Apathy in Parkinson's disease with REM sleep behavior disorder
Apathy in Parkinson's disease with REM sleep behavior disorder
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DOI：
10.1016/j.jns.2019.02.028
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发表时间：
2019-04-15
影响因子：
4.4
通讯作者：
Bassetti, Claudio L. A.
中科院分区：
文献类型：
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作者：
Bargiotas, Panagiotis;Ntafouli, Maria;Bassetti, Claudio L. A.
目的：帕金森病（PD）患者的快速眼动（REM）睡眠行为障碍（RBD）与非运动症状风险增加相关。然而，RBD和PD患者冷漠之间的关系尚不清楚，目的：比较PD患者RBD（PD-RBD +）和无RBD（PD-RBD-）患者冷漠症状的患病率和严重程度。此外，我们探讨了冷漠、抑郁症状和RBD之间的关联，同时考虑到人口统计学、疾病和治疗相关变量的伴随影响。方法：对64名PD患者进行了系统运动评估（统一帕金森病评定量表，UPDRS-III）和非运动评估。RBD的诊断基于使用视频多导睡眠图的国际共识标准。分别采用Starkstein冷漠量表（SAS，cut-off = 14）、埃普沃思嗜睡量表（ESS）、汉密尔顿抑郁量表（HAM-D，cut-off = 9）和简易精神状态检查量表（MMSE）评定冷漠、嗜睡、抑郁症状和认知功能。在PD-RBD+组中，与PD-RBD-组相比，冷漠症状更频繁（52% vs 42%）和更严重（14.3 +/- 5.8 vs 11.2 +/- 4.9，p < 0.05），尤其是在女性中（17.3 +/- 6.0 vs 11.4 +/- 5.8，p < 0.05）。高比例的患者，尤其是PD-RBD +组（53%），有孤立的冷漠，而没有增加抑郁症状。PD-RBD +组的抑郁症状增加也更频繁（50% vs 20%）且更严重。这两个组是可比的人口统计学和临床characteristics.Conclusions：在PD，RBD与孤立的冷漠和抑郁症状的严重程度增加，独立于药物治疗，电机和其他非电机症状。讨论了这种关联的潜在机制。
Objectives: Rapid eye movement (REM) sleep behavior disorder (RBD) in patients with Parkinson's disease (PD) is associated with increased risk of non-motor symptoms. However, the association between RBD and apathy in PD remains unclear.Aims: To compare the prevalence and severity of apathy symptoms in PD patients with RBD (PD-RBD + ) and without (PD-RBD-). In addition, we explored the association between apathy, depressive symptoms and RBD, taking into consideration the concomitant influence of demographic, disease- and therapy-associated variables.Methods: Sixty-four PD patients were evaluated with systematic motor (unified Parkinson's disease rating scale, UPDRS-III) and non-motor assessments. The diagnosis of RBD was based on the international consensus criteria using video-polysomnography. Apathy, sleepiness, depressive symptoms and cognitive performance were assessed using the Starkstein apathy (SAS, cut-off = 14), the Epworth sleepiness (ESS), the Hamilton depression (HAM-D, cut-off = 9) scales and the mini-mental state examination (MMSE), respectively.Results: Among 64 patients, 26 (40%) had RBD. In the PD-RBD+ group, apathy symptoms were more frequent (52% vs 42%) and more severe (14.3 +/- 5.8 vs 11.2 +/- 4.9, p < 0.05), especially in the females (17.3 +/- 6.0 vs 11.4 +/- 5.8 in males, p < 0.05) compared to the PD-RBD- group. A high percentage of patients, especially in the PD-RBD + group (53%), had isolated apathy without increased depressive symptoms. Increased depressive symptoms were also more frequent (50% vs 20%) and more severe in the PD-RBD + group. The two groups were comparable in respect to demographic and clinical characteristics.Conclusions: In PD, RBD is associated with isolated apathy and increased severity of depressive symptoms, independent of medication, motor and other non-motor symptoms. Potential mechanisms underlying this association are discussed.