帕金森病患者抑郁对睡眠、认知功能的影响

doi:10.6040/j.issn.1671-7554.0.2024.1221

摘要/Abstract

摘要： 目的探究帕金森病(Parkinsons disease, PD)患者抑郁对睡眠及认知功能的影响。方法选取2018年至2023年就诊的PD患者136例,根据汉密尔顿抑郁量表(Hamilton depression scale, HAMD)评分分为PD伴抑郁组(n=93)和PD不伴抑郁组(n=43)。收集两组帕金森病睡眠量表(Parkinsons disease sleep scale, PDSS)、蒙特利尔认知评估量表(Montreal cognitive assessment, MoCA)等相关临床量表及多导睡眠监测等数据。采用Wilcoxon秩和检验评估PD伴抑郁组和PD不伴抑郁组各睡眠及认知相关量表等数据的差异;采用Spearman等级相关分析对抑郁与睡眠及认知功能的相关性进行分析;采用多元线性回归分析PD抑郁的危险因素。结果 PD伴抑郁组日间过度嗜睡评定量表(epworth sleepiness scale, ESS)评分、生活质量评分等高于PD不伴抑郁组,PDSS评分及MoCA评分低于PD不伴抑郁组,PD伴抑郁组的入睡潜伏期长于PD不伴抑郁组,差异有统计学意义(P<0.05)。HAMD、MoCA及睡眠情况各项评分呈显著相关(P<0.05)。多元线性回归分析结果示焦虑及生活质量对PD抑郁有一定的预测价值(P<0.05)。结论在PD患者中,抑郁症状越重,其睡眠障碍、认知功能障碍越严重,生活质量越受影响。

关键词: 帕金森病, 抑郁, 睡眠障碍, 认知功能, 生活质量

Abstract: Objective To investigate the impact of depression on sleep and cognitive function in patients with Parkinsons disease(PD). Methods A total of 136 patients diagnosed with PD and hospitalised between 2018 and 2023 were carefully identified and categorised into PD with depression group(n=93)and PD without depression group(n=43), according to their Hamilton depression scale(HAMD)score. We collected sleep and cognition scale, such as Parkinsons disease sleep scale(PDSS), Montreal cognitive assessment(MoCA)and other clinical scales and polysomnography in the two groups. The Wilcoxon rank-sum test was used to assess discrepancies in sleep and cognitive metrics between the PD with depression group and the PD without depression group; the relationship between depression, cognitive function, and sleep quality was examined by Spearman rank correlation analysis; the risk factors associated with PD-related depression were examined by multiple linear regression analysis. Results ESS score and PDQ-39 scores in the PD with depression group were higher than those in the PD without depression group, whereas PDSS scores and MoCA scores were lower in the PD with depression group. Sleep latency in the PD with depression group was longer than that in the PD without depression group, and the differences were statistically significant(P<0.05). Depression scores were significantly correlated with MoCA and various sleep state scores(P<0.05). Multiple linear regression analysis showed that anxiety and quality of life had some predictive value for PD depression(P<0.05). Conclusion In PD patients, the more severe the depressive symptoms, the more severe the sleep disturbance and cognitive impairment, and the more impaired the quality of life.

Key words: Parkinsons disease, Depression, Sleep disturbance, Cognitive function, Quality of life

中图分类号:

R742.5

朱晓冉,李秀华,任延红,毛飞,方雨晴,赵张宁,王雅琳,刘天淏,张艳青,韩润冬. 帕金森病患者抑郁对睡眠、认知功能的影响[J]. 山东大学学报 (医学版), 2025, 63(3): 63-70.

ZHU Xiaoran, LI Xiuhua, REN Yanhong, MAO Fei, FANG Yuqing, ZHAO Zhangning, WANG Yalin, LIU Tianhao, ZHANG Yanqing, HAN Rundong. Effects of depression on sleep and cognitive function in patieuts with Parkinsons disease[J]. Journal of Shandong University (Health Sciences), 2025, 63(3): 63-70.

