Quality of life and depression in Parkinson's disease
Quality of life and depression in Parkinson's disease
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DOI：
10.1016/j.jns.2006.05.030
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发表时间：
2006-10-25
影响因子：
4.4
通讯作者：
Schrag, Anette
中科院分区：
文献类型：
--
作者：
Schrag, Anette
本文综述了帕金森病(PD)患者的健康相关生活质量(HR-QOL)和抑郁障碍及其相互关系的文献。帕金森病与HR-QOL降低有关，包括疾病造成的运动和非运动身体后果、情绪健康和社会功能。虽然这种影响在疾病晚期更大，但病程与对生活质量的影响之间没有密切关系，临床评定量表与HR-QOL评分之间的关系仅为中等。另一方面，抑郁症的存在和严重程度与HR-QOL得分密切相关，一些研究报告称，抑郁是HR-QOL得分较低的主要决定因素。尽管抑郁症是不良HR-QOL的主要决定因素，并被临床医生认为是一个重要的问题，但直到最近，抑郁症在研究中受到的关注相对较少。众所周知，抑郁症和焦虑症在帕金森病患者中的发生率高于对照组。抑郁症在帕金森氏病中呈双峰模式，发病时抑郁发生率增加，晚期疾病抑郁发生率较晚。焦虑和抑郁也可以在帕金森病的第一个运动症状出现之前和在诊断帕金森氏病之前发生，这表明这些共病是帕金森病潜在疾病过程的表现。影像研究表明，多巴胺能、去甲肾上腺素能和5-羟色胺能功能异常与抑郁症的严重程度有一定的相关性。疾病严重程度和抑郁率(非经期相关抑郁症除外)之间的总体关系很差，这表明仅有黑质纹状体功能障碍不足以解释帕金森病的抑郁症状。其他因素也可能导致帕金森病患者抑郁的发生和严重程度，要么是由于纹状体外的病理，要么是由于导致反应性抑郁的心理和环境因素。因此，帕金森病患者的抑郁可能是多因素的。由于帕金森病的症状与抑郁有相当大的重叠，因此在测量和诊断帕金森病患者的抑郁方面存在诊断困难，这使得对帕金森病患者抑郁的研究变得复杂。虽然已经提出了一些治疗方法，但有必要进行双盲随机对照试验，以证明帕金森病患者的抑郁和总体HR-QOL的改善。(C)2006爱思唯尔B.V.保留所有权利。
This paper reviews the literature on health-related quality of life (Hr-QoL) and depressive disorders, and the relationship between them, in patients with Parkinson's disease (PD). PD is associated with reduced Hr-QoL, including motor and non-motor physical consequences of the disease, emotional well-being and social functioning. While this effect is greater in advanced disease stages, there is no close relationship between disease duration and impact on quality of life, and the relationship between clinical rating scales and Hr-QoL scores is only moderate. On the other hand, presence and severity of depression in PD strongly correlates with Hr-QoL scores, and a number of studies have reported depression as the main determinant of poor HR-QoL scores. Despite being the main determinant of poor Hr-QoL and being recognized as an important problem by clinicians, until recently depression in PD has received relatively little attention in research studies. It is known that depression and anxiety occur more frequently in PD than in controls. Depression occurs in a bimodal pattern in PD, with increased rates at the onset and a later peak in advanced disease. Both anxiety and depression can also occur before the first motor symptoms of PD and predate the diagnosis of PD, indicating that these co-morbidities are manifestations of the underlying disease process of PD. Imaging studies have demonstrated abnormalities of dopaminergic, noradrenergic and serotonergic functioning with some correlation with severity of depression. The overall relationship between disease severity and rate of depression (except for off-period related depression) is poor, suggesting that nigrostriatal dysfunction alone is not sufficient to explain depressive symptoms in PD. Other factors are likely to contribute to occurrence and severity of depression in PD, either due to extrastriatal pathology or due to psychological and environmental factors leading to reactive depression. Thus, it is likely that depression in PD is multifactorial. The investigation of depression in PD is complicated by diagnostic difficulties in measuring and diagnosing depression in patients with PD due to the considerable overlap between symptoms of PD and depression. While a number of treatment approaches have been suggested, double-blind randomized controlled trials to demonstrate improvement of depression and overall Hr-QoL in PD are warranted. (C) 2006 Elsevier B.V. All rights reserved.