目的 调查帕金森病(Parkinson's disease,PD)患者中疲劳和睡眠障碍的患病率,研究疲劳和睡眠障碍的危险因素及相关性.方法 采用疲劳严重度量表(FSS)和匹兹堡睡眠质量指数量表(PSQI)对363例PD患者的疲劳及睡眠状况进行评价.FSS ＞4界定为疲劳,PSQI≥7界定为睡眠障碍.同时,采用统一帕金森病评分量表(UPDRS)及Hoehn&Yahr评价运动障碍及严重程度,美国国立精神卫生研究所流行病学研究中心编制的抑郁量表(CESD)评价抑郁,阿尔茨海默病评定量表(ADAS-Cog)评价认知,36条目简化医疗结局调查问卷(SF-36)评价生活质量.结果 363例PD患者61.7％存在疲劳,55.1％存在睡眠障碍.其中,136例(37.5％)疲劳与睡眠障碍共存,87例(24％)仅存在疲劳,63例(17％)仅存在睡眠障碍.单因素方差分析显示,疲劳组与对照组比较UPDRS第3部分评分、左旋多巴制剂等效剂量(LDE)、CESD分值均显著升高(均P＜0.001);睡眠障碍组与对照组比较UP-DRS第3部分评分、LDE、CESD分值均无显著差异(均P＞0.05).多参数Logistic回归显示,UPDRS第3部分评分和CESD分值能预测疲劳的发生,而LDE未被引入疲劳预测模型.与之相反,UPDRS第3部分评分、LDE、CESD分值均不能预测睡眠障碍的发生.结论 疲劳和睡眠障碍是PD常见的非运动症状.二者在临床上有所重叠,但危险因素不同,疲劳和睡眠障碍是PD独立的非运动症状.

Objective To investigate the prevalence,character-istics and risk factors of fatigue in a large cohort of subjects with early Parkinson’s disease （PD）.Methods A total of 391 individuals with PD,recrutied in Linzhi trial, were re-screened. Early, non-depressed subjects

目的 探讨硬脊膜动静脉瘘(spinal dural arteriovenous fistula,SDAVF)的临床和影像学特点,提高对于SDAVF的认识.方法 对6例确诊SDAVF患者的临床、影像学资料以及治疗与转归等进行回顾性分析.结果 6例患者中5例为中老年男性,1例为青年女性.6例患者的病灶部位均在胸腰段脊髓,其中5例有脊髓圆锥及马尾神经根受累.双下肢麻木症状发病5例,骶尾部或双下肢疼痛发病2例,下肢无力发病2例,6例患者均有尿便和性功能障碍,1例急性起病,5例亚急性或慢性起病.2例呈进行性病程,无明显波动,4例病程中病情有明显波动.脊髓磁共振检查(magnetic resonance imaging,MRI)全部病例均见到脊髓轻度增粗和髓内弥漫性长T<,2>异常信号灶,4例脊髓表面尤其是背侧可见到迂曲血管流空影,腰骶段受累病例更加明显.6例均行脊髓数字减影血管造影(digital subtraction angiography,DSA)检查,见到供血动脉形成的动静脉瘘口以及明显蜿蜒迂曲延长的引流静脉从而确诊本病.全部6例患者的临床体征水平与影像学上病变水平均不甚一致,影像学表现重于临床.4例患者接受了1～3次的介入拴塞治疗,其中3例取得较好疗效,但这3例患者均有复发.结论 SDAVF有其临床和影像学特点.男性中老年患者多见,主要为胸段脊髓或腰骶段脊髓、神经根的症状体征,下肢感觉异常、疼痛、步态异常或运动障碍、尿便和性功能障碍均是常见的临床表现,可先后受累.病程可呈慢性进展,可在波动中进展,也可以进展中有波动.脊髓MRI检查对于本病的诊断可有提示.及早规范的血管栓塞或手术治疗可能取得较好疗效.

