Abbreviation (ISO4): Chinese Journal of Alzheimer's Disease and Related Disorders
Editor in chief: Jun WANG
Chinese Journal of Alzheimer's Disease and Related Disorders >
The clinical features and correlative factors of apathy in patients with Parkinson's disese
Received date: 2020-08-01
Revised date: 2021-01-05
Online published: 2021-03-25
Objectives: To survey correlative factors of apathy through investigating clinical features of motor symptoms and non-motor symptoms (NMS) in Parkinson's disease (PD) patients.
Our cross-sectional study included 120 clinical diagnosed PD patients from neurology department, Affiliated Hospital of North Sichuan Medical College. Apathy was evaluated using the Lille Apathy Rating Scale (LARS) and Non-Motor Symptom Scale (NMSS) were used to access NMS.
Apathy was observed in 37.5% of PD patients in our study. The Montreal Cognitive Assessment (MoCA) and the Frontal Assessment Battery (FAB) were significantly lower in PD patients with apathy. The levodopa equivalent daily dose (LEDD), proportion of treatment with levodopa, scores of the H-Y stage, the Unified Parkinson’s Disease Rating Scale part III (UPDRS III), the 39-item PD Questionnaire (PDQ-39) and the Beck Depression Inventory (BDI) were significantly higher in PD patients with apathy. The prevalence of attention/memory domain with items “concentration” and “recent memory loss”, gastrointestinal domain with item “constipation”, urinary domain with items “nocturia” and “frequency micturition”, and items “difficulty falling asleep”, “lost of interest”, “apathy” and “feeling sad” were significantly higher in PD patients with apathy. The logistic regression indicated that lower MoCA scores, higher BDI scores and presence of urinary domain symptoms in NMSS were associated with apathy in PD.
Apathy was common in PD patients. PD patients with cognitive dysfunction, depression and urinary symptoms were prone to present with apathy.
HE Shijia , WANG Yirong , SUN Ling , CHENG Bo , YU Juming , ZHANG Shushan . The clinical features and correlative factors of apathy in patients with Parkinson's disese[J]. Chinese Journal of Alzheimer's Disease and Related Disorders, 2021 , 4(1) : 37 -41 . DOI: 10.3969/j.issn.2096-5516.2021.01.006
表1 PD人口学特征及临床特征Tab. 1 Demographic and clinical features of PD patients |
项目 | PD总体 | PD伴淡漠 | PD不伴淡漠 | P值 | |
---|---|---|---|---|---|
患者人数 | 120(100%) | 45(37.5%) | 75(62.5%) | - | |
