The Clinical Research Of Non-motor Symptoms Of Parkinson's Disease

Parkinson's disease(PD)is a common chronic progressive neurodegenerative disorder that occurs in middle and old age.The main clinical symptoms are bradykinesia,rigidity,resting tremor,and postural instability.Studies have shown that PD patients suffer a special movement disorder combined with non-motor symptoms(NMS),such as depression,anxiety,hyposmia,sleep disorders,sensory disturbance,salivation,dysphagia and constipation.The mechanism of the non-motor symptoms of Parkinson's disease is still unclear.Researches conducted by Bank find that the pathological changes of Lewy bodies and processes in imbic and neocortical areas such as the olfactory bulb,olfactory nucleus,raphe nucleus,locus coeruleus,pedunculopontine nucleus,dorsal nucleus of the vagus nerve,nucleus,ventrolateral nucleus,and ventromedial nucleus,are related to the non-motor symptoms like the sense of smell,sleep,autonomic nerve,nerve and mental disorders respectively.More and more evidence shows that Parkinson's disease involves not only the dopaminergic neurons in the substantia nigra and striatum,but also in other parts of the dopaminergic system,and 5-serotonin,norepinephrine,nitrogen,cholinergic system and peptide neurotransmitter system like dynorphin and enkephalin.The damage of these systems may possibly be related to the occurrence of non-motor symptoms.Based on the clinical studies on non-motor symptoms of Parkinson's disease,this paper investigates the incidence,clinical features and influencing factors of non-motor symptoms associated with Parkinson's disease,with the aim to provide theoretical basis for clinical treatment of PD patients,and to further improve the quality of life of patients.Part ? 30 cases of Parkinson's disease Quantified Olfactory FunctionObjective Research the relationships between dysosmia,age,duration of disease,and severity of the disease(H&Y hierarchical,UPDRS scale)of patients with Parkinson's disease(PD).Methods Using quantitative T&T smell program lfactometry,by compareing odor thresholds between 30 cases of Parkinson's disease(PD)patients and 60 cases of the healthy(control group),to analysis the relationships.Results dysosmia of PD group compaired with that of the control group,the respective incidence was 93.3 % and21.5%,it was of significant difference(P < 0.001);Double variable relationship indicated that:duration of disease,UPDRS scale and age has no obvious relationship with olfactory sensation,while H&Y hierarchical correlated with dysosmia.Conclusion Dysosmia occured to PD patients,it had nothing to do with duration of disease,UPDRS scale and age,but correlated with pathogenetic condition(H&Y hierarchical).Part ? Study of sleep disorder in patients with Parkinson's diseaseObjective To study the clinical traits of disorders and sleep structures in Parkinson's disease,and the influencing factors in patients of Parkinson disease.Methods Use PDSS and polysomnographic(PSG)to detect 40 PD patients and 42 healthy controls,and analyze the relationships between sleep structure disorders and age,duration,H-Y(revised)grading,dopamine drugs dose etc.Results Sleep disorders in PD group included difficulty in the initiation of sleep,early awakening,fragment sleep,restless legs syndrome,nap in the day,nightmare et al.It was corrected with H-Y(revised)grading.PD patients' total sleep time(TST),sleep efficiency(SE)and rapid eye movement sleep time(REMS)were lower than those in control group(P < 0.05);but their sleep latency(SL),awakening index(AI),REM sleep latency(RL)were higher(P < 0.05);the sleep proportions of phase1,and phase 3 and 4 in PD patients were lower than those in control group(P < 0.05),and phase 2 sleep in contrast with the control,the difference was not statistically significant(P > 0.05).The relationships in PD patients manifested SL?AI?RL and duration?H-Y(revised)3~5 grading?madopar dose(>375mg/d)were positive related(r=0.349~ 0.963,P<0.05~0.01),TST,SE,REMS and duration,H-Y(revised)3~5 grading,madopar dose(>375 mg/d)were negative related(r=-0.606~-0.336,P<0.05~0.001),and madopar dose(<375mg/d)were positive related.But the correlation between age and TST and SL,SE,AI,REMS had no statistical significance(P> 0.05).Conclusion There exist abnormal sleep structure in early stage of PD patients,which can be reflected in decreased SE?prolonged SL?lower TST and increased AI,those were correlated with H-Y(revised)grading,duration,dopamine drugs dose.Part ? Clinical study of depression with Parkinson's diseaseObjective To Study the incidence,clinical characteristics and related factors of depression in Parkinson's disease.Methods 35 patients with Parkinson's disease(PD group)and 32 healthy patients(normal group)were assessed by Application of Hamilton Depression Rating Scale(HAMD),to study the incidence of depression,clinical characteristics in PD patients and the relationship between the PD patients with depression and age,duration,Hoehn-Yahr grade,UPDRS score.Results The HAMD score in PD group is higher than that in normal,the incidence of depression is 51.4% in the former;The main features of depression in PD patients showed somatic anxiety,obsessive-compulsive symptoms,sleep disorders,hopelessness,inferiority complex,cognitive disorder,retardation,etc.Bivariate correlation analysis showed that depression in PD group was positively related with the severity of disease condition(HY classification),duration,UPDRS(Part I)score and UPDRS(Part III)score,while had no clear relationship with age and UPDRS(Part ?)score.Conclusion The incidence of depression in PD patients was high,and there were many forms of clinical manifestations,the extent of that was corelated with disease severity,UPDRS(Part I)score and UPDRS(Part III)score.Part ? The incidence and related factors of Parkinson's disease with cognitive dysfunctionObjective To Study the incidence,clinical characteristics and related factors of cognitive dysfunction in Parkinson's disease.Methods 52 patients with Parkinson's disease(PD group)and 58 healthy patients(normal group)were assessed by Application of Hamilton Depression Rating Scale(Mo CA),to study the incidence of cognitive dysfunction,clinical characteristics in PD patients and the relationship between the PD patients with cognitive dysfunction and age,duration,Hoehn-Yahr grade,UPDRS score.Results The Mo CA score in PD group is lower than that in normal(t=8.036,P=0.000),the incidence of cognitive dysfunction is 57.7% in the former(?2=19.200 P=0.000);The main features of cognitive dysfunction in PD patients showed attention and concentration,executive functions,memory,delayed recall,language skills,visual ability,abstract thinking and ability of orientation,retardation,etc.Logistic regression analysis showed that cognitive dysfunction in PD group was positively related with the severity of disease condition(H-Y classification),duration,UPDRS(Part I)score and UPDRS(Part ?)score(OR:5.464,6.172,1.138,1.305;95%CL:1.915~10.136,0.068~0.872,1.017~1.358,1.316~11.014).Conclusion The incidence of cognitive dysfunction in PD patients was high,and there were many forms of clinical manifestations,the extent of that was corelated with disease severity and UPDRS score.