帕金森病幻觉及其影响因素的研究  

Prevalence and risk factors of hallucination in patients with Parkinson disease

作　　者：张蓉[1] 冯涛[1] 刘萍[1] 陈彪[2] 

机构地区：[1]首都医科大学附属北京天坛医院神经内科 [2]首都医科大学宣武医院神经内科

出　　处：《中华临床医师杂志（电子版）》2011年第19期5560-5566,共7页Chinese Journal of Clinicians(Electronic Edition)

基　　金：国家高技术研究发展计划(863计划)项目(2006AA02A408)

摘　　要：目的探讨帕金森病(PD)中幻觉的发生率以及幻觉的影响因素,分析不同亚型与幻觉的相关性。方法筛选2008年4月至2010年6月在北京天坛医院帕金森病门诊就诊的原发性PD患者共163例,将患者分为幻觉组和无幻觉组。分别用统一帕金森病评定量表(UPDRS)、Hohen-Yahr分期、汉密顿抑郁量表(HAMD)、匹兹堡睡眠指数量表(PSQI)、疲劳严重度量表(FSS)、帕金森疲劳量表(PFS)、简易精神状态量表(MMSE)和蒙特利尔认知评测量表(MoCA)等对PD患者进行评测,并比较PD幻觉组和无幻觉组的差异。应用K型聚类分析的方法对PD患者进行亚型分析,比较各亚型之间幻觉的差异。结果 163例PD患者中有幻觉者共20例(12.27%)。PD幻觉组与无幻觉组患者在性别、年龄、起病年龄、病程、部分远期并发症(开关现象、剂末现象)、UPDRS运动部分评分、睡眠评分、疲劳评分、MMSE评分和MoCA评分方面差异均无统计学意义(P>0.05)。幻觉组异动症比例(35.0%)显著高于无幻觉组(9.1%)。PD幻觉组在姿势稳定评分、H-Y分期、UPDRS第1分量表(精神、行为和情绪)评分、UPDRS第2分量表(生活)评分、HAMD评分以及左旋多巴等效剂量方面均显著高于无幻觉组。Logistic回归分析抑郁为PD幻觉的独立影响因素。结论幻觉是PD各亚型均常见的非运动症状。姿势不稳、疾病严重度、左旋多巴等效剂量、抑郁是PD幻觉的重要影响因素,其中抑郁是PD幻觉的独立危险因素。Objective To investigate the prevalence and risk factors of hallucination in patients with Parkinson disease(PD),and to analysis the relationship between hallucination and different types of PD. Methods We recruited 163 patients with PD from outpatient department in Beijing Tiantan Hospital. The subjects were divided into two groups, the hallucination group and the non-hallucination group. We assessed both the two groups respectively with UPDRS, Hohen-Yahr rank, Hamilton Depression Scale(HAMD), Pittsburgh Sleep Quality Index(PSQI), Fagitue Severity Scale(FSS), Parkinson fatigue scale(PFS),Mini-Mental State Examination(MMSE) and Montreal Cognitive Assessment (MoCA). Then we compared the difference between the two groups, statistical cluster analysis was used to study the relationship between heterogeneity and hallucination. Results In our 163 patients with PD, 20 of them (12.27%) had hallucination. The hallucination and non-hallucination groups had no difference in sex, age, age of onset, duration of illness, long-term complications and the scores of UPDRS, PSQI, FSS, PFS, MMSE and MoCA (P>0.05). The proportion of dyskinesia (35.0%) in hallucination group was significantly higher than that (9.1%) in the non-hallucination group. There were also significant differences in scores of postural stability, H-Y, UPDRS I, UPDRS II, HAMD and Levodopa Equivalents between the two groups. Logistic regression revealed that depression was the independent risk factor for hallucination in PD patients. Conclusions Hallucination is one of the common non-motor symptom in all types of PD. Postural stability, the severity of disease, Levodopa Equivalents and depression are all important risk factors in PD hallucination, and depression is the only independent risk factor.

关 键 词：帕金森病 精神障碍 幻觉 运动障碍 抑郁 

分 类 号：R742.5[医药卫生—神经病学与精神病学]