帕金森病患者视觉及视空间障碍特点及相关因素分析

摘要

目的 了解帕金森病(Parkinson disease ,PD)患者视觉及视空间障碍症状的分布,及其可能的相关因素.方法 收集2010‐07 －2012‐07期间就诊于北京医院神经内科门诊的87例 PD 患者,采用自行修订的Mc Dowell和Harris视觉及视空间障碍症状调查问卷(35项)调查患者的视觉及视空间障碍症状,分析患者视觉及视空间障碍症状的分布特点,并进一步探讨视空间障碍症状与患者临床特征〔包括性别、年龄、病程、起病侧、左旋多巴等效剂量(levodopa equivalent dose ,LED ) 、统一帕金森病评定量表(unified Parkinson disease rating scale ,part 3 ;U PDRS‐Ⅲ) 、简易精神状态量表(M ini‐mental State Examination ,M M SE ) 、汉密尔顿抑郁量表(Hamilton Rating Scale for Depression ,HAMD) 、日常生活活动能力量表(Activity of Daily Living Scale ,ADL )评分的关系.结果 97.7% 的PD患者有一种或一种以上视空间障碍症状,其中走路偏斜／取物偏离发生率最高(55.2%) ,其次为误撞(43.7%) ,将运动因素参与的视空间障碍症状剔除后,仍有42.5% 的PD患者存在视空间障碍症状.伴和不伴空间感减退组间男性比例(P＝0.036)、年龄(P＝0.012)、左侧起病(P＝0.026)比较差异有统计学意义;伴和不伴视野缩减感两组间年龄(P＝0.041) 、U PDRS‐Ⅲ评分(P＝0.041)比较差异有统计学意义;伴和不伴估测深度／长度困难两组间男性比例(P＝0.026)、左侧起病(P＝0.044)比较差异有统计学意义;伴和不伴走路偏斜／取物偏离两组间年龄(P＝0.040)、左侧起病(P＝0.007)比较差异有统计学意义;伴和不伴狭窄处行动困难两组间左侧起病(P＝0.047) 、UPDRS‐Ⅲ评分(P＝0.024)比较差异有统计学意义.伴空间层次感减退、取物偏离／走路偏斜、狭窄处行动困难的 PD患者ADL评分较未伴有者更高(均 P＜0.05) .结论 视觉及视空间障碍在PD患者中发生率高,且其发生可能与年龄、性别、起病侧、UPDRS‐Ⅲ评分相关,影响患者生活质量.%Objective To investigate the features of visual and visuospatial dysfunction in patients with Parkinson’s disease (PD) ,and to explore the possible risk factors. Methods From July 2010 to July 2012 ,87 PD patients were enrolled in the Neurological Clinic of Beijing Hospital. An improved questionnaire first designed by Mc Dowell & Harris with 35 items about visual and visuospatial symptoms was applied to investigate the characteristics of visual and visuospatial disorders in PD patients. Additionally ,the relationship between visual‐spatial symptoms and clinical characteristics of the patients ,including gender ,age ,course of disease ,onset side , LED (levodopa equivalent dose ) ,unified Parkinson’s disease rating scale part 3 (U PDRS‐Ⅲ) score , mini‐mental state examination score (M M SE ) , Hamilton rating scale for depression score (HAMD ) and activity of daily living scale score (ADL ) were explored. Results 97.7% of the PD patients had one or more symptoms of visual‐spatial disorder , in w hich walking deviation／access deviation was the highest (55.2%) , followed by bumping (43.7%) . After removing symptoms due to PD motor symptoms ,the portion of PD patients with pure visual‐spatial disorders was still as high as 42.5% . T here were statistically significant differences in male ratio (P＝0.036) ,age (P＝0.012 ) ,left onset ( P＝0.026 ) between the two groups with and without spatial hypoxia. Significant differences also existed in age ( P＝0.041 ) and U PDRS‐Ⅲ score ( P＝0.041 ) between the two groups with and without sense of diminished field of vision. Significant differences were found in male ratio ( P＝0.026) and left onset (P＝0.044 ) between the two groups with and without difficulty in estimating depth／length. Statistically significant differences were also observed in age ( P＝ 0.040 ) and left onset ( P＝ 0.007 ) between the two groups with and without walking／fetching deviation. Significant differences were also found in left onset (P＝0.047) and U PDRS‐Ⅲ score (P＝0.024) between the two groups with and without difficulty of movement in narrow areas. T he ADL scores of PD patients with impaired spatial hierarchy ,walking／fetching deviation ,and difficulty in moving in narrow areas were higher than those without these symptoms (P＜0.05) . Conclusions Visual and visuospatial disorders are common in PD patients and may cause lower life quality. Age , gender ,side of onset ,UPDRS‐Ⅲ score maybe the possible risk factors.