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Clinical Study Of Sleep Disorder And Its Effect On Cognitive Function In Patients With Parkinson’s Disease

Posted on:2024-08-11Degree:DoctorType:Dissertation
Country:ChinaCandidate:H M LiuFull Text:PDF
GTID:1524307295461214Subject:Neurology
Abstract/Summary:PDF Full Text Request
Parkinson’s disease(PD)is a degenerative disease of the central nervous system with a positive correlation with ageing,affecting more than 1.37% of older adults worldwide.It is generally believed that PD mainly affects the motor function of patients,but more and more studies have found that PD is a multi-dimensional disease,including a variety of non-motor symptoms: sleep disorders,cognitive dysfunction,autonomic dysfunction,olfactory loss,constipation,mental abnormalities,paresthesias.A variety of non-motor symptoms predate the clinical diagnosis of Parkinson’s disease and continue throughout the course of Parkinson’s disease,generally worsening as motor symptoms worsen.Sleep disorders are one of the most common non-motor symptoms of PD,such as rapid eye movement sleep behavior disorder(RBD),excessive daytime sleepiness(EDS),restless legs syndrome(RLS),periodic leg movements(PLM)or sleep-related breathing disorders(SBD),insomnia.SBD is dominated by obstructive sleep apnea hypopnea syndrome(OSAHS),which affects the quality of life of PD patients seriously.The regulation of sleep and wakefulness relies on the comprehensive regulation of multiple neurotransmitters and multiple brain regions,including multiple Parkinson’s disease-related neurotransmitters such as serotonin(5-HT),dopamine(DA)and norepinephris(NA).In addition to regulating sleep,these neurotransmitters may also be associated with cognitive dysfunction in people with Parkinson’s disease.Studies have found a correlation between sleep disorders and cognitive decline.Some studies have found a variety of factors associated with PD cognitive dysfunction,including sleep disturbances,bradykinesia,prolonged duration of symptoms,rapid worsening of symptoms,etc.Other factors associated with cognitive decline,such as age,sex,course,clinical manifestations,antiparkinson’s drugs,have been reported differently.Therefore,it is necessary to conduct in-depth research on the sleep disorders of Parkinson’s disease patients and their impact on cognitive function,in order to identify the sleep disorders of Parkinson’s disease early and give effective intervention as soon as possible,delay the occurrence and development of cognitive dysfunction in Parkinson’s disease patients,delay the development of patients’ disease and improve the quality of life of patients.Sleep disorders and cognitive impairment are the most common non-motor symptoms in patients with PD,and they are closely related to motor symptoms and a variety of other non-motor symptoms.Therefore,this project studies the clinical features,structural features of sleep disorders,changes in polysomnography parameters,and their relationship with changes in cognitive function in patients with PD associated with sleep disorders.Part one Research on the structural characteristics and influencing factors of sleep disorders in Parkinson’s diseaseObjective: The incidence,sleep structure characteristics and influencing factors of sleep disorders in patients with Parkinson’s disease were discussed,and this paper was used for early clinical diagnosis and intervention.Methods: From August 2016 to April 2022,101 PD patients who attended the outpatient and inpatient department of neurology of the First Hospital of Hebei Medical University were selected as the study subjects.Demographic data of all PD patients were analysed.UPDRS-III.and H-Y stages were used to evaluate motor function and disease severity.PD patients were tested on the PSQI scale,ESS scale,IRLS scale,RBD scale,and measured the patient’s height,weight,BMI,neck circumference,abdominal circumference,and past medical history,and all patients received standardized nocturnal polysomnography monitoring.Results: 1.87(86.14%)of 101 PD patients had sleep disorders,sleep disorders were common in non-motor symptoms of Parkinson’s disease.2.Sleep disorders commonly found in patients with PSG include RBD,PLM,and OSAHS.3.The proportion of REM sleep in PD-RBD patients was(13.14±8.11%)%,and the subjective sleep quality was poor and accompanied by obvious depression.4.PLM in PD patients is easy to appear at the same time with RLS.5.PD-OSAHS is more likely to occur in PD patients with large neck and abdominal circumference,and there is no obvious correlation with BMI value,and EDS is more common in PD-OSAHS patients,which has a greater impact on patients’ daytime function.Conclusions: The incidence of sleep disorders in PD patients is high,PD patients with sleep disorders are mostly