早期帕金森病伴发情感淡漠患者的临床特征及其与其他非运动症状关系的研究

摘要

目的 观察早期帕金森病伴发情感淡漠患者的临床特征及其与其他非运动症状间的关系,探讨其对生活质量的影响.方法 选择2014年8月至2017年8月就诊于邢台市人民医院的75例帕金森病患者的临床资料,采用统一帕金森病的运动部分评分量表( unified Parkinson′s disease rating scale?III,UPDRS?III)、修订版情感淡漠评定量表( modified apathy evaluation scale,MAES)、蒙哥马利抑郁评定量表( montgomery?asberg depression rating scale,MADRS)、简易智力状态检查( mini?mental state examination,MMSE)评分评估患者的运动症状、淡漠、抑郁及认知功能;应用帕金森病非运动症状评价量表分析情感淡漠与其他非运动症状间的关系;应用 39 项帕金森病生活质量问卷(Parkinson′s disease questionnaire?39,PDQ?39)评定患者生活质量.按患者是否伴有情感淡漠分为情感淡漠组与非情感淡漠组,并比较两组患者上述各指标评分的变化.结果 21.3%(16／75)的患者合并有情感淡漠,情感淡漠组患者UPDRS?Ⅲ评分为( 23.98± 9.46)分,非情感淡漠组为(14.74± 6.27)分,两组比较差异有统计学意义(P＜0.001);情感淡漠组MMSE评分为(21.26±3.21)分,非情感淡漠组为(26.57±3.42)分,两组比较差异有统计学意义( P＝0.038);情感淡漠组PDQ?39评分为( 65.20 ±25.78)分,非情感淡漠组为(34.86±25.42)分,两组比较差异有统计学意义(P＜0.001);在帕金森病非运动症状评价量表最终得分比较中,情感淡漠组疲劳症状评分为(6.1±0.2)分,明显高于非淡漠组的(2.3±0.7)分,两组比较差异有统计学意义( P＝0.006);情感淡漠组兴趣缺乏症状评分为(4.8 ±1.5)分,非淡漠组为(1.3±0.8)分,两组比较差异有统计学意义(P＝0.017).结论 淡漠在早期帕金森病患者中有较高的发生率,常常合并疲劳及兴趣缺乏症状,对日后日常生活质量有严重影响.%Objective To observe the characteristics of apathy in early Parkinson′s disease patients,analyze its relationship with other non?motor symptoms, and explore its impact on the quality of life.Methods Clinical data of 75 patients with Parkinson′s disease admitted to xingtai people′s hospital from August 2014 to August 2017 were selected.Unified Parkinson′s disease rating scale?III(UPDRS?III ), Modified apathy rating scale ( MAES ), Montgomy?asberg Depression rating scale ( MADRS ) and Simple mental state test ( MMSE) were used to evaluate patients′ motor symptoms, indifference, depression and cognitive function.The relationship between apathy and other non?motor symptoms was analyzed by Parkinson′s disease non?motor symptom evaluation scale.Parkinson′s disease questionnaire?39 ( PDQ?39) was used to evaluate the quality of life.The patients were divided into the affective indifference group and the non?affective indifference group according to whether the patients were accompanied by affective indifference.Results 21.3%( 16／75) of the patients were diagnosed with apathy.Emotional indifference group UPDRS score ?Ⅲ(23.98±9.46),not apathy group(14.74±6.27).There was significant difference between the two groups (P＜0.001).MMSE score of the indifferent group was ( 21.26±3.21),and that of the non?indifferent group was (26.57± 3.42).There was significant difference between the two groups ( P＝0.038).PDQ?39 score of the emotionally indifferent group was (65.20± 25.78),which was significantly higher than that of the non?emotionally indifferent group ( 34.86± 25.42).There was significant difference between the two groups (P＜0.001).In the comparison of Parkinson′s disease non?motor symptom evaluation scale,the fatigue symptom score of the emotionally indifferent group was (6.1±0.2) significantly higher than that of the non?indifferent group (2.3±0.7),and the difference was statistically significant (P＝0.006).The score of lack of interest was ( 4.8 ± 1.5) in the indifferent group and ( 1.3 ± 0.8) in the non?indifferent group.The difference between the two groups was statistically significant (P＝0.017).Conclusion Apathy has a high incidence in early Parkinson′s disease patients,often combined with fatigue and lack of interest symptoms.It has a serious impact on the quality of daily life in the future.