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一项新研究结果显示，发生在进展性巴金森氏症（PD）之后的精神症状，对于早期至中期疾病生活品质的影响比后期大。
巴尔的摩马里兰大学助理教授与马里兰巴金森氏及运动异常中心Karen E. Anderson医师表示，这些发现是预期外的，因为他们已经预期精神症状会对于较后期疾病的生活品质有较大的影响。
Anderson医师向Medscape精神/神经与神经外科表示，似乎在中期，或许当病患开始发展出平衡的问题、或是开始发现他们服用的药物没有那么有效，或有开关效应时，正是忧郁、焦虑、或是身心疾病开始有影响的时候，且这些影响在初期疾病阶段较大，当这些病患开始接受罹患这种疾病的时候。
他们的发现发表在第132届美国神经医学会的年会中。
【随着疾病进程复制】
作者表示，PD的精神症状过去已经被认为与生活品质下降有关；然而，这些症状在于不同时期PD的影响仍然是未知的。
Anderson医师表示，我对于这项研究的预测是，如果你有精神方面的疾病，例如忧郁、焦虑、或是身心疾病，像嗜睡、胸痛或是呼吸短促，这在疾病后期将会是很大的负担；我们的想法是，在早期PD的阶段，我们有药物可以非常有效地控制神经症状，所以如果你在早期发生精神症状，或许你可以应付地比较好，因为此时，神经症状并非那么的难以控制；在疾病后期，这可能合并了原本就已经有的不适，且使得每件事都变得比较困难。
他们使用简短症状记录（BSI）来评估一群PD病患的情绪症状，以及使用SF-12健康调查来评估生活品质；后面这项工具有两种针对生理及心理生活品质的评量，他们表示，生理健康扼要分数包括生理功能、完成一项社交角色的能力、身体上的疼痛、以及整体健康评量；作者写道，精神健康扼要分数评量活力、社交功能、与角色－情绪以及精神健康事项。
其样本包括725位PD病患，其中657位病患有BSI数据，疾病的评估包括Hoehn & Yahr（H&Y）分数、整体联合巴金森氏症疾病评分指数（UPDRS）与UPDRS运动评分。
Anderson医师表示，基本上，我的假设并未成真，精神症状并未对后期疾病产生较大的影响，但对较中期，例如H&Y分期第2~3期疾病病患有较大的影响。
她表示，在较中期的疾病进程，有很高的关连性，所以如果你有忧郁、焦虑、身心症状，你的生理健康生活品质相较于没有这些高程度的症状的人是更差的；在疾病后期，我们确实发现这之间关连性不再、且没有那么强烈，所以这对我们来说是有点疑惑的，对于疾病中期来说，这显然是个更大的负担。
在所有分期中，精神症状分数较高与精神健康生活品质相关，除了第5期之外。
SF-12生理与精神生活品质与精神症状负担之间的关连，以PD疾病分期区分
|
Hoehn & Yahr 分期 |
SF-12 生理健康生活品质相较于精神症状负担 |
SF-12 精神健康生活品质相较于精神症状负担 |
|
1
|
0.00
|
-0.61 c
|
|
2
|
-0.30 c
|
-0.60 c
|
|
2.5
|
-0.34 c
|
-0.55 c
|
|
3
|
-0.24 b
|
-0.61 c
|
|
4
|
0.00
|
-0.59 c
|
|
5
|
-0.40 a
|
-0.33
|
Psychiatric Symptoms Have Greater Impact in Early vs Late PD
By Susan Jeffrey
Medscape Medical News
A new study suggests that psychiatric symptoms that appear in tandem with advancing Parkinson's disease (PD) have a bigger impact on patients' quality of life in the early to middle stages of disease compared with later stages.
Karen E. Anderson, MD, assistant professor of psychiatry and neurology at the University of Maryland in Baltimore and the Maryland Parkinson's and Movement Disorders Center, said that these findings were unexpected, since they had anticipated that psychiatric symptoms would have a greater effect on quality of life later on in the disease process.