<正>多系统萎缩(multiple system atrophy,MSA)是一组病因不明的,累及锥体外系、锥体系、小脑和自主神经等多系统的神经系统变性病,分为MSA-P(帕金森症状突出)和MSA-C(小脑症状为主)两型。MSA临床症状复杂,不同亚型之间症状重叠,加之病理取材困难,早期诊断颇具挑战。临床结

Objective To investigate the characteristics of health related quality of life(HR-QOL) in Chinese patients with early Parkinson' s disease(PD), to identify the motor and non-motor factors that are associated with a poorer quality of life in patients with early PD. Methods All 391 patients with early PD were identified in a clinical-based study. Motor functions were measured by Unified Parkinson' s Disease Rating Scale (UPDRS) and Hoehn-Yabr Scale. Non-motor variables were assessed by Center of Epidemiological Survey Depression Scale (CES-D) for depressive symptoms, Pittsburg Sleep Quality Index (PSQI) for sleep disturbance, Fatigue Severity Scale (FSS) for fatigue, Alzheimer' s Disease Assessment Scale-Cognitive Sections (ADAS-Cng) for cognitive function, and Constipation Severity Scale for constipation. HR-QOL was measured by SF-36. Motor and non-motor variables were collected at the baseline assessment of a clinical trial and determined during a structured interview and by clinical examination by movement disorder specialists. The results were compared with those in healthy elderly people. Multiple regression analyses were used to determine which variables were strongly associated with lower levels of quality of life. Results Patients with early PD had a lower score on all dimensions of SF-36, except bodily pain dimension. Motor factors, particular physical disability and disease severity, contributed to decreased HR-QOL, but to a lesser extent. The motor score of the UPDRS (23. 8±11.8), Hoehn-Yahr stage(2. 0± 0.7), together with the rigidity score (4.4 ± 3.1), only accounted for 18.9 % (R2=0. 189) of the variance of SF-36 total score. The variables that most strongly predicted a low total SF-36 score were non-motor factors, particularly depressive symptoms, sleep disorders and fatigue. When the CES-D, FSS, and PSQI score were included in the model, the R2 increased from 0. 189 to 0.617, indicating that 61.7% of the variance in HR-QOL could be explained if additional CES-D, FSS and PSQI scores were known. Depressive symptoms, as measured by CES-D, had an overwhelming impact on HR-QOL. When CES-D score was included, the R2 change was 0.433, which indicated that additional 43.3% of the variability in HR-QOL could be explained by adding depressive symptoms. Conclusions PD has a substantial impact on HR-QOL, even if in its early stage. Depressive symptoms, sleep disorders and fatigue correlated strongly with lower quality of life. Depressive symptoms appeared to be the strongest determinant of HR-QOL in early PD patients. Every effort should be made to recognize and treat these conditions, thus improving all aspects of PD and giving these patients as good a quality of life as possible.

Objective To investigate the impact of non-motor symptoms(NMS)on health related quality of life(HRQOL)in patients with early Parkinson disease(PD).Methods Three hundred and ninety-one patients with PD,non-motor symptoms were evaluated by rating scales,including National Institute of Health(NIH)Center for Epidemiologic Studies Depression Scale(CES-D),Pittsburgh Sleep Quality Index(PSQI),Fatigue Severity Scale(FSS),Alzheimer Disease Assessment Scale-Cognitive Subscale(ADAS-Cog) and Constipation Severity Scale(CSS).HRQOL was evaluated by Medical Outcomes Study 36-Item Short-Form Health Survey(SF-36).Multiple regression analysis was used to examine the relationship of these non-motor symptoms and HRQOL,as measured by the SF-36.The total score of SF-36 was compared between the patients with and without these non-motor symptoms as well.Results A total of 146 patients(37.34%)were screened positively for depression,214(54.73%)for sleep disorder,157(40.15%)for fatigue,136(34.78%)for memory disorder and 182(46.55%)for constipation.Patients with depression(t=18.469,P=0.000),sleep disorder(t=7.411,P=0.000),and fatigue(t=3.992,P=0.000)had significantly lower SF-36 total score than those without these features.No significant differences of total SF-36 score were seen among patients with and without memory disorder(t=1.234,P=0.221)and those with and without constipation(t=2.032,P=0.051).Multiple regression analysis revealed that depression(measured by CES-D),sleep disorder(measured by PSQI)and fatigue(measured by FSS)increased the ability to explain the variance of SF-36 total score from 27.70%to 64.90%.Additionally,the application of CES-D could predict not only the decreasing of SF-36 total score but also each sub-dimension score of SF-36.Conclusion Non-motor symptoms are common in early PD patients.Depression,sleep disorder and fatigue correlate strongly with the worsen of HRQOL.Depression has a substantial impact on HRQOL,which is the strongest predictive factor for the worsen of HRQOL.Our results highlight the broad importance of recognizing and treating these non-motor symptoms in PD patients in the early stage.