人口学特征 | |||||
男性 | 75(62.5%) | 25(55.6%) | 50(66.7%) | 0.224 | |
平均年龄(年) | 58.83 ± 11.91 | 59.98 ± 10.30 | 56.64 ± 13.29 | 0.417 | |
起病年龄(年) | 57.12 ± 12.16 | 57.94 ± 10.05 | 56.46 ± 12.91 | 0.581 | |
病程(年) | 1.58 ± 1.48 | 1.71 ± 1.66 | 1.51 ± 1.37 | 0.478 | |
教育年限(年) | 11.11 ± 3.65 | 10.25 ± 3.96 | 11.49 ± 3.47 | 0.110 | |
LARS | -23.70 ± 10.86 | -12.02 ± 8.13 | -30.71 ± 4.22 | <0.001 | |
临床特征 | |||||
PD家族史 | 21(17.8%) | 7(16.3%) | 14(18.7%) | 0.744 | |
高血压 | 17(14.3%) | 6(13.3%) | 11(14.9%) | 0.817 | |
糖尿病 | 9(7.6%) | 4(8.9%) | 5(6.8%) | 0.945 | |
吸烟 | 33(27.5%) | 11(24.4%) | 22(29.3%) | 0.561 | |
饮酒 | 28(23.3%) | 13(28.9%) | 15(20.0%) | 0.265 | |
药物使用 | |||||
LEDD | 180.92 ± 195.69 | 233.33 ± 177.27 | 148.06 ± 200.74 | 0.026 | |
左旋多巴 | 66(55.5%) | 34(75.6%) | 32(43.2%) | 0.010 | |
多巴胺受体激动剂 | 49(41.2%) | 21(46.7%) | 28(37.8%) | 0.343 | |
金刚烷胺 | 25(21.0%) | 13(28.9%) | 12(16.2%) | 0.100 | |
苯海索 | 10(8.4%) | 4(8.9%) | 6(8.1%) | 1.000 | |
COMT | 3(2.5%) | 0(0.0%) | 3(4.1%) | 0.289 | |
MAO-B抑制剂 | 2(1.7%) | 1(2.2%) | 1(1.4%) | 1.000 |
Note: Abbreviations: PD: Parkinson's disease, LEDD: levodopa equivalent daily dose, LARS: the Lille Apathy Rating Scale, COMT: Catechol-O-methyltransferase, MAO-B: Monoamine Oxidase B |
表2 PD伴淡漠与不伴淡漠患者运动症状和部分NMS比较Tab. 2 Motor symptom and partial NMS between PD patients with and without apathy |
项目 | PD总体 | PD伴淡漠 | PD不伴淡漠 | P值 |
---|---|---|---|---|
严重程度 | ||||
H-Y分级 | 2.07 ± 0.65 | 2.34 ± 0.65 | 1.91 ± 0.59 | <0.001 |
UPDRS III得分 | 25.54 ± 12.47 | 30.38 ± 12.98 | 22.63 ± 11.27 | 0.001 |
MoCA得分 | 27.91 ± 21.00 | 24.66 ± 2.57 | 26.35 ± 2.60 | <0.001 |
FAB得分 | 16.17 ± 1.74 | 15.53 ± 2.00 | 16.51 ± 1.50 | 0.004 |
BDI得分 | 5.10 ± 4.40 | 6.70 ± 4.95 | 4.13 ± 3.75 | 0.004 |
PDQ-39得分 | 25.86 ± 2.69 | 38.28 ± 22.62 | 22.15 ± 17.73 | <0.001 |
Note: Abbreviations: PD: Parkinson's disease, UPDRS III: the Unified Parkinson's Disease Rating Scale part III, MoCA: the Montreal Cognitive Assessment, FAB: the Frontal Assessment Battery, BDI: the Beck Depression Inventory, PDQ-39: the 39-item Parkinson's disease Questionnaire |
表3 PD伴淡漠与不伴淡漠患者NMS比较Tab. 3 Prevalence of NMS between PD patients with and without apathy |
项目 | PD总体 | PD伴淡漠 | PD不伴淡漠 | P值 |
---|---|---|---|---|
1.心血管症状 | 26(21.7%) | 6(13.3%) | 20(26.7%) | 0.086 |
头晕 | 24(20.0%) | 6(13.3%) | 18(24.0%) | 0.157 |
跌倒 | 5(4.2%) | 1(2.2%) | 4(5.3%) | 0.723 |
2.睡眠/疲乏 | 88(73.9%) | 37(82.2%) | 51(68.9%) | 0.109 |
