情感淡漠与早期帕金森病患者运动症状、睡眠及认知功能的关系  

Relationship between emotional apathy and motor symptoms,sleep and cognitive function in patients with early Parkinson′s disease

作　　者：晁婧媛 熊康平[1] 庄圣 张金茹[1] 黄隽英[1] 李洁[1] 毛成洁[1] 吴华蔓 王静怡 刘春风[1] Chao Jingyuan;Xiong Kangping;Zhuang Sheng;Zhang Jinru;Huang Junying;Li Jie;Mao Chengjie;Wu Huaman;Wang Jingyi;Liu Chunfeng(Department of Neurology,the Second Affiliated Hospital of Soochow University,Suzhou 215004,China)

机构地区：[1]苏州大学附属第二医院神经内科,苏州215004

出　　处：《中华医学杂志》2021年第35期2792-2797,共6页National Medical Journal of China

基　　金：江苏省重点研发计划(BE2018658);江苏省医学重点学科(ZDXKB2016022)。

摘　　要：目的:探讨早期帕金森病(PD)患者情感淡漠与运动症状、睡眠、认知功能之间的关系。方法:纳入2020年6—10月就诊于苏州大学附属第二医院的早期129例PD患者,其中男82例,女47例,应用修订情感淡漠评定量表(MAES)评定情感淡漠情况,将上述129例患者分为PD伴情感淡漠组67例(MAES>14分),PD不伴情感淡漠组62例(MAES≤14分)。同时收集年龄、性别、病程及左旋多巴等效剂量,应用Hoehn-Yahr分期及统一帕金森病评定量表第三部分(UPDRS-Ⅲ)、匹兹堡睡眠质量指数(PSQI)以及多导睡眠监测图、蒙特利尔认知评估量表(MoCA),分别评估早期PD患者的运动症状、睡眠及认知功能,探讨早期PD伴情感淡漠患者的临床特点。结果:与不伴情感淡漠组相比,伴情感淡漠组病程更长[M(Q 1,Q 3)][5.0(3.0,7.0)年比3.0(2.0,5.0)年,P=0.006]、运动症状受累显著[20.0(10.0,28.0)分比14.0(8.5,23.0)分,P=0.047]。两组患者PSQI得分差异无统计学意义。在完成多导睡眠图监测的33例患者中,与不伴情感淡漠组(16例)比较,伴情感淡漠的PD患者(17例)快速眼球运动(REM)睡眠潜伏期更长[150(124,184)min比87(57,133)min,P=0.035]、REM期周期性肢体运动更频繁(P=0.042),而REM睡眠比率(r=0.373,P=0.042)、呼吸暂停低通气指数(r=0.374,P=0.046)、氧减指数(r=0.409,P=0.025)与PD患者情感淡漠程度呈正相关。在认知评估中,伴情感淡漠PD患者认知功能障碍较重,MoCA总分与淡漠程度呈显著负相关(r=-0.231,P=0.017)。结论:伴情感淡漠的早期PD患者存在以REM睡眠障碍为主的客观睡眠障碍,可对认知功能产生负面影响。Objective To study the relationship between emotional apathy and motor symptoms,sleep,and cognitive function in patients with early Parkinson′s disease(PD).Methods One hundred and twenty-nine early PD patients who were treated in the Second Affiliated Hospital of Soochow University from June to October 2020 were included,including 82 male and 47 female patients.The emotional apathy was assessed by modified apathy rating scale(MAES).The above 129 patients were divided into 67 patients in the PD with emotional apathy group(MAES>14 points)and 62 patients in the PD without emotional apathy group(MAES≤14 points).Age,gender,course of disease and levodopa equivalent dose were also collected.Hoehn-Yahr stage and unified Parkinson′s disease rating scale PartⅢ(UPDRS-Ⅲ),Pittsburgh Sleep Quality Index(PSQI),polysomnography,and Montreal Cognitive Assessment Scale(MoCA)were used to evaluate the motor symptoms,sleep and cognitive functions of patients with early PD,and the clinical characteristics of patients with early PD with apathywere determined.Results Compared with PD patients without apathy,those with apathy had longer disease duration[M(Q1,Q3)][5.0(3.0,7.0)years vs 3.0(2.0,5.0)years,P=0.006]and severer motor symptoms[20.0(10.0,28.0)vs 14.0(8.5,23.0),P=0.047].There was no significant difference in PSQI score between the two groups.Among the 33 patients who completed polysomnography,compared with PD patients without apathy(n=16),those with apathy(n=17)had a longer rapid eye movement(REM)sleep latency[150(124,184)min vs 87(57,133)min,P=0.035)]and more frequent periodic limb movements in the REM phase(P=0.042).The REM sleep ratio(r=0.373,P=0.042),apnea-hypopena index(AHI)(r=0.374,P=0.046)and oxygen deficit index(r=0.409,P=0.025)were positively correlated with the degree of apathy in PD patients.PD patients with apathy had relatively poorer performance in cognition assessment than those without apathy and total MoCA score was inversely correlated with the degree of apathy(r=-0.231,P=0.017).Conclusion Early PD patie

关 键 词：帕金森病 情感淡漠 睡眠 运动症状 认知功能 

分 类 号：R742.5[医药卫生—神经病学与精神病学]