"It seems that the middle stages, perhaps when people are starting to develop balance problems or starting to find that their medication is not working so well or wearing off, is actually where the depression, anxiety, or somatization has a greater effect, more than in the later stages, when maybe they've come to terms with having the disease or are more accepting of it," Dr. Anderson told Medscape Psychiatry/Neurology & Neurosurgery.
Their findings were presented here at the 132nd Annual Meeting of the American Neurological Association.
Coping With Disease Progression
Psychiatric symptoms in PD have previously been associated with reduced quality of life, the authors write. However, the relative impact of these symptoms at various disease stages is not clear.
"My prediction in this study was that if you had psychiatric illness — depression, anxiety, or somatic symptoms like dizziness, chest pain, or shortness of breath — it would be a greater burden later on in Parkinson's disease," Dr. Anderson said. "The thought being that early on in PD, we have medications that treat the neurological symptoms very effectively, so if you develop a psychiatric illness early on, perhaps you could cope with it better because the neurological symptoms are not so overwhelming. Later on in the disease, it might just compound the difficulty they're already having and make everything more difficult."
They used the Brief Symptom Inventory (BSI) to assess emotional symptoms in a cross-sectional sample of PD patients, and the SF-12 Health Survey to assess quality of life. This latter tool yields 2 summary measures of physical and mental quality of life. The Physical Health Summary Score includes physical functioning, ability to fulfill one's social role, bodily pain, and general health items, they note. The Mental Health Summary Score rates vitality, social functioning, and role-emotional and mental health items, the authors write.
The sample included 725 PD patients; BSI data were available for 657 of these patients. Disease measurements included Hoehn & Yahr (H&Y) scores, total Unified Parkinson's Disease Rating Scale (UPDRS), and UPDRS motor ratings.
"Basically, my hypothesis was not borne out," Dr. Anderson said. Psychiatric symptoms did not appear to have a greater impact later in the disease but rather in the middle stages, H&Y stages 2 to 3 inclusive.
"In the middle stages of disease, there was a very high correlation — so if you have depression, anxiety, somatization symptoms, your physical-health quality of life is significantly worse than someone who doesn't have such a high level of those symptoms," she said. "Later in the disease, we actually found that correlation went away or was less strong. So that was somewhat puzzling to us, that in the middle stages it appears to be a bigger burden."
Higher scores for psychiatric symptoms correlated with mental-health quality of life in all stages except stage 5.
Correlation of SF-12 Physical and Mental Health Quality of Life with Burden of Psychiatric Symptoms by PD Stage
|
Hoehn & Yahr Stage |
SF-12 Physical Health Quality of Life vs Psychiatric Symptom Burden |
SF-12 Mental Health Quality of Life vs Psychiatric Symptom Burden |
|
1 |
0.00 |
-0.61c |
|
2 |
-0.30c |
-0.60c |
|
2.5 |
-0.34c |
-0.55c |
|
3 |
-0.24b |
-0.61c |
|
4 |
0.00 |
-0.59c |
|
5 |
-0.40a |
-0.33 |
A comparison of normal vs high total psychiatric burden showed that only in H&Y stage 2 was there a significant difference between patients with normal vs high emotional symptoms and a reduced physical quality of life, they note.
Their results suggest that quality-of-life impairment should be considered earlier in the disease course than some neurologists may otherwise think, Dr. Anderson said.
"If you have a patient who's depressed, and they're starting to have their medication not work so well or starting to develop balance problems, those are the people who you really need to watch and maybe do an intervention for mental health sooner than you might think," she concluded. "Just treating the motor symptoms may not give you the full impact of what you can do compared with treating both motor and psychiatric symptoms."
The study was supported by the Rosalyn Newman Foundation. The authors report no conflict of interest.
132nd Annual Meeting of the American Neurological Association: Abstract M-70. Presented October 8, 2007.