日间嗜睡 | 53(44.2%) | 21(46.7%) | 32(42.7%) | 0.669 |
疲乏 | 61(50.8%) | 24(53.3%) | 37(49.3%) | 0.671 |
入睡困难 | 59(49.2%) | 28(62.2%) | 31(41.3%) | 0.027 |
不宁腿 | 25(21.0%) | 11(24.4%) | 14(18.9%) | 0.473 |
3.情绪认知 | 79(66.4%) | 33(75.5%) | 46(61.3%) | 0.128 |
丧失兴趣 | 48(40.3%) | 23(52.3%) | 25(33.3%) | 0.042 |
缺乏动力 | 49(41.2%) | 23(52.3%) | 26(34.7%) | 0.060 |
紧张 | 36(30.3%) | 17(38.6%) | 19(25.3%) | 0.127 |
悲伤 | 60(50.4%) | 27(61.4%) | 33(44.0%) | 0.067 |
淡漠 | 30(25.2%) | 20(45.5%) | 10(13.3%) | <0.001 |
高兴不起来 | 38(31.9%) | 23(52.3%) | 15(20.0%) | <0.001 |
4.知觉/幻觉 | 11(9.2%) | 5(11.1%) | 6(8.0%) | 0.567 |
视幻觉 | 3(2.5%) | 2(4.4%) | 1(1.3%) | 0.651 |
妄想 | 1(0.8%) | 1(2.2%) | 0(0.0%) | 0.375 |
复视 | 8(6.7%) | 3(6.7%) | 5(6.7%) | 1.000 |
5.注意/记忆 | 90(75.6%) | 41(91.1%) | 49(66.2%) | 0.004 |
注意力缺乏 | 34(28.3%) | 18(40.0%) | 16(21.3%) | 0.028 |
近记忆下降 | 77(64.2%) | 37(82.2%) | 40(53.3%) | 0.001 |
忘记做事情 | 48(40.3%) | 22(48.9%) | 26(35.1%) | 0.138 |
6.胃肠道症状 | 67(56.3%) | 31(70.5%) | 36(48.0%) | 0.017 |
流涎 | 20(16.7%) | 8(17.8%) | 12(16.0%) | 0.800 |
吞咽困难 | 26(21.8%) | 13(29.5%) | 13(17.3%) | 0.120 |
便秘 | 54(45.0%) | 27(60.0%) | 27(36.0%) | 0.011 |
7.泌尿系统症状 | 75(62.5%) | 36(80.0%) | 39(52.0%) | 0.002 |
尿急 | 40(33.3%) | 19(42.2%) | 21(28.0%) | 0.110 |
尿频 | 37(30.8%) | 21(46.7%) | 16(21.3%) | 0.004 |
夜尿增多 | 64(53.3%) | 31(68.9%) | 33(44.0%) | 0.008 |
8.性功能症状 | 69(59.5%) | 26(60.5%) | 43(58.9%) | 0.869 |
性欲改变 | 66(56.9%) | 25(58.1%) | 41(56.2%) | 0.836 |
性生活障碍 | 62(53.4%) | 24(55.8%) | 38(52.1%) | 0.695 |
9.其他 | 86(71.7%) | 33(73.3%) | 53(70.7%) | 0.754 |
疼痛 | 50(41.7%) | 19(42.2%) | 31(41.3%) | 0.924 |
味觉减退 | 45(37.5%) | 17(37.8%) | 28(37.3%) | 0.961 |
体重改变 | 17(14.2%) | 8(17.8%) | 9(12.0%) | 0.380 |
多汗 | 34(28.3%) | 15(33.3%) | 19(25.3%) | 0.346 |
NMSS总分 | 39.47 ± 27.81 | 51.07 ± 29.97 | 32.774 ± 24.27 | 0.001 |
Note: Abbreviations: PD: Parkinson's disease, NMS: Non-Motor Symptom, NMSS: the Non-Motor Symptoms Scale |
表4 PD淡漠相关因素的logistic回归分析Tab. 4 Correlative factors of apathy in PD patients based on logistic regression analysis |
项目 | OR值 | 95%可信区间 | P值 |
---|---|---|---|
MoCA得分 | -0.241 | 0.625-0.988 | 0.039 |
BDI得分 | 0.218 | 1.047-1.478 | 0.013 |
泌尿系统症状 | 2.322 | 2.114-49.208 | 0.004 |
Note: Abbreviations: PD: Parkinson's disease, MoCA: the Montreal Cognitive Assessment, BDI: the Beck Depression Inventory |
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