| Background and objective:Parkinson’s disease（PD）is a common neurodegenerative disease.Clinically,there are not only motor symptoms such as static tremor,bradykinesia,myotonia and postural balance disorder,but also non motor symptoms such as emotional problems,sleep disorders,cognitive impairment and autonomic nerve dysfunction.After standardized drug treatment,the symptoms of early PD patients can be improved.However,with the progress of the disease,they enter the middle and late stage.Due to the aggravation of motor symptoms,the superposition of non motor symptoms,drug side effects and other factors,their motor function,self-care ability and social ability are significantly affected.In addition,psychological burden and economic pressure seriously damage the physical and mental health and social function of patients,Finally,it leads to the decline of patients’ quality of life.In the past,clinicians paid more attention to the improvement of patients’ motor symptoms,but ignored the overall quality of life of patients.With the development of modern medicine,the medical model has also begun to transform from biomedical model to biopsychosocial medical model.The World Health Organization also pointed out that "health is not only the absence of disease or physical weakness,but also good physical and mental health and social adaptability".The concept of health related quality of life（HRQOL）began to be paid more and more attention.It emphasizes that it is not only the disease itself that affects the state of the disease,but also the psychological status,social relations and self-care ability.Therefore,improving the symptoms of the disease itself is no longer the only consideration of the treatment effect of PD,but improving the quality of life of patients has become particularly important.However,at present,the evaluation of PD patients’ quality of life and the identification of related factors affecting PD quality of life are still lack of enough attention in China’s clinical practice,and there are few studies and reports in the literature.Therefore,this study will evaluate the overall quality of life of PD patients and explore its influencing factors,in order to provide help for better implementation of relevant interventions in different stages of the disease,achieve the goal of fine management,improve the quality of life of patients.Methods:1.The clinical information of 86 patients with PD were collected: age,gender,BMI,course of disease,disease stage,medication,education,economic level,caregiver care.2.PD patients were divided into two groups according to H-Y grade: early PD group（H-Y grade 1-2.5）and middle and late PD group（H-Y grade 3-5）.3.UPDRS scale（UPDRS Part II 13-16,all parts III and IV）;Hoehn Yahr（H ＆ Y）disease classification;Parkinson’s disease quality of life assessment scale（PDQ-39）;Simple Intelligence Scale（MMSE）;Montreal Cognitive Assessment Scale（Mo CA）;Hamilton Depression Scale（HAMD）;Hamilton Anxiety Scale（HAMA）;PDSS sleep scale.Non motor symptom screening scale（NMSS）.The blood pressure of all patients in lying and standing position was measured.4.SPSS 25.0 was used for statistical processing and analysis:（1）comparison of clinical data between early PD group and middle and late PD group.（2）Comparison of quality of life between early PD group and middle and late PD group.（3）Analysis of the main factors affecting PDQ-39 in early PD group and middle and late PD group.3.The blood pressure of all subjects in lying and standing position was measured.Results:1.A total of 86 PD patients were enrolled in this study,and relevant clinical information was collected and summarized: there were 86 patients with PD,including48 males and 38 females.There were 48 cases in the early PD group,25 males and 23 females,and 38 cases in the middle and late PD group,23 males and 15 females.There was no significant difference between the two groups（P = 0.434）;There were 22 cases< 65 years old and 26 cases ≥ 65 years old in the early PD group,20 cases < 65 years old and 18 cases ≥ 65 years old in the middle and late PD group.The difference between the two groups was no statistical significance（P = 0.887）;The educational degree of early PD group was 9 cases of primary school and below,32 cases of middle school,7cases of college and above,and 9 cases of primary school and below,24 cases of middle school and 5 cases of college and above in the middle and late PD group.The difference between the two groups was no statistical significance（P = 0.257）;There were 12 cases of BMI <23,31 cases of 23-28,5 cases of BMI>28 in the early PD group.There were16 cases of BMI <23,18 cases of 23-28,4 cases of BMI>28 in the middle and late PD group.There was no significant difference between the two groups（P = 0.222）;The LEDD of early PD group was 419.79 ± 265.78 and that of middle and late PD group was 650.60 ± 231.34.There was statistical significance between the two groups（P <0.001）;The course of disease of early PD group was 3.00（1.00,5.00）,and that of middle and late PD group was 6.00（5.50,7.00）.There was significant difference between the two groups（P <0.004）;In the early PD group,there were 19 cases with per capita monthly income less than 2000 yuan / month,24 cases with 2000-5000 yuan / month,5 cases with >5000 yuan / month,16 cases with economic income of 2000 yuan /month,17 cases with 2000-5000 yuan / month and 5 cases with>5000 yuan / month in the middle and late PD.There was no significant difference between the two groups（P= 0.988）;There were 35 cases with caregiver care and 13 cases without caregiver care in the early stage of PD,20 cases with caregiver care and 18 cases without caregiver care in the middle and late stage of PD.There was statistical significance between the two groups.