Effect of Motor Improvement on Quality of Life following Subthalamic Stimulation Is Mediated by Changes in Depressive Symptomatology
Effect of Motor Improvement on Quality of Life following Subthalamic Stimulation Is Mediated by Changes in Depressive Symptomatology
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丘脑底刺激后运动改善对生活质量的影响是由抑郁症状的变化介导的
DOI：
10.1159/000075159
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发表时间：
2004
影响因子：
1.7
通讯作者：
K. Lyons
中科院分区：
文献类型：
--
作者：
A. Tröster;J. Fields;S. Wilkinson;R. Pahwa;W. Koller;K. Lyons
背景/目的：丘脑深部电刺激(STN-DBS)治疗帕金森病(PD)可改善运动症状和生活质量(QOL)。由于抑郁与生活质量有很强的相关性，而STN-DBS可能与情绪变化有关，因此本研究试图确定生活质量的改善是运动改善的直接结果还是间接结果。方法：对26例接受双侧微电极引导下STN-DBS治疗的无痴呆和重度抑郁症的PD患者进行术前和术后3个月的神经心理评估，包括生活质量量表(PD Q-39)和抑郁症状量表(Beck Depression Inventory)。结果：统一帕金森病评定量表(UPDRS Part III)中的运动评分在接受STN-DBS治疗后较术前的“开”和“关”评分有显著改善，生活质量和抑郁症状也有明显改善。生活质量改善的程度往往与运动评分从术前到术后、刺激和药物状态的改善有关。生活质量的改善与抑郁症状的改善显著相关。部分相关性显示，当控制运动改善对生活质量和抑郁的影响时，生活质量改善和抑郁之间的关联仍然显著。在控制了抑郁的影响后，运动与生活质量的相关性不再显著。结论：STN-DBS术后生活质量的显著改善与运动状态和抑郁症状的改善有关。运动改善对生活质量的影响可能在很大程度上是通过减轻抑郁间接实现的。
Background/Aims: Subthalamic deep brain stimulation (STN-DBS) for Parkinson’s disease (PD) improves motor symptoms and quality of life (QOL). Because depression is a potent correlate of QOL, and STN-DBS may be associated with changes in mood, this study sought to determine whether QOL improvement is a direct or indirect consequence of motor improvement. Methods: 26 patients with PD, free of dementia and major depression, who consecutively underwent bilateral, microelectrode-guided STN-DBS, underwent preoperative and 3-month postoperative neuropsychological evaluation, including measures of QOL (PD Questionnaire –39) and depressive symptoms (Beck Depression Inventory). Results: Motor score in the Unified Parkinson’s Disease Rating Scale (UPDRS Part III) improved significantly with STN-DBS relative to preoperative ‘on’ and ‘off’ scores, as did QOL and depressive symptoms. Extent of QOL improvement tended to be associated with improvement in motor score from presurgical on to postsurgical on stimulation and on medication state. QOL improvement was significantly related to amelioration of depressive symptoms. Partial correlations revealed that the association between QOL improvement and depression remained significant when influence of motor improvement on QOL and depression was controlled for. The motor-QOL association was no longer significant when effects of depression were controlled for. Conclusions: Significant QOL improvements after STN-DBS are associated with improved motor ‘on’ state and depressive symptoms. The influence of motor improvement on QOL may be largely indirect by reducing depression.