表睡眠部分(SCOPA-SLEEP)评分(15.3±7.3)分,快速眼动期睡眠行为障碍(RBD)的患病率(60.0％),均显著高于无精神病性障碍的PD患者(66.6±9.3)岁、(461.1±317.2)、(9.7±7.6)分、28.9％ (P＜0.05).多因素分析结果显示:Hoehn-Yahr分级是PDPsy的保护因素(OR=0.039,95％CI:0.004～0.402);睡眠障碍是危险因素(OR=1.157,95％CI:1.015～1.320).精神病性症状数量多的PD患者年龄大、SCOPA-SLEEP评分高(P=0.0042、0.0112). 结论 PD患者精神病性障碍的患病率明显高于正常人群.PDPsy的发生和高龄、高左旋多巴等效剂量、严重的睡眠障碍及RBD相关.%Objective To discuss the clinical features and related factors of psychosis in patients with Parkinson's disease (PD) and assess the prevalence of psychosis.Methods A total of 82 patients with Parkinson's disease and 69 healthy controls were evaluated by Brief Psychiatric Rating Scale and neuropsychiatric questionnaire.For the PD group,the age at PD onset,type and dose of PD medications,and rapid eye movement (REM) sleep behavior disorder (RBD) were recorded.Unified Parkinson's disease rating scale (UPDRS,parts Ⅱ and Ⅲ) and Hoehn-Yahr staging were used for the evaluation of the severity of motor dysfunction,Hamilton depression scale (HAMD) for emotional state,montreal cognitive assessment (MoCA) for cognition,and scales for outcomes in Parkinson's disease-SLEEP (SCOPA-SLEEP) for quality of sleep.Results The prevalence of psychosis was 36.59％ in PD patients and 2.90％ in the control group.The difference between the two groups was statistically significant (P＜ 0.001).Among the 30 PD patients with PD psychosis meeting the NINDS/NIMH criteria,patients experienced illusions,false sense of presence,hallucinations and delusions was 22.0％,14.6％,29.3％,and 7.3％,respectively.Univariate analysis showed that age,levodopa equivalent dosage,SCOPA-SLEEP scores,and prevalence of RBD were significantly higher in thePDP group [(71.1±6.18),(628.7±283.2),(15.3±7.28),60.00％] than in the PDNP group [(66.6±9.25),(461.1±317.2),(9.7±7.64),28.85％] (all P＜0.05).Multivariate analysis showed that Hoehn-Yahr staging was a protective factor (OR =0.039,95％ CI:0.004-0.402),while sleep disorder was a risk factor (OR=1.157,95％CI:1.015-1.320).The PD patients with more psychotic symptoms were much older and with higher SCOPA-SLEEP scores,which had a statistically significant difference (P =0.0042,P =0.0112).Conclusions The prevalence of psychosis is much higher in PD patients than in healthy controls.PD psychosis is correlated with older age,larger levodopa equivalent doses,higher SCOPA-SLEEP scores,and prevalence of REM sleep behavior disorder.