（P = 0.016）.2.Other data of PD patients: there were 48 cases in the early PD group and 38 cases in the middle and late PD group.UPDRS-Ⅲ in the early PD group was 19.75 ±9.18,and UPDRS-Ⅲ in the middle and late PD group was 31.11 ± 12.98 points.The difference between the two groups was statistically significant（P < 0.001）;UPDRS-Ⅳin the early PD group was 1.92 ± 1.11 points,and UPDRS-Ⅳ in the middle and late PD group was 3.84 ± 3.19 points,The difference between the two groups was statistically significant（P < 0.001）;The NMSS in the early PD group was 43.25 ± 27.97,and in the middle and late PD group was 77.76 ± 28.90.The difference between the two groups was statistically significant（P < 0.001）;The MMSE in the early PD group was25.96 ± 3.49,and in the middle and late PD group was 23.55 ± 4.95.The difference between the two groups was statistically significant（P = 0.010）;The MOCA in the early PD group was 21.21 ± 4.45,MOCA in the middle and late PD group was 18.71 ±4.85,The difference between the two groups was statistically significant（P =0.015）;HAMA in the early PD group was 11.13 ± 6.20,HAMA in the middle and late PD group was 16.55 ± 8.18,The difference between the two groups was statistically significant（P = 0.001）;HAMD in the early PD group was 7.31 ± 5.06,HAMD in the middle and late PD group was 11.21 ± 7.01,The difference between the two groups was statistically significant（P = 0.004）;PDSS in the early PD group was 112.00 ± 23.97,The PDSS in the middle and late PD group was 93.63 ± 25.62,The difference between the two groups was statistically significant（P = 0.001）;There were 32 patients with PIGD type,1 with mixed type,16 with TD type in the early PD group,24 patients with PIGD type,5 with mixed type and 9 with TD type in the middle and late PD group.There was no significant difference between the two groups（P = 0.122）;The tremor score in the early PD group was 1.75 ± 1.96 and that in the middle and late PD group was 3.11 ±3.72.The difference between the two groups was statistically significant（P =0.033）;The rigidity score in the early PD group was 6.38 ± 3.35,The ankylosis score in the middle and late PD group was 9.37 ± 4.04,The difference between the two groups was statistically significant（P < 0.001）;The motor retardation score in the early PD group was 10.00 ± 5.87,and the motor retardation score in the middle and late PD group was 14.89 ± 6.38.The difference between the two groups was statistically significant（P< 0.001）;The abnormal posture and gait score in the early PD group was 1.65 ± 1.19,and the abnormal posture and gait score in the middle and late PD group was 3.74 ±1.86,The difference between the two groups was statistically significant（P < 0.001）.3.Comparison of quality of life scores in early,middle and late PD: the average PDQ-39 score in early PD group was 26.25 ± 16.41,and the average PDQ-39 score in middle and late PD group was 53.11 ± 22.82.The difference between the two groups was statistically significant（P < 0.001）;Comparison of PDQ-39 sub items: the average physical activity score of early PD group was 4.67±4.46,and that of middle and late PD group was 13.74 ± 8.98.The difference between the two groups was statistically significant（P < 0.001）;The average daily life behavior score of early PD group was2.00（0.00,6.75）,and that of middle and late PD group was 8.00（3.00,15.00）.There was significant difference between the two groups（P < 0.001）;The average mental health score of early PD group was 4.98±4.42,and that of middle and late PD group was8.74±5.62.There was significant difference between the two groups（P = 0.003）;The average score of humiliation in early PD group was2.00（0.00,6.75）,and that in middle and late PD group was5.50（0.00,9.00）.There was no significant difference between the two groups（P = 0.104）;The average social support score of early PD group was0.00（0.00,0.00）,and that of middle and late PD group was0.00（0.00,4.00）.There was significant difference between the two groups（P = 0.004）;The average cognitive score of early PD group was 5.00 ± 2.71,and that of middle and late PD group was7.37±2.82.There was significant difference between the two groups（P < 0.001）;The average communication score of early PD group was 0.00（0.00,0.75）and that of middle and late PD group was 3.00（0.00,3.25）.The difference between the two groups was statistically significant（P < 0.001）;The average physical discomfort score of early PD group was 3.13±2.39,and that of middle and late PD group was 4.47 ± 2.57.The difference between the two groups was statistically significant（P = 0.014）.4.The factors affecting quality of life in early PD group were obtained by single factor analysis were statistically significant in gender difference（P = 0.005）and lack of caregivers（P=0.018）.Quantitative data showed that gender（r = 0.404）,NMSS score（r = 0.546）,HAMA score（r = 0.715）,HAMD score（r = 0.415）and PDSS score（r =-0.448）.Stepwise multiple regression analysis showed that women and HAMA were the main factors affecting the quality of life of patients with early PD.5.The factors affecting quality of life in middle and late PD group were obtained by single factor were statistically significant in terms of age（P = 0.031）.The quantitative data showed that bradykinesia score（r=0.347）,UPDRS-Ⅳ score（r = 0.485）,NMSS score（r = 0.528）,MMSE score（r =-0.441）,MOCA score（r =-0.348）,HAMA score（r = 0.483）and HAMD score（r = 0.466）.Stepwise multiple regression analysis showed that bradykinesia,NMSS and UPDRS-Ⅳ were the main factors affecting the quality of life of patients with advanced PD.Conclusions:1.The quality of life in PD decreased significantly with the progress of the disease.Stigma appeared in the early stage of PD and persisted.2.The main influencing factors of quality of life in the early stage of PD were women and anxiety;The main influencing factors of quality of life in the middle and late stage of PD were motor retardation,non motor symptoms and motor complications. |
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