参考文献

[1] Jankovic J, Tan EK. Parkinsons disease: etiopathogenesis and treatment[J]. J Neurol Neurosurg Psychiatry, 2020, 91(8): 795-808.
[2] Prange S, Klinger H, Laurencin C, et al. Depression in patients with Parkinsons disease: current understanding of its neurobiology and implications for treatment[J]. Drugs Aging, 2022, 39(6): 417-439.
[3] Ahmad MH, Rizvi MA, Ali M, et al. Neurobiology of depression in Parkinsons disease: insights into epidemiology, molecular mechanisms and treatment strategies[J]. Ageing Res Rev, 2023, 85: 101840.doi:10.1016/j.arr.2022.101840
[4] 柴滨, 马惠姿, 冯涛. 帕金森病患者伴发焦虑抑郁的影响因素分析[J]. 中国医药, 2021, 16(1): 71-74. CHAI Bin, MA Huizi, FENG Tao. Related factors of anxiety and depression in patients with Parkinsons disease[J].China Medicine, 2021, 16(1): 71-74.
[5] 中华医学会神经病学分会帕金森病及运动障碍学组, 中国医师协会神经内科医师分会帕金森病及运动障碍专业委员会. 中国帕金森病的诊断标准(2016版)[J]. 中华神经科杂志, 2016, 49(4): 268-271.
[6] 马惠姿, 房进平, 冯涛, 等. 帕金森病患者不同程度抑郁在汉密尔顿抑郁量表的结构差异[J]. 中国康复理论与实践, 2021, 27(7): 829-833. MA Huizi, FANG Jinping, FENG Tao, et al. Structural differences of depression for patients with Parkinsons disease using Hamilton depression scale[J]. Chinese Journal of Rehabilitation Theory and Practice, 2021, 27(7): 829-833.
[7] Högl B, Arnulf I, Comella C, et al. Scales to assess sleep impairment in Parkinsons disease: critique and recommendations[J]. Mov Disord, 2010, 25(16): 2704-2716.
[8] Goetz CG, Tilley BC, Shaftman SR, et al. Movement disorder society-sponsored revision of the unified Parkinsons disease rating scale(mds-updrs): scale presentation and clinimetric testing results[J]. Mov Disord, 2008, 23(15): 2129-2170.
[9] Carod-Artal FJ, Martinez-Martin P, Vargas AP. Independent validation of scopa-psychosocial and metric properties of the pdq-39 brazilian version[J]. Mov Disord, 2007, 22(1): 91-98.
[10] Bocti C, Swartz RH, Gao FQ, et al. A new visual rating scale to assess strategic white matter hyperintensities within cholinergic pathways in dementia[J]. Stroke, 2005, 36(10): 2126-2131.
[11] 许保磊, 章晓君, 孙炎, 等. 帕金森病合并抑郁的影响因素及脑部葡萄糖代谢的改变[J]. 临床神经病学杂志, 2022, 35(5): 324-328. XU Baolei, ZHANG Xiaojun, SUN Yan, et al. Influencing factors of Parkinsons disease complicated with depression and the changes of glucose metabolism in brain[J]. Journal of Clinical Neurology, 2022, 35(5): 324-328.
[12] 吴玉, 潘小平, 杨淞然, 等. 帕金森病抑郁的发生率及相关因素分析[J]. 实用医学杂志, 2015, 31(16): 2717-2720. WU Yu, PAN Xiaoping, YANG Songran, et al. The incidence and the related factors of the depression in Parkinsons disease[J]. Journal of practical medicine, 2015, 31(16): 2717-2720.
[13] Ghaddar A, Fawaz M, Khazen G, et al. Prevalence of depression in Parkinsons disease in a lebanese tertiary clinic[J]. J Clin Exp Neuropsychol, 2015, 38(1): 51-58.
[14] Yamanishi T, Tachibana H, Oguru M, et al. Anxiety and depression in patients with Parkinsons disease[J]. Intern Med, 2013, 52(5): 539-545.
[15] Stauder M, Klerman EB, Wang W, et al. Relationships of self-reported and objective measures of sleep, sleepiness, and sleep quality in Parkinsons disease[J]. Park Relat Disord, 2022, 101: 57-61. doi:10.1016/j.parkreldis.2022.06.009
[16] 张荷笛, 张丽, 朱骏, 等. 基于量表的帕金森病睡眠障碍的发生率及临床特点分析[J]. 实用老年医学, 2020, 34(7): 674-678. ZHANG Hedi, ZHANG Li, ZHU Jun, et al. Analysis of the incidence and clinical features of sleep disorders in patients with Parkinsons disease[J].Practical Geriatrics, 2020, 34(7): 674-678.
[17] Bhattacharya A, Lenka A, Stezin A, et al. Overview of sleep disturbances and their management in Parkinsons plus disorders[J]. J Neurol Sci, 2020, 415. doi:10.1016/j.jns.2020.116891
[18] Gros P, Videnovic A. Overview of sleep and circadian rhythm disorders in Parkinsons disease[J]. Clin in Geriatr Med, 2020, 36(1): 119-130.
[19] Shafazand S, Wallace DM, Arheart KL, et al. Insomnia, sleep quality, and quality of life in mild to moderate Parkinsons disease[J]. Ann Am Thorac Soc, 2017, 14(3): 412-419.
[20] Staner L. Comorbidity of insomnia and depression[J]. Sleep Med Rev, 2010, 14(1): 35-46.