Objective: To identify the motor and non-motor factors that are associated with health related quality of life (HR-QOL) in a subgroup of Parkinson's disease (PD) patients with Levodopa therapy in early clinical stages.Methods: 391 Levodopa exposed patients were evaluated during the baseline assessment of a clinical trial in China. HR-QOL was measured by the Short Form 36 (SF-36). Motor and non-motor variables were determined during a structured interview and by clinical examination by movement disorder specialists. Multiple regression analyses were used to determine which variables were associated with low levels of HR-QOL.Results: Even if excluding non-motor variables from the regression model, motor factors, particularly motor deficits (measured by motor score of UPDRS), rigidity (measured by item 22 of UPDRS), and disease severity (measured by Hoehn&Yahr scale), explained only 18.9% of the variance of total SF-36 score. Whereas, when non-motor variables were included in the model, especially depression (measured by CES-D), sleep disturbances (measured by PSQ-1). and fatigue (measured by FSS), 61.7% of the variance of SF-36 score Could be explained. Two motor variables, UPDRS motor score and Hoehn&Yahr score, were also contributed to the model, however, the 95% confidence intervals (CIs) of these two motor factors were wide and included the null value (CIs -0.282, 0.019 for UPDRS motor score, and CIs -4.043, 0.856 for Hoehn&Yahr score). Neither, did higher daily levodopa dose contribute significantly to both models predicting SF-36 score.Conclusions: In our sample patients with levodopa therapy, motor disability and severity of parkinsonism contributed to a lesser extent to patients' self-report distress, within the first 5 years of disease onset. The clinical factors that showed the highest predictive value for worsen HR-QOL were non-motor symptoms, such as depression, sleep disorders, and fatigue. Great effort should be made to recognize and treat those conditions, thus improving all aspects of PD and giving these patients as a good HR-QOL as possible. (C) 2009 Elsevier Ltd. All rights reserved.

Objective: To investigate the impact of depressive symptoms on health-related quality of life (HR-QOL) in a group of patients with early Parkinson's disease (PD).Methods: A 20-item scale, the Center for Epidemiologic Studies Depression Scale (CESD) and a 36-item questionnaire, the medical outcomes study short form (SF-36) were administered as part of baseline assessment of a clinical trial in PD, enrolling 391 early-stage, L-dopa exposed PD patients in China. We used multiple regression models to examine the relationship of depressive symptoms, measured by the CESD with HR-QOL, as measured by the SF-36. The SF-36 score of the depressed patients was compared with those non-depressed, as well.Results: A total of 146 (37.3%) patients screened positive for depression. Compared with those non-depressed, depressed patients had lower scores in all dimensions of SF-36 profile (p < 0.001). Multiple regression analysis revealed that depressive symptoms, measured by CESD, increased our ability to explain the variance of SF-36 total score by 34.5%. Additionally, depressive symptom is the only variable which has the predictive value not only for total SF-36 total score, but also for each subdimension score of SF-36 profile.Conclusion: Depressive symptoms are common early in the disease, having a substantial impact on patients' HR-QOL, affecting many areas other than the obvious mental health dimension of the HR-QOL profile. Our results highlight the broad importance of treating depression in this population. Published by Elsevier B.V.