manifested as RBD,PLM and OSAHS,PD-RBD patients have poor sleep quality and accompanied by obvious depression,and PD-OSAHS patients are more common daytime.PD-OSAHS is more likely to occur in patients with PD with large neck and abdominal circumference,and there is no significant correlation with BMI value.Part two Analysis of sleep structure characteristics of Parkinson’s disease RBD and idiopathic RBDObjective: The sleep structure characteristics and influencing factors of patients with RBD with Parkinson’s disease and idiopathic RBD were discussed,and patients with Parkinson’s disease with RBD were divided into two groups before and after the appearance of motor symptoms in a controlled study,in order to clarify the characteristics of RBD in each stage of the occurrence and development of Parkinson’s disease.Methods: From August 2016 to April 2022,26 patients with Parkinson’s disease and 19 patients with iRBD diagnosed with RBD were diagnosed with PSG who were admitted to the outpatient and inpatient department of neurology of the First Hospital of Hebei Medical University from August 2016 to April 2022.Demographic data of all patients,including sex,age,years of schooling,BMI,neck circumference,abdominal circumference,age of onset,and course of disease were analyzed.All study subjects were evaluated on the Pittsburgh Sleep Quality Index(PSQI),Epworth Sleepiness Scale(ESS),and RBD Screening Questionnaire(RBDSQ)to assess subjective sleep.All patients received standardized nocturnal polysomnography monitoring.Results: 1.The PSG of iRBD and PD-RBD patients showed that the proportion of REM sleep was reduced and the latency period of REM sleep was prolonged.2.PSG showed that the PLMI index of iRBD patients was(27.84±50.53)and that of PD-RBD patients was(16.34±20.92),and the difference between the two groups was statistically significant(P=0.025).3.The PLMI index of PD patients with RBD before motor symptoms was(38.59±17.95)and that of PD patients with RBD after motor symptoms was(16.09±16.19),and the difference between the two groups was statistically significant(P=0.0001).Conclusions: Patients with iRBD self-reported higher severity of RBD,more aware of their abnormal sleep behavior,and more male,lower age of onset,and shorter duration of RBD;Patients with PD-RBD have lower PLMI than patients with iRBD.The PLMI index of patients with PD who had RBD before motor symptoms was also significantly higher than that of PD patients after motor symptoms.Part three A study on the relationship between sleep disorders and cognitive function in Parkinson’s diseaseObjective: To explore the correlation between sleep disorders and cognitive function in Parkinson’s disease,and to observe and analyze the impact of RBD on various cognitive domains of Parkinson’s disease patients.Methods: A total of 36 patients with Parkinson’s disease who were hospitalized in our hospital from March 2019 to January 2023 were selected for nocturnal polysomnography confirmed to have sleep disorders,and all patients were tested for neuropsychiatric conditions.Demographic data of all patients,including sex,age,years of schooling,BMI,neck circumference,abdominal circumference,age of onset,and course of disease were analyzed.Parkinson’s disease motor symptoms were assessed for all study participants: UPDRS-Ⅲ,Hoehn-Yahr(H-Y)grades,cognitive function assessment: Simplified Mental Status Test Scale(MMSE)and Montreal Cognitive Assessment Scale(Mo CA),Sleep Assessment: REM Sleep Behavior Abnormal Screening Scale(RBDSQ),Epworth Sleepiness Scale(ESS),Pittsburgh Sleep Quality Index Scale(PSQI),Nocturnal Polysomnography(PSG).Results: 1.Decreased executive function in PD patients was associated with higher RBD score and PLMI index.2.The cognitive decline of PD-RBD patients was more obvious than that of PD-n RBD patients,and there were significant differences in visual space and executive function and abstract function decline.3.The decline of cognitive function was more obvious in PD patients with RBDSQ≥6,and the decline in total Mo CA score,visual space and executive function and abstract function was significantly different than that in PD patients with RBDSQ<6.4.Cognitive decline in PD patients with RBD patients is more obvious,and RBDSQ≥6 is consistent with the damage to the cognitive domain of RBD patients confirmed by PSG,suggesting that RBDSQ can be used to evaluate and predict cognitive impairment in PD patients.Conclusions: RBDSQ≥6 score was consistent with cognitive domain impairment in PD patients diagnosed with RBD,suggesting that RBDSQ can be used to evaluate and predict cognitive impairment in PD patients.
Keywords/Search Tags:Parkinson’s disease, Sleep disorders, Polysomnography, REM stage sleep behavior disorder, Cognitive function
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