A Study Of Clinical Characteristics Of Parkinson's Disease Complicated With Diabetes

Objective: This study analyzed and summarized the clinical characteristics of the Parkinson's disease(PD)and diabetes mellitus(DM)by assessing the effects of diabetes on motor and non-motor symptoms of PD patients.Methods: 103 PD patients with comorbid diabetes(PD-DM)admitted to the Department of Neurology of the Second Affiliated Hospital of Soochow University from December 2011 to December 2017 were continuously collected,including 50 patients with complete clinical data.In the 50 patients,there were 23 patients who underwent polysomnography.A total of 23 patients underwent polysomnography.According to 1:2 ratio,100 PD patients without comorbid diabetes(PD-n DM)who matched the age,gender,and disease course during the same period of hospitalization were collected.In the 100 patients,46 PD-n DM patients underwent polysomnography in the same period.Baseline data were collected for two groups of patients,including age,gender,fasting plasma glucose(FPG),duration of disease,Hoehn and Yahr Staging Scale(H-Y),drug-taking history,Unified Parkinson's Disease Rating Scale(UPDRS),Montreal Cognitive Assessment(Mo CA),Mini-Mental State Examination(MMSE),Epworth Sleepiness Scale(ESS),Pittsburgh Sleep Quality Index(PSQI),Hamilton Rating Scale for Depression(HRSD),Hamilton Anxiety Scale(HAMA),Video-Polysomnography(PSG)recordings and some other datas.SPSS22.0 software was used for statistical analysis.The t-test was used for the data with normal distribution,and the Mann-Whitney U test was used for the data with non-normal distribution.Spearman correlation analysis was respectively performed on whether diabetes and fasting blood glucose levels were correlated with clinic features.Logistic regression analysis was used to explore independent risk factors for cognitiv disorders and sleep disorders.Results: Compared with the non-diabetic PD patients,PD patients with diabetes had lower scores of MMSE and Mo CA(P<0.05),higher UPDRS-II?III,ESS,PSQI,HRSD scores and levodopa equivalent dose(LED)(P<0.05).The total sleep time and sleep efficiency of PSG recordings in PD-DM group were lower than those in PD-n DM group(P<0.05),and the sleep latency and awakening time after falling asleep were longer than the PD-n DM group(P<0.05).After controlling for gender and age,The history of diabetes in patients with PD was negatively correlated with MMSE(r=-0.463 P<0.001),Mo CA(r=-0.471 P<0.001)scores and positively correlated with UPDRS-II(r=0.240 P=0.047),III(r=0.385 P=0.005),ESS(r=0.261 P=0.030),HAMA(r=0.354 P=0.003),HRSD(r=0.334 P=0.005)and PSQI(r=0.597 P<0.001)scores.Fasting blood glucose levels were positively correlated with duration of disease(r=0.254 P=0.048),UPDRS-I(r=0.452 P<0.001),II(r=0.403 P=0.001),III(r=0.437 P<0.001),ESS(r=0.292 P=0.022),HAMA(r=0.370 P=0.003),HRSD(r=0.373 P=0.003),PSQI(r=0.449 P<0.001),PDQ(r=0.378 P=0.003)scores and negatively correlated with MMSE(r=-0.498 P<0.001)and Mo CA(r=-0.459 P<0.001)scores.Logistic regression analysis showed that education level(P=0.005 OR=0.837)was a protective factor for cognitive impairment in PD patients.UPDRS-III score(P=0.041 OR=1.060),diabetes mellitus(P=0.034 OR=4.769)were risk factors for cognitive impairment in PD patients;diabetes mellitus(P=0.007 OR=8.061),UPDRS-III(P=0.047 OR=1.075)and HRSD score(P=0.012 OR=1.173)were risk factors for sleep disorders in PD patients.Conclusions: PD patients with comorbid diabetes had more severe motor symptoms and non-motor symptoms.Motor symptoms mainly manifested as bradykinesia,posture instability and gait difficulty;non-motor symptoms mainly manifested as cognitive impairment and sleep disorders;diabetes history was an independent risk factor for cognitive impairment and sleep disorders in PD patients.