Studies Of Polysomnography And Preliminary Studies Of 1h-magnetic Resonance Spectroscopy In Patients With Parkinson's Disease Depression

Parkinson's disease (PD) as a degenerative disease of the central nervous system is common in the elderly population. In 1817, English Doctor James Parkinson reported this disease as"paralysis agitans"for the first time. During more than 190 years, medical scientists have made series of success in its ethic, pathology, pathogenesis, clinical symptoms, diagnosis, treatment, et al. Now, its symptoms are divided into two series: (1) motor symptoms: resting tremor, muscle rigidity, bradykinesia, posture balance disorder, and so on, which were known in the early time; (2) non-motor symptoms: emotion disorder, sleep disorder, cognitive disorder, sense symptoms,et al. Parkinson's disease depression(PDD) , with incidence rate about 40%-70%, could aggravate the PD patient's sleep disorder. The ethic, neuropathogenesis and neurobiochemic of Parkinson's disease non-motor symptoms is not yet clear today.[Objective](1)Use the whole night polysomnography (PSG) to study the charateristics of PDD patients's sleep disorder about clinical and electrophysiological features; and futher to compare with PDND patients's sleep disorder(;2)To study the neurobiochemical pathogenesis with 1H-MRS displaying the chief metabolic changes in PD patients's vivo brain; and futher to compare PDD with PDND about the chief metabolic changes in vivo brain.[Method](1)28 patients up to the standard were included.To assess the PD patients using the Unified Parkinson disease rating scale (UPDRS), Hoehn-Yahrr state(H&Y),Pittsburgh sleep quality index(PSQI), Epworth sleepiness scale(ESS), Hamilton depression scale(HAMD), Hamilton anxiety scale(HAMA), Mini-mental state examination(MMSE),et al. PD patients will be divided into two groups according to HAMD scores,17 PD patients in PDD groupe and 11 PD patients without depression in PDND groupe, which were matched with gender, age and duration of disease. PDD group was divided into PDD anti-depression group (9 patients) and PDD non-anti-depression group (8 patients).Two-time monitoring of the whole night PSG were performed respectively in the foregoing groups. The PSG results of the 2nd night were compared. The characteristics of all PD patients including sleep architecture, process parameter and abnormal behaviors of sleep were analyzed, and made comparisons and analysis of these index between PDD and PDND groups; (2)22 patients up to the standard were included in the PD group, and to assess the PD patients using the Unified Parkinson disease rating scale (UPDRS), Hoehn-Yahrr state(H&Y),Pittsburgh sleep quality index(PSQI), Epworth sleepiness scale(ESS), Hamilton depression scale(HAMD), Hamilton anxiety scale(HAMA), Mini-mental state examination(MMSE),et al. 8 non-PD patients were recruited as the control group, which matched the PD group with gender and age. PDD group was divided into PDD anti-depression group (7 patients) and PDD non-anti-depression group (7 patients). To scan the brain hippocampus using the single voxel 1H-MRS in both PD and control subjects.To analysis the chief metabolic changes, and made comparisons and analysis between the PD group and the non-PD group, also between the PDD anti-depression group and PDD non-anti-depression group.[Results](1)PDD patients had PSG characteristics of long sleep latency, short total sleep time, somnolence increased, less N3 sleep, long R sleep latency, long arousal time. Compared with PDND group, the non-anti-depression group had PSG characteristics of longer sleep latency, shorter N3 sleep, longer arousal time, low sleep efficiency, short N1 sleep and shrot N2 sleep. Compared with PDND group , the anti-depression group had PSG characteristics of long total sleep time, high sleep efficiency, long N2 sleep, short N3 sleep, less stage shifts, short arousal sleep time, R sleep obviously decresed. There was significant statistical difference between the PDD group and the PDND group in R sleep decrease(P<0.05), but not in other foregoing index(P>0.05);(2)Compared with the non-PD group, a NAA/Cr and NAA/Cho ratios decline trend was found in the hippocampus in PD group in the focus of disease, but the Cho/Cr ratio has a ascended trend. In PD group, compared with the normal side, there was a NAA/Cr and NAA/Cho ratios decline trend in the hippocampus in the focus of disease, but the Cho/Cr ratio has a ascended trend. Compared with the PDND group, there was a NAA/Cho ratios decline trend in the hippocampus, but no NAA/Cr decreased or Cho/Cr ascended; the PDD anti-depression group had a higher NAA/Cr ratio and Cho/Cr ratio, lower NAA/Cho ratio than PDD non-anti-depression group in the hippocampus. There was no significant statistical difference in the foregoing index (P>0.05).[Conclusions](1)PDD patients had PSG characteristics of long sleep latency, short total sleep time, low sleep efficiency, somnolence increased, less N3 sleep, short R sleep or long R sleep latency, long arousal time; compared with PDND group , the anti-depression group had PSG characteristics of long total sleep time, high sleep efficiency, long N2 sleep, short N3 sleep, less stage shifts, short total sleep time, R sleep obviously decresed. (2)There were NAA/Cr ratios decreased in PD patients in the hippocampus in the focus of disease, which suggested dysfunction of neurons and abnormal cell membrane's phospholipids metabolism; NAA/Cr ratios decreased more obviously in the PDD anti-depression group than PDD non-anti-depression group, which suggested that anti-depression drugs may protect PD patients's neuro.