[21] 司慧丽, 纪别克, 赵鸿雁, 等. 帕金森病患者睡眠障碍特点及其影响因素分析[J]. 广东医学, 2020, 41(1): 61-65. SI Huili, JI Bieke, ZHAO Hongyan, et al. Characteristics and influencing factors of sleep disorders in patients with Parkinsons disease[J].Guangdong Medical Journal, 2020, 41(1): 61-65.
[22] Kay DB, Tanner JJ, Bowers D. Sleep disturbances and depression severity in patients with Parkinsons disease[J]. Brain Behav, 2018, 8(6). doi:10.1002/brb3.967
[23] Rana AQ, Qureshi ARM, Shamli Oghli Y, et al. Decreased sleep quality in Parkinsons patients is associated with higher anxiety and depression prevalence and severity, and correlates with pain intensity and quality[J]. Neurol Res, 2018: 1-6. doi:10.1080/01616412.2018.1462880
[24] 金莹, 李凯, 李淑华, 等. 帕金森病患者睡眠障碍与抑郁焦虑和生活质量的相关性[J]. 中国神经免疫学和神经病学杂志, 2021, 28(6): 459-463. JIN Ying, LI Kai, LI Shuhua, et al. Relationship between sleep disturbance with depression, anxiety and quality of life in patients with Parkinsons disease[J]. Chinese Journal of Neuroimmunology and Neurology, 2021, 28(6): 459-463.
[25] 吕冬芳, 王雪笠, 朱艳霞, 等. 并发焦虑、抑郁和睡眠障碍的帕金森病临床分析[J]. 临床误诊误治, 2019, 32(2): 83-88. LYU Dongfang, WANG Xueli, ZHU Yanxia, et al. Clinical Analysis of Parkinsons disease with anxiety, depression and sleep disorders[J]. Clinical Misdiagnosis & Mistherapy, 2019, 32(2): 83-88.
[26] Lima MM. Sleep disturbances in Parkinsons disease: the contribution of dopamine in rem sleep regulation[J]. Sleep Med Rev, 2013, 17(5): 367-375.
[27] Zhang Y, Ren R, Sanford LD, et al. Sleep in Parkinsons disease: a systematic review and meta-analysis of polysomnographic findings[J]. Sleep Med Rev, 2020, 51: 101281. doi:10.1016/j.smrv.2020.101281
[28] 孙述昱, 程金湘, 邱健, 等. 帕金森病伴不宁腿综合征患者多导睡眠图的临床特征研究[J]. 中风与神经疾病杂志, 2021, 38(4): 335-339. SUN Shuyu, CHENG Jinxiang, QIU Jian, et al. Clinical and polysomnography findings in patients with Parkinsons disease with restless leg syndrome[J]. Apoplexy and Nervous Diseases, 2021, 38(4): 335-339.
[29] Weintraub D, Simuni T, Caspell-Garcia C, et al. Cognitive performance and neuropsychiatric symptoms in early, untreated Parkinsons disease[J]. Mov Disord, 2015, 30(7): 919-927.
[30] Marinus J, Zhu K, Marras C, et al. Risk factors for non-motor symptoms in Parkinsons disease[J]. Lancet Neurol, 2018, 17(6): 559-568.
[31] Aarsland D, Batzu L, Halliday GM, et al. Parkinsons disease-associated cognitive impairment[J]. Nat Rev Dis Primers, 2021, 7(1): 47.
[32] 朱贺, 殷实. 认知障碍与抑郁症关系的研究进展[J]. 实用老年医学, 2023, 37(3): 234-237. ZHU He, YIN Shi. Research progress on the relationship between cognitive impairment and depression[J]. Practical Geriatrics, 2023, 37(3): 234-237.
[33] Klepac N, Trkulja V, Relja M. Nondemented Parkinsons disease patients: is cognitive performance associated with depressive difficulties?[J]. Cogn Behav Neurol, 2008, 21(2): 87-91.
[34] Weintraub D, Mavandadi S, Mamikonyan E, et al. Atomoxetine for depression and other neuropsychiatric symptoms in Parkinsons disease[J]. Neurol, 2010, 75(5): 448-455.
[35] Yang AN, Wang XL, Rui HR, et al. Neuropsychiatric symptoms and risk factors in mild cognitive impairment: a cohort investigation of elderly patients[J]. J Nutr Health Aging, 2020, 24(2): 237-241.
[36] Chung SJ, Yoo HS, Lee YH, et al. Frontal atrophy as a marker for dementia conversion in Parkinsons disease with mild cognitive impairment[J]. Hum Brain Mapp, 2019, 40(13): 3784-3794.
[37] Cohen ML, Aita S, Mari Z, et al. The unique and combined effects of apathy and depression on cognition in Parkinsons disease[J]. J Parkinsons Dis, 2015, 5(2): 351-359.
[38] Lee JE, Cho KH, Song SK, et al. Exploratory analysis of neuropsychological and neuroanatomical correlates of progressive mild cognitive impairment in Parkinsons disease[J]. J Neurol Neurosurg Psychiatry, 2014, 85(1): 7-16.
[39] Menon B, Nayar R, Kumar S, et al. Parkinsons disease, depression, and quality-of-life[J]. Indian J Psychol Med, 2015, 37(2): 144-148.

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