帕金森病患者抑郁与认知障碍相关性的纵向研究

A longitudinal study on the correlation between depression and cognitive impairment in patients with Parkinson’s disease

摘要

目的：探索帕金森病（Parkinson’s disease，PD）患者抑郁和认知障碍的纵向变化规律及其影响因素，检验两者的双向预测关系，初步分析药物对抑郁和认知障碍的修饰作用。方法：纳入86例初诊未治疗的特发性PD患者，并在初诊（基线）和随访时接受运动症状和非运动症状评估，包括统一帕金森病评定量表第3部分用于评估运动症状、汉密尔顿抑郁量表用于评估抑郁症状、蒙特利尔认知评估量表用于评估认知功能。采用Spearman相关性分析初步筛选与PD患者抑郁症状和认知障碍有关的临床特征，通过广义线性模型分析认知障碍与抑郁症状纵向变化之间的关联。结果：PD患者运动症状加重，抑郁症状呈现出动态转换的特征。运动症状和其他非运动症状（焦虑、睡眠）在不同抑郁程度组间的差异有统计学意义，轻度认知障碍患者主要表现在视空间与执行功能及延迟记忆方面的损害。多巴胺能药物治疗对抑郁和认知功能的影响不具有统计学意义。认知障碍和抑郁症状具有同向变化的特征，且存在双向预测效应。结论：PD患者的抑郁症状呈现动态转变，焦虑和睡眠障碍可能是PD抑郁筛查的重要指标，认知障碍与抑郁症状具有双向预测效应。多巴胺能药物治疗对认知和抑郁症状未表现出改善作用。

Abstract

Objective：To explore the longitudinal patterns and influencing factors of depression and cognitive impairment in patients with Parkinson’s disease（PD），verify their bidirectional predictive relationship，and preliminarily analyze the modifying effects of medication on depression and cognitive impairment. Methods：A total of 86 de novo drug-naïve patients with idiopathic PD were enrolled and assessed for motor and non-motor symptoms at initial consultation（baseline）and follow-up，including the Unified Parkinson’s Disease Rating Scale part Ⅲ for motor symptoms，Hamilton Depression Rating Scale for depressive symptoms，and Montreal Cognitive Assessment for cognitive function. Spearman correlation analysis was used to preliminarily screen clinical characteristics associated with depressive and cognitive impairment in PD，and generalized linear models were used to analyze the associations between longitudinal changes in cognitive impairment and depressive symptoms. Results：Patients’ motor symptoms significantly deteriorated，while depressive symptoms exhibited dynamic conversion characteristics. Motor symptoms and other non-motor symptoms（anxiety，sleep disturbances）demonstrated statistically significant differences across groups stratified by varying degrees of depression severity. Patients with mild cognitive impairment primarily exhibited impairments in visuospatial and executive functions and delayed memory. Dopaminergic medication showed no significant effects on depression or cognitive function. Cognitive impairment and depressive symptoms showed synchronous changes and had bidirectional predictive effects. Conclusion：Depressive symptoms in PD patients exhibit dynamic progression patterns. Anxiety and sleep disturbances may serve as critical indicators for depression screening in PD. There exists a bidirectional predictive relationship between cognitive impairment and depressive symptoms. Dopaminergic drug therapy fails to improve cognitive function and depressive symptoms.

关键词

帕金森病 / 抑郁 / 认知障碍 / 纵向研究

Key words

Parkinson’s disease / depression / cognitive impairment / longitudinal study

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基金资助

国家自然科学基金(82371268)